RFs for colon cancer?
Age Adenomatous polyps Family hx (FAP, HNPCC) IBD Previous cancer Diet (high fat, low fibre) Diabetes
Primary prevention of colon CA?
Increase dietary fibre Less animal fat and red meat Decrease smoking and EtOH Exercise Weight loss if overweight
Colon CA screening for people at average risk (>50, no FHx)?
One of: FOBT every 2 years Flex sig every 5 years FOBT + Flex sig every 5 years Double contrast barium enema every 5 years Colonoscopy every 10 years
Colon CA screening for people at above average risk?
HNPCC: genetic testing + cscope q2yrs at age 20
FAP: genetic testing + flex sig annually at age 10-12
Fam Hx of cancer/polyps: colonoscopy q5 at 40yo or 10 years earlier than youngest relative
Signs and symptoms of colon CA?
Often asymptomatic
Hematochezia (L sided lesions)
Melena (R sided lesions)
Weakness, anemia, wt loss, palpable mass, obstruction
Where does colon CA like to metastasize?
Lymph Nodes
Liver (most common) and lung via hematogenous spread
Ovary, Blumer’s shelf via peritoneal seeding
Intraluminal
Investigations for colon CA?
Cscope or air contrast barium enema or flex sig to look for synchronous lesions
FOBT+ and microcytic anemia or bowel habit change = cscope
Metastatic workup for colon CA?
CXR, abdo CT/S, bone scan, CT hear only if lesions suspected
Treatment for colon CA?
Surgery in potentially curable or symptomatic cases
Radiotherapy and chemotherapy for patients with node positive disease and/or palliative