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Tumors of the colon and rectum are relatively common; the colorectal area (the
colon and rectum combined) is now the third most common site of new
cancer cases and deaths in the United States.
Colorectal cancer is a disease of Western cultures; there were an estimated
148,300 new cases and 56,000 deaths from the disease in 2002
(American Cancer Society, 2002).
The incidence increases with age (the incidence is highest for people older than
85 years of age) and is higher for people with a family history of colon
cancer and those with IBD or polyps.
The exact cause of colon and rectal cancer is still unknown, but risk factors
have been identified
• increasing age
• family history of colon cancer or polyps
• previous colon cancer or adenomatous polyps
• history of inflammatory bowel disease
• high-fat, high-protein (with high intake of beef), low-fiber diet
• genital cancer or breast cancer (in women)
PATHOPHYSIOLOGY
The symptoms are greatly determined by the location of the cancer, the stage of
the disease, and the function of the intestinal segment in which it is located.
Symptoms may also include unexplained anemia, anorexia, weight loss, and
fatigue.
COMPLICATIONS
The incidence of carcinoma of the colon and rectum increases with age.
These cancers are considered common malignancies in advanced age.
Cancer patients usually report fatigue, which is caused primarily by iron-
deficiency anemia.
In early stages, minor changes in bowel patterns and occasional bleeding may
occur.
The later symptoms most commonly reported are abdominal pain, obstruction,
tenesmus, and rectal bleeding.
Colon cancer in the elderly has been closely associated with early carcinogens.
Lack of fiber is a major causative factor because the passage of feces through
the intestinal tract is prolonged, which extends exposure to possible
carcinogens.
Excess fat is believed to alter bacterial flora and convert steroids into
compounds that have carcinogenic properties.
MEDICAL MANAGEMENT
SURGICAL MANAGEMENT
Surgery is the primary treatment for the most colon and rectal cancers.
Advances in surgical techniques can able the patient with cancer to have
sphincter-saving devices that restore continuity of the GI tract.
The type of surgery recommended depends on the location and size of tumor.
Cancers limited to one site can be removed through the colonoscope.
Laparoscopic colotomy with polypectomy minimizes the extent of surgery needed
in some cases.
A laparoscope is used as a guide in making an incision into the colon; the tumor
mass is then excised. Use of the neodymium/yttrium-alluminum-garnet
(Nd:YAG) laser has proved effective with some lesion as well. Bowel
resection is indicated for most class A lesions and all class B and C lesions.
Surgery is sometimes recommended for class D colon cancer, but the goal
of surgery in this instance is palliative; if the tumor has spread and involves
surrounding vital structures, it is considered nonresectable.
Surgical procedures include the following: