Colon cancer final

A
american instituion of medical universityamerican instituion of medical university
GANESH
CHANDAN
ROBIN
MATHEW
Learning Objectives
 Overview
Anatomy of colon
Epidemiology
Etiology
Pathology
Clinical features
Investigation
Overview
Colon cancer begins when abnormal cells within the
colon start growing uncontrollably.
 Symptoms may not occur initially, but as the disease
progresses, a person may notice a change in their
bowel habits or dark / bright red blood in their stools.
There are several factors that increase a person's
chance of developing colon cancer, some within a
person's control (for example, being overweight and
leading a sedentary lifestyle) and some not (for
example, having an inflammatory bowel disease).
Colon cancer final
EPIDEMIOLOGY
• Colon cancer is the third most common cancer in the
United States, with around 100,000 new cases being
diagnosed each year
• The incidence of colon cancer varies between and within
the countries suggesting environmental factors
The ratio between male & female is almost equal
It is common in western countries but rare in Asia &
Africa
The difference is among racial groups within different
areas of the country suggesting genetic or cultural
factors are important
ETIOLOGY
• The exact cause/s of the colon cancer is
unknown
Who's at Risk?
Age
Diet
Polyps
Personal Medical History
Family Medical History
Genetic factors
Inflammatory bowel disease
Irradiation
RISK FACTORS for Colon Cancer
• Age
– Colon cancer is more likely to occur as people get
older. This disease is more common in people over
the age of 50.
– However, colon cancer can occur at younger ages,
even, in rare cases, in the teens.
• Diet
 Colon cancer seems to be associated with diet that
is high in fat(animal fat), calories, and low in fiber.
Increased fecal bile salt- Postcholecystectomy
High anaerobic bacterial count in feces
Polyps
• A polyp is a growth of tissue in the lining of an organ.
• There are 2 main types of colon polyps:
 Hyperplastic :
Very small chance they’ll grow into cancer
 Adenomatous :
Most colon cancers start as adenomatous polyps
(“adenomas”)
Colon cancer final
• Personal Medical History.
Research shows that women with a history of cancer of
ovary, uterus, or breast may have an increased chance of
developing colon cancer.
Also, a person who had colon cancer may develop this
disease again.
• Family Medical History.
First-degree relatives (parents, siblings, children) of a
person who had colon cancer are likely to develop this
type of cancer themselves, especially if the relative had
the cancer at a young age.
 If many family members have had colon cancer, the
chances increase even more.
Genetic factors:
• Play very important role in Colonic cancer
• The familial syndromes with increased risk of colon
carcinoma includes:
– Familial adenomatous polyposis
– HNPCC
» Lynch syndrome
» Turcots syndrome
» Peutz-jeghers syndrome
Hereditary Colon Cancer Syndromes:
Familial adenomatous polyposis
APC gene
• Individuals develop thousands of adenomatous polyps
in the colon
Both copies of the APC gene must be lost for
development of adenomas
• Invariably, one or more of these polyps undergoes
malignant transformation, giving rise to colon cancer
Non familial colon carcinomas and sporadic
adenomas
• Has homozygous loss of APC gene
Hereditary Colon Cancer Syndromes:
HNPCC
Hereditary non-polyposis colon cancer (HNPCC),
sometimes called Lynch syndrome,
Accounts for approximately 5% to 10% of all colon cancer
cases
The risk of colon cancer in families with HNPCC is 70% to
90%, which is several times the risk of the general
population
 Gene encoding the type II TGF-β receptor is inactivated in
colon cancers that develop in patients with HNPCC
• Inflammatory bowel disease:
 Ulcerative colitis:
Patient with extensive colitis and for long duration are
at high risk of developing colon cancer
 Crohn’s disease :
Is also associated with increased risk of cancer
• Irradiation & immunosuppresion:
Irradiation is well known carcinogenic,
patient on immunosuppression drugs or disease are at
increased risk of developing colon cancer
PATHOLOGY
• Adenoma-carcinoma sequence
– Between 70-90 % of colon cancer arise from
adenomatous polyp.
– the adenoma- carcinoma sequence is multi-
step process involving sequential mutations or
deletions of genes
• The larger the polyp (more than 2cm in diameter)
the greater the risk of cancer
Colon cancer final
Adenoma-carcinoma sequence
Colon cancer final
• Macroscopically:
colon cancers may appear to the naked eye as:
 Exophytic cauliflower-type of growth
 Ulcerating lesion penetrating through the
bowel wall
 Annular constricting growth
 or as the rare colloid mucus- secreting tumors
SYMPTOMS
SYMPTOMS
Fatigue
Persistent diarrhea or
constipation & weight loss
Abdominal cramps
Dark & bright red blood
in your stool
Loss of appetite
Anemia
These type of cancers have two general varieties
BASED ON WHERE IN THE AFFECT YOUR WHOLE BODY
COLON THE TUMOR IS LOCATED
 Change in bowl habits (1) Unexpected weight loss
a) Change in stool frequency/shape/color (2) Loss appetite
b) Constipation and diarrhea (3) Unexplained fatigue
LOCAL
SYMPTOMS
SYSTEMIC
SYMPTOMS
RARE SYMPTOMS
If colon cancer is not diagnosed until its advanced stages, it may
cause one or more of these symptoms:
Fever
Air bubbles in urine
Problem in breathing
Headache and neurological problems
Bone pain
DIAGNOSIS
 PHYSICAL EXAM
 DIGITAL RECTAL EXAM
 COMPLETE BLOOD COUNT(CBC)
 LIVER FUNCTION TEST (LFT)
 COLONOSCOPY
 BIOPSY
 IMAGING
Colon cancer final
MRI
TYPES OF STAGING
SEROSA
SUB-SEROSA
MUSCULARIS
SUB-MUCOSA
MUCOSA
STAGE 0
STAGE 1
STAGE 2
STAGE 3
Colon cancer final
Other medical conditions with the same symptoms
 one or more of the symptoms like rectal bleeding or
abdominal pain may also be reason for another medical
problem
 Examples of these conditions that may mimic that of colon
cancer include:
1. Hemorrhoids
2. Appendicitis
3. Diverticulitis
4. Infectious Colitis
TREATMENT
Surgery
1.Ploypectomy
2.Colectomy
 Chemotherapy
REVIEW QUESTIONS
1. What biomarker mutation do 40% of colon
cancer possess?
2. If a patient is diagnosed with colon cancer
which part of the body would be effected
first because of metastasis?
3. What genetic disorder are associated with
colon cancer?
R.Q
• A patient underwent colectomy and
chemotherapy after 3 months of this
cycle, she is now in remission, and when
she met her doctor for the follow up she
complained of fatigue and difficulty with
concentration at weekly bridge games
which of the following explanation could
account of her symptoms?
A. Symptoms may be the result of anemia
caused by chemotherapy
B. The pt. may be dehydrated
C. The pt. may be immunosuppressed
A. The pt. may be depressed
Colon cancer final
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Colon cancer final

  • 2. Learning Objectives  Overview Anatomy of colon Epidemiology Etiology Pathology Clinical features Investigation
  • 3. Overview Colon cancer begins when abnormal cells within the colon start growing uncontrollably.  Symptoms may not occur initially, but as the disease progresses, a person may notice a change in their bowel habits or dark / bright red blood in their stools. There are several factors that increase a person's chance of developing colon cancer, some within a person's control (for example, being overweight and leading a sedentary lifestyle) and some not (for example, having an inflammatory bowel disease).
  • 5. EPIDEMIOLOGY • Colon cancer is the third most common cancer in the United States, with around 100,000 new cases being diagnosed each year • The incidence of colon cancer varies between and within the countries suggesting environmental factors The ratio between male & female is almost equal It is common in western countries but rare in Asia & Africa The difference is among racial groups within different areas of the country suggesting genetic or cultural factors are important
  • 6. ETIOLOGY • The exact cause/s of the colon cancer is unknown
  • 7. Who's at Risk? Age Diet Polyps Personal Medical History Family Medical History Genetic factors Inflammatory bowel disease Irradiation
  • 8. RISK FACTORS for Colon Cancer • Age – Colon cancer is more likely to occur as people get older. This disease is more common in people over the age of 50. – However, colon cancer can occur at younger ages, even, in rare cases, in the teens.
  • 9. • Diet  Colon cancer seems to be associated with diet that is high in fat(animal fat), calories, and low in fiber. Increased fecal bile salt- Postcholecystectomy High anaerobic bacterial count in feces
  • 10. Polyps • A polyp is a growth of tissue in the lining of an organ. • There are 2 main types of colon polyps:  Hyperplastic : Very small chance they’ll grow into cancer  Adenomatous : Most colon cancers start as adenomatous polyps (“adenomas”)
  • 12. • Personal Medical History. Research shows that women with a history of cancer of ovary, uterus, or breast may have an increased chance of developing colon cancer. Also, a person who had colon cancer may develop this disease again. • Family Medical History. First-degree relatives (parents, siblings, children) of a person who had colon cancer are likely to develop this type of cancer themselves, especially if the relative had the cancer at a young age.  If many family members have had colon cancer, the chances increase even more.
  • 13. Genetic factors: • Play very important role in Colonic cancer • The familial syndromes with increased risk of colon carcinoma includes: – Familial adenomatous polyposis – HNPCC » Lynch syndrome » Turcots syndrome » Peutz-jeghers syndrome
  • 14. Hereditary Colon Cancer Syndromes: Familial adenomatous polyposis APC gene • Individuals develop thousands of adenomatous polyps in the colon Both copies of the APC gene must be lost for development of adenomas • Invariably, one or more of these polyps undergoes malignant transformation, giving rise to colon cancer
  • 15. Non familial colon carcinomas and sporadic adenomas • Has homozygous loss of APC gene
  • 16. Hereditary Colon Cancer Syndromes: HNPCC Hereditary non-polyposis colon cancer (HNPCC), sometimes called Lynch syndrome, Accounts for approximately 5% to 10% of all colon cancer cases The risk of colon cancer in families with HNPCC is 70% to 90%, which is several times the risk of the general population  Gene encoding the type II TGF-β receptor is inactivated in colon cancers that develop in patients with HNPCC
  • 17. • Inflammatory bowel disease:  Ulcerative colitis: Patient with extensive colitis and for long duration are at high risk of developing colon cancer  Crohn’s disease : Is also associated with increased risk of cancer • Irradiation & immunosuppresion: Irradiation is well known carcinogenic, patient on immunosuppression drugs or disease are at increased risk of developing colon cancer
  • 18. PATHOLOGY • Adenoma-carcinoma sequence – Between 70-90 % of colon cancer arise from adenomatous polyp. – the adenoma- carcinoma sequence is multi- step process involving sequential mutations or deletions of genes • The larger the polyp (more than 2cm in diameter) the greater the risk of cancer
  • 22. • Macroscopically: colon cancers may appear to the naked eye as:  Exophytic cauliflower-type of growth  Ulcerating lesion penetrating through the bowel wall  Annular constricting growth  or as the rare colloid mucus- secreting tumors
  • 24. SYMPTOMS Fatigue Persistent diarrhea or constipation & weight loss Abdominal cramps Dark & bright red blood in your stool Loss of appetite Anemia
  • 25. These type of cancers have two general varieties BASED ON WHERE IN THE AFFECT YOUR WHOLE BODY COLON THE TUMOR IS LOCATED  Change in bowl habits (1) Unexpected weight loss a) Change in stool frequency/shape/color (2) Loss appetite b) Constipation and diarrhea (3) Unexplained fatigue LOCAL SYMPTOMS SYSTEMIC SYMPTOMS
  • 26. RARE SYMPTOMS If colon cancer is not diagnosed until its advanced stages, it may cause one or more of these symptoms: Fever Air bubbles in urine Problem in breathing Headache and neurological problems Bone pain
  • 27. DIAGNOSIS  PHYSICAL EXAM  DIGITAL RECTAL EXAM  COMPLETE BLOOD COUNT(CBC)  LIVER FUNCTION TEST (LFT)  COLONOSCOPY  BIOPSY  IMAGING
  • 29. MRI
  • 32. Other medical conditions with the same symptoms  one or more of the symptoms like rectal bleeding or abdominal pain may also be reason for another medical problem  Examples of these conditions that may mimic that of colon cancer include: 1. Hemorrhoids 2. Appendicitis 3. Diverticulitis 4. Infectious Colitis
  • 34. REVIEW QUESTIONS 1. What biomarker mutation do 40% of colon cancer possess? 2. If a patient is diagnosed with colon cancer which part of the body would be effected first because of metastasis? 3. What genetic disorder are associated with colon cancer?
  • 35. R.Q • A patient underwent colectomy and chemotherapy after 3 months of this cycle, she is now in remission, and when she met her doctor for the follow up she complained of fatigue and difficulty with concentration at weekly bridge games which of the following explanation could account of her symptoms?
  • 36. A. Symptoms may be the result of anemia caused by chemotherapy B. The pt. may be dehydrated C. The pt. may be immunosuppressed A. The pt. may be depressed