Kolo-Rektale Karsinoom Sept ‘11 Dr Chris Ziady - PowerPoint PPT Presentation

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Kolo-Rektale Karsinoom Sept ‘11 Dr Chris Ziady

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  1. Kolo-RektaleKarsinoomSept ‘11Dr Chris Ziady

  2. Epidemiologie • Etiologie • Predisponerendefaktore • Natuurlikeverloop / stadering • Prognose • Klinieseeienskappe • Diagnose / Sifting / Opvolg • Behandeling

  3. Epidemiologie • 4e meesalgemeneKarsinoom in die Weste (long, prostaat, bors) • Hoogstevoorkoms in N Amerika, Australia, New Zealand • Laag in Asia, S Amerika, Sub-Sahara Afrika • Kolon tot Rektumverhouding >2:1 in hoe risikolande • Risikostygvinnig in bevolkingswatmigreerna hoe risikolande • Risiko in Japan gestyg van laag tot gelykaan Europa en VSA

  4. Etiologie • Omgewingfaktorebelangrik • Dieet: HoeVet, laeVeselinname, ? Ookrooivleis, sekonderegalsoute • Moontlikefaktore: • Bier, Sig rook, laedieet selenium, omgewingkarsinogene, • Oefeninggebrek, obesiteit

  5. Beskermend • Aspirien, NSAID’s, COX2 inhibitore • Kalsium • Estrogeen (HVT) • Laeliggaamgewig • Oefening • Moontlik: • Karotene, Hoe veseldieet, Vit C,E en D, geel en groengroentes

  6. SA Publikasies • 1. S Afr J Surg. 2010 Nov;48(4):109-13. • Incidence and histological features of colorectal cancer in the Northern Cape Province, South Africa. • Wentink MQ, Räkers M, Stupart DA, Algar U, Ramesar R, Goldberg PA. • AIM: The purpose of this study was to determine the incidence of colorectal cancer (CRC) in the Northern Cape province of South Africa, and to identify patients with histological and demographic features suggestive of hereditary non-polyposis colon cancer (HNPCC).

  7. RESULTS: The annual incidence of CRC in the Northern Cape was 3.7/100,000 population (3.5/100,000 for men and 3.9/100,000 for women). The median age at which colorectal cancer was diagnosed was 59 years (range 16-90 years). On pathological and demographic criteria, 75/206 (36%) of the patients met at least one of the criteria of the revised Bethesda guidelines for microsatellite instability testing. • CONCLUSION: CRC is rare in the Northern Cape, and one-third of the patients had demographic or tumour histological features suggestive of HNPCC.

  8. S Afr Med J. 2001 Aug;91(8):689-93. • Colorectal carcinoma--a new threat to black patients? A retrospective analysis of colorectal carcinoma received by the Institute for Pathology, University of Pretoria. • Angelo N, Dreyer L. • OBJECTIVE: To compare black and white patients with colorectal carcinoma treated at Pretoria Academic and Kalafong hospitals, and to compare pathological trends of our study population with others reported in the literature.

  9. RESULTS: There has been a significant increase in the number of black patients with colorectal carcinoma at our Institute. In addition, adenomatous polyps were found in 9 of our black patients (1996/97). This is significantly higher than expected from reports in the literature. This could be predictive of an increase in incidence of colorectal carcinomas in our black population. • Black patients were also found to be considerably younger at age of presentation than their white counterparts. A further significant finding was a considerable increase in the number of black females under the age of 40 years from 1986/87 to 1996/97. On the other hand, the number of white females above 40 years of age decreased considerably over this time. The reason for this finding is uncertain and warrants further study

  10. Trop Gastroenterol. 1995 Oct-Dec;16(4):55-61. • Clinicopathological trends in colorectal carcinoma in a Black South African population. • Degiannis E, Sliwa K, Levy R, Hale MJ, Saadia R. • Department of Surgery, University of the Witwatersrand Medical School, Johannesburg, South Africa. • The clinico pathological characteristics of colorectal carcinoma in 127 Black South African patients were studied. The main presenting symptoms were altered bowel habits in 70% of the patients, weight loss in 64.3% and abdominal pain in 47.1%. Anaemia was present in 75.7%. There was a 31% incidence of mucinous carcinoma with a particular predilection for the younger age groups. Mucinous tumorswere found more commonly in Duke stage C and D than in earlier stages. Tumorsarising from a pre-existing adenoma constituted to 5.5% of the lot of patients with cancer colon.

  11. S Afr J Surg. 1997 May;35(2):63-5; discussion 65-7. • Disease profile of colon and rectum carcinoma at Pelonomi Hospital, Bloemfontein. • Bonnet GC, GroblerSP. • Department of Surgery, Faculty of Medicine, University of the Orange Free State, Bloemfontein. • A retrospective study evaluated all new cases of colorectal cancer which presented over a 7-year period at Pelonomi Hospital, Bloemfontein. The aim of the study was to compare patients younger than 40 years with the group older than 40 years.

  12. Most patients presented late, with advanced disease. • A high proportion of patients were younger than 40 years (32.4%). • No significant differences in sex ratio, tumour position, differentiation or stage of tumour were detected between the two groups. • Of note was a high proportion (45%) of right-sided colon cancer in both groups. • The younger patients did not have more advanced disease at presentation than the older group. Their prognosis, when matched stage for stage, was similar.

  13. Die perd het van kleurverander!

  14. S Afr Med J. 1997 Feb;87(2):152-8. • Dietary factors associated with a low risk of colon cancer in coloured west coast fishermen. • Schloss I, Kidd MS, Tichelaar HY, Young GO, O'Keefe SJ. • Gastro-intestinal Clinic, University of Cape Town. • OBJECTIVE: To examine the relative roles of dietary fibre, anti-oxidant vitamins and fish oils in the relatively low incidence of colon cancer in coloured West Coast fishermen. • DESIGN: Dietary intake survey, based on food frequency questionnaire and household surveys. Blood sampling for vitamin and fatty acid concentrations. • SETTING: Isolated West Coast fishing villages (sample population) and urban Cape Town inhabitants (controls).

  15. PARTICIPANTS: 101 male and female West Coast fishermen over the age of 40 years, and 99 age- and sex-matched urban whites. • CONCLUSION: The low incidence of colorectal carcinoma in West Coast fishermen might be explained by the protective effects of fish (omega-3) oils, but not by other "protective' dietary items such as fibre, anti-oxidant vitamins or calcium. • The high incidence of hypertension may be related to a higher sodium intake, accompanying high consumption of salted fish, or to the higher prevalence of tobacco smoking.

  16. Predisponerendefaktore • Ouderdom >50 jr • Hoe vet, laeveseldieet • Vorigegesk van KolorektalePoliepe of Karsinoom • FamilielePoliposissindroom (FAP, HNPCC,Peutz-Jeghers, oa) • Direktefamilielid met K-R Karrsinoom • InflamatorieseDermSiekte

  17. Amsterdam kriteriavirhnpcc • Minstens 3 familielede met KRK, eenwaarvandirektefamiliemoetwees van die ander twee • KRK in 2 geslagte • Een of meer KRK gevallejonger as 50 jaar

  18. Verloop / Stadering • R-sydigetumore is meestalblomkoolagtig, nekroties • DistaleKolon en Rektaletumore is sirkumferensieel, stenoserend • BuitenvirAdenokarsinome, mag daar 5% van andertumorevoorkom ( melanome, Karsinoide, plaveisel, limfomeoa)

  19. KlassifikasieAstler en Collermodifikasie van Dukes • A: Beperk tot Mukosa • B1: Beperk tot in, maar niedeurM.Propria • B2: Penetreer M Propria, sonderkliereaangetas • C: Tumore met limfklieraantasting • C1: beperk tot dermwand / 1 tot 4 kliere • C2: penetreer wand / >4 kliere • D: Afgelee metastases

  20. Kliniesevoorspelling van prognose • Tumoreontdek in sifting programme is dikwels minder gevorderd • Dermobstruksie of perforasieimpliseerswakkerprognose • L-sydigebeterprognose as R-sydiges • Kolonbeter as Rektum • Jong pasiente <30 jrdoenswakker • Graad van differensiasie, vaskulere en limfatieseinfiltrasie • Hoe CEA pre-op doenswakker

  21. Kliniesebeeld • Karsinome mag 2 tot 5 jrneemomsimtomete gee • Voorafbestaandepoliepneem 6 tot 10 jrommalignete word • Ystergebrekanemie • Veranderdestoelgangpatroon / obstruksie • Bloed in stoelgange • Onderliggendelangstaande IDS

  22. Sifting en opvolg • Primerevoorkoming = identifiseergenetiese, omgewingsbiologiesefaktore en modifiseer • Sekonderevoorkoming = Identifiseerbestaande pre-neoplastiese, vroeeneoplastieseletsels en behandeltoepaslik • Sifting impliseerbevolkingevaluasie in asimptomatiesemense • Is daarbewys van kosteeffektieweresultate: JA • Gemiddelderisiko: Kolonoskopie van 50 jr, en 10 jaarliks tot 75 jr (? 80jr)

  23. Hoe Risiko: • FAP : begin teen 10 jr • “attenuated FAP” 18 – 20 jr • HNPCC: Begin teen 20 jr • Familie van CA pasient : begin 10 jrjonger • VorigePoliepe: • 1 of 2 kleinTubulereadenome: 5 jrliks • 3 tot 10 kleinadenome: 3jr, dan 5jr • 1 Villeuse, of Hoe graaddispastieseadenoom :3 jrdan 5 Jaarliks • > 10 adenome : 3 Jaar, ? Familielesindroom • Na Sessielepoliepektomie: 6m dan ? 5 jaarliks

  24. Hoe risiko: • VorigeKarsinoom: 3 tot 6m nareseksie, dan 3jr dan 5 jaarliks • UlseratieweKolitis • Pan – kolitismeer as 10 jaar: jaarliks • L – Sydigekolitis, en Crohn’skolitismeer as 15 jaar: jaarliks

  25. Behandeling • Endoskopies • Sjirurgie • Onko-radio terapie

  26. Nogbaieveromtegaan!!!