Carcinoma of the Colon

Risk Factors
o Adenomatous polyp
o Family history of benign or malignant colon tumors
o Chronic ulcerative colitis
o Crohns disease
o Prior pelvic radiation
o In women who have carcinoma of breast or uterus
o Retinitis pigmentosa
o Familial polyposis
o Gardeners syndrome
o For synchronous lesions=! "two or more colon cas at same time#
o For metachronus lesions=$%&! "li'elihood of a person with colon ca developing
(nd#

Pathology
o Adenocarcinomas ma'e up the vast ma)ority
o *+uamous cell carcinoma can start at the anal verge
o Cloacogenic carcinoma spreads mostly by direct invasion

Clinical
o Pea' age &,%-, years
o .eight loss
o /lood in stool
o 0oss of appetite
o Change in bowel habits

Location
o Rectum "&!#1 sigmoid "(,!#1 descending colon ",!#1 transverse colon
"(!#1 ascending colon "2!#1 cecum "2!#
o 0ocation seems to be changing and moving bac' to cecum
o 3ore common in right colon with advancing years
o 3ore common in left colon with chronic ulcerative colitis

Imaging findings
o 4,%4&! rate of detection by /5
o Polypoid filling defect
o Annular constricting=apple-core lesion

Spot film from a double contrast barium enema of the rectum and distal sigmoid colon
demonstrates a typical annular constricting carcinoma of the colon
with overhanging edges on both the proximal and distal margins forming a so called
"apple-core" lesion.
Clic' here for enlarged photo


o *cirrhous ca%rare infiltrating type which gives lead-pipe appearance seen
especially in ulcerative colitis
o Calcifications%rare
o 3ay have retrograde without antegrade obstruction

Mets to colon
o *tomach1 breast1 pancreas1 and G6 pelvic malignancies via blood
o 3ay also spread via intraperitoneal seeding1 especially from ovary

Complications
o 7bstruction%antegrade8retrograde or both
o Perforation is relatively common
o Carcinomas of the transverse colon can spread via direct e9tension to stomach
o Intussusception of lesions in :I or cecum
o Ischemic colitis may occur if chronic obstruction

Metastases
o 0iver "(&!#
o Retroperitoneal and mesenteric nodes "&!#
o ;ydronephrosis "<!#
o Adrenal ",!#
o 7varian mets
o Ascites

Complications
o 7bstruction%may be retrograde but not antegrade
3ore li'ely to be left%sided than right%sided
o Perforation
o Intussusception
o Pneumatosis intestinalis
www.learningradiology.com/.../coloncacorrect.htm