Transcript COLON CANCER: CURRENT SURGICAL OPTIONS.

COLON CANCER:
CURRENT SURGICAL
MANAGEMENT
OPTIONS.
ANTHONY D.I. SIBIYA, MD.,
GABORONE PRIVATE HOSPITAL
COLON CANCER: CURRENT
SURGICAL OPTIONS.
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THE EXACT INCIDENCE OF
COLORECTAL CANCER IN BOTSWANA
REMAINS UNKNOWN.
IN COUNTRIES WHERE STATISTICS ARE
AVAILABLE, COLORECTAL CANCER IS
THE THIRD MOST FREQUENTLY
DIAGNOSED, AND THE SECOND MOST
FATAL CANCER.
COLON CANCER: CURRENT
SURGICAL OPTIONS
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THE PEAK INCIDENCE OF THE DISEASE IS IN
THE SIXTH DECADE OF LIFE. EARLIER ONSET
IS HOWEVER FOUND IN THOSE WITH
CERTAIN GENETIC SYNDROMES (HNPCC, FAP,
PJS, JPS, COWDEN DISEASE AND
RUVALCABA-MYRE-SMITH SYNDROME)
THERE IS ANEDOCTAL EVIDENCE TO
SUGGEST THAT IN HIV, THE RISK IS
SIGNIFICANTLY INCREASED.
COLON CANCER: CURRENT
SURGICAL OPTIONS
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EARLY DETECTION AND TREATMENT
REMAIN THE MOST IMPORTANT
FACTORS IN PROGNOSIS.
EARLY DETECTION REQUIRES A HIGH
INDEX OF SUSPICION WITH CERTAIN
PRESENTING SYPMTOMS, AND A LOW
THRESHOLD FOR BOTH BIOCHEMICAL
AND PHYSICAL TESTING
COLON CANCER: CURRENT
SURGICAL OPTIONS
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HISTORY, PHYSICAL EXAMINATION
(INCLUDING COLONOSCOPY) AND
RADIOLOGICAL EXAMINATION
REMAIN THE MAINSTAYS OF
DIAGNOSIS AND STAGING. FOR RECTAL
CANCERS, ENDORECTAL ULTRASOUND
AND MRI, ESPECIALLY PHASED ARRAY
MRI, ARE IMPORTANT TOOLS IN
STAGING.
COLON CANCER: CURRENT
SURGICAL OPTIONS.
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THE AIMS OF SURGICAL TREATMENT
OF ALL CANCERS WHICH ARE
AMENABLE TO THIS MODALITY ARE:
- COMPLETE EXCISION OF TUMOR AND
NODAL BASIN DRAINING THE AREA.
- COMPLETE EXCISION OF METASTATIC
DEPOSITS WHERE FEASIBLE.
- PALLIATION WHERE THE ABOVE
CANNOT BE ACHIEVED
COLON CANCER: CURRENT
SURGICAL OPTIONS
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THE DISTRIBUTION OF COLON
CANCERS.
COLON CANCER: CURRENT
SURGICAL OPTIONS
COLON CANCER: CURRENT
SURGICAL OPTIONS
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THE CHANCE OF CURE IN COLORECTAL
CARCINOMA IS DEPENDENT ON
SEVERAL FACTORS, THE MOST
IMPORTANT OF WHICH IS STAGE OF
THE DISEASE.
STAGE
I
II
III
IV
5 YEAR SURVIVAL
90%
75%
50%
<5%
COLON CANCER: CURRENT
SURGICAL OPTIONS
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STAGING OF COLON CANCER
PRIMARY TUMOR
REGIONAL NODES
DISTANT METASTASES
TX-CANNOT ASSESS
NX-CANNOT ASSESS
MX CANNOT ASSESS
TO- NO PRIMARY TUMOR
NO-NO METS RN
MO- NO DISTANT METS
TIS- TUMOR IN SITU
N1-METS 1-3 RN
M1- DISTANT METS
T1- INVADES SUBMUCOSA
N2- METS >3 RN
T2- INVADES MUSCULARIS
T3-INVADES THROUGH MUSCULARIS PROPIA INTO SUBSEROSA OR ONTO NONPERITONIALISED PERICOLIC OR PERIRECTAL TISSUES
T4-DIRECTLY INVADES OTHER ORGANS OR STRUCTURES AND/OR PERFORATES
VISCERAL PERITONEUM
COLON CANCER: CURRENT
SURGICAL OPTIONS.
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STAGE GROUPING
STAGE
0
I
IIA
IIB
IIIA
IIIB
IIIC
IV
T
TIS
T1
T2
T3
T4
TI-T2
T3-T4
ANY T
ANY T
N
NO
NO
NO
NO
NO
NI
NI
N2
ANY N
M
MO
MO
MO
MO
MO
MO
MO
MO
MI
DUKES
A
A
B
B
C
C
C
MAC
A
B1
B2
B3
CI
C2/C3
C1/C2/C3
D
COLON CANCER: CURRENT
SURGICAL OPTIONS
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STAGE I AND II COLON CANCERS ARE
CURABLE BY SURGERY ALONE. THUS THE
COMPLETENESS OF SURGICAL RESECTION IS
PARAMOUNT, AS IS GOOD TECHNIQUE.
-ADEQUATE MOBILISATION.
-ADEQUATE MARGINS.
-ADEQUATE NODAL BASIN RESECTION.
- REESTABLISHMENT OF BOWEL
CONTINUITY
COLON CANCER: CURRENT
SURGICAL OPTIONS.
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STAGE 4 CANCERS IN WHICH THE
TUMOR IS TI-T3, WITH HEPATIC
METASTASES CAN BE RESECTED, WITH
SIMULTANEOUS RESECTION OF THE
LIVER METASTASES.
COLON CANCER: CURRENT
SURGICAL OPTIONS
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OBSTRUCTING CANCERS
- USUALLY RIGHT SIDED.
- RESECTION, ANASTOMOSIS
- ON THE LEFT SIDE
DIVERTING STOMA, RESECTION, OR INTRA-OP COLONIC LAVAGE WITH
ANASTOMOSIS
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PERFORATING CARCINOMAS
- CAN BE FROM EROSION OR PERFORATION SECONDARY TO OBSTRUCTION.
WASHOUT, RESECTION AND ANASTOMOSIS IF FEASIBLE
COLON CANCER: CURRENT
SURGICAL OPTIONS
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SYNCHRONOUS CANCERS
RECTAL CANCER
NEW AVENUES
-LAPAROSCOPY