1. Diagnosis

2. Barium studies • demonstrate the primary lesion and reveal a synchronous cancer elsewhere in the colon  

3. Annular constricting or napkin-ring carcinoma of colon

4. Annular constricting or napkin-ring carcinoma of colon

5. Colonoscopy • most accurate and complete examination of the large bowel. • The purpose of a complete colon and rectal evaluation for patients with large-bowel cancer is to rule out synchronous carcinomas and polyps. • Serum level of CEA • important in the evaluation of patients with colorectal cancer.

6. Chest x-ray - pulmonary metastasis. • CT of the abdomen - extent of invasion of the primary tumor and to search for intraabdominal metastatic disease.

7. Staging • depth of tumor, penetration into the bowel wall • presence of both regional lymph node involvement • distant metastases

8. Staging of colorectal cancer

9. Treatment

10. Optimum Treatment Strategy • Surgery is the only hope for CURE • Adjuvant chemotherapy for Colon CA • > Stage III disease • High risk Stage II disease • Obstruction / Perforation • High grade histology • Adjuvant chemo-radiotherapy for Rectal CA • > Stage II disease • Either pre-operative or post-operative

11. Total resection of tumor - optimal treatment when a malignant lesion is detected in the large bowel.. • The detection of metastases should not preclude surgery in patients with tumor-related symptoms such as gastrointestinal bleeding or obstruction, but it often prompts the use of a less radical operative procedure. • Laparotomy- the entire peritoneal cavity should be examined, with thorough inspection of the liver, pelvis, and hemidiaphragm and careful palpation of the full length of the large bowel.

12. Radiation therapy • reduces the 20–25% probability of regional recurrences following complete surgical resection of stage II or III tumors, especially if they have penetrated through the serosa. • either pre- or postoperatively, reduces the likelihood of pelvic recurrences but does not appear to prolong survival.

13. Chemotherapy • 5-FU – backbone of treatment • Concomitant administration of folinic acid (leucovorin) improves the efficacy of 5-FU in patients with advanced colorectal cancer, presumably by enhancing the binding of 5-FU to its target enzyme, thymidylatesynthase.

14. Irinotecan- prolongs survival when compared to supportive care in patients whose disease has progressed on 5-FU.

15. FOLFIRI regimen • Irinotecan -180 mg/m2 as a 90-min infusion day 1 • LV - 400 mg/m2 as a 2-h infusion during irinotecan • 5-FU bolus - 400 mg/m2 and 46-h continuous infusion of 2.4–3 g/m2 every 2 weeks. • FOLFOX regimen • 2-h infusion of LV (400 mg/m2 per day) • 5-FU bolus -(400 mg/m2 per day) and 22-h infusion (1200 mg/m2) every 2 weeks, • Oxaliplatin, 85 mg/m2 as a 2-h infusion on day 1. • FOLFIRI and FOLFOX are equal in efficacy.