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Colorectal cancer (CRC) Dr. Mohamed Shekhani. MBChB-CABM-FRCP.
CRC : Key points ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CRC : Key points ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CRC : Key points ,[object Object],[object Object],[object Object]
CRC : pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CRC : Genetics ,[object Object],[object Object]
CRC : Genetics ,[object Object],[object Object],[object Object],[object Object],[object Object]
CRC : Genetics ,[object Object],[object Object],[object Object]
Tumor supp genes  APC  FAP, AFAP p53  Sporadic colon cancer DCC  Non-syndromic FCRC Oncogenes  myc  Sporadic CRC ras src erbB2 Mismatch repair genes  MLH1  HNPCC MLH3  Sporadic CRC Base excision repair genes  MYH  FAP, AFAP—aut resisive Gene Function  Affected Gene  Clinical Manifestation
CRC : Genetics ,[object Object],[object Object],[object Object]
CRC : Epidemiology/RFs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CRC : Epidemiology/RFs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Factors Associated with the Development of CRC Protective Factors Risk Factors No family history of colorectal cancer or an inherited colorectal cancer syndrome Family history of colorectal cancer or an inherited colorectal cancer syndrome Birth in Asia or Africa Personal history of inflammatory bowel disease Diet high in fruits and vegetables * Birth in North America or Northern Europe Regular aerobic exercise Diet high in red meat, sucrose, fat Calcium and folate supplementation Physical inactivity Lack of dietary calcium and folate Obesity Smoking Excessive alcohol intake Cholecystectomy
Hereditary CRC Syndromes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hereditary CRC Syndromes ,[object Object],[object Object],[object Object],[object Object],[object Object]
Hereditary CRC Syndromes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hereditary CRC Syndromes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hereditary CRC Syndromes ,[object Object],[object Object],[object Object],[object Object]
 
Stratification of Colorectal Cancer Risk Lifetime Risk Risk Level High 100 % Presence of familial adenomatous polyposis 10% Presence of hereditary nonpolyposis colorectal cancer Moderate 20% Presence of chronic colitis due to ulcerative colitis or Crohn's colitis 10-20% Familial: First-degree relative with colorectal cancer Average (negative family history ) 5-6% >50 years of age
Diagnosis/Management of those at Increased Risk: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis/Management of those at Increased Risk: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis/Management of those at Increased Risk: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis/Management of those at Increased Risk: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Screening for those with Family H/O CRC or Adenomatous Polyps FDR(s) with CRC <60 ys  CS at 40 or 10 years <affected relative  If N,repeat *3-5 FDR(s) with CRC >60 ys  CS at 40 ys  If N, * 10 years FDR(s) with AdP <60 ys  CS at 40 or 10 years <affected relative  If N,rep *5 FDR(s) with AdP >60 ys  CS at 40 ys  Ind; if N, as average risk 2nd- or 3rd DR with ca or polyps  CS as ARP  If N, as ARP Patient Category  Screening  Surveillance
Diagnosis/Management of those at Increased Risk: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis/Management of those at Increased Risk: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Screening for CRC: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Screening for CRC: ,[object Object],[object Object],[object Object]
Screening for CRC: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Screening for CRC:  Screening tests   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Screening for CRC: ,[object Object],[object Object],[object Object]
Screening for CRC: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Screening for CRC: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Screening for CRC: ,[object Object],[object Object],[object Object]
Screening for CRC: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Screening for CRC: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Algorithm for screening for CRC
Colonoc neoplasia & CRC: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Staging for CRC: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Staging for CRC: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment of CRC: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment of CRC: ,[object Object],[object Object],[object Object],[object Object]

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CRC for 5th.

  • 1. Colorectal cancer (CRC) Dr. Mohamed Shekhani. MBChB-CABM-FRCP.
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  • 9. Tumor supp genes APC FAP, AFAP p53 Sporadic colon cancer DCC Non-syndromic FCRC Oncogenes myc Sporadic CRC ras src erbB2 Mismatch repair genes MLH1 HNPCC MLH3 Sporadic CRC Base excision repair genes MYH FAP, AFAP—aut resisive Gene Function Affected Gene Clinical Manifestation
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  • 13. Factors Associated with the Development of CRC Protective Factors Risk Factors No family history of colorectal cancer or an inherited colorectal cancer syndrome Family history of colorectal cancer or an inherited colorectal cancer syndrome Birth in Asia or Africa Personal history of inflammatory bowel disease Diet high in fruits and vegetables * Birth in North America or Northern Europe Regular aerobic exercise Diet high in red meat, sucrose, fat Calcium and folate supplementation Physical inactivity Lack of dietary calcium and folate Obesity Smoking Excessive alcohol intake Cholecystectomy
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  • 20. Stratification of Colorectal Cancer Risk Lifetime Risk Risk Level High 100 % Presence of familial adenomatous polyposis 10% Presence of hereditary nonpolyposis colorectal cancer Moderate 20% Presence of chronic colitis due to ulcerative colitis or Crohn's colitis 10-20% Familial: First-degree relative with colorectal cancer Average (negative family history ) 5-6% >50 years of age
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  • 25. Screening for those with Family H/O CRC or Adenomatous Polyps FDR(s) with CRC <60 ys CS at 40 or 10 years <affected relative If N,repeat *3-5 FDR(s) with CRC >60 ys CS at 40 ys If N, * 10 years FDR(s) with AdP <60 ys CS at 40 or 10 years <affected relative If N,rep *5 FDR(s) with AdP >60 ys CS at 40 ys Ind; if N, as average risk 2nd- or 3rd DR with ca or polyps CS as ARP If N, as ARP Patient Category Screening Surveillance
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