Colon
COLON CA
RF
·       family history
·       IBD
·       colorectal polyps
·       low fiber, high fat diet (now controversial)
·       diet low in vitamin A, E, C, and selenium
S/S
Ⓡ
Ⓛ
·       typically shows up with anemia (hypochromic, iron deficiency)
·       the right age group (elderly), for no good reason.
·       Stools will be 4+ for occult blood.
·       Colonoscopy and biopsies are diagnostic;
·       surgery (right hemicolectomy) is treatment of choice.
·       typically shows with bloody bowel movements. Blood coats the outside of the stool,
·       there may be constipation,
·       stools may have narrow caliber.
·       Flexible proctosigmoidoscopic exam (45 or 60 cm) and biopsies are usually the first diagnostic study.
·       Before surgery is done, full colonoscopy is needed to rule out synchronous second primary.
·       CT scan helps assess operability and extent.
·       Pre-op chemotherapy and radiation may be needed for large rectal cancers.
Dx
·       Colonoscopy + Bx
·       Evaluate for mets w/ CT
·        
Classification
Description
5y survival
Duke A
Tumor limited to mucosa or submucosa (mus. propia)
80%
Duke B1
Tumor invades but not through muscle wall
60%
Duke B2
Tumor penetrates entire wall but no node involvement.
55%
Duke C1
Tumor into but not through wall but positive lymph nodes
30%
Duke D
Distant metastasis regardless of invasion
<5%
Tx
Resection
PPx
PREVENT COLON CA?
If there is Aspirin in the choices choose it, then choose fiber, then go with vitamin D.
Prog
Regardless of stage, the overall five year survival is 35%

Crohn’s
·       Crohn’s disease is surgically treated only when there are complications such as bleeding, stricture, or fistulization.
UC
·       We can tx it surgically, but it’s not a wise choice (stoma or illioanal anastomosis are not very nice)
·       When to tx surgically?
o   active disease for more than 20 years (malignant degeneration),
o   severe nutritional depletion,
o   multiple hospitalizations,
o   need for high-dose steroids or immunosuppressants
o   development of toxic megacolon (fever, leukocytosis, abdominal pain and tenderness, and massively dilated colon with gas within the wall).
Pseudomembranous enterocolitis
·       caused by overgrowth of Clostridium difficile in patients who have been on antibiotics.
·       Any antibiotic can do it. Clindamycin was the first one described, and, currently, cephalosporins are the most common cause.
·       There is profuse, watery diarrhea, crampy abdominal pain, fever, and leukocytosis.
·       The diagnosis is best made by identifying the toxin in the stool.
·       The culpable antibiotic should be discontinued, and no antidiarrheals should be used.
·       Metronidazole is the treatment of choice, with vancomycin serving as an alternate.
·       A virulent form of the disease, unresponsive to treatment, with a WBC above 50,000 and serum lactate above 5, requires emergency colectomy.
Sigmoid volvulus:
·       Old pt
·       S/S of obsturction
·       Dx: KUB (Parrot’s peak) –> Air-fluid level + dilated colon + SB
·       Tx: proctosigmoidoscopy
·       If rx –> remove affecetd segment

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