This document summarizes information about colorectal carcinoma: - It is the 3rd most common cancer and most common after age 60. Risk factors include diet, diabetes, ulcerative colitis, and genetic conditions. - Inherited conditions like familial adenomatous polyposis (FAP) and Lynch syndrome can cause colorectal cancer. FAP causes multiple polyps developing by the teen years and cancer by age 40. - Presenting symptoms include blood in stool, changes in bowel habits, abdominal pain, obstruction, and weight loss. Investigations include colonoscopy, imaging, and blood tests. Treatment depends on staging but may include surgery, chemotherapy, and radiation.

1. colorectal carcinoma

2. epidemiology
 3rd most common
 3rd of this disease arise in rectum
 rare before 50( except in inherited colorectal
cancer syndromes)
 common after 60
 other factor: diet(low fibre , high fat,red
meat,alcohol,) , diabetic, UC, inherited genetic
condition
 more common in developed (sporadic young
indian subcontinent)
 reduction in dss if taken aspirin

3. inherited condition causing bowel
cancer
1.polyposis syndromes
2.hereditary non polyposis colorectal cancer
(HNPCC)- low polyp but high risk to get CA

4. polyposis syndromes
• familial adenomatous polyposis (FAP)
• AD in APC gene coz hundredss polyps develop
by mid teen.
• develop CA at age 40
• prevention : surgery in early adulthood 1.
(subtotal colectomy with ileorectal anastomosis)
2. (panproctocolectomy)

5. polyposis syndromes
 peutz-jeghers syndrome
 develop hamartomas polyps throughout GI tract
 others features: freckles around mouth, hand,
feet, genitalia
 die at 50 because - bowel intussusception
-cancer
 cancer usually at
small/large/stomach/pancreas/testes and breast

6. HNPCC
Lynch syndrome
defect in mismatch repair genes which mend
damaged DNA
70% risk to get colorectal CA
indicator cancer : endometrium/ ovary/
urothelium/ small bowel / brain
when patient > 45 develop indicator cancer then
we test marker for genetic condition.

7. pathophysiology
• most CA initially exophytic(protrude into lumen)
then ulcerated and progressively invade the
muscular bowel wall. then eventually involved
serosa and surrounding structures.
• stromal fibrosis cause luminal narrowing (IO)
large bowel spread via lymphatic then blood
stream
 lymphatic 1-mesenteric node 2.para aortic
nodes( duodenal obstruction)(compress bile
duct coz jaundice)
 blood spread 1. liver

8. presentation
 blood loss anaemia
caecum and asc colon rare cause obstruction
palpable mass in right iliac fossa
 change in bowel habit
blood and mucus and loose stool
 large bowel obstruction(partial and complete)
left colon because more solid

9.  rectal bleed
 tenesmus
 perforation
SIGN
cachexia
low
supraclavicular lymp node enlarge
mass/ liver/ ascitis
 rectal examination mandatory

11. Investigations
• Colonoscopy (best), look for synchronous
lesions -Alternative: air contrast barium enema
(“apple core” lesion) + sigmoidoscopy
• FBC
• Metastatic workup: CXR, abdominal
CT/ultrasound
• Bone scan, CT head only if lesions suspected
• Labs: CBC, urinalysis, liver function tests, CEA
(before surgery baseline)

12. barium enema

13. capsule

16. staging

17. Treatment
• SURGERY (indicated in potentially curable or symptomatic cases
-not always in stage IV)
• Curative: wide resection of lesion (5 cm margins) with nodes and
mesentery
• Palliative: if distant spread, then local control for hemorrhage or
obstruction
• 80% of recurrences occur within 2 years of resection
• Improved survival if metastasis consists of solitary hepatic mass that
is resected
• Colectomy:
• -most patients get primary anastomosis (e.g. hemicolectomy, low
anterior resection (LAR)-
• -if cancer is below levators in rectum, patient may require an
abdominal perineal resection (APR) with a permanent end
colostomy, especially if lesion involves the sphincter complex
• -complications: anastomotic leak or stricture, recurrent disease,
pelvic abscess, enterocutaneous fistula

18. RADIOTHERAPY & CHEMOTHERAPY
• Chemotherapy (5 FU based regimens): for patients with
node-positive disease
• Radiation: for patients with node-positive or transmural
rectal cancer (pre ±post-op), not effective in treatment of
colon cancer
• Adjuvant therapy –chemotherapy (colon) and radiation
(rectum)
• Palliative chemotherapy/radiation therapy for
improvement in symptoms and survival

19. Local Excision, Resection Anastomosis

20. Resection and Colostomy

21. Thank You
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