Colorectal Cancer

- Disease in which normal cells in the lining of the colon or rectum begin to change, grows without
control, and no longer dies.
- 3
rd
most commonly diagnosed cancer

Types of cancer in the colon:
Adenocarcinomas: More than 95% of colorectal cancers are a type of cancer known
as adenocarcinomas. These cancers start in cells that form glands that make mucus to
lubricate the inside of the colon and rectum.
Carcinoid tumors: These tumors start from specialized hormone-producing cells in the
intestine.
Gastrointestinal stromal tumors (GISTs): These tumors start from specialized cells in
the wall of the colon called the interstitial cells of Cajal. Some are benign (non-cancerous);
others are malignant (cancerous). These tumors can be found anywhere in the digestive
tract, but they are unusual in the colon.
Lymphomas: These are cancers of immune system cells that typically start in lymph nodes,
but they may also start in the colon, rectum, or other organs.
Sarcomas: These tumors can start in blood vessels as well as in muscle and connective
tissue in the wall of the colon and rectum. Sarcomas of the colon or rectum are rare.
Risk Factors:
Advanced Age
Inflammatory Bowel Disease( ulcerative colitis and Crohn's disease)
Low fiber and high fat diet
Smoking
Obesity
Race (African-Americans have increased risk)
Polyps (a noncancerous or precancerous growth associated with aging)
Family history & genetics
The most common forms of inherited colon cancer syndromes are:
Familial adenomatous polyposis (FAP). FAP is a rare disorder that causes you to develop
thousands of polyps in the lining of your colon and rectum. People with untreated FAP have a greatly
increased risk of developing colon cancer before age 40.
Hereditary nonpolyposis colorectal cancer (HNPCC).HNPCC, also called Lynch syndrome,
increases the risk of colon cancer and other cancers. People with HNPCC tend to develop colon cancer
before age 50.

Signs & symptoms
Change in bowel habits
Passage of blood in the stool
Unexplained anemia
Unexplained weight loss
Right sided:
Melena (dark tarry stools)
Fatigue (there is a feeling of constantly needing to pass stools)
Abdominal pain
Left sided:
Abdominal pain
Cramping
Constipation
Distention
Rectal:
Hematochezia-( the passage of fresh blood through the anus, usually in or with stools)
Tenesmus
Feeling incomplete evacuation of stool
Rectal mass

Screening Methods:
colonoscopy
Barium enema
Sigmoidoscopy
Fecal occult blood test
Digital rectal exam

*current recommendations for colorectal screening:
Annual digital rectal exam starting at age 40 (10% of tumors palpable by rectal exam)
Annual test for fecal occult blood starting at 40
Flexible sigmoidoscopy or colonoscopy at 50
Repeated 3-5 years thereafter

Staging
Stage 0- Known as cancer in situ, Removal of the polyp (polypectomy)
Stage I- The cancer has grown through the mucosa and invaded the muscularis (muscular coat)
Stage II- The cancer has grown beyond the muscularis of the colon or rectum but has not spread to
the lymph nodes
Stage III- The cancer has spread to the regional lymph nodes (lymph nodes near the colon and
rectum)
Stage IV- The cancer has spread outside of the colon or rectum to other areas of the body
*most common type of metastasis: LIVER



Approximate 5-year survival by stage:
Stage I - - 90%
Stage II - -75%
Stage III- -50%
Stage IV- -5%

Treatment:
Chemotherapy
Radiotherapy
Surgery:
*Total colectomy- removal of the entire colon

*Right hemicolectomy- removal of the last part of small intestine, ascending colon,
hepatic flexure, and a portion of the transverse colon.

*Left hemicolectomy- removal of descending colon, adjoining portion of sigmoid colon,
splenic flexure, and portion of transverse colon.

*abdomino-perineal resection(APR) for rectosigmoid cancer- removal of the rectum and
sigmoid colon through abdominal and perineal incisions, patient is left with a colostomy,
for low rectal cancers less than 8 cm from the anal verge.

*Low anterior resection(LAR) resection of low rectal tumors through an anterior
abdominal insicions, for tumors higher than 8 cm from anal verge.

colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of
the large intestine or colon through an incision in the anterior abdominal wall and suturing it into
place. This opening, in conjunction with the attached stoma appliance, provides an alternative
channel for feces to leave the body.
Types:
Loop colostomy: This type of colostomy is usually used in emergencies and is a temporary and
large stoma. A loop of the bowel is pulled out onto the abdomen and held in place with an external
device. The bowel is then sutured to the abdomen and two openings are created in the one stoma:
one for stool and the other for mucus.
End colostomy: A stoma is created from one end of the bowel. The other portion of the bowel is
either removed or sewn shut (Hartmann's procedure).
Double barrel colostomy: The bowel is severed and both ends are brought out onto the
abdomen. Only the proximal stoma is functioning.