CA COLON

Pembimbing
Dr. Yanti, Sp.B KBD

Nama Kelompok :
WHAT IS THE FUNCTION OF THE
COLON AND RECTUM?
The colon and rectum
comprise the large
intestine (large bowel)

The primary function of

the large bowel is to turn
liquid stool into formed
fecal matter
 WHAT IS COLORECTAL
CANCER?
Third most common type of cancer and second
most frequent cause of cancer-related death

A disease in which normal cells in the lining of the

colon or rectum begin to change, grow without
control, and no longer die

Usually begins as a noncancerous polyp that can,

over time, become a cancerous tumor
 ETIOLOGY
genetic influences:
preexisting ulcerative colitis or polyposis
syndrome
hereditary nonpolyposis colorectal cancer
syndrome (HNPCC, Lynch syndrome) germ-
line mutations of DNA mismatch repair genes
 ETIOLOGY
environmental influences:
dietary practices
low content of unabsorbable vegetable fiber
corresponding high content of refined carbohydrates
high fat content
decreased intake of protective micronutrients
(vitamins A, C, and E)
 Risk factors for CRC

Age

Adenomas, Polyps

Sedentary lifestyle, Diet, Obesity

Family History of CRC

Inflammatory Bowel Disease (IBD)

Hereditary Syndromes
(familial adenomatous polyposis (FAP))
 Dietary factors implicated in
colorectal carcinogenesis

consumption of red meat

animal and saturated fat

increased risk
refined carbohydrates

alcohol
 Dietary factors implicated in
colorectal carcinogenesis

dietary fiber

vegetables

fruits
decreased risk
antioxidant vitamins

calcium

folate (B Vitamin)
 EPIDEMIOLOGY

one of the most common cancers in the world

US: 4th most common cancer (after lung,

prostate, and breast cancers)

2nd most common cause of cancer death

(after lung cancer)

2001: 130,000 new cases of CRC

56,500 deaths caused by CRC
 Development of CRC

result of interplay between environmental and

genetic factors

Central environmental factors:

diet and lifestyle

35% of all cancers are attributable to diet

50%-75% of CRC in the US may be preventable

through dietary modifications
Typical sites of incidence and sympoms of colon cancer
 CARCINOGENESIS

chromosome instability pathway

 CARCINOGENESIS
mismatch repair (microsatellite instability)
pathway
 MORPHOLOGY
25% of colorectal carcinomas: in cecum or ascending
colon
similar proportion: in rectum and distal sigmoid
25%: in descending colon and proximal sigmoid
remainder scattered elsewhere
multiple carcinomas present often at widely
disparate sites in the colon
 MORPHOLOGY
all colorectal carcinomas begin as in situ lesions
tumors in the proximal colon: polypoid,
exophytic masses that extend along one wall of
the cecum and ascending colon
 MORPHOLOGY
in the distal colon: annular, encircling lesions
that produce napkin-ring constrictions of the
bowel and narrowing of the lumen
both forms of neoplasm eventually penetrate
the bowel wall and may appear as firm masses
on the serosal surface
 Symptoms associated with CRC

weight loss rectal bleeding

loss of appetite change in bowel habits

night sweats obstruction

fever abdominal pain & mass

iron-deficiency anemia
 Staging of CRC

Dukes staging system

A Mucosa 80%
B Into or through M. propria 50%
C1 Into M. propria, + LN ! 40%
C2 Through M. propria, + LN! 12%
D distant metastatic spread <5%
 TNM Staging of Colon Cancer

Tumor (T)
T0 = none evident
Tis = in situ (limited to mucosa)
T1 = invasion of lamina propria or submucosa
T2 = invasion of muscularis propria
T3 = invasion through muscularis propria into subserosa or nonperitonealized perimuscular tissue
T4 = invasion of other organs or structures

Lymph Nodes (N)

0 = none evident
1 = 1 to 3 positive pericolic nodes
2 = 4 or more positive pericolic nodes
3 = any positive node along a named blood vessel

Distant Metastases (M)

0 = none evident
1 = any distant metastasis

5-Year Survival Rates

T1 = 97%
T2 = 90%
T3 = 78%
T4 = 63%
Any T; N1; M0 = 66%
Any T; N2; M0 = 37%
Any T; N3; M0 = data not available
Any M1 = 4%
STAGE 0 COLORECTAL CANCER
Known as cancer in
situ, meaning the
cancer is located in the
mucosa (moist tissue
lining the colon or
rectum)

Removal of the polyp

(polypectomy) is the
usual treatment
STAGE I COLORECTAL CANCER
The cancer has grown
through the mucosa and
invaded the muscularis
(muscular coat)

Treatment is surgery to
remove the tumor and
some surrounding lymph
nodes
STAGE II COLORECTAL CANCER
The cancer has grown
beyond the muscularis of the
colon or rectum but has not
spread to the lymph nodes

Stage II colon cancer is

treated with surgery and, in
some cases, chemotherapy
after surgery

Stage II rectal cancer is

treated with surgery,
radiation therapy, and
chemotherapy
STAGE III COLORECTAL CANCER
The cancer has spread to
the regional lymph nodes
(lymph nodes near the
colon and rectum)

Stage III colon cancer is

treated with surgery and
chemotherapy

Stage III rectal cancer is

treated with surgery,
radiation therapy, and
chemotherapy
STAGE IV COLORECTAL CANCER
The cancer has spread
outside of the colon or
rectum to other areas of
the body
Stage IV cancer is treated
with chemotherapy.
Surgery to remove the
colon or rectal tumor may
or may not be done
Additional surgery to
remove metastases may
also be done in carefully
selected patients
 Sites of metastasis

Via blood
Via lymphatics
Liver Per continuitatem
Lymph nodes
Lung Abdominal wall

Brain Nerves

Bones Vessels
 SCREENING METHODS FOR
COLORECTAL CANCER
Colonoscopy

Fecal occult blood test

Double contrast barium enema

Digital rectal examination

 Current Screening Guidelines

Regular screening for all adults aged 50 years or

older is recommended

FOBT every year

flexible sigmoidoscopy every 5 years

total colon examination by colonoscopy

every 10 years or by barium enema every
510 years
 Types of Screening

fecal occult blood test (FOBT)

chemical test for blood in a stool sample.
annual screening by FOBT reduces colorectal cancer
deaths by 33%

Flexible sigmoidoscopy can detect about 65%75% of

polyps and 40%65% of colorectal cancers.
rectum and sigmoid colon are visually inspected
 THERAPY

chemotherapy
radiotherapy
photodynamic therapy
radical surgery
gene therapy
 CANCER TREATMENT:
SURGERY
Foundation of curative therapy

The tumor, along with the adjacent healthy colon or

rectum and lymph nodes, is typically removed to offer
the best chance for cure

May require temporary or (rarely) permanent

colostomy (surgical opening in abdomen that provides
a place for waste to exit the body)
 CANCER TREATMENT:
CHEMOTHERAPY
Drugs used to kill cancer cells

Typical medications include fluorouracil (5-FU), oxaliplatin

(Eloxatin), irinotecan (Camptosar), and capecitabine
(Xeloda)

A combination of medications is often used

 TYPES OF
CHEMOTHERAPY
Adjuvant chemotherapy is given after surgery to
maximize a patients chance for cure

Neoadjuvant chemotherapy is given before surgery

Palliative chemotherapy is given to patients whose

cancer cannot be removed to delay or reverse
cancer-related symptoms and substantially improve
quality and length of life
 CANCER TREATMENT:
RADIATION THERAPY
The use of high-energy x-rays or other particles to
destroy cancer cell

Used to treat rectal cancer, either before or after

surgery

Different methods of delivery

External-beam: outside the body

Intraoperative: one dose during surgery

 NEW THERAPIES:
ANTIANGIOGENESIS
THERAPY
Starves the tumor by disrupting its blood supply

This therapy is given along with chemotherapy

Bevacizumab (Avastin) was approved by the U.S.

Food and Drug Administration (FDA) in 2004 for the
treatment of stage IV colorectal cancer
 NEW THERAPIES:
TARGETED THERAPY
Treatment designed to target cancer cells
while minimizing damage to healthy cells

Cetuximab (Erbitux) was approved by the

FDA in 2004 for the treatment of advanced
colorectal cancer
 FOLLOW-UP CARE
Serial carcinoembryonic antigen (CEA)
measurements are recommended
Colonoscopy one year after removal of
colorectal cancer
Surveillance colonoscopy every three to
five years to identify new polyps and/or
cancers
 Summary

CRC is a leading cause of death

Early stages are detectable

Screening can prevent CRC

THANK YOU