Colonic carcinoma

Risk factors
● Red meat consumption. Carcinogenic amines are formed during cooking
● Saturated animal fat.
High levels of fat and bile acid in faceal matter lead to increased prostaglandins
production in the colon.
● Exposure to pelvic radiology
● Existing Crohn's disease or ulcerative colitis.
● Obesity
● Inactivity
● Alcohol intake
● Smoking or second hand smoke exposure
● Hyperinsulinemia in diabetes
● Familiar history of adenoma

Clinical presentation
There is accumulation of genetic mutations which lead to development of the tumour.
If the left colon is affected it presents as
● Rectal bleeding
● Intestinal obstruction symptoms
If the right colon is affected, it presents as
● Anaemia
● Altered bowel habits
● Colicky lower abdominal pain
If the rectum is affected, it presents as
● Early bleeding
● Mucus discharge in stool
● Incomplete emptying sensation after defecation

physical examination
On inspection
● Blood in stool
● Signs of anaemia
● Weight loss
on palpation
● Abdominal mass
● Abdominal tenderness
 ● Hepatomegaly
● Palpable mass on digital rectal examination
On percussion
● Fluid splash suggesting ascites

Dukes staging

Stage A
● The tumour is confirned to bowel wall .
● 10% prevalence during diagnosis
● More 90% 5- year survival rate

Stage B
● Tumour has expanded through the bowel wall
● 35% prevalence at diagnosis
● 65% 5 year survival rate

Stage C
● Tumour has invaded the lymph nodes
● Has a 30% prevalence rate
● Has 30-35% 5 year survival rate

Stage D
● The tumour has metastasized to other organs
● Has 25% prevalence rate during diagnosis
● Has less than 5% 5 year survival rate

Stages of colorectal cancer

Early adenoma. It affect adenomatous polyposis coli gene .There is mutation of chromosome
5q. It inhibits translocation of beta catenin to the nucleus. This results in inhibition of cell growth.
It leads to early development of adenoma.
Intermediate adenoma. It affects k- ras gene. It affects chromosome 12p. It leads to distortion
of mutations signals. This leads formation of more mutation and cell proliferation.
Late adenoma. It affect gene DCC in chromosome 18q. It inhibits the function to suppress
tumour growth and apoptosis process.This enhances tumour growth, invasion to the nearest
organs and metastasis to far organs.
Differential diagnosis
● Ischemic bowel
● Crohn's disease
● Ulcerative colitis
● Ileus

Investigation

● Colonoscopy with biopsy of the lesions. It is the investigation of choice.

● Complete blood count
● Liver function test
● Renal function tests
● Serum cea levels. It crucial during follow up during treatment.
● Chest ,abdominal pelvic CT scan . It useful for diagnosis and staging of carcinoma.
● Pelvic MRI and endoanal ultrasound. They are used for local staging of rectal cancer.

Management

Surgical management.
Tumour resection followed by anastomosis of the affected region.
Tumour near anal region require resection and colostomy.

Medical management
chemotherapy reduced risk of recurrence especially dukes staging B and C .
Post operative radiotherapy
Monoclonal antibodies drugs for advanced disease.
Endoscopic laser therapy or stent use is suitable to relieve intestinal obstruction.

Prevention
Increase dietary fiber, fruits and vegetables, calcium, folic acid and omega 3.