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1、 Colon Ca incidence: 105,500/US/yr Colon Ca mortality: 48,100/US/yr implies 45% colon Ca case mortality Rectal Ca incidence: 42,000/US/yr Rectal Ca mortality: 8,500/Us/yr implies 21% rectal Ca case mortality Epidemiology 3 3 Characteristics in china Young Lower location ulceration Ethiology Dietary
2、habits Precancous diseases Environment factors Heredity factors Other factors Dietary habit Heredity factors Adenomatous polyposis syndromes (APS) Hereditary “Non-polyposis” Colon Cancer (HNPCC, Lynch syndrome) Familial Adenomatous Polyposis (FAP) Other factors Anatomy Arterial supply of the colon I
3、leocolic artery Right colic artery Meddle colic artery Left colic artery Sigmoid arteries Venous drainage of the colon Superior mesenteric vein Inferior mesenteric vein Splenic vein Hepatic portal vein Lymphatic drainage of the colon Epicolic nodes Paracolic nodes Intermediate nodes Central nodes Il
4、eocecal region Arterial supply of the rectum Superior rectal artery Middle rectal artery Inferior rectal artery Venous drainage of the rectum Internal hemorrhoidal plexus External hemorrhoidal plexus Rectal region Model of colorectal carcinogenesis（90% ） Nomal epithelium Heperproliferative epitheliu
5、m Adenoma Carcinoma 病理生理 Pathology Morphology Protrude type Infiltrate type Ulceration type Pathology Cytology Carcinome Mucinous carcinoma carcinoide Undifferentiated carcinoma Squamous carcinoma Route of metastasis Route of metastasis Infiltration direct lymphatic metastasis Hematogenous dissemina
6、tion Implantation metastasis Liver Metastasis Implantation metastasis Classification of Pathology Dukes stages Dukes A、B、C、D TNM stages 、 DUKES Classification Dukes Stages Stage A: limited to mucosa and submucosa 90% Stage B: extends into muscularis or serosa 60-75% Stage C: one positive node - 69%
7、six or more positive nodes, 27% Stage D: mets. to liver, bone, lung 5% COLORECTAL CANCER SURVIVAL (Dukes Stages, 5 y) Stage Classification Stage 0 Tis, N0, M0 Stage I T1, N0, M0 T2, N0, M0 Stage II T3, N0, M0 T4, N0, M0 Stage IIIAny T, N1, M0 Any T, N2, M0 Stage IV Any T, Any N, M1 Clinical findings
8、 Hematochezia (distinct from melena) Change in bowel habit: alternating constipation and diarrhea. Obstipation to clinical lower bowel obstruction. Anemia Weight lossAbdominal pain FOBT Mass Fever Anorexia Location in right colon Obstruction Diarrhea Location in left colon Blood in feces Constipatio
9、n Blood in stool Change in normal bowel habits Rectal examination Cancer of rectum Method of diagnosis Digital examination Fecal occult blood Endoscope anoscope Flexible sigmoidoscope Electrical Colonoscope Air-contrast barium enema CEA othersCT、MRI、PET Single contrast Double contrast Air-contrast b
10、arium enema Endoscopes Endoscopes Colonoscopy Colonoscopy Colonoscopy Colonoscopy Rectal polypRectal CA CT ScanRectal tumor Treatment The main method is the operation Operation of clolon Right hemicolectomy Transverse colon resection Left hemicolectomy Sigmoide resection Right hemicolectomy Ileo-tra
11、nsversal anastomose Cecum Ascending colon Hepatic flexure of colon Terminal ileum 15cm Greater omentum Transverse colon LN of right gastroepiploic artery Transverse colectomy Ascendo-descending colon anastomose Hepatic flexure of colon Splenic flexure of colon Transverse colon Greater omentum Mesoco
12、lon LN of gastrocolic ligament Radical correction of descending colon Transversorectal anastomose Splenic flexure of colon Descending colo Sigmoid colon Parts of greater omentum Mesocolon Radical correction of sigmoid colon Descendorectal anastomose Parts of descending colon Sigmoid colon Superior e
13、xtremity of rectum Mesocolon of sigmoid Operation of rectum Transanus Local resection (APR)-Miles (LAR)-Dixon Parks Reforming Bacon Hartmann Post-cavitas pelvis cleare Entire cavitas pelvis cleare Radical correction of rectum Dixon location 5cm dentate line Incisal margin 3cm Abdominal Perineal Rese
14、ction(Miles) Indication location 5cm Extent Post-cavitas pelvis cleare male female Radical correction of rectum Parks Reforming Bacon Hartmann Complication Hemorrhage anterosacrum Ureter injury Bladder injury Urine retention Sexual disturbance Stomal leak Chemotherapy Method systemic chemotherapy re
15、gional chemotherapy Medicin 5-FU、CF Systemic Chemotherapy Regional hepatic chemotherapy Chemoport Radiotherapy External radiotherapy Internal radiotherapy New adjuvant therapy Sandwich Chemotherapy + Radiotherapy operation Chemotherapy + Radiotherapy Treatment indication STAGE 0 Local excision with clear margins Large lesion not amenable to local excision STAGE 1 Wide surgical resection and anastomosis Treatment indication STAGE 2 Wide surgical resection and anastomosis Systemic
