Colon cancer is cancer of the large intestine (colon), the lower part of your digestive system. Also called colon cancer or large bowel cancer, includes cancerous growths in the colon, rectu…Full description
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Descripción: cancer de colon
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GI self test assessment
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cancer
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Klasifikasi polip colon, deteksi dengan Colon in loop (Double Contras Barium Enema/ DCBE)Deskripsi lengkap
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Resumen del tema "Colon Hermeneuta" del libro de TODOROV
Gastroenterology [COLON CANCER] Pathogenesis Colon cancer is typically a disease of > 50 yr olds that’s a progression of either genetic errors (see the chart to the right) or long term inflammation (Crohn’s, UC) into cancerous growth. The mechanism is Ø important, but there’s loss of the APC, ATM, and p53 genes - in that order - that eventually turns a premalignant polyp into an invasive carcinoma. The process (polyp à Cancer) occurs over 3-7 yrs.
Patient The initial presentation can be highly variable. The best way to discover colon cancer is with appropriate screening (see next section). Think colon cancer if you see any of these three presentations. 1 A post-menopausal female or any male with Iron Deficiency Anemia, 2 alternating bowel habits (diarrhea and constipation) with change in the caliber of their stool (generally to "pencil thin"), or finally, there may be nothing to tip you off the initial presentation is 3 a metastasis to the liver or lung. Screening Colonoscopy is the golden standard done q10y unless abnormalities are found, at which the frequency is increased. This will identify adenomatous polyps which will be removed and analyzed. Sessile, Villous polyps have an increased risk of malignant transformation, while pedunculated, tubular polyps have a lower risk. Colonoscopy is required in order to visualize the entire colon because only 50% of polyps are Left sided (opposed to rigid sigmoidoscopy). In communities where colonoscopy isn’t available screening with FOBTx3 annually or FOBT q3 yrs with Flex Sig q5yrs is also appropriate. Barium Enema is NOW NEVER the right answer as it only detects colon cancer at > Stage III disease (incurable with resection). If either the barium enema or the flex sig are positive a colonoscopy must be done anyways to get a biopsy.
Pathology APC gene Mutation
Treatment PPX Colectomy
3 family members DNA ↑ Screening 2 generations Mismatch Start at 20. 1 under 50 Repair Or 10 years Colon Cancer AND prior to reproductive organs first CRC. GI tumors and Brain Tumors Turcot, Turban (head) GI Tumors + Jaw Tumors Nonmalignant polyps and hyperpigmented buccal mucosa + small intestine tumors (hamartomas) Asx Screen Polyps Low Risk
Colonoscopy
Colonoscopy q10y + FOBT q1y
Polyps Precancer
Curative
Ø Ca
Noninvasive Biopsy
Colonoscopy q5y + FOBT q1y
Curative Colonoscopy q5y + FOBT q1y
Invasive Cancer
Stage I / II Resection
Mets
Mets
Stage
Nodes
Nodes
> Stage III FOLFOX (Chemo)
Colonoscopy
Diagnosis In someone with severe disease all that’s necessary is a barium enema to reveal the apple core lesion (don’t do it, but still a test question because of the radiograph). The best test is colonoscopy. If there’s invasive disease a metastatic workup (CT chest/abdomen/pelvis) is required for staging. Intraoperative staging can be performed. Disease regression or relapse is followed by the CEA levels – it’s never diagnostic. Treatment This is dependent on staging. If there’s extracolonic involvement (Lymph Nodes or Mets) the treatment is FOLFOX (5-Fu + Leucovorin + Oxaliplatin) or FOLFIRI. Recently added to improve remission is Bevacizumab, a VEGF Inhibitor. If there’s no extracolonic involvement a simple resection is curative.
Presentation 1000 polyps by 18, Cancer by 40, Death by 50
