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Carcinoma of colon

Carcinoma of colon. Third most common type of cancer in men and women. Carcinoma of colon. Etiology: Diet- high protein , high fat diet, Fish, Beer, Low fibre diet : Intestinal bacteria

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Carcinoma of colon

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  1. Carcinoma of colon

  2. Third most common type of cancer in men and women

  3. Carcinoma of colon Etiology: Diet- high protein , high fat diet, Fish, Beer, Low fibre diet : Intestinal bacteria :Genetic - siblings, children.FAP, HNPCC, PeutzJegher’s syndrome :Inflammatory bowel diseases :Radiation : Depressed immunity :Ureterocolicanastomosis

  4. Normal colonic mucosa>dysplastic aberrant crypt foci>early adenoma>intermediate adenoma>late adenoma>ca in situ>invasive ca • Tumour suppressor genes- APC gene, p53 gene, STK 11 gene. • Mismatch Repair Gene, microsatellite instability. • Oncogenes- k ras.

  5. Pathology • Adenocarcinoma(majority), undifferentiated carcinoma, neuroendocrine tumours, spindle cell tumour, squamous cell carcinoma, adenosquamous carcinoma • Common in distal colon: Sigmoid 21%, descending colon 5%, transverse colon12%, Ascending & caecum 25%, Each flexures 2% • Synchronous 3% and Metachronous 5%

  6. Gross: Polypoidal/ cauliflower, Ulcerative, Annular/stenosing, Diffuse infiltrating

  7. Microscopy: arise from the columnar epithelium or crypts of Liberkunh. Glandular formation. Varying degrees of differentiation (well, moderately, poorly).

  8. Spread • Direct- along mucosa and submucosa, surrounding bowel, bladder, peritoneum, anterior abdominal wall • Lymphatic- epicolic nodes, paracolic, intermediate, main lymph nodes, para aortic • Haematogenous- liver, lungs, adrenals, kidneys, bones • Transcoelomic spread

  9. Staging • Dukes: A- tumour confined to bowel wall B- spread beyond serosa to adjacent structures, no nodes C- Lymph nodes involved • TNM:Tx- primary cannot be assessed, T0- no evidence of primary, T1- tumour invades uptosubmucosa, T2- tumouruptomuscularispropria, T3- invades uptosubserosa or uptopericolic or pararectal tissue at unperitonealised area, T4- invasion of adjacent organ or perforation

  10. N0- no regional nodes, N1- 1 to 3 nodes, N2- metastasis to 4 or more regional nodes • M0 , M1

  11. Clinical Features • > 50 years • More in men • Depends on the site of tumour

  12. Caecum & Asc Colon • Asymptomatic • Anorexia, Anemia, Asthenia • Rt Iliac Fossa pain • Increasing constipation • Nausea, Vomiting • Blood and mucous in stools • Intestinal obstruction • Mass in RIF • Acute appendicitis • Intussusception

  13. Transverse colon • Vague symptoms • Constipation • Diarrhoea, Borborygmi • Intestinal obstruction

  14. Descending colon • Increasing constipation • Alternating constipation with diarrhoea- blood and mucous • Left sided abdominal pain • Mass abdomen • Abdominal distension

  15. Sigmoid colon • Progressive constipation • Pain abdomen • Tenesmus • Bleeding PR • Spurious diarrhoea • Sciatica • Perforation- peritonitis, paracolic abscess • Colo- vesical/ enteric/ cutaneous fistula

  16. Investigations • F O B • USG abdomen • Sigmoidoscopy/Colonoscopy, biopsy • Ba Enema • C T scan • I V P • C E A

  17. Treatment • Wide Resection or palliative resection/bypass • Preparation for surgery: Mechanical cleansing, Sterilisation of bowel (antibiotics), Hydration and electrolyte correction

  18. Operations • Right Hemicolectomy- tumours of Caecum, ascending colon • Extended right hemicolectomy- Hepatic flexure, transverse colon, splenic flexure • Left hemicolectomy- splenic flexure, descending colon, sigmoid • Anterior resection- sigmoid colon. • Hepatic resections • Colostomy- transverse/ sigmoid • Ileo transverse anastomosis

  19. Intestinal obstruction or perforations Lt side growth: primary resection, EEA , proximal colostomy/ Resection, end colostomy and mucous fistula/ Hartmann’s operation. Rt sided growth: Rthemicolectomy and primary anastomosis

  20. Chemotherapy- FOLFOX( 5 FU, Leucovorin, Oxaliplatin), FOLFIRI(5FU, Leucovorin, Irinotecan). Targeted therapy with bevacizumab (VEGF inhibitor) or cetuximab (EGFR inhibitor) in patients with k ras mutation. • Radiotherapy- no significant role.

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