COLON CANCER

5 Sections of large
intestine :

Right colon
Transverse colon
Descending colon
Sigmoid colon
Rectum
Difference between Colon and
Rectum
Tube - shaped
organ inside
abdomen stretch
from right side
of abdomen over
to the left
like an upside
down ”U”

Muscular bands
of the colon
splay out and
create a pouch
(last 15 cm of
large
intestine)
4 layers of colon :
Mucosa
-Innermost layer of colon

Submucosa
-Lies below mucosa
-Contain microscopic blood
vessels & lymph channels
that supply the colon

Muscularis
-Push the contents of
colon toward rectum

Serosa
-Outermosts layer of
tissue
 Colon cancer

üCaused by polyps (abnormal mucosal growth)

üSurgery required for its removal differs depending on
the segment of colon involved

Polyps
 Definition of polyp:
 - any growth arise from the intestine
and
 protruding into the lumen


Generally, polyp arise from sub

epithelial tissue . In colon cancer,
polyp is arise from intestinal
epithelium.


Polypcan be either malignant or

benign. The polyp in colon cancer is
 Classification of Polyp

Neoplostic Non - neoplastic

Adenomatous polyps are The most commonly
neoplastic by definition encounter in the colon
Precursor to colon are hyper plastic polyp
cancer Less risky and lower
Subclassfied into frequency in being
dysplasia depending on malignant
the architechtural
features;
-high
-low
-medium
High-gred dysplasia and
adeno carcinoma and the
main cause in most
cancer cell
Genetic Event in
Colon Cancer
 A model of Genetic Event in Cololectal
Cancer.
 Adenoma-Carcinoma
Sequence
Originally proposed by Hill and in
1978
It is generally believed that almost all
colorectal adenocarcinoma arise
from adenomas.
Specific chromosomal and somatic
genetic changes during the
transition from colonic to invasive
carcinoma.

A PC gene
 APC gene has been mapped to the tumor
suppressor locus (5q21-q22) and it is thought
to be involved in the initiation of adenoma
formation

 Inactivation of APC gene by 2 mutations is
involved in the development of adenomas,
and loss of heterozygosity of the APC gene is
associated with the further progression to
carcinoma.

 Mutation in AOC gene is the most frequent
genetic mutation seen in colon cancer cells.

K- ras protooncogene
This gene is thought to promote
tumorigenesis by causing
hyperproliferation of the colon cells,
both at early adenoma stage and later
at the time of malignant
transformation.

DCC gene
Located in chromosome 18q and is a
neural cell adhesion molecule.
It may play role in tumor progression,
invasion and metastatis.
p53 gene
Located on chromosome p17 and
involved in late malignant
transformation, during the
conversion from adenoma to focal
carcinoma.
Lost gene function is more common
in carcinomas.
Mutation of p53 mat have multiple
effects
- Decrease ability to detect DNA
damage
 

 Causes or factors
for developing
colorectal cancer
 High fat diet intake.
- A diet high in fat, especially animal fat,

not only raises the risk factor of being

overweight, it also increases risk factor
for colon cancer.
Have a mother, father, sister, or brother
who developed colorectal cancer or
polyps.
- When more than one family member

has had colorectal cancer, the risk to

other members may be three-to-four
times higher of developing the disease.
This higher risk may be due to an
inherited gene.


Have history of benign growths, such

as polyps, that have been surgically
removed.
Age. Colon cancer is rare in those
under 40 years. The rate of colorectal
cancer detection begins to increase
after age 40. Most colorectal cancer is
diagnosed in those over 60 years.


Stages of the Colon
Cancer
Why colon cancer divided
into many stages?
Important to indicate the extent
of cancer within the body
Staging needed to determine the
likely outcome of cancer and
treatment suitable to cure it.
Useful way to identifying the
extent of tumor-size, degree of
growth and its ability to spread.

 Colon cancer stages
categorized based on 3
criteria:
1)Tumor(T) depth
2)Evidence of lymph node(D) spread
3)Present or absent of metastases(M).
Stage 1
The tumors are small and just
start developing.
The cancer is confined to the
lining or muscular wall of the
colon and yet spread anywhere
else
Less advance tumor
Normally treated by surgery
Have 90% of curability

Stage 2
Cancer have spread through
muscular muscle of intestine
and might as well extended to
the adjacent organs through the
structure but have not spread to
the lymph node.
Treated by surgery.
Have 80% chances of cure.
Stage 3
Cancer have spread outside the
intestine to one or more lymph
node near the bowel.
Can be treated by surgery or
chemotherapy.
Have 60-70% chance of cure.

Stage 4
The cancer have spread beyond
the colon to distant sites or
organs, possibly including the
liver or lungs.
Only can be treated by
chemotherapy.
The chance of cure is rare.
 Treatment for Colon Cancer
1. Surgical resection
- Remove affected region
-
2. Chemotherapy
- Chemical treatment
- Kill off cancer cell
- Keep the cell from dividing
-
3. Radiation therapy


- Before surgery- shrink the tumor

- After surgery – prevent the tumor
from coming back
- Most common use- external radiation
- Quick but frequent
Surgery
Surgery (removing the cancer in
an operation) is the most
common treatment for
all stages of colon cancer.
There are 5 types of surgery that
can be done to the patient that
are:
◦ Local excision
◦ Resection
◦ Resection and colostomy
◦ Radiofrequency ablation
◦ cryosugery
Local excision
Ifthe cancer is found at a very
early stage, it may be remove
without cutting through
the abdominal wall.
By putting a tube through
the rectum into the colon and
cut the cancer out. This is called
a local excision. If the cancer is
found in a polyp (a small bulging
piece of tissue), the operation is
called a polypectomy.
polyp
Resection
Ifthe cancer is larger,
perform a
partial colectomy (removing the
cancer and a small amount of
healthy tissue around it).
The doctor may then perform
an anastomosis (sewing the
healthy parts of the colon
together). The doctor will also
usually remove lymph nodes near
the colon and examine them under
a microscope to see whether they






 Colon cancer surgery with anastomosis. Part
of the colon containing the cancer and
nearby healthy tissue is removed, and then
the cut ends of the colon are joined.
Large polyp
Resection and colostomy
 If the doctor is not able to sew the 2
ends of the colon back together,
a stoma(an opening) is made on the
outside of the body for waste to pass
through.
 This procedure is called a colostomy.
 A bag is placed around the stoma to
collect the waste.
 Sometimes the colostomy is needed
only until the lower colon has healed,
and then it can be reversed.
 If the doctor needs to remove the entire








 Colon cancer surgery with colostomy. Part of

the colon containing the cancer and nearby
healthy tissue is removed, a stoma is
created, and a colostomy bag is attached to
the stoma.
Radiofrequency ablation
The use of a special probe with
tiny electrodes that kill cancer
cells.
Sometimes the probe is inserted
directly through the skin and
only local anesthesia is needed.
In other cases, the probe is
inserted through an incision in
the abdomen. This is done in the
hospital with general anesthesia.
Cryosugery
A treatment that uses an
instrument to freeze and
destroy abnormal tissue, such
ascarcinoma in situ.
Also called cryotherapy.
Side effect
Surgery
causes short-term pain and
tenderness in the area of the
operation.
Surgery for colorectal cancer may
also cause temporary
constipation or diarrhea.
Patients who have a colostomy
may have irritation of the skin
around the stoma.

 Chemotherapy
 Affects cancer cells and also normal
cells.
 Side effects depend largely on the
specific drugs and the dose (amount of
drug given).
 Common side effects of chemotherapy
include:
◦ nausea and vomiting
◦ hair loss
◦ mouth sores
◦ Diarrhea
◦ Fatigue
◦ Less often, serious side effects may
occur, such as infection or bleeding.
 Radiation therapy
 Also affects on cancer cells and normal
cells.
 Side effects of radiation therapy depend
mainly on the treatment dose and the
part of the body that is treated.
 Common side effects of radiation
therapy:
◦ Fatigue
◦ skin changes at the site where the
treatment is given
◦ loss of appetite
◦ Nausea
◦ Diarrhea
◦ Sometimes, radiation therapy can cause
Prevention
 Taking non-steroidal anti-
inflammatory drugs(NSAids)- it
protect against colon cancer
development by inducing cell death
or by inhibiting growth in colon
cancer cell lines


Taking high calcium diet may be

protective – calcium may counteract
the carcinogenic properties of high
fat meat by binding free bile and
fatty acids.
Other prevention on daily
basis
Eat plenty of fruits and
vegetables – for example five
portions a day
Diet low in animal fat
Reduce red meat intake and
replace with fish and poultry
Moderate alcohol intake
Avoid smoking
Regular exercise
Maintain a healthy weight
Seek advice about the symptoms-
so , we can get early treatment and
reduce the risk getting the colon
cancer
References
 1. Bub et al. (2008) Colorectal Cancer 2nd Ed. Canada. Jones & Bartlett

Publishing.

 2. Bub et al. (2003) About Colorectal Cancer. Canada. Jones & Bartlett

Publishing.

 3. Holen & Chung (2008) Dx/Rx Colorectal Cancer. Canada. Jones & Bartlett

Publishing.

 4. Edited by Swan (2005) Colorectal Cancer. London. Whurr Publishers.

 5. Vogelstein & Kinzler (2002) The Human Genetic Basis of Human Cancer 2nd

Ed. New York. Mc-Graw Hill Medical Publishing Division.

 6. Dollinger et al. (1991) Everyone’s Guide to Cancer Therapy. U.S.A. A

Somerville House Book.

 Edited by Saltz(2007) Colorectal Cancer Evidence-Based Chemotherapy