CANCER OF COLON

          CARCINOMA OF COLON

PREMALIGNANT CONDITIONS leading to COLON CANCER:

Precancerous situations which lead to development of colon cancer are:

• ·      Polyps
• ·      Ulcerative Colitis
• ·      Increasing Age >50 years
• ·      Previous Colon Cancer Surgery
• ·      Family history of Colon Cancer or Polyposis

Polyps are usually adenomatous  of 3 types: 

1. tubular adenoma, 
2. villous adenoma and 
3. tubulovillous adenomas.

Uncommon inherited conditions causing large number of polyps with multiple cancers are Polyposis Syndromes namely :

• Familial Adenomatous Polyposis (FAP) and 
• Hereditary Non Polyposis Colon Cancer (HNPCC)

Video of surgey  by auhor for total colonic polyposis with more than 13 localized cancers in a 12 year old is seen at:

https://www.youtube.com/watch?v=Wq4FFIbNiPg

SIGNS AND SYMPTOMS OF COLON CANCER:

Bleeding in stools , from rectum

Intestinal blockage

Abdominal pain

Irregular bowel movements – constipation or diarrhea or both.

STAGING AND PROGNOSIS OF COLON CANCER: (See Fig 1)

1. ·      Stage I    Tumor confined to inner most lining of the colon wall only
2. ·      Stage II  Tumor confined to the wall of the colon, but not outside
3. ·      Stage III Tumor extending to outer wall, to the lymph nodes
4. ·      Stage IV Tumor extension to far away from colon like liver, umbilicus, neck mass,etc           

Fig 1:

Prognosis depends on the staging of colon cancer and is given in the above table (Fig1).

TREATMENT OF COLON CANCER:

• Stage I    Surgery to remove the tumor and small amount of tissue around the tumor
• Stage II   Standard surgery to remove the cancer with lymph nodes and an area surrounding the tumor. Chemotherapy may be required
• Stage III  Surgery to remove cance with all involved lymph nodes + Chemotherapy + may need radiotherapy.
• Stage IV  Surgery usually ineffective. Exception in the case of liver secondaries ( see table on prognosis).

PREVENTION OF COLON CANCER:(See Fig 2)

• ·      High risk groups for colon cancer should be screened periodically.
• ·      Familial groups, ulcerative colitis groups, earlier operated groups of patients should be under supervision.
• ·      Regular intake of Aspirin in case of polyps, high fibre diet and exercise help.  

Fig 2.