Colorectal Cancer (CRC)
Colorectal Cancer (CRC)
Colorectal Cancer (CRC)
Age
Adenomas, Polyps
Sedentary lifestyle, Diet, Obesity
Family History of CRC
Inflammatory Bowel Disease (IBD)
Hereditary Syndromes (familial
adenomatous polyposis (FAP))
Development of CRC
Result of interplay between environmental and
genetic factors
refined carbohydrates
alcohol
Dietary factors implicated in
colorectal carcinogenesis
dietary fiber
vegetables
fruits
Decreased risk
antioxidant vitamins
calcium
folate (B Vitamin)
Specimen containing an invasive colorectal carcinoma and
two adenomatous polyps.
Multiple adenomatous polyps of the cecum are seen here in a
case of familial polyposis.
Familial polyposis in which mucosal surface of the colon is a
carpet of small adenomatous polyps. Even though they are small ,
there is a 100% risk over time for development of
adenocarcinoma, for which total colectomy is recommended
Adenocarcinoma of the rectosigmoid region . Heaped up margin
of tumor at each side with a central area of ulceration. Normal
mucosa at the right. The tumor encircles the colon and infiltrates
into the wall. Staging is based upon the degree of invasion into
Adenocarcinoma of the cecum demonstrates an exophytic growth
pattern.
The barium enema instills the radiopaque barium sulfate into the colon,
producing a contrast with the wall of the colon that highlights any masses
present. In this case, the classic "apple core” lesion is present, representing an
encircling adenocarcinoma that constricts the lumen.
Staging of CRC
TNM system
*Note: Tis includes cancer cells confined within the glandular basement membrane
(intraepithelial) or lamina propria (intramucosal) with no extension through the
muscularis mucosae into the submucosa.
A Mucosa 80%
B Into or through M. propria
50%
C1 Into M. propria, + LN !
40%
C2 Through M. propria, + LN!
12%
D distant metastatic spread <5%
Sites of metastasis
Liver
Abdominal wall
Lung
Lymph nodes Nerves
Brain
Vessels
Bone
Therapy
Postoperative chemoradiotherapy =
standard of care for RC Stage II,III
1. Radio(chemo)therapy
2. Importance of circumferential margin
(TME)
Screening
What is screening?
To benefit:
to reduce the risk of a disease or its
complications
Types of Screening