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Colon Cancer: Risk Factors, Diagnosis & Treatment

by Carlo Raj, MD

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    00:01 Our topic now is colon cancer.

    00:03 It's the fourth most common cause of cancer in the United States.

    00:06 And the second most common cause of cancer death.

    00:09 Dr. Raj, I thought this was a number three.

    00:12 Yeah, it is.

    00:13 What do you mean? How could we both? Listen, if you were to separate the genders and the sexes, males and females.

    00:22 Mortality.

    00:23 Males: Number one, lung cancer; number two, prostate; number three, colorectal cancer.

    00:31 Females. Mortality. Number one, lung cancer.

    00:37 Number two, breast cancer. Number three colorectal cancer.

    00:42 So, you just don't use third, correct? But if you combine your genders... Oh...

    00:50 When combined for both genders, it becomes the second most common cause of cancer death.

    00:54 That's up there.

    00:56 Age: greater than 40.

    01:01 Low fiber, high fat diet.

    01:05 Personal history of colonic adenoma or cancer.

    01:10 History is big.

    01:11 Long-standing.

    01:15 Such as inflammatory bowel disease, especially ulcerative colitis.

    01:20 No joke.

    01:22 Family history: Sporadic colon cancer, and HNPCC.

    01:27 Hereditary nonpolyposis colorectal cancer Nonpolyposis.

    01:34 Now, pause here for a second.

    01:37 I want to bring two things to light here so that we're clear moving forward.

    01:43 HNPCC. Remember that colorectal cancer What do you want to do? You want to divide this into really two types.

    01:49 Just like we did for primary gastric adenocarcinoma.

    01:52 We talked about two types there.

    01:55 You have two types here.

    01:56 But two types here.

    01:58 literally, anatomically, location wise.

    02:01 You have left sided, right sided.

    02:04 Left sided, descending colon; right sided, ascending colon.

    02:10 Genetically, amazingly, pay attention.

    02:14 HNPCC. Hereditary Nonpolyposis Colorectal Cancer.

    02:19 Remember biochemistry, microsatellite instability.

    02:22 You've heard of MLH and MSH and such.

    02:26 That will give rise to much more, so, right side of colorectal cancer.

    02:30 Memorize that.

    02:32 Whereas, if it's Familial adenomatous polyposis then it'll be left side of colorectal cancer.

    02:38 What do you know about FAP? 100% of going on to colorectal cancer.

    02:42 No joke. No, the genetics here big time.

    02:48 Diagnosis: Slow growing tumor may present as iron deficiency, especially if it's right sided.

    02:56 Could you find blood with left sided? Remember, you've heard a napkin ring or circumferential? So you have a ring around a napkin squeezing the napkin, "the napkin is the colon." Left sided, the descending colon.

    03:11 You're squeezing strangulating it. Is that clear? That's left sided.

    03:14 So the circumferential pattern, and napkin ring is the left side, apple core.

    03:20 Once again. Could you find beating there? Sure, but that's more altered bowel habit.

    03:26 On the right side, we'll talk about the description it's called polypoid.

    03:31 And with the polypoid, much more so involved with bleeding and iron deficiency.

    03:38 Abdominal pain, change in bowel habits much more so with left sided.

    03:43 Perforation is a complication we're worried about, and rectal bleeding obviously will be taking place with both.

    03:49 But much more so with right, and therefore iron deficiency.

    03:55 Your tests for diagnosis include colonoscopy is the test of choice here.

    04:00 Remember the colonoscopy, you want to use prudently.

    04:03 And a patient that made them present with diverticular disease acutely.

    04:07 But in colorectal cancer, my goodness, it is detested choice.

    04:11 And your tumor marker, not sensitive, but prognostic evaluation is important known as CEA.

    04:18 Carcinoembryonic antigen.

    04:21 And of course, some of the new things that you want to pay attention colorectal cancer include your KRAS.

    04:28 And with management, remember, not only would you have drugs such as your Leucovorin and company, but then you have a drug cost cetuximab which is then addressing your receptor tyrosine kinase.

    04:39 Those are molecular pharmacology that you want to be familiar with.

    04:44 Let's talk about colonoscopy in colon cancer, test of choice.

    04:49 With the colonoscopy very rarely would ever ask you anything about sigmoidoscopy? Because if you were to only do and examine or investigate the sigmoid, what if you had a cancer on the right side? What if you had a polyp on the right side? You would miss it completely.

    05:03 And hat makes no sense.

    05:04 We know for a fact that a second leading killer overall third, leading killer individually engenders.

    05:13 So, therefore, never choose sigmoidoscopy, when you're dealing with a colonoscopy.

    05:16 You do a full colonoscopy to make sure that you catch anything on the right side.

    05:22 This particular lower colonoscopy is showing you decreased caliber of the lumen of your colon.

    05:31 And you see a little bit of blood as well.

    05:33 You notice here, but this colonoscopy that you would have altered bowel habits as you're coming down the descending limb.

    05:42 The left side we show you what's known as circumferential.

    05:45 The left side oftentimes referred to as being, apple core.

    05:49 And you might have heard this being used as napkin ring.

    05:55 Colon cancer prognosis, it's important that you pay attention to staging.

    05:59 On a boards, nowadays, whatever board that you're taking, I understand the staging becomes important because it tells you, well, prognosis goes from relatively maybe decent, to absolutely poor.

    06:12 The staging system for colon cancer is known as the SEER system.

    06:15 And it's based on three categories.

    06:18 Localized: where there's no sign of spread outside the colon or rectum.

    06:21 Regional: where the cancer has spread to nearby tissues or structures.

    06:25 Or distant: Where the cancer spread to distant parts of the body such as the liver or lungs.

    06:30 And their survival rates are 91%, 72%, and 14%.

    06:36 Once you get the D, you're gone.

    06:38 What that means is that metastasis taking place, and with colorectal cancer, you can either choose hematogenous or lymphatic spread.

    06:47 And if it chooses hematogenous spread therefore, the number one place that metastasized to colon to the liver.

    06:55 Alright? Colon to the liver.

    06:58 From the liver, then maybe perhaps up into the lungs.

    07:02 Management: surgery with wide resection, adjuvant chemotherapy, radiation therapy, especially when you start getting into Duke staging...

    07:10 B B B as in boy.

    07:14 Prevention: screening, screening, screening.

    07:17 Age 50 years of age, a general population.

    07:19 Keep in mind because of low fiber, high fat diet type of issue.

    07:23 Age 40 years, 10 years, prior to diagnosis, if you're thinking about a patient, and the relative is in fact affected 10 years younger.

    07:32 So, kind of behaves like you're mammography and a female with breast cancer, doesn't it? Beginning eight years if you're thinking about a patient with the inflammatory bowel disease of the ulcerative colitis type Prevention: Test for screening, colonoscopy.

    07:51 A cold blood testing, and virtual colonoscopy.

    07:54 Nowadays, of course, is playing a major role.


    About the Lecture

    The lecture Colon Cancer: Risk Factors, Diagnosis & Treatment by Carlo Raj, MD is from the course Small and Large Intestine Diseases. It contains the following chapters:

    • Colon Cancer - Clinical Presentation
    • Colon Cancer - Diagnosis
    • Colon Cancer - Prognosis, Treatment & Prevention

    Included Quiz Questions

    1. Men — Lung cancer, prostate cancer, colon cancer Women — Lung cancer, breast cancer, colon cancer
    2. Men — Colon cancer, prostate cancer, lung cancer Women — Colon cancer, breast cancer, lung cancer
    3. Men — Prostate cancer, colon cancer, lung cancer Women — Breast cancer, colon cancer, lung cancer
    4. Men — Lung cancer, prostate cancer, gastric cancer Women — Lung cancer, breast cancer, cervical cancer
    5. Men — Lung cancer, gastric cancer, prostate cancer Women — Lung cancer, cervical cancer, breast cancer
    1. High-fiber diet
    2. Low-fiber diet
    3. Long-standing inflammatory bowel disease
    4. Hereditary polyposis syndrome
    5. Colorectal adenoma
    1. Colonoscopy
    2. Proctoscopy
    3. Ultrasound
    4. X-ray of the abdomen
    5. Sigmoidoscopy
    1. CEA
    2. Inhibin
    3. Beta HCG
    4. CA 19-9
    5. CA 125
    1. K-ras
    2. RET
    3. Src
    4. Wnt
    5. Myc
    1. Liver
    2. Bone marrow
    3. Breast
    4. Brain
    5. Spleen
    1. Regional lymph node involvement
    2. Involvement limited to the submucosa
    3. Involvement beyond the submucosa without lymph node involvement
    4. Distant metastasis to liver
    5. Distant metastasis to the brain
    1. In FAP disease, screening starts after 50 years of age.
    2. Screening starts when people are 50 years old.
    3. Screening is by colonoscopy.
    4. Screening in a patient who has a first-degree relative with the disease is at 40 years (or 10 years before the first-degree relative was diagnosed).
    5. Screening must begin after 8 years of inflammatory bowel disease of the colon.

    Author of lecture Colon Cancer: Risk Factors, Diagnosis & Treatment

     Carlo Raj, MD

    Carlo Raj, MD


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