Description
Colon cancer is a type of cancer that begins in the large intestine (colon). The colon is the final part of the digestive tract. Colon cancer typically affects older adults, though it can happen at any age. It usually begins as small, noncancerous (benign) clumps of cells called polyps that form on the inside of the colon. Over time some of these polyps can become colon cancers.
Polyps may be small and produce few, if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying and removing polyps before they turn into cancer.
Résumé
- Colorectal cancer is a significant health concern, with a substantial percentage of cases being preventable. While data is somewhat outdated due to the pandemic, statistics from the UK indicate a large number of diagnoses and deaths annually, highlighting the importance of preventative measures. The prevalence of colorectal cancer varies geographically, with higher incidence rates observed in the Middle East compared to certain other regions like India, where lip and oral cancer are more prominent.
- In the UK, a national screening program involves sending stool test kits to individuals at age 60, aiming to detect fecal occult blood and prompt colonoscopy if necessary. This strategy aims to identify and remove polyps, which are precursors to cancer. However, there's growing concern about increased incidence among younger patients, suggesting the screening age may need adjustment. The UAE currently recommends regular stool tests for individuals aged 40 and above, despite the absence of a national screening program.
- Colorectal cancer often manifests through symptoms such as bleeding, anemia, weight loss, abdominal pain, and changes in bowel habits, particularly diarrhea. It's crucial for clinicians to perform a digital rectal examination when patients present with rectal bleeding to rule out more serious conditions, and to avoid solely diagnosing hemorrhoids or irritable bowel syndrome without further investigation. Initial clinical steps involve digital rectal examination, anoscopy, and possibly colonoscopy with biopsy.
- Colon cancer surgery involves removing affected sections of the colon (right hemicolectomy, left hemicolectomy) or the rectum (anterior resection), with considerations for blood supply and anastomosis. Surgical approaches include open surgery, which allows direct access and palpation, and laparoscopic surgery, a minimally invasive alternative. While open surgery may have some disadvantages in terms of patient recovery, laparoscopic surgery has become more common in recent years.
- Laparoscopic techniques involve making smaller incisions, using specialized instruments and staplers for resection and anastomosis. Single-incision surgery and robotic surgery are also emerging as options to minimize scarring and improve precision. Regardless of the surgical approach, adhering to oncological principles of clear margin resection remains paramount.
- The Rapido trial introduced a modified approach to rectal cancer treatment, involving short-course radiation, extensive chemotherapy, and delayed surgery, yielding promising results. Another groundbreaking study explored treating MMR-deficient rectal cancer with PD-1 blockade drugs, demonstrating complete tumor regression in a significant number of patients. While surgery remains the standard of care for most colorectal cancers, the potential for non-surgical cures is evolving.
- Clinical trials and research are continually refining treatment protocols and exploring new drug therapies. However, for now, complete responses to chemo-radiotherapy still warrant surgery in the absence of a specific research trial accepting a 'watch and wait' approach. The best screening test to rule out colon cancer is the faecal occult blood test.
- Individuals should be aware that rectal bleeding requires thorough investigation, and individuals over 40 should consider stool-based blood tests. Units conducting cancer surgery must have robust multidisciplinary tumor boards to ensure optimal and informed treatment decisions. Also meat consumption is related to high incidence of colorectal cancer.
Exemple de certificat
À propos des intervenants
Dr Zakir K Mohamed
MRCSEd (Gen surg) CCBST (UK) MSc (Leeds) FRCSEd (Colorectal)FRCSEng CCT (UK)
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