Escolar Documentos
Profissional Documentos
Cultura Documentos
Colorectal Cancer
SGD B8
Denpasar, November 28,
2014
Chapter-1: Introduction
last of 20th century,
Lifestyle, lot of fast food, less
in physical activity
Metabolic
Disease
Health
Problems
Chapter-II: Content
Definiti
on
Epidemiolo
Epidemiolo
gy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Is it urgent problems ?
Risk factors
Need To be
Consider
Colorectal cancer is a type of
Staging
number of colorectal cancer cases
in the United States for 2014 are
Preventi
cancer is the third most in
96,830
new cases of colon
Indonesia, the number of cases of
on
cancer 40,000 new cases of
Treatme
1.8 / 100,000 population
rectal cancer
nt
Prognos
1.
World Cancer Report 1.
2014.Stephen
World Health
Organization.
2014.
pp.Mellitus.Endicrinology
Chapter 5.5. ISBN 9283204298.
A. Brietzke,
MD, FACP,
FACE.
(2007) Vol 6 Part 3: 1-12.
2.
Chapter-II: Content
How Can it Developed ?
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
1.
2.
Troitza K. Bratanova-Tochkova, Haiying Cheng, Samira Daniel, et al. Diabetes (2002) Vol. 51,
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Hormonal
Substance
Cancer Sel
Syndrome
1ST Type
2ND Type
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Cushing
Syndrome
1.
2.
Stephen A. Brietzke, MD, FACP, FACE. Mellitus.Endicrinology (2007) Vol 6 Part 3: 1-12.
Troitza K. Bratanova-Tochkova, Haiying Cheng, Samira Daniel, et al. Diabetes (2002) Vol. 51,
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Bcl2A1
Bcl2A1
Mcl-1
Mcl-1
PUMA
PUMA
Release C
cytokrome
cytokrome C
Tomer C., Ioannis S.P. Ohad T., et al. Mutant p53 Prolongs NF-kB Activation and Promotes Chronic Inflammation and
Inflammation-Associated Colorectal Cancer. Cancer Cell 2013: 23(4); 634-646.
Mitchell S. C. The pathophysiology, clinical presentation, and diagnosis of colon cancer and adenomatous polyps. Med Clin
N Am 2005: 89(4); 142.
Chapter-II: Content
Definiti
on
Epidemiol
Apaf-1
Apaf-1
Epidemiol
ogy
Risk
Factor
Caspase
Apoptosom
Caspase9
Apoptosom
9
Pathogen
esis
Diagnos
is
Dif. Dx
ICAD
ICAD
Caspase Caspase3
3
Staging
Procaspase p21waf1
p53
type
wild
Procaspase9 type wild Release p21waf1
or cip1
p53
Preventi
9
or
cip1
Release C
cytokrome
Apoptosison
cell. This mechanism is not
Apoptosis
cytokrome C
Apoptosis
cell. This
Apoptosis
Treatme
cancer cell
happen
in mechanism
cancer cell. is not
cancer cell
happen in cancer cell.
Tomer
C.,
Ioannis
S.P.
Ohad
T.,
et
al.
Mutant
p53
NF-kB Activation and Promotes Chronic Inflammation
nt and Inflammation-Associated Colorectal Cancer. Prolongs
Cancer Cell 2013: 23(4); 634-646.
Prognos
Mitchell S. C. The pathophysiology, clinical presentation, and diagnosis of colon cancer and adenomatous
polyps. Med Clin N Am 2005: 89(4); 142.
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Colorectal cancer
Colorectal
cancer
cell
cell
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
POMC
POMC
Melanocyte
Melanocyte
stimulating
stimulating
hormone
hormone
Corticotropin
Corticotropin
releasing
releasing
hormone
hormone
ACTH
Staging
ACTH
Preventi
Ectopic production of ACTH hormone
on
Ectopic production of ACTH hormone
Treatme
nt
Prognos
Gomez R.T., Otero J.D., Escalada P.R., et al. Carcinoma of the colon associated to ectopic ACTH secretion. An Med Interna 2004: 19(10); 548549.
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Kaplan Meier plots for CSS according to p53 functionality
Treatme
Kaplan Meier plots for CSS according to p53 functionality
nt
Prognos
Arantza F.S., Giusi I.F., Wim E.C., et al. Integral analysis of p53 and its value as prognostic factor in sporadic colon cancer. BMC Cancer 2013:
13(6); 277-288.
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Moon face
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Stage-0
The tumor is very small,
in the inner part of colon
& rectum. The therapy
can be surgery
Stage-1
The tumor cells invade
into the other layer of
the intestine but not out
of the colon
Stage-2
spread out of the colon
and rectum but do not
reach the lymph node.
Stage-4
Stage-3
The tumor cells
tumor cells
have been
have spread out
spread into the
into the nearest
other organs
lymph node but
such as liver
do not reach the
and lung. The
other organs.
possible
The possible
therapies are
therapies are
surgery,
surgery,
chemotherapy,
chemotherapy,
L. P. Fielding, P. A. Arsenault, P. H. Chapuis, dkk. 1991. Clinicopathological staging for colorectal cancer: An
radiation, and
and radiation.
International Documentation System (IDS) and an International Comprehensive Anatomical Terminology (ICAT).
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-II: Content
Definiti
on
Epidemiol
Epidemiol
ogy
Risk
Factor
Pathogen
esis
Diagnos
is
Dif. Dx
Staging
Preventi
on
Treatme
nt
Prognos
Chapter-III: Conclusion
Chapter-III: Conclusion
Case Study-1
NI Tsabedze, C Ray, M Hale. Ectopic
ACTH syndrome: a clinical
challenge. JEMDSA 2011;16(2):107110
History
A 29-year-old woman with a six-month
history of human immunodeficiency virus
(HIV)
infection
on
highly
active
antiretroviral
therapy
(HAART)
was
referred to endocrinology unit.
Her presenting complaints were a onemonth history of malaise and fatigue,
emotionally labile, dyspnea with poor
effort tolerance, recent weight gain
and darkening of her skin.
Physical Exam
Normotensive Cushingoid young woman with central
obesity and moon facies.
Purple striae over her flanks and thighs.
Facial acne
Bruising on her forearms
Hyperpigmentation of her extensor surfaces on her
upper and lower limbs.
A significant right inguinal lymph node was
palpable, which was fixed and nontender.
On rectal examination a worrying ulcer was noted on
her anus.
Thyroid examination was normal.
Lab test
No
Test
Value
Normal Value
Serum
Bicarbonate
39 mmol/l
C-reactive
Protein
4.1 mg/l
< 1 mg/l
Normochromic
macrocytic
anemia wth MCV
110.3 fl
79.1-98.9 fl
4.4 x 109/l
(neutrophils
80.8%)
4 11 x 109 / l
Absolute CD4
count
81 x 106 /l
Random serum
cortisol
ACTH level
742 ng/l
Urinary
cortisol
2691
nmol/24 h
3.3-5.3 mmol/l
Lab Test
2069 nmol/l
18-29 mmol/l
500-1200 x 106 /l
120-620 nmol/l
< 46 ng/l
80-590 nmol/24 h
Thyroid
function
tests,
serum
aldosterone,
alpha
foetoprotein,
luteinising
hormone,
folliclestimulating hormone, Liver function
tests, urea and creatinine
Normal limit
Imaging
CT scan of the
abdomen
revealed a locally
invasive rectal
tumor
An
obstructive
rectal tumor was
identified
by
sigmoidoscopy
and biopsy was
taken
Histopathology
Histopathological
examination
showed
ulceration of the squamous epithelium
Extensive infiltration of the perianal soft
tissue by discohesive nests of small cells with
hyperchromatic nuclei having finely stippled
chromatin
with
a
salt-and-pepper-like
appearance .
Small, eosinophilic nucleoli were present.
The cells also had a moderate amount of pale
staining cytoplasm. Occasional mitoses were
identified together with focal necrosis.
Immunohistochemistry showed paranuclear, dotlike, positive staining for the pankeratins MNF 116
and AE1/3, together with positive cytoplasmic
staining for synaptophysin, chromogranin A and
ACTH in the malignant cells.
Case Study-2
Cecum
biopsy
poorly differentiated
adenocarcinoma
Pictures
Treatment
ACTH supression
therapy
Systemic
chemotherapy
Metyrapone and
etomidate were
used during this
period for
treatment of
hypercortisolism
A right
hemicolectomy and
intrabdominal
lavage
perforated cecum
and intraabdominal
abcess