Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Hernias
- Dysphagia: gastro-oesophageal reflux disease (GORD)
- Dysphagia: oesophageal neoplasia
- Dysphagia: oesophageal dysmotility syndromes
- Gastric disease: peptic ulcer disease (PUD)
- Gastric disease: gastric neoplasia
- Hepatobiliary disease: jaundice
- Hepatobiliary disease: gallstones and biliary colic
- Hepatobiliary disease: pancreatic cancer
- Hepatobiliary disease: liver tumours
- The spleen
- Inflammatory bowel disease: Crohn's disease
- Inflammatory bowel disease: ulcerative colitis
- Inflammatory bowel disease: infective colitis
- Inflammatory bowel disease: non-infective colitis
- Colorectal disease: colorectal cancer
- Colorectal disease: colonic diverticular disease
- Perianal: haemorrhoids
- Perianal: anorectal abscesses and fistula in ano
- Perianal: pilonidal sinus and hidradenitis suppurativa
- Perianal: anal fissure
- Chronic limb ischaemia
- Abdominal aortic aneurysms
- Diabetic foot
- Carotid disease
- Raynaud's syndrome
- Varicose veins
- General aspects of breast disease
- Benign breast disease
- Breast cancer
- The thyroid gland
- Parathyroid
- Adrenal pathology
- Multiple endocrine neoplasia (MEN)
- Obstructive urological symptoms
- Testicular lumps and swellings
- Haematuria
- Brain tumours
- Hydrocephalus
- Spinal cord injury
- Superficial swellings and skin lesions
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Colorectal disease: colorectal cancer
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Hernias
- Dysphagia: gastro-oesophageal reflux disease (GORD)
- Dysphagia: oesophageal neoplasia
- Dysphagia: oesophageal dysmotility syndromes
- Gastric disease: peptic ulcer disease (PUD)
- Gastric disease: gastric neoplasia
- Hepatobiliary disease: jaundice
- Hepatobiliary disease: gallstones and biliary colic
- Hepatobiliary disease: pancreatic cancer
- Hepatobiliary disease: liver tumours
- The spleen
- Inflammatory bowel disease: Crohn's disease
- Inflammatory bowel disease: ulcerative colitis
- Inflammatory bowel disease: infective colitis
- Inflammatory bowel disease: non-infective colitis
- Colorectal disease: colorectal cancer
- Colorectal disease: colonic diverticular disease
- Perianal: haemorrhoids
- Perianal: anorectal abscesses and fistula in ano
- Perianal: pilonidal sinus and hidradenitis suppurativa
- Perianal: anal fissure
- Chronic limb ischaemia
- Abdominal aortic aneurysms
- Diabetic foot
- Carotid disease
- Raynaud's syndrome
- Varicose veins
- General aspects of breast disease
- Benign breast disease
- Breast cancer
- The thyroid gland
- Parathyroid
- Adrenal pathology
- Multiple endocrine neoplasia (MEN)
- Obstructive urological symptoms
- Testicular lumps and swellings
- Haematuria
- Brain tumours
- Hydrocephalus
- Spinal cord injury
- Superficial swellings and skin lesions
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Summary
Incidence
Second commonest cause of cancer deaths in both sexes after lung. 30 000 new cases per year in the UK. Increasing incidence with age, > 75 yrs = 300/100 000. Increasing incidence in UK. Colon M = F, rectal M > F, More common in developed countries. Incidence increasing in less-developed nations.
Aetiology
Family history: if one first-degree relative, the risk is increased more than two-fold. Two first-degree relatives or one first-degree relative diagnosed < 45 yrs indicates a lifetime risk of death from colorectal cancer of 1 in 6, or 1 in 10, respectively. 5% of colorectal-cancer patients have a genetic syndrome. Familial adenomatous polyposis (FAP) is an autosomal dominant mutation of the APC gene and presents with multiple colonic polyps. Hereditary non-polyposis coli (HNPCC) and Gardner's syndrome are also responsible.
Inflammatory bowel disease: ulcerative colitis for over 10 years gives an eight-fold age-related risk.
Lifestyle – increased risk with: obesity; smoking; diet – high in processed meats, low in vegetables and fibre, alcohol; reduced exercise; bile salts. Reduced risk with: folic acid, Ca2+, selenium, NSAIDs (including aspirin), HRT.
Pathogenesis
Two-thirds of cancers develop in the colon, the rest in the rectum. Adenomatous polyps have malignant potential via adenoma-carcinoma sequence: have tubular (70%), villous (10%), tubulovillous (20%) morphology. Left-sided cancers tend to be annular, stenosing and more likely to obstruct. Right-sided cancers are sessile and cause occult bleeding. 3% of tumours synchronous, 5–10% metanchronous. Majority are adenocarcinomas. Others: carcinoid, lymphoma, sarcoma. Cancers are graded as well, moderately or poorly differentiated.
- Type
- Chapter
- Information
- Hospital SurgeryFoundations in Surgical Practice, pp. 424 - 428Publisher: Cambridge University PressPrint publication year: 2009