Colorectal Carcinoma Essay

January 12th, 2017, I received a phone call that changed my world and in the next few weeks I watched the world as I knew it shatter. Six little words “…it will be to say goodbye,” yet I could not comprehend them. I would not believe it, that is until I was there.

Colorectal cancer mainly starts at colon or the rectum. They are common in most of the way like features, but they have different treatment. What is the different between colon cancer and rectum cancer? Colon cancer happens first four to five feet of the large intestine and rectal cancer happens in the last few inches of the large intestine where it is connected to anus.

There are about 35,000 new cases each year in the UK. More than 80% of

The American College of Gastroenterology Guidelines recommend colonoscopy,as the preferred cancer screening test for patients 50 years and older(Rex 2017). The technique of Endoscopic Mucosal Resection (EMR) was developed for removingsessile or flat lesions confined to the superficial layers (mucosa and submucosa) of the gastrointestinal (GI) tract, including the colon, esophagus, stomach, and duodenum. EMR with submucosal injection helps facilitate complete resection of polyps (Hwang 2015; Fyock 2010; Steele 2013), which is critical, as incomplete resections may contribute to the development of colon cancer in patients despite being on a colonoscopy screening/surveillance pathway (i.e. interval cancers). (von Renteln 2017; Bujanda 2010;

Recommended follow up regimen after curative treatment for colorectal cancer and signs and symptoms associated with colorectal cancer recurrence.

One of the many goals developed by the United States Government in its Healthy People 2020 campaign was to “reduce the number of new cancer cases, as well as the illness, disability, and death caused by cancer” (Healthy People 2020, 2016). This goal is further broken down by cancer types. The goals for colorectal cancer (CRC) is to reduce the 2007 baseline mortality rate of 17.1 deaths per 100,000 to 14.5 deaths per 100,000 and to increase the proportion of adults to receive colorectal cancer screening (CRCS) based on the most recent guidelines by the year 2020. The American Cancer Society (ACS,

For stage zero colon cancer patients, the cancer cells haven’t spread past the inner lining of the colon so surgery is the only thing needed. The surgery is usually done by polypectomy if the tumor is small enough; if not, a colon resection, or colectomy is needed. By stage one of colon cancer, the cells have spread throughout many layers of the colon, but not through the colon’s walls so surgery would only be needed to take out the part of the colon that has cancer or any lymph nodes. Stage two and three treatments include more colectomy and chemotherapy and possibly radiation treatments depending on how many cancer cells were removed. For stage four of colon cancer, there is a small chance that surgery could remove the cancer cells since it could spread to the liver, lungs, the lining of the abdominal cavity, or other lymph nodes. If the cancer is too widespread, then colectomy or diverting colostomy might be

Theres are five stages of colon cancer beginning at stage 0. Stages 0 and 1 indicate the tumor has not grown out of the inner lining of the colon wall, therefore the polyps can be removed by a colonoscope. As long as all the cancerous cells are removed completely, no additional treatment is necessary and the cancer has not spread to the lymph nodes. In stage 2, the cancerous cells have grown through the wall of the colon, possibly to healthy tissue nearby however they have not spread to the lymph nodes. Once an individual has reached stage two, there is a higher risk that a margin of cancerous cells was left behind, and the cancer has blocked the colon off. In stages 3 and 4, more aggressive treatments are necessary in order to rid not only the colon but also the metastases at which the cancer has spread. In stage 3, a partial colectomy is necessary to surgically remove part of the diseased colon as well as any infected area. Chemotherapy may also be required to make sure that all of the cancerous tissue has been removed from the abdominal lining and vital organs like the lungs or liver. Doctors may also use radiation to further target cells left behind that surgery was unable to extract. At stage 4, the cancer has spread far from the colon to other tissues and organs which makes it a lot more challenging to remove with surgery. Chemo is often given before surgery as to hopefully reduce the size of tumors so they may be taken out surgically later on. At this stage of colon cancer, the goal is to elongate the person's life and relieve symptoms rather than rid them of cancer because it is very unlikely chemotherapy and radiation will be enough to demolish all of the cancerous tissues (Treatment of Colon

Globally more than 1 million people get colon cancer every year resulting in about 715,000 deaths as of 2010 up from

MRI due to its high sensitivity for soft tissue enables to view structures clearly which has been a major advance in visualizing rectal tumors and can predict the T stage (mrTstage) with good accuracy Brown G. et al, 2003. Detailed staging using high resolution magnetic resonance imaging (MRI) enables the selection of patients that require pre/ post-operative therapy for tumor regression. This information can be used to select neoadjuvant therapy and adjuvant therapy in those patients with poor prognostic features before disturbing the tumor bed and potentially disseminating disease. Extramural venous invasion (EMVI) is recognized as an independent factor for poor prognosis in rectal cancer and may therefore influence treatment decisions regarding oncological therapy. Extramural venous invasion is seen on MRI as a serpiginous extension of tumor signal within a vascular structure. This is best identified on T2-weighted images where the characteristic signal and morphology differentiates it from nodal disease Smith et al, 2008.

The availability of the peritoneal disease in relation to colorectal cancer has a poor prognosis; therefore, traditional treatment such as systemic chemotherapy is usually associated with less survival rate. Currently, several innovative individuals globally are seeking to utilise more rapid and thorough strategies for the management of colorectal cancer. Cytoreductive surgery (CRS) is one of the most popularised methods of managing the disease in some selected patients. Peritoneal carcinomatosis has been established as one of the major causes of treatment failure among patients with colorectal cancer. Even though it is considered fatal, scientist have postulated that a localised peritoneal carcinomatosis without any other metastases can be considered as a regional disease metastasis and should be pliable to local-regional therapy.8 Despite the fact that curative liver resection for colorectal cancer is well established with a survival rate of 5 years, peritoneal cancer has been considered as an end stage disease. The notion that some individuals who have peritoneal carcinomatosis possess a regional disease rather than a metastatic malignancy has led to the development of multiple complex surgeries that can result in a macroscopic excision of the cancer completely (cytoreduction), which is combined with hyperthermic intraperitoneal chemotherapy to manage some of the microscopic diseases.15

The questions that may arise are why are the rates of cancer in this group of people exceed other ethnic groups? We may also ask if social economic, risk factors, traditional values, education, language barriers halt the direction for reducing the alarming rate. The fact that China has the ninth highest incidence rate of liver cancer of males worldwide while lung cancer incidence among women in China is also the ninth highest worldwide, makes it deserving of special attention.

Bowel cancer can be detected using various techniques. The most common being colonoscopy and flexible sigmoidoscopy. Flexible sigmoidoscopy detects cancer in “the rectum and sigmoid colon and, at times, the descending colon.” Colonoscopy also focusses on these areas but can “permit inspection of the entire transverse and the right colon.”

This is a prospective phase II single arm study performed at Clinical Oncology Department, Tanta University hospital, throughout the period between June 2013 and December 2015. Thirty-one patients with locally advanced rectal adenocarcinoma were enrolled with a minimum follow-up period of 6 months.

Omega-3 PUFAs and the colorectal cancer: a review of the similar and different effect of EPA and DHA