Cases of Cancer colon is increasing as more and more screening programmes are being developed. For more info , plz visit https://drnitinjha.com/

2. COLON CANCER SURGERY
Dr Nitin Jha
(MBBS,MS,FIAGES)
Consultant
Laparoscopic,MIS and Bariatric surgeon
FORTIS Hospital, Noida. INDIA
drnitinjha@yahoo.com

4. Typical sites of incidence and
sympoms of colon cancer

5. Carcinogenesis
 chromosome instability pathway

6. Risk Factors
Risk Factor Description
Diet High in fat, especially animal fat, red meats and processed meats 
risk
Lack of exercise  risk
Overweight  risk of incidence and death
Smoking - risk of incidence and death
-30-40% more likely to die of colorectal cancer
Alcohol Heavy use of alcohol  risk
Diabetes 30%  risk of incidence and  death rate
Night shift work More research is needed but over time may  risk

7. Screening Guidelines, Advantages, and
Disadvantages
Screening Guidelines Advantages Disadvantages
Fecal Occult Blood
Test (FOBT)
Annually starting at age 50 -Cost effective
-Noninvasive
-Can be done at home
-False-positive/false-negative
results
-Dietary restrictions
-Duration of testing period
Flexible
Sigmoidoscopy
(FS)+FOBT
Every 5 years starting at
age 50
-Cost effective
-Can be done w/o sedation
-Performed in clinic
-Any polyps can be biopsied
-Examines only portion of colon
(additional screening may be
done)
-Discomfort for patient
-Bowel cleansing
* Colonoscopy
(preferred method b/c
polyps can be biopsied
and removed)
Every 10 yrs starting at age
50
-Patient sedated
-Outpatient screening
-Views entire colon and rectum
-Polyps can be removed and
biopsied
-Bowel cleansing
-Sedation may be a problem for
some
-Cost if uninsured
-Risk of perforation
Virtual Colonoscopy
(a.k.a. computed
tomography
colonography-CT)
Every 10 yrs starting at age
50
-Relatively noninvasive
-No sedation needed
-Can show 2- or 3-D imagery
-Small polyps may go undetected
-Bowel cleansing
-Cost
-If polyps found, colonoscopy
required
-Exposure to radiation
-Patient discomfort
*American Cancer Society

16. Clinical Features
 may remain asymptomatic for years
 symptoms develop insidiously
 cecal and right colonic cancers:
 fatigue
 weakness
 iron deficiency anemia
 left-sided lesions:
 occult bleeding
 changes in bowel habit
 crampy left lower quadrant discomfort
 anemia in females may arise from gynecologic causes, but it is a
clinical maxim that iron deficiency anemia in an older man means
gastrointestinal cancer until proved otherwise

17. Clinical Features
 spread by direct extension into
adjacent structures and by
metastasis through lymphatics
and blood vessels
 favored sites for metastasis:
 regional lymph nodes
 liver
 lungs
 bones
 other sites including serosal
membrane of the peritoneal
cavity
 carcinomas of the anal region →
locally invasive, metastasize to
regional lymph nodes and distant
sites
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%

18. Clinical Features
 detection and diagnosis:
 digital rectal examination
 fecal testing for occult blood loss
 barium enema, sigmoidoscopy
and colonoscopy
 confirmatory biopsy
 computed tomography and other
radiographic studies
 serum markers (elevated blood
levels of carcinoembryonic
antigen)
 molecular detection of APC
mutations in epithelial cells,
isolated from stools
 tests under development:
detection of abnormal patterns of
methylation in DNA isolated from
stool cells

19. Symptoms associated with CRC
weight loss
loss of appetite
night sweats
fever
rectal bleeding
change in bowel habits
obstruction
abdominal pain & mass
iron-deficiency anemia

20. TNM system
Primary tumor (T)
Regional lymph nodes (N)
Distant metastasis (M)
Staging of CRC

21. Sites of metastasis
Liver
Lung
Brain
Bones
Via blood
Lymph nodes
Abdominal wall
Nerves
Vessels
Via lymphatics
Per continuitatem

23. Screening
What is screening?
a public health service in which members
of a defined population are examined to
identify those individuals who would benefit
from treatment
to benefit:
to reduce the risk of a disease or its
complications

24. 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
Types of Screening

25. 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
5–10 years
Current Screening Guidelines

29. Staging-American Joint Committee on
Cancer system (AJCC/TNM)
 Staging is an indicator of survival
 Stage grouping: From least advanced (stage 0) to most advanced (stage IV) stage of colorectal cancer
Stage TNM
Category
Survival
Rate
Stage 0: Tis, N0, M0 The earliest stage. Has not grown beyond inner layer (mucosa) of colon
or rectum.
Stage I: T1, N0, M0
T2, N0, M0
93% Has grown into submucosa (T1) or muscularis propria (T2)
Stage IIA:
Stage IIB:
T3, N0, M0
T4, N0, M0
85%
72%
IIA: Has spread into subserosa (T3).
IIB: Has grown into other nearby tissues or organs (T4).
Stage IIIA:
Stage IIIB:
Stage IIIC:
T1-T2, N1, M0
T3-T4, N1, M0
Any T, N2, M0
83%
64%
44%
IIIA: Has grown into submucosa (T1) or into muscularis propria (T2) and
has spread to 1-3 nearby lymph nodes (N1)
IIIB: Has spread into subserosa (T3) or into nearby tissues or organs
(T4), and has spread to 1-3 nearby lymph nodes (N1)
IIIC: Any stage of T, but has spread to 4 or more nearby lymph nodes
(N2).
Stage IV: Any T, Any N, M1 8% Any T or N, and has spread to distant sites such as liver, lung,
peritoneum (membrane lining abdominal cavity), or ovaries (M1).

30. 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

31. 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

32. 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

33. 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

34. Summary: Treatment
 Treatment
 Colon surgery
 Rectal surgery
 Radiation therapy
 Chemotherapy
 Immunotherapy
 Side effects of all therapies
http://recong2.com/system/files/erbitux_avastin.png

35. Advantages and disadvantages of the
laparoscopic approach
 Smaller wounds
 Less pain
 Faster recovery
 Teaching/audit
 Port site recurrence
 Oncological margins
 Cost
 Longer operation
 Learning curve
 ‘Off camera’ injury
 Long term outcome data

36. LAPAROSCOPIC RIGHT
HEMICOLECTOMY VIDEO