Colorectal Cancers

Colorectal cancers have better prognosis among all gastrointestinal cancers

Risk factors
  • Smoking
  • Obesity
  • Diet high in refined carbohydrates
  • Diet high in red meat
  • Less consumption of fruits and vegetables
  • Syndromes associated with colorectal cancers
  • Colorectal polyps
  • Inflammatory bowel diseases
Clinical Features
  • Unexplained weakness and anaemia
  • Mass in abdomen
  • Blood in stools
  • Intestinal obstruction
  • Pain
  • Altered bowel habits
  • Weight loss, jaundice,ascites in advanced cases
Evaluation
  • Serum CEA evels
  • Colonoscopy and biopsy
  • CT scan of abdomen, pelvis and thorax
  • MRI abdomen and pelvis in rectal cancers
  • PET scan may be done
Stage of Disease
  • Very early stage – Cancer involves very superificial layers of rectum and no lymph node spread
  • Early stage – cancer involves deeper layers with minimal or no lymph node spread
  • Advanced stage – cancer involves all layers of rectum or invading near by organs with advanced disease in lymph nodes
  • Very advanced stage – disease has spread to inner lining of abdomen (peritoneum), liver, lung,bones
Treatment – Surgery
  • Very early stages – If feasible, colonoscopic resection of cancer can be done.
  • Early stages – Depending on the site of cancer, that particular part of colon is removed(colectomy). In rectal cancers, depending on site partial or complete removal of rectum is done.
  • Advanced stages – First chemoradiotherapy is given to shrink the disease(neoadjuvant), then surgery is planned.
  • Very advanced stages – Only chemotherapy is given. Surgery is done to relieve problems like continuous bleeding or intestinal obstruction by stoma(bowel is brought out the abdomen wall) due to cancerous growth.
  • Some select cases, where disease spread to peritoneum a complete removal of disease is done and special chemotherapy inside abdomen called HIPEC is given.
  • Some select cases even with liver metastasis is treated with curative intend, unlike other gastro intestinal cancers.
Chemotherapy

Except in very early stages stages, patients gets chemotherapy in all stages of rectal cancer.

Radiotherapy

Radiation is given in select cases