The Familial adenomatous polyposis (FAP) syndrome affecting 1:10,000 people and accounts for aproximately 0.5% of colorectal cancer. Clasis form of FAP is caracterized by the developments of hundreds to thousands of colonic adenomatous polyps and a variety of extracolonic symtons.
The colorectum cancer is the second leading cause of death due to malignancy in the EU. Colorectal cancer will develop in approximately 65% of Americans and 40% of those will die of the disease.
Betewwn 1996 and 2010, the mortality has decrease by 46%. During this same period,the perc entage of patients 50 years older who were screened for colorectal cancer has increased to 66.1%.
The high suspicios about more of the colorectal cancer originates from adenomatous popys in the colon.
These cells grow like fungus and are usually benign, once in a while they turn cacerous with time. In more of the cases, the diagnosis from cancer localized is for colonoscopy.
R I S KÂ Â F A C T O R S.
The population in the USA has the risk to contrac cancer colon is about 7%. Such kind of factor that help to develop this disease.
#1. Age.Â The risk to develop colorectal cancer increases with age. Most of the cases presnt between 60 to 70 years. It is less common before 50 hears excep with the presence of colorectal cancer.
Particularly adenomatous polyps. The elimination of polyps from colon around the colonoscopy dismiss the subsecquen risk from colon cancer.
#2. History of cancer. The individuals that previously was diagnosed and treat withÂ cancer has one high risk from the population to get colorectal cancer. The woman with history of ovary cancer, wound or breast has risk in the apparition of colon cancer.
#3. Inherence. It is the second important cause of colorectal cancer the cause of death around the world every year andÂ the thir mos common form of cancer. The history of colorectal cancer in the family, especially from one closer member less the 55 years.
#4. Familiar adenomatous polyposis in 100 % develop to colorectal cancer for the 40 years.
#5. Lynch Syndrome or heritage colorectal cancer is associated with polyposis.
#6. Chronic ulcers colitis of Crohn disease, approximate 30% from 25 years if the whole colon is compromise.
#7. Smoking. Is probably that one smoker death from colorectal cancer that non smoker person. The American society against cancer made a study and found the 40% is more probable thatn smoker woman’s detah from colorectal cancer compared with women who never smoke. The male smoker has a risk of 30% high to die that those who do not smoke.
#8. Diet. The studies show up the diet with meat and los in fruit, vegetables bird and fish increase the risk of colorectal cancer.One prospective Europe Study by Cancer and Nutrition sugest that diets high in red meat, the same like the low fiber are associated to colorectal cancer. Such people eat fish show up low risk . However other studies put in dude, to confirm a diet rich in fiber decrease the risk of colorectal cancer. The less fiber diet are associated with colorectal cancer. The less fiber diet are associated with colorectal cancer is controversial.
#9. Physical activity. Persons with activity has a less risk to develop a colorectal cancer.
#10. The lack of selenium corporal is a factor.
#11. Alcoholismo play important role in the risk of colorectal cancer.
Other epidemiologic studies show association with the alcohol and cancer of colon is not determinate.
A study found those who drink more that 30-45 have more risk to develop colorectal cancer. Other study show that consumption of one alcoholic drinkj every day is associated with high incidence in 70% high to the half of colon cancer.
While we found a duplication of colon cancer. With the consumption of alcohol, included beer and other beverages. The studies show for minimized the risk of colorectal cancer is better minimized the consume.
SY M P T O M S.
The colorectal cancer cannot give symptoms in the advance stage and for the mayor of patiens present tumors and invade all the intestine wall or are affrected the regional ganglions. When appear the sumptoms and signs of colorectal carcionma are variable and inespecific. The age the develop of cancer colorecta is between 60-80 years of age.
When there is hereditary the diagnosticÂ is before 50 years age. The frequent symptoms include low digestive hemorrhages and rectorrhagy, changes in the defecations and abdominal pain. The present of distinguishes systems o the form of manifestation depend of the site from the tumor and the extension from the disease.
P A T H O L O G Y.
The pathology report after the resection of tissue through the operation. The pathologic description the cells type and the degree of advance. The common type is canc erogenic cells is Adenocarcinoma, in 95% of the cases. Other less frequent is lymphomas and the squeamous cells carcinoma.
The cancer from the right size (ascendent colon and sigmoide), with exohphilic pattern, it menas the tumor grow into the intestinal space. This type cause obstruction from the heces and present symptoms like anemia. The cancer from the left size can be cincunferential and produce obstructive symptoms.
Frequent Types of Cancer.
Right Colon Cancer. The principal symptoms are anemic syndrome and occasional, palpitation form the abdominal tumor. In this portion the tumors can be bigger size, producing stenosis without obstructive sumptoms. The abdominal pain presence in more the 60% of patients in the right half from abdomen. The anemic syndrome is present in 60% for the continued lose, that not modifies the feces aspect, from the ulcers superfies from tumor. Presence of fatigie, palpitations angor pectoris with anemia hypochromia and macrocytic with iron deficit. Is necessary to do Endoscopy and Radiology from the whole colon.
Cancer left colon. The pain in abdomen inferios can relief with the defecations in case some patients can develop anemis for lack of iron in case of colon cancer right.
Recommendations for Colorectal Cancer Screening.
Average risk individuals >59 years old.
Annual fecal occult blood testing using higher sensitivity tes (Hemoccult SENSA)
Annual fecal Immunochemical test (FIT)
Fetal DNA test (interval uncertain)
Fexible sigmoidoscopy every 5 years
Colonoscopy every 10 years
CT Colonography every 5 years.
Individuals with a family history of a first degree member with colorectal neoplasia.
Single first degree relative with colorectal cancer diagnosed at age >60 years. Begin screening at age 40.
Screening guidelines same as average risk individual; however preferred method is colonoscopy every 10 years.
Single first degrtee relative with colorectal cancer or advance adenoma diagnosed at age <60 years, or two first-degree relatives: beging screening at age 40 or at age 10 years younger than age at diagnosis of the youngest effected relative, whichever is first in time. Recommended screening colonoscopy every 5 years.
The colonoscopy allows evaluation of the entire colon and is the way of detection and removing adenomatous and serrated poyps. It should be performed in all patiens who have positive FOBT, FIT, fecal or DNA test or iron deficiency anemia (see Occult Gastrointestinal bleeding and obscure gastrointestinal bleeding) as the prevalence of colonic neoplasm is increased in this patients.
The Stages from Colon Cancer.
The TNM system is used classification to stage colorectal cancer. Staging is important no only because it correlates with the patient long term survival but also because it is used to determine which patient should receive therapy.
State I. Has a 90-100% survival 5 years rate, no therapy required.
Stage II. The 5 years survival year drops to 80% and who are in higher risk for recurrence (perforations, obstruction, T4 tumor or fewe than 12 lymph nodes) get benefit from adjuvant chemotherapy.
Stage III. (node positive disease) The surgical resection alone, the expected 5 year survival rate is 30-50%. Postoperative adjuvant chemotherapy significantly increases disease free survival as well as overall survival up to 30% and is recommended tor all fit patients. Large designated studies of adjuvant therapy for stage III colon cancer reported a higher rate of disease free survival at 5 years for patiens treated for 6 months posoperatively in combination with chemotherapy.
Stage IV. (metastatic disease) Approximately 20% of patients have metastatic disease at the time of initial diagnosis and additional 30% eventually develop metastasis. A subset of these patients has limite disease that is potentially curable with surgical resection. The majory of patients with metastatic disease do not have resectable (curable) disease. In the absence of other treatment, the median survival is less than 12 months. However with current therapies median survival approaches 24 months.
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