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Colon Cancer


Colon ca risk: doubles each decade after 40 yo; M>F; 90% occur after 50; sig higher risk if 1st-degree relative with colon ca
Colon ca Genl RFs Age; Personal hx colon polyps or ca; FH; inherited syndromes; T2DM; IBD
Colon ca Liefstyle RFs Diet (red meat); physical inactivity; obesity; smoking; heavy alcohol use
2 types of dx criteria for HNPCC Amsterdam; Bethesda
S/S colon ca Rectal bleeding; Fe def anemia; Fatigue / wt loss; obstruction (left sided tumors); change in stool quality/caliber; abdominal mass or abd pain
Colon ca: most common metastases are to: liver, then lung (colon); liver or lung (rectal ca)
Colon ca: gold standard of dx eval: colonoscopy
Colon ca: other dx eval CT with contrast abd/pelvis (for staging); CXR; needle bx of suspected mets dz; PET Scan only for suspected mets dz
Colon ca: labs CBC, chemistry; may check CEA, but not for dx (help w/staging)
Cancer stage is determined from: PE, biopsy, imaging, lymph node dissection
Layers of colon wall Mucosa; muscularis mucosa; submucosa; muscularis propia; subserosa/serosa
Types of ablation of mets Radiofrequency Ablation; Ethanol ablation; Cryosurgery; Hepatic artery embolization
Goal of chemo: Eradicate micrometastasis to increase likelihood of cure; none for stage 0 or I; resected stage II: poss modest survival benefit but not routinely recommended
Radiation tx not typically used for colon ca; used for rectal ca
Screening: stool Tests: primarily detect cancer; Guaiac FOBT & immunochemical-based FIT; Stool DNA (sDNA)
Screening: Structural Exams: Detect cancer and polyps; Colonoscopy; CT colonography; Flexible Sigmoidoscopy; Double-contrast barium enema (uncommon)
Best mortality data for CRC screening: Guiac FOBT
Never screen for colon ca with: DRE
Positive FOBT should always be followed by: colonoscopy (and no more FOBTs needed)
Negative FOBT tests: should be repeated annually
Flexible Sigmoidoscopy Examines left colon; some bowel prep needed; can performed w/o sedation in Dr’s office; 5-year interval between exams
Patients w/ adenomas found on flex sig: should go for colonoscopy
Colonoscopy Direct inspection of entire colon with sedation (usu conscious); thorough bowel prep required
Colonoscopy: miss rates 6-12% miss rates for large adenomas; 5% miss rates for cancer
Most common serious complication of colonoscopy: bleeding post-polypectomy; Perforation = 1/1000 and increases with age and diverticular disease
Colon ca screening Screening: can be every 10 yr;
Colon ca surveillance: once ca/adenomatous polyps are detected, occurs at shorter intervals (usually repeat colonoscopy in 3-5 years); If FH CRC: every 5 yr; IBD: yearly once disease present for more than 15 yr
Colon polyps (types) adenomatous (poss pre-malig: req shorter surveillance colonoscopy interval); hyperplastic (not considered pre-malig)
CT colonography No sedation; req bowel prep; pos result req f/u colonoscopy
Created by: Adam Barnard Adam Barnard