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  • I. Anatomy and Physiology

The

large

intestine

is

a

hollow tube

that makes up

the

last

6

feet of

the

digestive tract. It is often referred to as the large bowel or colon (which is technically just one part of the large intestine). The large intestine consists of the cecum (a pouch-like structure at beginning of the large intestine), colon, rectum and anus. The colon and rectum are next to other organs, including the spleen, liver, pancreas, and reproductive and urinary organs. Each of these organs can be affected if colorectal cancer spreads beyond the large intestine.

I. Anatomy and Physiology The large intestine is a hollow tube that makes up the last

Structure

The colon begins at the cecum, where it joins the end of the small intestine (ileum). The colon changes to rectal tissue in its last 6 inches. Because there is not a clear

border between the colon and rectum, colon and rectal cancers are grouped together as colorectal cancer.

The colon is divided into 4 parts:

ascending colon – begins at the cecum, where it joins the end of the small

intestine, and

travels upward

along

the right

side

of

the

body to

the

transverse colon

transverse colon – connects the ascending colon to the descending colon and lies across the upper abdomen

descending colon – connects the transverse colon and the sigmoid colon and lies along the left side of the body

sigmoid colon – connects the descending colon and the rectum

 
border between the colon and rectum, colon and rectal cancers are grouped together as colorectal cancer.

The colon and rectum are made up of a number of different tissues organized into layers:

mucosa

 

o

inner lining (epithelium), lamina propria (connective tissue) and thin

o

layer of muscle (muscularis mucosa) submucosa

o connective tissue, glands, blood vessels, lymphatic vessels and nerves muscularis propria (muscular layer)

serosa (serous layer)

outer lining of the colon but not the rectum

o inner lining (epithelium), lamina propria (connective tissue) and thin o  layer of muscle (muscularis

Mesentery is a fold of tissue that connects organs to the body wall. Part of the colon is connected to the abdominal wall by mesentery. The upper two-thirds of the rectum is also covered by mesentery called the mesorectum. The mesentery is made up of fatty connective tissue that contains the blood vessels, nerves, lymph nodes and lymphatic vessels that supply the colon. When surgeons remove part of the colon or rectum to treat cancer in these areas, they will remove the mesentery next to these organs as well. The lymph nodes within the removed mesentery will be examined to see if they contain cancer.

Function

The main functions of the colon and rectum are to absorb water and nutrients from what we eat and to move food waste out of our body.

The colon receives partially digested food, in a liquid form, from the small intestine.

Bacteria (bowel flora) in the colon break down some materials into smaller parts.

The epithelium absorbs water and nutrients. It forms the remaining waste into semi-solid material (feces or stool).

The epithelium also produces mucus at the end of the digestive tract, which makes it easier for stool to pass through the colon and rectum.

Sections of the colon tighten and relax (peristalsis) to move the stool to the rectum.

The rectum is a holding area for the stool. When it is full, it signals the brain to move the bowels and push the stool from the body through the anus.

Abnormal

Rectal cancer is a malignant tumour that starts in cells of the rectum. Malignant means that it can spread, or metastasize, to other parts of the body. The rectum is a part of the digestive system. Together, the colon and rectum make up the large intestine, or large bowel. The colon takes up water and nutrients from food and passes waste to the rectum. Cells in the colon and rectum sometimes change and no longer grow or behave normally. These changes may lead to benign tumors such as polyps, which are not cancerous.

Changes to cells of the colon and rectum can also cause precancerous conditions. This means that the cells are not yet cancer but there is a higher chance these abnormal changes will become cancer. The most common precancerous conditions of the colon are adenomatous polyps (also called adenomas) and polyposis syndromes. In some cases, changes to colon and rectum cells can cause colorectal cancer.

Most often, rectal cancer starts in glandular cells, which make mucus and digestive fluids. These cells line the inside of the colon. This type of cancer is called adenocarcinoma of the rectum. Rare types of rectal cancer can also develop. These include carcinoid tumor, lymphoma and sarcoma.