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Colon and Rectal Cancer

Terms in this set (47)

Colorectal Cancer
Fourth most common cancer in men and women, age age of diagnosis -72 yo, lifetime risk is 1 in 20.
Symptoms of Colorectal Cancer
Abdominal Pain and discomfort, blood in stool, guiac positive hemocult, weakness or fatigue, changes in bowel habits, feeling of inability to empty bowel, weight loss
Risk Factors for colorectal cancer
> 60 yo, Crohn's disease, ulcerative colitis, fmhx of colon cancer, colorectal polyps, breast cancer, eat red meat, and high fat low fiber diet, tobacco, etoh, african american, diabetes, radiation
Colorectal cancer
adenocarcinoma of colon (95%),lymphoma, neruoendocrine tumors, soft tissue, and squamous cell carcinoma
Adenocarcinoma
mucinous and signet ring
FAP
Cause of adenocarcinoma- mutation in the APC gene- causes thousands of polyps to develop in the lining of the colon and rectum
Hereditary Nonpolyposis Colorectal Cancer
inherited changes in a number of genes, also known as lynch syndrome. have polyps but they only have a few. Develop colon cancer before age 50, linked to other types of cancer: endometrium, ovary, stomach, small bowel, pancreas, kidney, brain, ureters, and bile duct
Epithelial Cells
Colorectal cancer arises in __________ cells of colon or rectum when multiple cumulative genetic mutations alter cell processes
Polyps
Most cases of colorectal cancer develop from ________.
Types of polyps
Inflammatory polyps, hamartoma polyps, hyperplastic polyps, neoplastic polyps
Junior Polyp
Hamartoma
Hyperplastic benign proliferation
90% of polyps are benign protrusions- aka ____________
Adenomatous Polyp
5 years of growth to reach a clinical significance
Sessile
flat adenomatous polyp that is more likely to progress to cancer
Pedunculated
stalked adenomatous polyp
Tubular
most common adenomatous polyp- can be found anywhere in the colon
Villous
Adenomatous polyp which is most likely to progress to cancer
2.5 cm
Polyps greater than _______ (size) are five times more likely to be cancerous than those less than 1.5 cm
Diagnostics for polyps
DRE, fecal occult blood test, blood test carcinoembryonic antigen (CEA), barium enema, sigmoidoscopy, colonoscopy
barium enema
barium liquid is instilled into the large intestine through the anus
Polypectomy
removal of polyp- cut at stalk (treatment for polyps)
Open colectomy
Removal of part of the colon, as well as near by LN
laproscopic assisted colectomy
a laparoscope that has a small video camera on one end- allows surgeon to see inside the abdomen and diseased part of the colon can be removed
Local transanal resection
T1 N0 M0 stage I rectal cancers that are relatively small and not too far from the anus can be removed this way
Transanal Endoscopic Microsurgery
This operation can sometimes be used for early T1 N0 M0 stage I cancers that are higher in the rectum than could be reached doing a standard transnasal resection
Low Anterior Resection
Some stage I cancers and most stage II or II cancers in the upper third of the rectum can be removed by this surgery
Proctectomy with colo-anal anastamosis
some stage I and most stage II and III rectal cancers in the middle and lower third of the rectum require removing of the entire rectum and colon is connected to the anus
abdominoperineal resection
rectal cancers in the lower third of the rectum, one incision in the abdomen and another in the perineal area around the anus- removal of anus and tissues surrounding it, including the sphincter mm. Need permanent colostomy bag
Pelvic Exenteration
remove the rectum, but also near by organs such as bladder, prostate,or uterus- need colostomy
Surgery
small number of metastases are present in the liver or lungs- can sometimes be removed by surgery
Radiofrequency Ablation
High energy radio waves to kill tumors. Thin, needle like probe is placed through the skin and into the tumor under CT or ultrasound guidance
Percutaneous ethanol injection
injection of concentrated alcohol directly into the tumor to kill cancer cells. done through the skin with a needle guided by US or CT
Cryosurgery
Destroys tumor by freezing it with a metal probe. The probe is guided through the skin and into the tumor using US
Hepatic Artery Embolization
technique used to reduce the blood flow in the hepatic artery, which feeds most cancer cells in the liver
Hepatic Artery chemotherapy
chemo instilled into the liver to kill the tumor
TNM staging
Tumor- how far its spread into the wall of the colon, LN- how much cancer has spread to the lymph nodes, metastasis- whether cancer has spread to other parts of the body
Stage 0 colorectal cancer
Cancer has not grown beyond the lining of the colon or rectum
Stage 1 colorectal cancer
the cancer has penetrated through the lining of the colon or rectum into the underlying tissues but has not spread beyond the colon wall
Stage II colorectal cancer
the cancer has grown through the wall of the colon or rectum but has not yet spread to nearby lymph nodes
Stage III colorectal cancer
The cancer has spread to nearby lymph nodes but has not yet affected other organs
Stage IV colorectal cancer
The cancer has spread to other organs- liver, lungs, abdomen, or ovaries
five
`one to four + LN have a higher survival rate than people with more than _____ (number) + LN
Anal Cancer
very rare, inc incidence among HIV infected, HPV +
Dentate line
superiot aspect of the anus, reflects the change from squamous epithelium to transitional epithelium then to columnar at a higher level
Anal Margin
Tumors originating at the _____________ are considered more skin cancer. rarely involve LN
Symptoms of Anal Cancer
pain, irritation, and bleeding in the anal area
Anal cancer tx
chemotherapy, radiation, surgery
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