Colorectal Cancer

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Risk factors:

1. Age (incidence begins to increase after age 40; peak incidence between 60-75 years)

2. Family history (especially with familial polyposis or Gardner, Turcot, or Lynch syndrome)

3. Inflammatory bowel disease (ulcerative colitis > Crohn's disease, but both increase risk)

4. Low-fiber, high-fat diet (weak evidence)

Important points:

1. Patients may present with asymptomatic blood in stool (visible streaks of blood on stool or guaiac-positive), anemia with right-sided colon cancer, change in stool caliber ("pencil stool") or frequency (alternating constipation and frequency) with left-sided colon cancer. As with any cancer, look for weight loss.

2. Occult blood in the stool of a patient > 40 years old should be considered colon cancer until proved otherwise. To rule out colon cancer, either do flexible sigmoidoscopy and a barium enema or do a iota), colonoscopy If you see any lesions with a flexible sigmoidoscope or barium enema, you need to do a total colonoscopy with removal and histologic examination of all polyps/lesions. For this reason, most people now start with colonoscopy.

3. Carcinoerabryonic antigen (CIA) is often, elevated with colon cancer, and a preoperative level is usually measured. After surgery to remove the tumor, CEA should return to normal levels. Periodic, monitoring of CEA postoperatively helps to detect recurrence before it is clinically apparent. CEA is not: used as a screening tool for colon cancer; it is used only to follow known cancer,

4. Treatment is primarily surgical, with resection of involved bowel. Adjuvant chemotherapy is sometimes done with. .S fluorouracil (5-FU) and levamisole or leucovorin.

5. Colon cancer frequently metastasizes to the li ver; if the metastasis is solitary, surgical resection is often attempted/With metastases elsewhere, chemotherapy is the only option. Prognosis is poor.

6. Colon cancer is a common cause of a large bowel obstruction in an adult.

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