1. Colorectal Cancer

2. Colorectal cancer - statistics Leading causes of cancer death in the US Male Female Lung – 31% Lung – 25% Prostate – 11% Breast – 11% Colorectal –10% Colorectal –11%

3. Colorectal cancer - statistics  Affects 150,000 new patients per year  Accounts 60,000 deaths annually  Peak incidence at 70-80 years

4. Large Intestine - Colon

5. Layers of the large intestine 1.Mucosa 2.Submucosa 3.Muscularis externa 4.Serosa

6. Changes associated with aging a)Decreased secretory mechanisms; b)Decreased motility; c)Loss of strength and tone of the muscular tissue; d)Diminished response to pain and internal sensations

7. Colon cancer Risk factors 1.Diet 2.Alcohol consumption 3.Smoking 4.Hypovitaminosis 5.Genetics 6.Obesity

8. Colon Cancer Premalignant conditions and diagnoses: 1.Crohn’s disease 2.Non-specific ulcerative colitis 3.Polyps 4.Polyposis 5.Villous adenomas

9. Classification of colon cancer I External grow II Infiltrative grow III Mixed grow

10. Classification of colon cancer 1) adenocarcinoma 2) mucous adenocarcinoma 3) mucocellular carcinoma 4) non-differentiated cancer 5) non-classified cancer

11. Classification of rectal cancer 1) adenocarcinoma 2) mucous adenocarcinoma 3) mucocellular carcinoma 4) squamous cell carcinoma 5) glandular-squamous cell carcinoma 6) non-differentiated cancer 7) non-classified cancer

12. Classification of colorectal cancer TNM – system T1 - up to mucosa and submucosa T2 - up to muscular or serous layer T3 - outside of the bowel T4 – other organs are involved

13. Classification of colorectal cancer TNM-system N1 – lesions in regional nodules N4 – lesions in other nodules M0, M1, MX G1, G2, G3, GX

14. Classification of colon cancer Dukes system: Dukes A – tumor within the muscularis propria Dukes B – tumor invading the muscularis Dukes C – tumor with positive lymph nodes Dukes D - metastases

15. Clinical features of colon cancer 1.Vague abdominal pain 2.Rectal bleeding 3.Change in bowel habits 4.Systemic syndromes a) weakness b) malaise c) fatigue

16. Colorectal cancer I. Iron-deficiency anemia in an elderly male patient is colon cancer until proven otherwise II. Large bowel obstruction in all patients is colon cancer until proven otherwise

17. Clinical forms of colon cancer 1. Asymptomatic 2. Toxic 3. Enterocolitis -like 4. Dyspepsia -like 5. Pseudo inflammatory 6. Obstructive

18. Diagnostics of colon cancer 1.X-ray 2.Colonoscopy 3.Rectoscopy 4.Sygmoscopy 5.CEA –carcinoembryonic antigen 6.CT 7.MRI

19. Treatment of colon cancer Left-sided hemicolectomy Right-sided hemicolectomy Excision of the colon Excision of the sigmoid colon Colostomy

20. Treatment of rectal cancer Depends on the proximity to the anal verge Abdominoperineal resection (extirpation) Low anterior resection Wide local excision Sygmostomy

21. Treatment of colorectal cancer 1. Management of colon cancer depends on lymph node status 2. Colon cancers are resected even if metastatic

22. Screening  Digital rectum examination  Stool guaiac test  Flexible sigmoidoscopy  Colonoscopy