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1、Colorectal Disease,Jichao Qin Department of Surgery Tongji Hospital in HUST ,Anatomy of the large intestine,Diameter: 7.5-2.5cm Length: 150 cmAnatomic landmark:Haustra Epiploic appendagesTaeniae coli,Blood supply of the Large intestine,SMA(superior mesenteric artery) Middle colic artery Right colic
2、artery Ileocolic artery IMA(inferior mesenteric artery) Left colic artery Sigmoid artery Superior rectal,Lymphatics of large intestine,Anatomy of the Rectum,The rectum, along with the sigmoid colon, is 12 to 15 cm in length.,Rectum is divided into two parts,the upper and lower section, by Pelvic per
3、itoneal reflection,Anatomy of the Anal Canal,Anal Canal: the end of the digestive tract.,Blood supply of Rectum and Anal Canal (post view),Above the dentate line ： Superior rectal artery inferior rectal artery middle rectal arteryBelow the dentate line： Anal artery,COLORECTAL CANCERs(CRCs),Morbidity
4、 and risk factors for CRC,Epidemiology,Colorectal Cancer (CRC),which include colon cancer and rectal cancer, is one of the most popular malignant carcinoma.the third most common in the whole World the second most in USA the third most common in China,High-risk groups for CRC,gastrointestinal symptom
5、s after the age of 50 a history of Colorectal Adenomas, Ulcerative Colitis, Schistosomiasis Colitis family history of Cancer and FAP (Familial Adenomatous Polyposis) a history of pelvic Radiation Therapy a history of Cholecystectomy or Appendectomy,Colorectal cancer incidence by age in the US,Percen
6、t of adenomas containing invasive cancer by size and histology,Probability of developing colorectal carcinoma in patients with ulcerative colitis an 0.5% cumulative incidence per year,The Percentage of CRCs in USA, but high% of rectal cancer in China,Pathology of CRCs,1 Endophytic (ulcerative)common
7、 type in Colorectal Cancer 2 Exophyticin right-sided tumors 3 Infiltrativein left-sided tumors,Gross appearance of tumor,Exophytic (fungating),Endophytic (ulcerative),Infiltrative (linitis plastica),Histological Classification,Adenocarcinoma 95% Lymphoma Squamous cell carcinoma,Development of Colore
8、ctal Carcinoma,Growth Malignant Transform Invade through the bowl wall Spread to regional lymph nodes Metastasize to distant sites,TNM Staging SystemDukes Classfication System,Cancer Staging System,How to diagnose CRCs,Signs & Symptoms,Change in bowel habits Blood in Stool Diarrhea Constipation,Gene
9、ral abdominal discomfort Weight loss with no explained reason Constant tiredness Vomiting,Biopsy Endoscopy Digital rectal exam Imaging examination Tumor markers Fecal Occult Blood Testing,Diagnosis,More useful for Diagnosis,Digital rectal exam (DRE),Colonoscopy,Double-contrast barium enema (DCBE),ap
10、ple core,CT image for hepatic metastasis,Tumor Markers (CEA),Relative with the extent of tumor. Combined with CA199 for monitoring of postoperative recurrence and evaluating prognosis,Fecal Occult Blood Testing (FOBT),Detects blood from cancers or large polyps Bleeding increases with polyp size and
11、stage of cancer Limited sensitivity: 30% - 50%,Screening,After the age of 50, persons should be screened with FOBT (Fecal occult blood testing ) annually DRE (Digital rectal exam) every 1 to 2 years Endoscopy every 5 years,How to treat CRCs,Surgery Chemotherapy Radiotherapy ,A：Right hemicolectomy B：
12、Transverse colectomy C：Left hemicolectomy D：Sigmoidectomy,Surgical treatment of colon cancer,Right hemicolectomy,greater omentum , 15cm terminal ileum, cecum, ascending colon, hepatic flexure and right transverse colon and its mesentery,Transverse colectomy,the greater omentum , transverse colon, he
13、patic flexure splenic flexure and its mesentery,Left hemicolectomy,the greater omentum, left transverse colon, splenic flexure , descending colon, its mesentery,Sigmoidectomy,Sigmoid colon and its mesentery,Surgical treatment of rectal cancer,Surgery remains the primary treatment. A more advanced tu
14、mor typically requires surgical removal of the section of bowl containing the tumor with sufficient margins, and radical en-bloc resection of mesentery and lymph nodes to reduce local recurrence Include: Local excision Abdominoperineal resection (APR, Miles) Lower anterior resection (LAR，Dixon) Hart
15、mann operation,Lower anterior resection (LAR),Surgical treatment of rectal cancer,Abdominoperineal resection (APR) (shown with colostomy),Surgical treatment of rectal cancer,Surgical treatment of rectal cancer,Hartmann operation,Colostomy (intestinal stoma),Total Mesorectal Excision (TME),TME has be
16、come the “gold standard“ treatment for rectal cancer Devised at 1982 by Professor Bill Heald,Necessity :10% -25% of patients had liver metastases at surgery, 40-70% of recurrence or metastasis for patients with high risk Goal：reduce the likelihood of metastasis developing, slow tumor growth, improve survival Group: chemotherapy after surgery is usually only given if the cancer has spread to the lymph nodes (Stage III).,Adjuvant treatment of colorectal cancer,
