Coronavirus: Stem Cell therapy
— 2020-03-03Worst crisis for decades : Corona Virus (COVID-19) The South China Morning Post published an article entitled Coronavirus: critically ill…
Colon Cancer
— 2015-08-18
Colon cancer risk factors
• Age > 50
• Adenomatous polyps (current or past)
• Ulcerative colitis
• Crohn colitis
• BRCAJ mutation
• Acromegaly
• Obesity
• Smoking
• Diets high in calories and animal fat
• Adenomatous polyps (current or past)
• Ulcerative colitis
• Crohn colitis
• BRCAJ mutation
• Acromegaly
• Obesity
• Smoking
• Diets high in calories and animal fat
Hereditary risk factors
• 1st degree relatives with colon cancer or adenomatous polyps
• Familial polyposis syndromes (see next page)
• Hereditary, nonpolyposis colon cancer (HNPCC-see below)
Lifetime risk of colon cancer is 6% in average-risk persons.
• Familial polyposis syndromes (see next page)
• Hereditary, nonpolyposis colon cancer (HNPCC-see below)
Lifetime risk of colon cancer is 6% in average-risk persons.
Diagnostic flags for colon cancer
• Anorexia
• Weight loss
• Anemia
• Fever
• Heme+ stools
• Change in bowel habits, especially with nocturnal stools
• Onset of symptoms after age 45
Endocarditis caused by either Streptococcus bovis or Clostridium septicum is often associated with colon cancer, so perform a colonoscopy in these patients.
Aspirin reduces the risk of both colonic adenomas and carcinoma. In some series, the protective effect did not become evident until after 10 years of use. Low dose aspirin has now been shown to reduce the risk of right-sided colon cancer. Aspirin also reduces the risk of development of recurrent colon cancer, and evolving data suggest a reduction in carcinomas and adenomas after resection.
• Weight loss
• Anemia
• Fever
• Heme+ stools
• Change in bowel habits, especially with nocturnal stools
• Onset of symptoms after age 45
Endocarditis caused by either Streptococcus bovis or Clostridium septicum is often associated with colon cancer, so perform a colonoscopy in these patients.
Aspirin reduces the risk of both colonic adenomas and carcinoma. In some series, the protective effect did not become evident until after 10 years of use. Low dose aspirin has now been shown to reduce the risk of right-sided colon cancer. Aspirin also reduces the risk of development of recurrent colon cancer, and evolving data suggest a reduction in carcinomas and adenomas after resection.
Adenomas with advanced features
• Presence of high-grade dysplasia
• Presence of villous histology
• Size> 10 mm
Progression to cancer from an early adenoma takes 5-10 years. Diet plays a role in GI cancer-possible dietary factors include high animal protein and fats, low fiber, and low calcium. Be sure and discuss these important considerations with patients on a “low-carb” diet.
• Presence of villous histology
• Size> 10 mm
Progression to cancer from an early adenoma takes 5-10 years. Diet plays a role in GI cancer-possible dietary factors include high animal protein and fats, low fiber, and low calcium. Be sure and discuss these important considerations with patients on a “low-carb” diet.
Statistics
30% of people> 40 years old have adenomatous polyps, but only 1 % of adenomatous polyps ever become malignant. Hyperplastic polyps have no malignant potential and contain no features of dysplasia. This makes sense because hyperplasia, by definition, is increased growth of normal tissue.
After polyps are found, follow-up depends on the type of polyp, size, number, and family history. Only adenomatous polyps require specific follow-up. Hyperplastic polyps, if < 1cm (except for those with a hyperplastic polyposis syndrome), have the same follow-up as no polyp (10 years).
The 2008 American Cancer Society (ACS) guidelines recommend the following
• Patients with 1 or 2 small tubular adenomas with low-grade dysplasia should have repeat colonoscopy 5-10 years after initial polypectomy.
• Patients with 3-10 adenomas, or 1 adenoma > 1cm, or any adenoma with villous features or high-grade dysplasia should have repeat colonoscopy in 3 years.
Low-risk patients: The 2008 American Cancer Society guidelines for colorectal cancer screening for asymptomatic adults > 50 years of age with a negative family history for colon cancer or adenomatous polyps have broken down the tests into the following 2 areas:
1) Tests that detect adenomatous polyps and cancer
• Colonoscopy every 10 years, or Flexible sigmoidoscopy every 5 years, and FOBT yearly, or CT colonography every 5 years
2) Tests that primarily detect cancer
• Annual fecal immunochemical test with high sensitivity for cancer, or Annual guaiac-based fecal occult blood test with high sensitivity for cancer, or Stool DNA test with high sensitivity for cancer, interval uncertain
After polyps are found, follow-up depends on the type of polyp, size, number, and family history. Only adenomatous polyps require specific follow-up. Hyperplastic polyps, if < 1cm (except for those with a hyperplastic polyposis syndrome), have the same follow-up as no polyp (10 years).
The 2008 American Cancer Society (ACS) guidelines recommend the following
• Patients with 1 or 2 small tubular adenomas with low-grade dysplasia should have repeat colonoscopy 5-10 years after initial polypectomy.
• Patients with 3-10 adenomas, or 1 adenoma > 1cm, or any adenoma with villous features or high-grade dysplasia should have repeat colonoscopy in 3 years.
Low-risk patients: The 2008 American Cancer Society guidelines for colorectal cancer screening for asymptomatic adults > 50 years of age with a negative family history for colon cancer or adenomatous polyps have broken down the tests into the following 2 areas:
1) Tests that detect adenomatous polyps and cancer
• Colonoscopy every 10 years, or Flexible sigmoidoscopy every 5 years, and FOBT yearly, or CT colonography every 5 years
2) Tests that primarily detect cancer
• Annual fecal immunochemical test with high sensitivity for cancer, or Annual guaiac-based fecal occult blood test with high sensitivity for cancer, or Stool DNA test with high sensitivity for cancer, interval uncertain
TREATMENT OF COLON CANCER
• Surgical resection is the 1st treatment option and is potentially curative. Recurrences after surgery are probably due to micro-metastases.
• Adjuvant chemotherapy consists of a 5FU-based therapy. [Typically, 5FU plus leucovorin (LY) is used. Trials have shown benefit rrom oxaliplatin being added to this regimen. This protocol is called FOLFOX.] Adjuvant chemo is effective only for stage III or locally advanced II.
Radiation therapy prior to surgery is helpful for rectal lesions only.
Hepatic resection increases survival with solitary liver mets. If we remove a cancerous polyp, we must do a bowel resection if the cancer extends to either a blood vessel or the cautery line.
• Adjuvant chemotherapy consists of a 5FU-based therapy. [Typically, 5FU plus leucovorin (LY) is used. Trials have shown benefit rrom oxaliplatin being added to this regimen. This protocol is called FOLFOX.] Adjuvant chemo is effective only for stage III or locally advanced II.
Radiation therapy prior to surgery is helpful for rectal lesions only.
Hepatic resection increases survival with solitary liver mets. If we remove a cancerous polyp, we must do a bowel resection if the cancer extends to either a blood vessel or the cautery line.
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