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Colon Cancer

Colon Cancer. Profile. CL 54/M from Batangas C hief complaint of rectal bleeding. History of Present Illness. 2 years PTA patient noted dark/blackish stools. There were no associated symptoms at the time. 1 year PTA

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Colon Cancer

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  1. Colon Cancer

  2. Profile • CL • 54/M • from Batangas • Chief complaint of rectal bleeding

  3. History of Present Illness • 2 years PTA • patient noted dark/blackish stools. There were no associated symptoms at the time. • 1 year PTA • patient started having abdominal pain at the hypogastric area, described as squeezing in quality, intermittent, pain scale 4/10, accompanied by blood-tinged stools. No consult done.

  4. History of Present Illness • 2 months PTA • persistence of hypogastric pain VAS now 7/10. Patient consulted at PGH OPD. Colonoscopy and biopsy were subsequently done A> Colon CA, Adenocarcinoma St. I. Patient was then scheduled for elective admission.

  5. Review of Systems • (-) wtloss • (+) good appetite • (+) difficulty in defecation • (+) melena • (+) hematochezia • (+) good urine output • (-) diarrhea • (+) constipation

  6. Past Medical History • (+) Hypertensive suspect • LBP 100/80 HBP 150/100 UBP 140/100, currently no medications • (+) Benign prostatic hyperplasia, 2005, treated medically • (-) BA/DM/PTB • (-) known allergies • (-) previous hospitalizations/surgeries

  7. Family Medical History • (+) Colon Cancer- sibling • (+) CVD-mother • (-) DM/ PTB/ HPN/ BA

  8. Personal Social History • (+) Smoker, 72 pack years • (+) regular alcoholic beverage drinker, almost everyday, stopped when he was confined • Used to work as a farmer but stopped due to current illness.

  9. Physical Exam

  10. Laboratory CBC • Hgb 146 • Hct 0.446 • WBC 6.40 • Plt 155 • Monocytes 0.075 • Eosinophils 0.035 • Basophils 0.003 • Neutrophils 0.512 • Lymphocytes 0.375

  11. Laboratory • AST 32 • ALT 35 • TB 8.9 • DB 2.0 • IB 6.9 • (01-13-12) Tumor marker: CEA 1.85 (N: 0-5)

  12. Laboratory • CXR • No significant chest findings • Colonoscopy report • Scope inserted up to cecum, noted circumferential fungating mass 45cm FAV, obstructing 60% of the lumen • Abdominal CT • Irregular thickening of the anterior wall of the rectum • Distal Ileal wall thickening, consider tumor focus • Cardiomegaly • Renal cortical cysts, bilateral, Bosniak I • Compression deformity, L2 vertebra

  13. Laboratory • Histopathologic Report • Adenocarcinoma, well-differentiated

  14. Assessment • Adenocarcinoma, descending colon St. 1 (T2 N0 M0)

  15. Clinical Presentation • Rectal bleeding • Abdominal pain • Change in bowel habits • Intestinal obstruction or perforation • Weight loss

  16. Clinical Presentation • Iron deficiency anemia • weakness, fatigue, dyspnea, or palpitations • Advanced cancer can cause cancer cachexia, involuntary weight loss, anorexia, muscle weakness

  17. Laboratory anomalies • Blood Tests • Anemia • Hypoalbuminemia • Alkaline Phosphatase • elevated if with liver metastasis • CEA • Not useful for screening, moderately sensitive • For prognosis and baseline for comparison post-op

  18. Pathophysiology • Arises from mucosal colonic polyps • Hyperplastic • Increased number of glandular cells with decreased cytoplasmic mucus • Lack nuclear hyperchromatism, stratification, or atypia • Adenomatous • Hyperchromatic, enlarged, cigar -shaped, and crowded together in a palisade pattern • Almost all colon cancers arise from adenomas

  19. Pathophysiology • Familial Adenomatous Polyposis (FAP) • Mutation of APC gene on chromosome 5q • Autosomal dominant • Hereditary Nonpolyposis Colon Cancer (HNCC) • Mutation of mismatch repair genes hMSH2

  20. Risk Factors

  21. Risk Factors

  22. Screening of Average Risk Patients • Fecal Occult Blood test • low cost, simple, non-invasive, safe • low specificity • Barium Enema • Flexible sigmoidoscopy • every 3 to 5 years has been recommended in conjunction with annual FOBT for screening • Colonoscopy • recommended for patients more than 50 years old at average risk for colon cancer or colonic polyps

  23. Surgical Management • Surgery is the only curative modality for localized colon cancer (stage I-III) • Removal of the primary tumor with adequate margins including areas of lymphatic drainage • Right hemicolectomy • cecum and right colon • ileocolic, right colic, and right branch of the middle colic vessels are divided and removed

  24. Surgical Management • Extended right hemicolectomy • proximal or middle transverse colon • ileocolic, right colic, and middle colic vessels are divided and the specimen is removed with its mesentery. • Left hemicolectomy • splenic flexure and left colon • left branch of the middle colic vessels, the inferior mesenteric vein, and the left colic vessels along with their mesenteries are included with the specimen

  25. Surgical Management • Sigmoid colectomy • sigmoid colon lesions • inferior mesenteric artery is divided at its origin, and dissection proceeds toward the pelvis until adequate margins are obtained

  26. Adjuvant Chemotheraphy • Standard therapy for patients with stage III and some patients with stage II colon cancer

  27. Prevention of Colon Cancer • Dietary modification • Fiber decreases exposure to carcinogens • Chemoprevention with aspirin and other NSAIDs • Reduce cellular proliferation, slow cell cycle progression, induce apoptosis • Inhibit COX whichis required for PGE synthesis • Colonic polypectomy • Endomusosectomy

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