Colon cancer is the most frequent GI cancer, the third cause of death in males after lung and prostate cancers and the second cause of death in females following breast cancer. The chances of developing cancer increase with age, but it is also seen in younger ages (<50 years) and in the context of hereditary syndromes such as familial polyposis and hereditary nonpolyposis colon cancer.
Clinical image:
- Presence of blood in the stool
- Presence of mucus in the stool
- Change of intestinal habits (alternation between diarrhea and constipation)
- Anemia
- Asthenia, fatigue
- Weight loss
- Occlusive ileus (vomiting, inability to pass gas or stool)
In most cases, histology is consistent with an adenocarcinoma but also with other forms of cancer. Complications of malignant tumors include obstruction, hemorrhage, and perforation. When they are malignant, tumors metastasize to adjacent lymph nodes or at remote sites (metastases). Diagnosis is possible based on the endoscopy of the lower GI tract (total colonoscopy) while a CT scan is required for staging the disease. The monitoring of the disease may be assisted by measuring cancer indicators (Carcinoembryonic Antigen -CEA).
Treatment:
Surgery is the treatment of choice. The laparoscopic approach is increasingly gaining ground and it has been established as a routine treatment in a number of clinics. The resection of the affected part of the intestine within healthy margins (the so-called “colectomy”) is currently performed laparoscopically with equally good oncology results with conventional open surgery. The most frequent typical interventions, depending on the localization of the tumor, are right hemicolectomy, extended right hemicolectomy, transversectomy, left colectomy, sigmoidectomy, anterior resection, low anterior resection, abdominoperineal excision, Hartmann colostomy. All the above procedures may be performed laparoscopically with less loss of blood, less postoperative pain, faster recovery and patient’s mobilization.
Complementary chemotherapy and radiotherapy may be indicated, depending on the case, based on the results of the histologic examination and the stage of the disease. In advanced stages of the disease, adjuvant treatment may be used.