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Colorectal Cancer

Colorectal Cancer
Colorectal Cancer

Introduction

Risk factors include: inherited genetic syndromes, diet high in red and processed meat, smoking and alcohol abuse, having inflammatory bowel disease, type ll diabetes and obesity. Histology; commonest is adenocarcinoma – 95%.

Management.

Surgery is the primary treatment for early disease. Hemicolectomy with lymphnode dissection is commonly performed in colon cancer. Give preoperative chemotherapy for locally advanced disease to shrink the tumor. Radiotherapy plays a role in rectal tumor as neo–adjuvant, adjuvant or palliative

Signs and Symptoms

Diagnostic criteria

• Change in bowel habit eg constipation or diarrhea, sense of incomplete bowel emptying.
• Rectal bleeding or blood in stool.
• Abdominal mass with or without obstructive symptoms
• Unexplained weight loss and other symptoms of advanced disease.

Investigation

• FBC, ESR, LFTs,CEA, Stool for occult blood
• CXR, Barium enema (double contrast), abdominal and pelvic USS.
• Digital rectal examination
• EUA and biopsy
• Colonoscopy
• Biopsy at colonoscopy or laparatomy
• Abdominal and pelvic CT scan

Staging: TNM

Treatment

  • Pharmacological

    Management of locally advanced and metastatic colorectal cancer involves various active chemotherapy drugs, either in combination or as single agents: 5–FU, leucovorin, capecitabine, oxaliplatine, irinotectecan and bevacizumab are available for various combination regimens and schedules.

    Neo-adjuvant chemo radiotherapy in rectal tumors

    • 5–FU IV 350 mg/m2 over 20 min + Leucovorin IV 20 mg/m2 Day1–Day 5 given on 1st and 5th weeks of RT, concurrent with RT: 45 Gy/25#/5weeks followed by surgery in 4–10 weeks. 3 –10 weeks after surgery continue with chemo as below:

    • 5–FU IV 350 mg/m2 over 20 min Day1–Day5 + Leucovorin IV 20 mg/m2 Day1– Day5 every 3 weeks for 4 cycles Adjuvant chemo Radiotherapy

    • 3–10 weeks after surgery Bolus IV 5–FU 500 mg/m2 day1–5 & day 29–33, concurrent with RT:45 Gy/25#/5 weeks.

    • Four weeks after completion of chemo radiation; continue with chemo: IV 5–FU 450 mg/m2 bolus D1–D5, Every 4 weeks for 2 cycles

    Note: colorectal cancers are usually asymptomatic until advanced stage hence regular screening with annual digital rectal examination, stool for occult blood + colonoscopy and is recommended starting at 50 years of age.
  • Non-pharmacological

Prevention

Updated on,

5 Novemba 2020 11:30:34

References

1.STG

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