Colon Cancer

Colon Cancer free pdf ebook was written by Randolph Steinhagen, MD on May 09, 2006 consist of 12 page(s). The pdf file is provided by www.mssurg.net and available on pdfpedia since September 10, 2011.

colon cancer epidemiology • 2nd most common cause of cancer mortality • lifetime..blacks > whites > asians > hisp > na • m..are sporadic risk factors • diet o red meat and animal fat o folate,...

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Colon Cancer pdf




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: September 10, 2011
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: Randolph Steinhagen, MD
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Colon Cancer - page 1
COLON CANCER Epidemiology 2nd most common cause of cancer mortality Lifetime risk is about 1 in 17 Industrialized nations have the highest risks o South America and China are among the lowest Blacks > Whites > Asians > Hisp > NA M > F (slightly) Incidence increases after age 50 (90%) 80% are sporadic Risk factors Diet o Red meat and animal fat o Folate, fiber, calcium, selenium, fruits and vegetables Smoking and alcohol IBD Hereditary syndromes Previous carcinoma Polyps Family history S. Bovis bactermia ?protective 124
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Colon Cancer - page 2
Anatomy Location Adenoma-Carcinoma Sequence Larger adenomas harbor cancer more often Residual benign tissue found in most cancer specimens Benign polyps have been observed to become cancer Adenomas occur more frequently in cancer patients Adenoma patients have increased lifetime risk of dev. cancer Removal of polyps decreases risk Populations with cancer have high prevalence of polyps FAP 100% cancer Peak incidence of adenomas is 50; peak incidence of cancer is 60 suggesting 10-year time span 125
Colon Cancer - page 3
Polyps Morphology o Tubular, villous, tubulovillous Risk of malignancy; 5% - tubular, 22% - tubulovillous, 40% - villous o Pedunculated, flat (sessile) Sessile polyp with cancer has 10% chance of lymph node metastasis Size o o o o 0.6 – 1.5 cm = 2% chance of cancer 1.6 to 2.5 = 19% chance of cancer 2.6 to 3.5 = 43% chance of cancer >3.5 cm = 76% chance of cancer Hyperplastic polyps o Most common o 90% are less than 3mm o Considered to have no malignant potential o Adenomatous changes have been found so polyps should be excised Haggitts: Applies only to pedunculated polyps Level 0 – in situ Level 1 – head of polyp Level 2 – neck Level 3 – stalk Level 4 – submucosa Any sessile polyp is Level 4 Excision of Level 1-3 with 2mm margin and NO poor prognostic indicator is sufficient treatment Familial Adenomatous Polyposis Autosomal dominant Defect in APC gene Hundreds to thousands of polyps 100% cancer conversion rate – avg age 42 Colectomies usually deferred until adulthood Colectomy with IRA or RPC with lifelong rectal/pouch surveillance Phenotypic variants o Gardners, Turcots, attenuated 126
Colon Cancer - page 4
HNPCC Lynch I syndrome Autosomal dominant Mismatch repair genes altered 85% cancer penetrance Rapid progression to cancer Limited number of adenomas usually proximal to splenic flexure Lynch II – extracolonic manifestations o Usually endometrial cancer Adenoma-Carcinoma Sequence Signs & Symptoms Bleeding, abdominal pain, change in bowel habits, anorexia, wt loss, nausea, vomiting, fatigue, anemia o Left sided more likely to obstruct o Proximal cancers have occult bleeding Pelvic pain, tenesmus in rectal ca RUQ pain, hepatomegaly, ascites, lymphadenopathy in metastatic disease Virchow’s node, Blumers shelf, Sister Mary Joseph node Work-up Labs – CBC, LFTs, CEA Detection o Colonoscopy o Double contrast BE o Virtual colonoscopy Staging o CXR o CT/MRI 127
Colon Cancer - page 5
o PET - good for extrahepatic mets o Intra-op ultrasound – best evaluation of liver Dukes Staging Surgical Issues Bowel Prep Perioperative intravenous antibiotics Midline incision or laparoscopy Exploration o Extent of tumor o Liver Oncologic resection 128
Colon Cancer - page 6
o No-touch technique Anastomosis Surgical Resection Obstructing cancer o Hartmans 40% morbidity of colostomy closure o On-table lavage with primary anas. Low leak rate o Subtotal colectomy with IRA addresses risk of proximal tumors Perforated cancer o Poor prognosis o Assume all adhesions are malignant o 20% carcinomatosis risk Polyp Treatment 129
Colon Cancer - page 7
Cancer Treatment Treatment by Stage 130
Colon Cancer - page 8
Liver Mets 131
Colon Cancer - page 9
Laparoscopy Short Term o Bowel function o Hospital stay o Analgesia o Earlier recovery o Wound benefit Long Term o ?Hernias o ?Bowel obstruction o ?Immune function o ?Oncologic outcome 132
Colon Cancer - page 10
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