ulgesLlve 1racL ulseases

coIorectaI cancer
[k'lrek'tl]
Etymology: Gk, kolon, colon; L, rectus, straight
a malignant neoplastic disease of the large intestine, characterized by a change in bowel
habits; the passing of blood (melena), which may be occult initially; and anemias. Malignant
tumors of the large bowel usually occur after 50 years of age, are slightly more frequent in
women than in men, and are common in the Western world. They are rare in children;
clustering in families is common. The risk of large bowel cancer is increased in patients with
chronic ulcerative colitis, villous adenomas, and especially familial adenomatous polyposis of
the colon. 75% of all colorectal cancers have no known predisposing factors, but people who
have a high-fat diet and low activity levels may be more likely than others to have this cancer.
n the vermiform appendix, carcinoid is the most common tumor. Most lesions of the large
bowel are adenocarcinomas. These tumors have a long preinvasive stage, and, when they
invade, they tend to grow slowly. Rectal tumors may cause pain, bleeding, and a feeling of
incomplete evacuation. They may metastasize slowly through lymphatic channels and veins
and occasionally prolapse through the anus. Typical napkin ring tumors in the sigmoid and
descending colon grow circumferentially and constrict the intestinal lumen, causing partial
obstruction and production of flat or pencil-shaped stools. Manifestations include progressive
abdominal distension, pain, vomiting, constipation, cramps, and bright red blood on the stool's
surface. Malignant lesions in the ascending colon are usually large growths that may be
palpable on physical examination; they generally cause severe anemia and nausea. There
may be dark red or mahogany-colored blood mixed with the stool. The diagnosis of colorectal
cancer is based on digital rectal examination, testing for blood in the stool,
proctosigmoidoscopic examination of the sigmoid, and x-ray studies of the G tract.
Colonoscopy is the definitive test for colorectal cancer. Suspicious polyps may be removed for
histologic study, often through a sigmoidoscope or colonoscope or by laparotomy. Surgical
treatment of colorectal cancer may involve a wide resection of the lesion, the surrounding
colon, and the attached tissues. Tumors of the rectum may require removal of the entire
rectum by abdominoperineal resection and the creation of a permanent colostomy.
Chemotherapy and irradiation may be administered as palliative therapy or adjuvant treatment.
Nursing care of the patient after a diagnosis of colorectal cancer focuses on coping with a
possible loss of or alteration in body function.
Mosby's Medical Dictionary, 8th edition. 2009, Elsevier.

coIorectaI cancer
Colon cancer Oncology A malignant epithelial tumor arising from the colonic or rectal mucosa,
which is the 3
rd
leading cause of cancer in _, 4
th
? in in the US; risk of CC is with a low fat,
high fiber diet Epidemiology 152,000 new cases, 57,000 deaths1993, US Surveillance Annual
Fecal occult blood testing is reported to mortality by 33% Predisposition Adenomatous
polyps, family Hxhighest if 1
st
-degree family memberparents, siblings or children had CC
and even higher if < age 55, ulcerative colitis Screening Most colorectal cancers develop from
polyps; colon polypectomy CC; colon polyps and early cancer may be asymptomatic;
screening is recommended every 3 yrs Clinical Rectal bleeding, occult blood in stools and, in
advanced cases, bowel obstruction and weight loss Diagnosis Colonoscopy with biopsy, CT,
barium enema Pathology Most CCs are adenocarcinomas; 'raromas' include lymphomas,
neuroendocrine carcinomas, and sarcomas Molecular pathology CCs develop as genetic
alterations accumulateeg, K-ras oncogene on chromosome 12, and tumor-suppressor genes
on chromosomes 5, 17pwhich encodes p53, and 18qDCC gene Management Surgery; cure
likely if CA is confined to intestine. See Colorectal adenoma.
oIorectaI cancer-TNM cIassification
Stage I Tumor invades muscularis propria, but has not spread to nearby lymph nodes
Stage II Tumor spread into the subserosa and/or perirectal tissues with up to 3 regional lymph
nodes, or directly invades adjacent tissues without lymph node involvement
Stage III Any depth of tumor invasion with four or more positive lymph nodes, thout distant
metastases
Stage IV Any depth of tumor involvement; any number of involved lymp nodes, th distant
metastases
McGraw-Hill Concise Dictionary of Modern Medicine. 2002 by The McGraw-Hill Companies,
nc.