ColoRectal Cancer incidence is rising. Incidence is more in older age group after the age of 50 year. This cancer has got good prognosis compared to other GI Cancer. Screening colonoscopy is advised after the age of 50 year in normal risk patients. It can detect cancer at early stage.
ColoRectal Cancer Symptoms
The most common symptom is altered bowel habits. Fresh Bleeding per rectum is common in rectal cancer. Ascending colon cancer patients may have symptoms of anemia such as weakness. Ascending or Right side colon cancer have a tendency to bleed. Descending or Sigmoid colon cancer patient may present with features of large bowel obstruction. Anorexia and weight loss are common. Advance tumors can have liver metastases and ascites.Patients with ascites complain of abdomen distension
The main stay diagnostic tool is colonoscopy done by Gastroenterologist. Full length colonoscopy is done as the incidence of synchronous colon cancer is high. Biopsy will confirm the diagnosis.
CECT whole abdomen is done. It will determine the resectability of the cancer. CEA is tumor marker for colon cancer. It is used in follow up after surgery for early detection of recurrence.The level of CEA should decrease after complete resection. Persistent high level suggest incomplete resection
Colon Cancer Treatment
The recommended treatment of colon cancer is surgery. Colon cancer is one of the gastrointestinal cancer in which surgery carries a very good prognosis. Patient should be fit for surgery and cancer should be resectable. Recent studies suggest that no bowel preparation is required before surgery.Patient should be on clear liquid diet one day prior to surgery
Curative Surgical Treatment
The standard surgical treatment of colon cancer is radical colectomy. Colon is divided into four parts, ascending or right colon, transverse colon, descending or left colon and sigmoid colon. Depending on location of cancer respective colectomy is done. After colonic resection depending on patient nutrition status and tumor burden either anastomosis is done or stoma is created. Minimal 12 lymph nodes is the criteria for adequate lymadenectomy for colon canecr has been recommended. If the number of lymph nodes resected is less than 12 then the patient need adjuvant chemotherapy irrespective of staging on histopathology report
Colon cancers are being operated more frequently laparoscopically by Laparoscopic colo-rectal surgeon. The length of incision in laparoscopic surgery is very minimum as compared to open surgery. Minimal incision cause less pain in the post-op period, allow early mobilization of patient and early recovery
Palliative Surgical Treatment
Palliative surgery is done for multiple site metastatic disease.The two most common symptoms for which palliation is required is large bowel obstruction and bleeding. Right or ascending colon have a tendency to bleed. Left or descending colon because diameter is less compared to right colon causes obstruction. For patients who present with large bowel obstruction depending on tumor burden and patient nutrition status either bypass is done or stoma is created. For bleeding tumors resection is done and attendants are counselled for high risk surgery
Role of Chemo-Radiotherapy in Treatemnt of Colon Cancer
Colon cancer are less sensitive to chemo-radiotherapy thats why there role is minimal in the management of colon cancer