Colorectal Cancer
Associations
Presentation
- Depends on site
- Right colon
- anaemia
- palpable mass
- change in bowel habit
- weight loss
- Left colon
- change in bowel habit
- lower abdominal colicky pain
- Blood or mucus on or mixed in with stool
- Sigmoid
- Rectum
- frequency defaecation
- tenesmus
- blood and mucus PR
- sacral pain or sciatica
- Symptoms due to direct spread
- Jaundice
- Obstruction
- Small bowel - obstruction of caecal valve
- Large bowel - left-sided cancer
- Perforation
- of cancer
- due to closed-loop obstruction
Investigations
- Hb
- FBC
- U&E's (may be ureteric involvement)
- LFTs (liver secondaries)
- Sigmoidoscopy
- Biopsy
- Barium enema
- 5% metachronous
- Apple core stricturing
- Colonoscopy
- USS
- liver mets
- ureteric obstruction
Duke's classification
- A
- Confined to bowel wall
- 80% 5 year survival
- B
- Through wall into surrounding tissue
- 60% 5 year survival
- C
- Any lymph node involvement, regardless of direct spread
- 30% 5 year survival
- ( D
- Not part of Duke's original classification
- Distant metastases
- 5% 5 year survival )
Spread
- Intraperitoneal
- Lymph
- caecum→ proximal transverse colon
- distal transverse colon→ upper rectum
- lower rectum
- middle and inferior rectal arteries
- venous
Treatment
- Resection of appropriate section of colon
- right / left hemilcolectomy
- sigmoid colectomy
- anterior resection
- abdomino-perineal resection
- radiotherapy
- if rectal Ca then may decrease local recurrence
- cheomtherapy
Prognosis
- 60% amenable to radical surgery
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