COLORECTAL CANCER, HOW

TO DIAGNOSIS AND THERAPY

BY : NARITA EKANANDA

BACKGROUND
Colorectal cancer is the most common type of

gastrointestinal cancer
Colorectal cancer is the third most cancer in
Indonesia, with 1,8/100.000 incidence
Colorectal cancer is a term used to refer to cancer
that develops in the colon or the rectum. These
cancers are sometimes called colon cancer or rectal
cancer, depending on where they start

Colorectal cancer is the second leading cause of

cancer death when numbers for both men and

women are combined.
Regular colorectal cancer screening and early
diagnosis is one of the most powerful weapons
against colorectal cancer.

Anatomy

Vascularitation

PHYSIOLOGY
Colonic
motility
Metabolic
activity of
colonic
flora

Mucosal
absorption
and
secretion
Recycling
Nutrients

Metabolic
activity of
colonic flora

Colonic Flora
Fermentation

Short Chain
Fatty Acid
(SCFA)

Nutrition for
colonocytes
Influence of GI motility

COLORECTAL CANCER
Colorectal cancer (CRC) is the occurrence of

malignant lesions in the mucosa of the colon or

rectum.
Colorectal cancer occurs in a hereditary and
sporadic form
Colorectal cancer is a multifactorial disease process.

Genetic factors
Environmental exposures (including diet)
Inflammatory conditions of digestive tract

HEREDITARY
Family history
Young at age onset
Familial
Adenomatous
Polyposis (FAP)
Hereditary
Nonpolyposis
colorectal cancer
(HNPCC)

SPORADIC
No family history
Older population
Inflammatory
condition of digestive
tract

Most colorectal cancer begin as a growth on the

inner lining of the colon or rectum called polyp

Type of polyp :

Adenomatous polyps (pre cancerous condition)

Hyperplastic polyps & inflammatory polyps

FAP
Mutation of adenomatous polyposis
gene (APC)
Suppressor gene turned off
Polyps
Carcinoma

HNPCC
DNA repair enzyme genes mutation
Affect growth regulating gene
Development of cancer

COLORECTAL CANCER RISK FACTORS

Can Change

Can not
Change

Being overwight or obese

Being older

Physical inactivity

History of CRC or CR
polyps

Certain types of diet

Smoking
Heavy alcohol use

History of IBD
Inherited syndrome

Sign and Symptoms

A change in bowel habits
Rectal bleeding
Blood in the stool, which may make it look dark
Cramping or abdominal (belly) pain
Weakness and fatigue
Unintended weight loss

diarrhea

constipation

DIAGNOSIS
Anamnesis

Sign and Symptoms

Physical Examination

Mass per abdomen palpable

Colonoscopy, CIL, CT Scan

Colorectal Screening Test

Tests that can find
both colorectal polyps
and cancer
Flexible
sigmoidoscopy
Colonoscopy
Double-contrast
barium enema
(DCBE)
CT colonography
(virtual colonoscopy)

Tests that mainly find

cancer
Guaiac-based fecal
occult blood test
(gFOBT)
Fecal
immunochemical test
(FIT)
Stool DNA test

THERAPY

The objective of surgery for colon adenocarcinoma is

the removal of the primary cancer with adequate

margins, regional lymphadenectomy, and restoration
of the continuity of the GI tract by anastomosis

RIGHT
HEMICOLECTOMY

LEFT
HEMICOLECTOMY

STAGING

CHEMOTHERAPY
Adjuvant chemo
After surgery
Kill any cancer cells that may have been left behind after
surgery

Neoadjuvant chemo
Before surgery
Shrink the cancer and make the surgery easier
Often used in treating rectal cancer

Chemo for advance cancer

For cancer that have spread to other organs