1. Colorectal cancer in Norway Maria Mai Ingvild Hvalby

2. What is colon cancer? Malignant tumor arising from inner wall of the large intestine and rectum 98 % of these tumors are variations of adenocarcinomas The rest are carcinoid tumors, malignant lymphomas or sarcomas

3. Prevalence Norway has the highest incidence of colorectal cancer in the world More than 2300 new cases every year 1 in 29 Norwegian men and 1 in 24 women develop colorectal cancer during life Rare before the age of 40-50, except from people with genetic disposition Incidence of colorectal cancer has increased with 50 % during the last 30 years in Norway

5. Causes There is no stated external causes of colorectal cancer, but: Diet and insufficient physical activity can be a cause Age  increased life expectancy in Norway Chemical substances developed from bacteria and/or substances from bile can be carcinogenic Can be caused by a rare (dominant) genetic condition called Familial Adenomatous Polyposis

6. Development of disease Polyps can be normal in the large intestine Can be caused by irritation of mucous membrane or benign tumors (tubular adenoma) Benign tumors can be harmless, but can also be precancerous Especially high-graded dysplasia of tubular adenomas can develop into cancer if they are not removed

8. Symptoms Often the patient will have symptoms for a long time before the tumor is discovered Upper part of bowel: Anemia, weight loss, diarrhea Lower part of bowel: constipation, blood or mucus in stool, colicky pain Blockage in ileum at later stage due to growth of tumor Perforation of intestine near tumor

9. Diagnosis Blood sample Colonoscopy with biopsy confirmation of cancer tissue Barium enema X-ray procedure

10. Normal vs Cancerous

11. Treatment Surgical removal of tumor, regional lymph nodes and parts of the large intestine Additional treatment can be chemo therapy Reduces mortality rate with 30 % Radiotherapy is rarely used, except when cancer has spread to the bones

12. Prognosis Survival rate when the tumor is only in the intestinal wall is 80 % after 5 years If there’s no relapse after 5 years, the patient is considered cured If the cancer spreads to the regional lymph nodes the survival rate is 50-60 % for 5 years. Only 5 % of the patients are alive more than 5 years after detected spread

13. Prevention Screening of all people over 50 years of age is done in some areas of Norway Goal is to detect potential polyps and remove them By removal of polyps and later check up, the hope is to reduce the risk of colorectal cancer

14. Sources https://sml.snl.no/tykktarmskreft http://www.medicinenet.com/colon_cancer/article.htm# colon_cancer_facts http://www.medicinenet.com/colon_cancer/article.htm# colon_cancer_facts http://www-dep.iarc.fr/NORDCAN/NO/frame.asp http://www.kreftregisteret.no/no/Generelt/Fakta-om- kreft-test/Tykk--og-endetarmskreft/ http://www.kreftregisteret.no/no/Generelt/Fakta-om- kreft-test/Tykk--og-endetarmskreft/