ASST.PROF.AND CONSULTANT GENERAL SURGEON
One of the most common cancers in the western
Increasing in our region.
More common in males. Age >50
Almost half occur in the rectum.
3/4 are within reach of the flexible
sigmoidoscope[60cm from the anal margin].
Colorectal ca is defined as the occurrence of malignant
lesions in the mucosa of the colon or rectum.
Previous colorectal ca. or adenomatous polyps.
Hereditary polyposis coli syndromes.
Chronic active ulcerative colitis.
Diet[low fibre,high in animal fat].
Polypoid, Ulcerating,Annular and infiltrating.
75% of lesions are within 60cm of the anal margin
[rectum ,sigmoid, left colon]
3% are synchronous
3% are metachronous
Mets is to the regional lymph nodes and via
bloodstream to the liver etc.
Adenocarcinoma [10-15% are mucinous].
Staging [Dukes and TNM].
Anaemia ; Caecal ca often present with anaemia.
Colicky abdominal pain; tumours causing partial
obstruction, e.g Transverse or descending colonic
Altered bowel habit[constricting lesions]
Bleeding or passing of mucus per rectum.
Tenesmus [rectal lesions].
Digital rectal exam.[FOB]
U/E ; hypokalaemia
LFT ; liver mets
Sigmoidoscopy[rigid to 30 cm/ flexible to 60cm] and
colonoscopy [whole colon] ; to observe lesions, obtain
Bx. [virtual colonoscopy].
Double contrast barium enema ; apple core lesion or
CEA raised in advanced disease.
Resection of the tumour with adequate margins to
include regional lymph nodes.
Resection possible for liver mets if fewer than five are
Right hemicolectomy [no bowel prep] for lesions from
caecum to splenic flexure.
Left hemicolectomy [bowel prep] for lesions of
descending and sigmoid colon.
Anterior resection for rectal tumours.
Abdominoperineal resection and colostomy for very
low rectal lesions.
Hartmann’s procedure for emergency surgery to the
Resection of obstructing tumours despite mets.
Bypass for obstructing inoperable.
Intraluminal stents for obstructing cancers.
Radiotherapy may be used to shrink rectal cancers
preoperatively or palliate inoperable rectal cancers.
Adjuvant chemotherapy [5-FU/Levamisole] to reduce
risk of systemic recurrence [Dukes C and some B] or to
palliate liver mets.
5 year survival depends on staging.