2. Epidemology:
International > Colorectal Cancer (CRC) is the 3rd most common cancer in
men (663,000 cases, 10.0% of the total cancers) and the second in women
(570,000 cases, 9.4% of the total cases) worldwide.
India >
Males = 4.3/1,00,000
Females = 3.4/ 1,00,000
Race > Higher Incidence in African Americans
Sex > almost equal (ratio of 1.2:1)
Age > 55-65 years
Geographic > Countries which are more industrialized like U.S., Canada, UK,
Western Europe, Australia have a much higher incidence than less
industrialized parts of the world like Asia, Africa, and South America.

3. 3
Etiology / Risks
• Age > 60 Yrs
• Diet high in red or processed meats
• Ulcerative colitis or Crohn’s Disease
• Have a family history of colon cancer
• Other Cancers Breast, uterine, or ovarian cancer
• Familial Adenomatous Polyposis (FAP).
• Hereditary non-polyposis colorectal cancer (HNPCC) syndromes
• Smoking & Alcohol
• Obesity
• Drug effects: Recent studies have suggested that estrogen replacement
therapy and NSAID’s such as aspirin may reduce colorectal cancer risk.

4. How Does Colorectal Cancer Develop?

5. • Abdominal pain and tenderness in the lower abdomen
• Blood in the stool / Rectal bleeding
• Diarrhea, constipation, or other change in bowel habits
• Narrow stools / ribbon-like stools
• Weight loss with no known reason
• Unexplained, persistent nausea or vomiting
• Few present with – Intestinal Obstruction / Peritonitis in Emergency
• Iron-deficiency anemia,
• Change in bowel habits
• Right-sided lesions are more likely to bleed and cause diarrhea, while left-sided
tumors are usually detected later and could present with bowel obstruction.

6. Sites of Colon Cancer:

7. Tumors on Left Side of Colon
• Intestinal Obstruction
• Lower Abdominal Pain ( Colicky )
• Abdominal Distention
• Alternating Diarrhoea & Constipation
Sigmoid Tumors
Transverse Colon Tumors
• Tenesmus + Passage of Mucus & Blood
• Mistaken for Ca Stomach – Position , Anemia + Lassitude
Caecum & Ascending Colon Tumors
• Sever Anemia
• Mass in Rt. Iliac Fossa

10. Examination & Investigations
• Digital rectal exam
• Fecal occult blood test (FOBT)
• Sigmoidoscopy ( Flexible )
• Colonoscopy
• Radiology
– Double Contrast Barium Enema
– USG ( Liver Metastases )
– Spiral CT ( Elderly )
• Future Techniques
– Stool DNA Testing
– Capsule Endoscopy
– Virtual Colonoscopy
( CT Colonography )

12. Double-contrast Barium Enema

13. Differential Diagnoses
• Arteriovenous malformation (AVM)
• Carcinoid/Neuroendocrine Tumors and Rare Tumors of GI Tract
• Crohn’s Disease
• Diverticulosis, Small Intestinal
• Gastrointestinal Lymphoma
• Ileus
• Ischemic bowel
• Small Intestinal Carcinomas
• Ulcerative Colitis

14. Staging :
Dukes
TNM
Jass

15. Treatment :
1) Surgical

16. Ca Ceacum > Rt. Hemicolectomy Hepatic Flexure
Pelvic Colon

17. 2) Palliative Chemo ( In Advanced Stages )
• TS-inhibitors
– Raltitrexed
– Multitargeted Antifolat
• Oral 5-FU prodrugs
– Capecitabine
– UFT (Ftorafur + Uracil)
– S-1
– Emitefur
• New 5-FU modulators
– 5-Ethyniluracil
– Trimetrexate
• Other new compounds
– Irinotecan
– Oxaliplatin
Others :
• Bevacizumab (Avastin) anti-angiogenesis
drug ( humanized monoclonal antibody
to (VEGF)
• EGFR - Targeted monoclonal antibodies.
• Cetuximab (Erbitux)
• Panitumumab (Vectibix)

18. 3) Radiotherapy
• ( Stage III ) - Used in combination with chemotherapy
• ( Stage IV + Liver Spread ) –
• Ablation
• Delivering chemotherapy or radiation directly into the liver
• Cryotherapy
• Combined with Surgery

19. Prevention :
A ) Screening : ( Reduces Mortality Risk Upto 15% )
Testing options for the early detection of colorectal cancer and adenomatous polyps
for asymptomatic adults aged 50 > years
• Tests that detect adenomatous polyps and cancer
• Flexible sigmoidoscopy every 5 years, or
• Colonoscopy every 10 years, or
• Double-contrast barium enema every 5 years, or
• computed tomographic colonography every 5 years
• Colonoscopy in every 10 Years ( High Risk Individuals )
• Tests that primarily detect cancer
• Annual guaiac-based fecal occult blood test with high test sensitivity for cancer, or
• Annual fecal immunochemical test with high test sensitivity for cancer, or
• Stool DNA test with high sensitivity for cancer, interval uncertain

20. B ) Lifestyle Modification & Others
• Low-fat and high-fiber diets
• Avoid diet high in red or processed meats, or meats cooked at high
temperatures
• Eat a variety of fruits and vegetables every day.
• Engage in physical activity every day.
• NSAIDs
• Quit Smoking & Alcohol