Docstoc

COLORECTAL MALIGNANCIES

Document Sample
COLORECTAL MALIGNANCIES Powered By Docstoc
					                                      BY
                           M.S.AL-AMOODI
ASST.PROF.AND CONSULTANT GENERAL SURGEON
 INTRODUCTION
 AETIOLOGY
 PATHOLOGY
 CLINICAL FEATURES
 MANAGEMENT
 OTHERS
INTRODUCTION
 One of the most common cancers in the western
  world.
 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.
AETIOLOGY
 Previous colorectal ca. or adenomatous polyps.
 Hereditary polyposis coli syndromes.
 Family hx.
 Chronic active ulcerative colitis.
 Diet[low fibre,high in animal fat].
PATHOLOGY
Macroscopic
 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.
Histology
 Adenocarcinoma [10-15% are mucinous].
 Staging [Dukes and TNM].
CLINICAL FEATURES
 Anaemia ; Caecal ca often present with anaemia.
  Progresses silently.
 Colicky abdominal pain; tumours causing partial
  obstruction, e.g Transverse or descending colonic
  lesions.
 Altered bowel habit[constricting lesions]
 Bleeding or passing of mucus per rectum.
 Tenesmus [rectal lesions].
INVESTIGATIONS
  Digital rectal exam.[FOB]
 CBC; anaemia
 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
  polyps
 CEA raised in advanced disease.
MANAGEMENT
Surgery[potentially curative]
 Resection of the tumour with adequate margins to
  include regional lymph nodes.
 Resection possible for liver mets if fewer than five are
  present.
Procedures
 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
  colon.
Surgery /Intervention[palliative]
 Resection of obstructing tumours despite mets.
 Bypass for obstructing inoperable.
 Intraluminal stents for obstructing cancers.
Other treatments
 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.
Prognosis
 5 year survival depends on staging.
 A,80%
 B,60%
 C,35%
 D,5%
THANK YOU

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:13
posted:8/16/2011
language:English
pages:23