II. Epidemiology
III. Risk Factors
IV. Management: Non-resectable hepatic metastases
- Radiofrequency Ablation
- Small trials suggest prolonged survival or cure
- Wong (2001) Am J Surg 182:552-7 [PubMed]
V. Prevention
- Primary prevention
- Secondary prevention
- Routine screening for other cancers
- Tobacco Cessation
- Obesity Management and Healthy Diet (Colorectal Cancer risk factors)
- Exercise improves quality of life and decreases overall mortality (goal: 150 min/week)
- Daily low dose Aspirin
VI. Course
- Five-year survival: 65%
- Recurrence risk
- Highest risk within first 5 years post-resection (17 to 42%)
VII. Complications: General
- Colorectal Cancer recurrence (typically in first 5 years after treatment)
- Second primary Colorectal Cancer
- Urinary symptoms
- Stress Incontinence
- Urge Incontinence
- Urology Consultation indications
- Persistent Urinary Retention (pelvic nerve injury is common in initial post-operative period)
- Persistent Hematuria
- Neuropsychiatric
- Cognitive dysfunction (Chemotherapy associated)
- Typically mild and transient
- Major Depression
- Anxiety Disorder
- Insomnia
- Sexual Dysfunction
- Vaginal Dryness and Dyspareunia in women
- Erectile Dysfunction (pelvic radiation, platinum-based Chemotherapy)
- Ostomy-related concerns
- Neuropathy (esp. platinum-based Chemotherapy such as oxaliplatin)
- Fatigue
- Common in Colorectal Cancer survivors
- Consider evaluating for alternative Fatigue cause (e.g Anemia, Hypothyroidism)
- Cognitive dysfunction (Chemotherapy associated)
VIII. Complications: Gastrointestinal adverse effects
- Ostomy care
-
Diarrhea
- Dietary Fiber supplementation
- Probiotic supplementation
- Periodic Loperamide (Imodium) use
-
Fecal Incontinence
- Periodic Loperamide (Imodium) use
- Methylcellulose and Dietary Fiber
- Biofeedback
- Radiation Proctitis (Diarrhea, bleeding)
- Endoscopic argon plasma coagulation
- Sucralfate enemas
- Hanson (2012) Dis Colon Rectum 55(10): 1081-95 [PubMed]
-
Abdominal Pain
- Acute pain (esp. RUQ Pain, Pelvic Pain)
- Evaluate for cancer recurrence
-
Chronic Pain
- Radiation Proctitis
- Incisional Hernia
- Acute pain (esp. RUQ Pain, Pelvic Pain)
-
Pelvic Fracture
- Higher risk in women who undergo pelvic radiation
IX. Protocol: Monitoring post-resection
- See Cancer Survivor Care
- Oncology may often establish a survivorship care plan
- Follow-up visits (starting 4-5 weeks after curative resection)
- Visit every 3-6 months for 2-3 years, then every 6 months until 5 years post-resection
- Focus areas
- Ostomy problems or Stool Incontinence
- Radiation Proctitis
- Bowel adhesions
-
Carcinoembryonic Antigen (CEA-125)
- Perform at each visit (every 3-6 months for 2-3 years, then every 6 months until 5 years post-resection)
- May avoid in Stage I at low risk of recurrence
- Other labs (e.g. CBC, Comprehensive panel) are not routinely indicated (unless other concerns)
-
Colonoscopy
- Perform at one year post resection and resect new polyps
- Normal Colonoscopy
- Repeat at 3 years post-resection, and then every 5 years
- Advanced adenomatous polyp (>1 cm, high grade dysplasia or villous component)
- Repeat Colonoscopy in 1 year
- Rectal cancer at risk of recurrence
- Flexible Sigmoidoscopy every 3-6 months for first 2-3 years post-resection
- Imaging
Images: Related links to external sites (from Bing)
Related Studies
Definition (NCI) | A malignant epithelial neoplasm that arises from the colon or rectum and invades through the muscularis mucosa into the submucosa. The vast majority are adenocarcinomas. |
Definition (NCI_NCI-GLOSS) | Cancer that develops in the colon (the longest part of the large intestine) and/or the rectum (the last several inches of the large intestine before the anus). |
Concepts | Neoplastic Process (T191) |
MSH | D015179 |
English | Carcinoma, Colorectal, Carcinomas, Colorectal, Colorectal Carcinomas, carcinoma of large intestine, carcinoma of large intestine (diagnosis), Colorectal carcinoma, carcinoma colorectal, Carcinoma;bowel;large, colorectal carcinoma, Colorectal Carcinoma, CRC, Large intestine carcinoma, Colorectal cancer, NOS, colorectal cancer, Colorectal Cancer, Large Bowel Cancer, Large Bowel Carcinoma, Large Intestine Cancer, Large Intestine Carcinoma, Cancer of Large Bowel, Cancer of Large Intestine, Cancer of the Large Bowel, Cancer of the Large Intestine, Carcinoma of Large Bowel, Carcinoma of Large Intestine, Carcinoma of the Large Bowel, Carcinoma of the Large Intestine, Carcinoma;intestine;large, carcinoma of the large bowel, carcinoma of the large intestine |
Dutch | colorectaalcarcinoom, dikkedarmcarcinoom |
German | Kolorektalkarzinom, Kolorektales Karzinom, Dickdarmkarzinom |
Italian | Carcinoma di colon e retto, Carcinoma del colon e del retto, Carcinoma dell'intestino crasso |
Portuguese | Carcinoma colorrectal, Carcinoma do intestino grosso |
Spanish | Carcinoma colorrectal, Carcinoma del intestino grueso |
Japanese | 結腸直腸癌, ケッチョウチョクチョウガン, ダイチョウガン, 大腸癌 |
French | Carcinome colorectal, Carcinome du gros intestin, Carcinome du colorectum, Carcinomes colorectaux, Carcinome colo-rectal, Carcinome recto-colique, Carcinome rectocolique, Carcinomes colo-rectaux |
Czech | Karcinom kolorekta, kolorektální karcinom, Karcinom tlustého střeva |
Hungarian | Colorectalis carcinoma, Vastagbél carcinoma |
Norwegian | Kolorektalt karsinom |
Ontology: Colon Carcinoma (C0699790)
Definition (NCI_NCI-GLOSS) | Cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). |
Definition (NCI) | A malignant epithelial neoplasm that arises from the colon and invades through the muscularis mucosa into the submucosa. The vast majority are adenocarcinomas. |
Concepts | Neoplastic Process (T191) |
SnomedCT | 154454005, 269533000 |
English | CARCINOMA OF COLON, COLON CARCINOMA, CARCINOMA COLON, Colon cancer, COLON CANCER, Carcinoma colon, Colon carcinoma, Carcinoma;colon, bowel carcinoma large, carcinoma colon, colon carcinoma, carcinoma colon cancer, carcinoma intestine large, carcinoma of colon, colon cancer, Carcinoma of colon, Carcinoma of colon (disorder), Colon Carcinoma, Colon Cancer, Colonic Carcinoma, Carcinoma of Colon, Carcinoma of the Colon, carcinoma of the colon |
Dutch | coloncarcinoom, carcinoom colon |
French | Carcinome du côlon, CANCER COLIQUE, CARCINOME COLIQUE |
German | Kolonkarzinom, Karzinom, Kolon, COLONKARZINOM, DARMKARZINOM |
Italian | Carcinoma del colon |
Portuguese | Carcinoma do cólon, CARCINOMA DO COLON |
Spanish | Carcinoma de colon, CARCINOMA DE COLON, carcinoma del colon (trastorno), carcinoma del colon |
Japanese | 結腸癌, ケッチョウガン |
Czech | Karcinom tračníku |
Hungarian | Colon carcinoma, Vastagbél-carcinoma |