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39 Cards in this Set
- Front
- Back
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what is type of patient in colorectal carcinoma ??
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*Age : seventh Decade , while rectal carcinoma is not uncommon in young age
* Sex: - rectum & sigmoid : more in males - Cecum : more in females |
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what are predisposing factors of colorectal carcinoma ??
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1. Benign adenoma
***2.Familial Polyposis & Garnder Syndrome (risk is 100% if not treated) 3. Ulcerative colitis 4. more in western countries (less fibres in diet) 5. after uretro-colic anastmosis |
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what is the most common site ??
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rectum & sigmoid . . (2/3) of cases
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what are pathological types (Gross) ??
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1. Cauliflower-like mass (commonly in cecum)
2. Ulcerative type 3. stricture schirrous type ( commonly in left colon) |
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what are microscopic types ??
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1. Adenocarcinoma
2. colloid carcinoma (bad prognosis) |
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explain late infiltration of the U.B by rectal carcinoma ??
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due to strong fascia of Denonvillier that retards the spread of rectal cancer to U.B
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Lymphatic spread
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right & transverse ---> Epicolic , paracolic ---> Sup.mes. LNs
left ---> Epi,paracolic ---> Inf.mes. LNs |
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Blood spread
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liver in 20%
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Transperitoneal spread
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lead to transperitoneal nodules and ascites
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what does it mean that the carcioma is
Duke C , Duke A , Duke B |
A - limited to bowel wall
B - outside the wall , but no metastasis in the LNs C - secondary deposits in the regional LNs * C1 - local para rectal ,para colic alone * C2 - sup. ,or Inf. mesentric |
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What might be complications of colorectal carcinoma ??
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1. Obstruction
2. perforation & fistulea 3. Bleeding 4. Spread to distant organs |
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what part of the colon is more prone to obstruction by carcinoma ?? why ??
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Left Colon due to :
1. smaller lumen 2. Stools tend to be more solid 3. carcinoma usually of the STENOSING variety |
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what are clinical presentations of Right Colon Cancer ??
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1. Anemia , Anorexia , Asthenia
2. Hard mass in the right iliac fossa 3. Obstruction : rare , when the lesion obstructs the iliocecal valve 4. Pain : recurrent , right iliac 5. Metastases |
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what are clinical presentations of Rectal Cancer ??
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1. Change in bowel habits : progressive constipation OR constipation alternating constipation & diarrhea
* Spurious diarrhea maybe present 2. Obstruction : acute , subacute or chronic ,,, sever abdominal distension but vomiting is late 3. Bleeding per rectum 4. Mass in the left side of the abdomen usually due to impacted stools as left colon carcinoma is of schirrous type |
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what are clinical presentations of Left Colon Cancer ??
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* as left >bowel habits
>obstruction >Bleeding per rectum >Mass + Tenesmus + P/R ---> palpation of lesions that lie 10cm of the anal verge |
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What are the clinical Presentations of Rectal Carcinoma ??
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* as Left colon carcinoma :
> bowel habits > Bleeding Per rectum > Obstruction > Left iliac mass + Tenesmus + P/R --> allows palpation of mass 10 cm form the anal verge |
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What might General examination reveal in a case of colorectal carcinoma ??
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1. nutritional status , Anemia , Jaundice
2. Abdominal examination : ascites , hepatomegaly 3. Rectal examination : pelvic deposits |
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what are the differentials of cecum carcinoma ??
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Causes of mass in the right iliac fossa
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what are the differentials of transverse colon carcinoma ??
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Causes of mass in the epigastrium
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what are the differentials of left colon & rectal carcinoma ??
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* causes of mass in the left iliac fossa
- Bilharzial mass ( diffuse bilharzial colitis) - Pericolitis in diverticulosis coli - Spastic colon - Mass of stools in chronic constipation * Causes of Bleeding per rectum * Causes of I.O |
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What are investigations for Colorectal carcinoma ??
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*0. SIGMOIDOSCOPY & COLONOSCOPY
1. CBC 2. Barium enema 3. metastatic workup 4. CarcinoEmberyonic antigen (CEA) 5. plain x ray ,barium enema & lab investigations for acute I.O |
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what are findings of barium enema in colorectal carcinoma ??
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1. fixed irregular filling defect
2. Apple core appearance |
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Treatment of Operable non obstructed cecum tumor ??
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*Right Hemicolectomy
* vessels ligated : iliocecal ,right colic * Structures removed : > terminal 10 inches of the ileum > ascending colon & hepatic flexure > divided artreis and veins with corresponding LNs are removed in continuity * the operation is completed by performing iliotransvers anastmosis |
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Treatment of Operable non obstructed transverse colon tumor ??
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* Transverse colectomy
* vessels ligated : middle colic *Structures removed: > transverse colon > hepatic & splenic flexures > transverse mesocolon & omentum |
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Treatment of Operable non obstructed Sigmoid colon tumor ??
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* Sigmoid colectomy
* vessels ligated : sigmoid vessels flush at their origin *Structures removed: > sigmoid colon N.B : other option : is to divide the inferior mesentric at it's origin |
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Treatment of Operable non obstructed Left colon tumor ??
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* Left Hemicolectomy
* vessels ligated : Inf. mesentrric *Structures removed: > tresection extends down to the rectum but rectum is not removed |
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Treatment of Operable non obstructed upper 1/3 of rectum tumor ??
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* Anterior restorative resection
* vessels ligated : Inf.mesetric *Structures removed: > sigmoid colon and upper 1/2 of the rectum |
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Treatment of Operable non obstructed lower 1/3 rectal tumor ??
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* Abdomino perineal resection (of Miles)
* vessels ligated : Inf.mesentric *Structures removed: sigmoid and whole rectum is removed together with the anal canal and terminal colostomy is fashioned |
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Why the (Abdomino perineal resection) is termed so ??
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as part of it is done through abdominal incision and the other part is done through the perineum
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in (Abdomino perineal resection) do we star twith abdominal part or perineal part ?? Why ??
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start with the Abdominal part in order to :
1. Asses operability 2. ligate vessels |
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Treatment of Operable non obstructed lower 1/3 rectal tumor ??
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* Abdomino perineal resection (of Miles)
* vessels ligated : Inf.mesentric *Structures removed: sigmoid and whole rectum is removed together with the anal canal and terminal colostomy is fashioned N.B it was treated in the past byAbdomino perineal resection but changed that policy due to 1. realization that 2cm saftey margine is enough 2. development of circular stapler |
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Treatment of Operable non obstructed ascending colon ir hepatic flexure tumors ??
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* Extended Right Hemicolectomy
* vessels ligated : ileocolic , middle colic , Rt.colic *Structures removed: resection extends to the junction bt. the Rt.2/3 and left 1/3 of the Tr.colon |
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Treatment of Operable non obstructed lower 1/3 rectal tumor ??
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* Abdomino perineal resection (of Miles)
* vessels ligated : Inf.mesentric *Structures removed: sigmoid and whole rectum is removed together with the anal canal and terminal colostomy is fashioned |
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Why the (Abdomino perineal resection) is termed so ??
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as part of it is done through abdominal incision and the other part is done through the perineum
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in (Abdomino perineal resection) do we star twith abdominal part or perineal part ?? Why ??
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start with the Abdominal part in order to :
1. Asses operability 2. ligate vessels |
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Treatment of Operable non obstructed lower 1/3 rectal tumor ??
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* Abdomino perineal resection (of Miles)
* vessels ligated : Inf.mesentric *Structures removed: sigmoid and whole rectum is removed together with the anal canal and terminal colostomy is fashioned N.B it was treated in the past byAbdomino perineal resection but changed that policy due to 1. realization that 2cm saftey margine is enough 2. development of circular stapler |
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Treatment of Operable non obstructed ascending colon ir hepatic flexure tumors ??
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* Extended Right Hemicolectomy
* vessels ligated : ileocolic , middle colic , Rt.colic *Structures removed: resection extends to the junction bt. the Rt.2/3 and left 1/3 of the Tr.colon |
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Treatment of inoperable cases ?
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* resectable ---> palliative resection without wide resection nor removal or blood vessels & LNs
*Irresctable ---> operation to avoid obstruction - Rt.-->side to side iliotransverse - elsewhere--> proximal colostomy |
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Treatment of Acute I.O in colorectal carcinoma ?
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*URGENT surgery
1. Left --> colon resection + colostomy 2. Rt. (rare) --> primary anastmosis |
