Colon cancer
Colon cancer
2022-05-20 10:59:11/ Kategori : General Surgery
It is the most common type of cancer of the gastrointestinal system both in Turkey and in the world. It ranks 4th in men and 3rd in women among the most common cancers in Turkey. Colon cancer rates have been increasing rapidly, especially in the last 10 years.
Due to the high number of patients, the prevalence of Colon Cancer screening tests, the development of chemotherapy and surgical treatments, and the increase in medical awareness, the death rates from Colon Cancer are also decreasing. It has been shown that polyps are responsible for 90-95% of the development period of Colon Cancer. Based on this information, colonoscopic examination, which is the most reliable method among screening methods, has once again demonstrated its importance.
Colon Cancer Risk Factors
- Age; After the age of 50, the risk steadily increases.
- Hereditary Risk Factors; Colorectal cancer in a first-degree relative
- Some genetic diseases (Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome), Familial Adenomatous Polyposis (FAP) Coli Syndrome)
- History of adenomatous polyps in the past
- Environmental and Dietary Risk Factors
- male gender
- Life style
- There is a 5-10 fold difference between nations against developed societies. Consuming animal fat Red meat (Do not eat charred meat and juices)
- Obesity
- eating too much sugar
- Alcohol
- Cigarette
- Individuals who have received pelvic radiotherapy
Inflammatory Bowel Disease (Both ulcerative colitis and Crohn’s disease increase the risk in direct proportion to the duration of the disease.)
Conditions That Mitigate Risk
- Eating plenty of vegetables (raw and green vegetables are the most beneficial)
- Nutrition with foods containing fiber and carotenoids, active life
- Aspirin and other NSAIDs
- Oils containing oleic acid, such as olive oil, hazelnut oil, fish oil, do not increase the risk.
- Calcium, selenium, vitamins A, C and E.
Colon Cancer Symptoms
There may be a change in bowel habit (diarrhea or more in the form of constipation). Especially in rectal cancers, due to narrowing, constipation, thin stools like pencils are seen. In fact, the patient may become unable to pass any gas or stool.
- rectal bleeding
- Stomach ache
- Swelling
- tenesmus
The person goes to the toilet with the need to pass stool, but cannot pass stool. In rectal cancers, it occurs because the rectum is filled with a mass instead of stool.
- iron deficiency anemia
If the stool occult blood test is positive in patients whose anemia is investigated, colonoscopy is required again.
- Weight loss and loss of appetite
Screening Tests
Stool Occult Blood Test
The easiest and least invasive method for the detection of Colon Cancer is the stool occult blood test (FOC). This test is based on the knowledge that adenomas and their tumoral lesions are prone to bleeding. After the age of 50, it is recommended to be examined once a year.
Fecal Immunochemical Based Stool Tests
It is based on the detection of hemoglobin protein in erythrocytes. Therefore, vitamin C and foods containing it do not need to be cut.
DNA Stool Tests
The detection mechanism of stool DNA tests (sDNA) is based on the knowledge that cells (normal colonocytes, adenomatous cells, and cancerous cells) are constantly shed from the colonic mucosa into the stool.
Serum Biomarkers
Currently, the most widely studied serum biomarkers for colon cancer are carcinoembryonic antigen (CEA) and cancer antigen 19.9 (CA 19.9). CEA has been used for years as a biomarker in the follow-up of colon cancer progression after resection and metastatic colon cancer. Unfortunately, as a colon cancer detection method, CEA does not have a high sensitivity and specificity as it is elevated in many non-colon cancer conditions such as liver and lung diseases.
Imaging Tests
Barium Enema
Double contrast barium enema, sometimes called air-contrast barium anema, identifies pathologies in the large intestine by coating the colonic mucosa with barium and then inflating the colon with air. Multiple images are then acquired to evaluate the entire colon and rectum. Today, it is rarely used in cases where colonoscopy cannot be performed.
Virtual Colonoscopy
Virtual colonoscopy combines helical tomography scans with a computer imaging program to produce both two-dimensional (2D) and three-dimensional (3D) images of the colon. To improve accuracy, the patient requires complete bowel preparation (as in colonoscopy) and inhalation with a rectal tube to inflate the entire colon. Its advantage is the absence of sedation and minimal complication rates. When a suspicious finding is encountered, it requires colonoscopy.
rectosigmoidoscopy
In this procedure, the sigmodoscope, which is a finger-thick flexible light tube, is examined, along with the rectum, about the last 60 cm of the large intestine. Colon cleansing is done before the examination. A diet containing watery food is started a few days before and the person uses diarrhea-inducing (laxative, laxative) drugs the night before. The process takes about 10-20 minutes. Sedation is hardly necessary. The sigmoidoscope itself and the air introduced can cause mild cramping pain in your intestines.
colonoscopy
It is longer than the sigmoidoscope. The entire colon and the end of the ileum are evaluated. As in sigmoidoscopy, diet and colon cleansing are performed before the examination. The person stays hungry the night before. Since sedatives are often used, you’ll need to come with someone to drive you home. The test takes around 30 minutes.
Colonoscopy is a gold standard diagnosis and treatment method with the highest sensitivity and specificity among diagnostic methods.
Scan Suggestions
Patients without any increased risk factors:
- Rectal touch examination once a year over the age of 45
- Searching for occult blood in the stool once a year over the age of 50,
- Colonoscopy every 10 years and Sigmoidoscopy every 5 years over 50 years of age,
- Colonoscopy should be performed at the age of 40 if there is a first-degree relative older than 60 years of age with colon cancer in the family, or 10 years before the age at which the cancer occurs in case of colon cancer younger than 60 years of age.
- Those with ulcerative colitis should have a colonoscopy and biopsy once a year.
Treatment
Today, Colon Cancer treatment varies depending on the early diagnosis of the tumor. In early diagnosed tumors, the tumor can be removed under colonoscopy. After the tumor removed with clean margins, no additional treatment is often required. However, if the tumor has spread to the deeper layers of the intestine, the intestinal area where the tumor is located should be removed together with the lymph nodes accompanying the vessels feeding the intestine in accordance with oncology principles. These surgeries are now performed with the laparoscopic (closed surgery) method. Chemotherapy may be required for certain periods of time after surgery.
