Colon Cancer Flashcards
Rectum
15cm
7cm are intra-peritoneal
Anus
4.2cm ( 3-5.3cm)
Anatomical anus :
up to marginal line
Chances of synchronous lesion on colonoscopy
6-8%
If not performed before, 3 months after Surgery
CEA
most likely correlated with advanced disease, but absent in 50% of cases
% that have metastatis at presentation
20
PET CT
not routinely recommended
Tumor in Caecum, Ascending Colon
Right hemicolectomy
High ligation of :
- ileocolic
- right colic
Tumor in Transversum
Right or left extended
- including middle colic artery
Sigmoid cancer
- Left hemicolectomy
Sigmoid colectomy
Number of lymph nodes for correct staging
12
Node positive (Stage) Colon
III adjuvant therapy (FOLFOX 6 months)
Surveillance post operative for T3 or greater
CEA
- every 3 months for the first 2 years
- every 6 months for the following 3 years
- CT yearly
Surveillance post operative
at 1 year or within 6 months if incomplete pre op
Colon : Adjuvant therapy for
Stage III or Stage II with risk factors:
- poorly differentiated
- lymphovascular invasion
- bowel perforation
- inadequate tumor margins
- T4 lesions
- low nodal count
T1
submucosa
T2
muscularis propria
T4
neighbouring organs
T4a
perforates visceral peritoneum
T4b
infiltrates or adheres directly other organs
N1
1-3 pericolic LN
N2
4 or more pericolic LN
N3
LN in central vascular structures
M1
Remote metastasis
- Liver
- LN
- Peritoneum
- Lungs
- Skelet
- Adrenal glands
- Brain
Stadium AJCC
Stage I : T1 or T2, N0 M0
Stage II : > T3 and N0 M0
Stage III : N+
Stage IV : M+
T3
Through muscularis mucosa into pericolorectal tissues
Liver first
If liver metastasis Neo adjuvant chemotherapy Liver resection \+/- Chemotherapy Colon resection
Rectum : Neo Adjuvant Rx Chemo
II-III
cT3-T4 N0, M0
cT1-4 N1-2
Rectum : Adjuvant Chemo
cT3-T4 N0, M0
cT1-4 N1-2
Rectum Stadium I
pT1-2, N0, M0
no adjuvant or neo-adjuvant
Stadium IV
Operation + palliatve Chemo
Safety Margins
4-5 cm
For low risk deep tumors 3cm
