Colon Cancer Common Colo-Rectal Disorder in old age
Colo-Rectal Cancer Incidence has increased. Colon is divided into four parts ascending colon/transverse colon/descending colon/sigmoid colon; cancer can occur at any part and patient symptoms differ depending on site of cancer, Generally right side colon cancer present with symptoms of anemia like weakness/fatigue as the tumor here bleeds and lumen diameter is more so features of constipation are rare whereas left side colon cancer mainly present with constipation or acute intestinal obstruction; Full length colonoscopy for Colo-Rectal cancer will show the growth and can also show other synchronous lesions if present, biopsy will confirm the diagnosis; CECT abdomen is done as part of staging and if resectable curative resection is done; Radical colectomy is done depending on site of malignancy, Surgery is done laparoscopically because of its benefit and literature also support that if surgery is done on oncological principle then there is no difference in survival and recurrence rate between open and laparoscopy surgery; Pre-operative blood CEA level is done which is used to follow-up patient after surgery, Increased CEA level suggest recurrence of tumor.
Ulcerative colitis is a chronic inflammatory condition involving mucosa of the rectum and colon, it starts from the rectum and involve proximally, when located in the rectum only and patient present with bleeding per rectum sometimes they are misdiagnosed and treated for hemorrhoids (piles); when patient presents with recurrent diarrhea and bleeding per rectum colonoscopy is done and biopsy is taken and patient is diagnosed to have ulcerative colitis; the First line of treatment is medical, in acute phase steroids are given once the patient respond steroids are tapered and stopped and maintenance medical therapy is started, this maintenance therapy should never be stopped otherwise disease will recur, sometimes patient does not respond to steroid or other immunosuppressive therapy or disease become active as steroids are stopped (steroid dependent) or develop complications related to disease per se then surgery is done; As the disease process involve whole of large bowel and rectum, so total proctocolectomy is done and bowel continuity is maintained by creating an ileal pouch and it is anastomosed to anal canal
The incidence of cancer rectum has increased, frequently being seen in young female; most common presentation is bleeding per rectum bright red in color not mixed with stool; constipation and intestinal obstruction are other presentations; First step is sigmoidoscopy and biopsy; once the diagnosis is confirmed on biopsy full length colonoscopy should be done as these patients can have synchronous lesion in other parts of large bowel, however it should be attemted if the scope is negotiable through the lesion; CECT abdomen is done as part of staging; if the tumor is resectable surgery is the preferred choice, however in case of locally advanced tumor neoadjuvant chemo-radiotherapy (given before surgery) is given which has shown to increase survival rate, Surgery done is anterior resection, Sphicter saving surgery is possible with the help of circular stapler even in tumors located low in the rectum; Abdominal-Perineal Resection (APR) is done in those cases when the tumor involve the sphincter muscle (In APR bowel continuity can not be maintained and permanant colostomy is done);Pre-operative blood CEA level is done which is used to follow-up patient after surgery, Increased CEA level suggest recurrence of tumor
Dr Amit Jain MS MCh Gastrointestinal Surgeon is best Colo-Rectal Surgeon. Trained in Laparoscopic Colo-Rectal Cancer Surgery. Fellow in Advance Laparoscopic Colo-Rectal Surgery.Known for Pouch surgery for Ulcerative colitis.Senior Consultant Dept of Laparoscopic GI Surgery at Max Hospital Patparganj East Delhi and Vaishali Ghaziabad. To Know more on Colo-Rectal disease visit our facebook page