COLON CANCER: CURRENT SURGICAL MANAGEMENT OPTIONS.

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COLON CANCER CURRENT SURGICAL MANAGEMENT OPTIONS.

• ANTHONY D.I. SIBIYA, MD.,
• GABORONE PRIVATE HOSPITAL

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COLON CANCER CURRENT SURGICAL OPTIONS.

• 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.

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COLON CANCER CURRENT SURGICAL OPTIONS

• 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.

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COLON CANCER CURRENT SURGICAL OPTIONS

• 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

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COLON CANCER CURRENT SURGICAL OPTIONS

• 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.

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COLON CANCER CURRENT SURGICAL OPTIONS.

• 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

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COLON CANCER CURRENT SURGICAL OPTIONS

• THE DISTRIBUTION OF COLON CANCERS.

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COLON CANCER CURRENT SURGICAL OPTIONS
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COLON CANCER CURRENT SURGICAL OPTIONS

• THE CHANCE OF CURE IN COLORECTAL CARCINOMA IS
  DEPENDENT ON SEVERAL FACTORS, THE MOST IMPORTANT
  OF WHICH IS STAGE OF THE DISEASE.
• STAGE 5 YEAR SURVIVAL
• I 90
• II 75
• III 50
• IV lt5

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COLON CANCER CURRENT SURGICAL OPTIONS

• 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 gt3 RN
• T2- INVADES MUSCULARIS
• T3-INVADES THROUGH MUSCULARIS PROPIA INTO
  SUBSEROSA OR ONTO NON-PERITONIALISED PERICOLIC OR
  PERIRECTAL TISSUES
• T4-DIRECTLY INVADES OTHER ORGANS OR STRUCTURES
  AND/OR PERFORATES VISCERAL PERITONEUM
  

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COLON CANCER CURRENT SURGICAL OPTIONS.

• STAGE GROUPING
• STAGE T N
  M DUKES MAC
• 0 TIS NO
  MO - -
• I T1 NO
  MO A A
• T2 NO
  MO A B1
• IIA T3 NO
  MO B B2
• IIB T4 NO
  MO B B3
• IIIA TI-T2 NI
  MO C CI
• IIIB T3-T4 NI
  MO C C2/C3
• IIIC ANY T N2
  MO C C1/C2/C3
• IV ANY T ANY N MI
  D

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COLON CANCER CURRENT SURGICAL OPTIONS

• 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

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COLON CANCER CURRENT SURGICAL OPTIONS.

• STAGE 4 CANCERS IN WHICH THE TUMOR IS TI-T3, WITH
  HEPATIC METASTASES CAN BE RESECTED, WITH
  SIMULTANEOUS RESECTION OF THE LIVER METASTASES.

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COLON CANCER CURRENT SURGICAL OPTIONS

• OBSTRUCTING CANCERS
• - USUALLY RIGHT SIDED.
• - RESECTION, ANASTOMOSIS
• - ON THE LEFT SIDE
• DIVERTING STOMA, RESECTION, OR
  INTRA-OP COLONIC LAVAGE WITH
• ANASTOMOSIS
• PERFORATING CARCINOMAS
• - CAN BE FROM EROSION OR PERFORATION
  SECONDARY TO OBSTRUCTION.
• WASHOUT, RESECTION AND ANASTOMOSIS IF
  FEASIBLE

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COLON CANCER CURRENT SURGICAL OPTIONS

• SYNCHRONOUS CANCERS
• RECTAL CANCER
• NEW AVENUES
• -LAPAROSCOPY