Documente Academic
Documente Profesional
Documente Cultură
In this large population of patients with stage IV colon cancer, BO after diagnosis was
less common (8.0%) than previously reported. Risk was associated with site and
histological type of the primary tumor. Future studies will explore management and
outcomes in this serious, common complication.
Incidence and Predictors of Bowel Obstruction in Elderly Patients With Stage IV Colon
CancerA Population-Based Cohort Study
Megan Winner, MD, MS1,4; Stephen J. Mooney, MS4; Dawn L. Hershman, MD2,4; et alDaniel
L. Feingold, MD1; John D. Allendorf, MD1; Jason D. Wright, MD3; Alfred I. Neugut, MD, PhD2,4
Author Affiliations Article Information
JAMA Surg. 2013;148(8):715-722. doi:10.1001/jamasurg.2013.1
4. Jadi utk screeningnya gimana?
Barium enema dan rektosigmoidekopi, Kalo ada lesi yg mencurigakan baru
kolonoskopi.
Fecal occult blood test (FOBT) untuk mendeteksi adanya darah dalam tinja.
Pembuluh darah di permukaan polip atau usus besar seringkali rapuh dan mudah
rusak karena dilalui oleh feses/kotoran.
Digital rectal exam 1-2th.
But your doctor may recommend adjuvant chemotherapy (chemo after surgery) if
your cancer has a higher risk of coming back (recurring) because of certain
factors, such as:
The cancer looks very abnormal (is high grade) when viewed under a
microscope.
Cancer was found in or near the margin (edge) of the removed tissue,
meaning that some cancer may have been left behind.
6. Jadi kalo udah ketauan polip hrs diapain biar dia gak berkembang jd crc?
Recent research on the immunology of cancer has provided intriguing insight into the metastatic
process, and may help us further understand the difference between thoracic and liver metastases.
In the present study, many CRC patients presented with extrahepatic metastases and without
detectable liver metastases. As discussed above, anatomical factors may be an explanation.
However, one could hypothesize that liver metastases have indeed been present, but have been
eliminated or entered a dormant phase, rendering treatment ineffective.
At lower stages, thoracic metastases were almost as frequent as liver metastases,
and also in stage IV patients with multiple metastases. The only group where liver
metastases were clearly more common was in stage IV patients with single
metastases. Similar findings were reported in a recent Japanese hospital study,
where lung metastases were more frequent in CRC patients who underwent
curative surgery, compared with stage IV patients.
Therefore, it seems that lung metastases need a longer time to grow, compared
with liver metastases. an unaccustomed thought, because the liver is considered an
immunosuppressive organ29 and survival in liver metastases was indeed poor, only 9 months. If
the metastasis succeeds in escaping the immune system, the milieu of the liver will promote the
growth of liver metastases, which thus will become clinically apparent. Metastases to other sites
have yet not occurred, at least at a clinically detectable rate. The relatively better prognosis in
thoracic metastases implies a slower growth rate, which is compatible with retained activity of
anti-tumor immune responses. Improvements in radiological methods have enabled detection of
event smaller tumor growths, e.g. lung metastases
It appears that CRC spreads via the portal circulation to the liver, and from there to the lungs. It
may also reach the lungs directly, perhaps using lymphatics, or directly from the distal rectum.
However, in the present data there were clear indications that the lungs seem to be an important
waypoint toward further spread: nervous system metastases occurred more frequently together
with respiratory metastases than with liver metastases
The vast majority of polyps are NOT cancerous or even pre-cancerous. The polyps without the
potential to turn into cancer include small hyperplastic polyps, inflammatory polyps, and
hamartomatous polyps which are not part of an inherited polyp syndrome. The precancerous
polyp which can turn into a cancer is called an adenoma. The two most common types of
colorectal polyps are hyperplastic polyps and adenomas. Usually, the larger the size of the
adenoma, the greater the chance that there may be cancer or pre-cancerous cells present in the
polyp. Since it is hard to determine the exact nature of a polyp, polyps found during colonoscopy
are removed and sent to the lab for a microscopic analysis.
Current theories propose it will take about 10 years for a small adenoma to transform into a
cancer. That is why the standard interval for screening colonoscopy is 10 years. However, the
time interval may be shorter for patients with a hereditary form of colon cancer (like familial
adenomatous polyposis or hereditary non polyposis colorectal cancer) or inflammatory bowel
disease. The recommended intervals are general guidelines and may not apply to every patient.
11. Apa hubungannya red meat sm crc?
Scientists have offered a number of explanations for the link between red meat
and colon cancer. One theory blames heterocyclic amines (HCAs), chemicals
produced when meat is cooked at high temperatures. HCAs may play a role, but
since high levels can also be present in cooked chicken, they are unlikely to be
the whole explanation. Preservatives have also been implicated in the case of
processed meats; nitrates are a particular worry, since the body converts them
to nitrosamines, which are carcinogenic. But since fresh meat is also linked to
colon cancer, preservatives can't be the whole answer.
These results are interesting enough on their own, but Dr. Michelle Lewin and
her colleagues went one step further. They were able to retrieve cells from the
lining of the colon that are shed into the stool with every bowel movement as a
normal event. The cells from people eating the high-meat diet contained a large
number of cells that had NOC-induced DNA changes; the stools of vegetarians
had the lowest number of cells with damaged genetic material, and the people
who ate high-meat, high-fiber diets produced intermediate numbers of damaged
cells.
Did you ever wonder what puts the red into red meat? The short answer
is myoglobin, a protein that looks red when it binds with oxygen. But after a few
days in the refrigerator, myoglobin gives up its oxygen and the meat turns brown.
To keep meat looking rosy, manufacturers may pump in some carbon monoxide,
which sticks to myoglobin like glue, keeping it red for weeks. Carbon monoxide is
also used to keep tuna looking fresh, and a variety of additives are used to
improve the appearance of other foods. The moral: Don't judge a food by its
color.
The study from England showed that large amounts of red meat can produce
genetic damage to colon cells in just a few weeks. It's an important finding, but it
does not prove that red meat causes cancer. None of the cells were malignant,
and the body has a series of mechanisms to repair damaged DNA. In most
cases, the repairs are successful, but when they fail, cells can undergo malignant
transformation.
12. Jadi kalo ada ileus obstruktif pada crc itu tatalaksananya hrs diapain?
One such problem is bowel obstruction (BO), which occurs when a cancerous growth or adhesions
block intestinal flow; the resulting nausea, vomiting, pain, and dehydration usually require
inpatient hospitalization.2,3 Although untreated BO can be fatal,4 most patients receive treatment
because onset is typically progressive rather than acute,5,6 and symptoms are too severe to be
ignored.7 The prognosis of patients with BO is poor; life expectancy is typically measured in
weeks to months,8,9 in part because the circumstances that typically give rise to BOs herald the
end of life
Surveillance for recurrences, particularly for relapses in the liver and lung, should be
performed for at least 4 years in colon cancer patients. Patients with rectal cancer should
be followed for a longer period than those with colon cancer, focusing on locoregional,
liver and lung recurrence. It is particularly noteworthy that adjuvant chemotherapy may
prolong the interval until recurrence and the interval until lung metastasis is relatively
longer.
Symptoms of recurrent colorectal cancer may include systematic changes that affect
the whole body, such as fatigue or weight loss. Other symptoms may be related to
lymph node swelling or lumps in the lymph nodes.
Insiden terjadinya perforasi kanker kolorektal 2,3-2,5%, ditandai dengan adanya peritonitis.Perforasi kolon
merupakan kegawatdaruratan dimana terjadi kebocoran kolon sehingga isi kolon masuk ke rongga
peritoneum dan menimbulkan peritonitis baik lokal maupun difus.
Pemeriksaan colok dubur dilakukan pada setiap pasien dengan gejala ano-rektal. Pemeriksaan ini bertujuan
untuk menetapkan keutuhan sfingter ani dan menetapkan ukuran dan derajat fiksasi tumor pada rektum 1/3
tengah dan distal. Pada pemeriksaan colok dubur ini yang harus dinilai adalah: Keadaan tumor: Ekstensi
lesi pada dinding rektum serta letak bagian terendah terhadap cincin anorektal, cervix uteri, bagian atas
kelenjar prostat atau ujung os coccygis. Mobilitas tumor: Hal ini sangat penting untuk mengetahui prospek
terapi pembedahan. Ekstensi dan ukuran tumor dengan menilai batas atas, bawah, dan sirkuler
b). Diagnosa62,63
Secara keseluruhan, pemeriksaan foto polos mempunyai sensitivitas 84 % dan spesifitas 73 %
dalam diagnosis ileus obstruksi .Standar pemeriksaan foto polos abdomen adalah serial yang
terdiri dari 3 jenis foto yaitu: foto abdomen supine AP, abdomen tegak AP dan foto toraks tegak.
Pada pasien yang tidak kooperatif, pemeriksaan foto polos abdominal minimal dilakukan dua
posisi yaitu pada posisi supine yaitu anteroposterior (AP) dan tegak (AP) hal hal yang harus
diperhatikan pada pemerisaan foto polos abdominal adalah adanya pelebaran usus, adanya fluid
level patologis, penebalan dinding usus dan distribusi udara Gambaran radiologis obstruksi usus
besar bergantung pada kompetensi katup ileosekal. Terdapat beberapa tipe obstruksi kolon yaitu
tipe obstruksi dimana katup ileosekal masih kompeten. Pada keadaan ini dapat terlihat berupa
dilatasi kolon tipis tanpa adanya distensi usus halus. Bila obstruksi terus berlangsung maka dapat
menyebabkan katup ileosekal tidak kompeten, sehingga akan terjadi distensi usus halus. Pada
keadaan awal dari inkompetensi katup ileosekal menunjukkan diameter sekum dan kolon asendens
terdistensi maksimal dibandingkan kolon bagian distal disertai adanya udara pada usus halus. Bila
obstruksi berlangsung lama udara pada sekum dan kolon asendens berangsur berkurang, dan udara
masuk ke dalam usus halus dan mengisi ke lebih banyak ke usus halus. Pada keadaan ini
menyerupai obstruksi usus halus Gambaran radiologis dari ileus obstruksi usus besar adalah kolon
yang terdistensi terletak pada abdomen bagian perifer dan dapat dibedakan dari usus halus yang
terletak pada sentral abdominal dengan adanya gambaran haustra. Dilatasi sekum yang melebihi 9
cm dan dilatasi bagian koloksin lain yang melebihi 6 cm dianggap abnormal yang Bagian usus
yang terletak distal dari obstruksi akan kolaps dan bagian rektum tidak terisi oleh udara.
Identifikasi kolon pada sonografi seringkali sulit karena kolon dipenuhi dengan gas dan feses.
Penyebab obstruksi kolon dapat diidentifikasi. Adanya massa kolon atau intususepsi ileosekal
dapat di perlihatkan pada pemeriksaan ultrasonografi. Gambaran yang dapat terlihat pada
intususepsi adalah adanya lingkaran konsentris seperti sosis. Diagnosa banding ileus obstruksi
adalah ileus paralitik Pada ileus paralitik biasanya gas tidak terkumpul (terlokalisir) disatu bagian
namun terdapat gambaran udara di seluruh bagian usus (baik usus halus maupun usus besar) atau
sama sekali tidak terdapat gambaran gas (gasless) di seluruh bagian usus. Namun demikian
gambaran ini tidak definitif. karena dapat disebabkan oleh obstruksi usus besar dengan
inkompetensi valve ileosekal atau juga didapatkan pada obstruksi usus halus pada tahap awal.
Pada ileus paralitik lumen usus berdilatasi sesuai dengan proporsinya masing-masing, sehingga
gambaran kolon tetap lebih besar dari pada gambaran usus halus. Pemeriksaan CT scan
mempunyai sensitivitas dan adalah 96 % dan 93 %. Penggunaan CT dinilai lebih menguntungkan
dibanding kontras enema terutama pada pasien usia tua dan pada pasien dengan keadaan umum
yang kurang baik. CT biasanya dilakukan dengan pemberian kontras intravena. Pemeriksaan CT
scan dapat menunjukkan level obstruksi, penyebab obstruksi dan adanya komplikasi yang dapat
terjadi seperti strangulasi, perforasi, pneumatosis intestinal. Gambaran dari CT scan Abdomen
menunjukan adanya obstruksi dan terdeteksi adanya tumor primer. Bila bukan merupakan
obstruksi total dan kondisi umum memungkinkan, dapat dilakukan kolonoskopi dan biopsi. Pasien
diperiksa laboratorium berupa ureum, kreatinin, elektrolit dan analisa gas darah. Gambaran foto
thorax memperlihatkan apakah ada metastase paru 27 Pasien biasanya dehidrasi, maka perlu
dilakukan penanganan preoperatif.