Colon_Cancer - Colon Cancer Vic V. Vernenkar, D.O...

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Unformatted text preview: Colon Cancer Vic V. Vernenkar, D.O Epidemiology 3 rd most common cancer in males and females. Accounts for 11% of cancer deaths. In 2000, 130,200 cases (colon and rectum). Lifetime risk 6%. Epidemiology Rare before the age of 40y, rapid increase at 50y. At presentation 37% localized, 37% regional, 20% metastatic. 1 and 5y survival is 80% and 61% overall. IBD, FAP, HNPCC, FHX are at inc risk 75% sporadic, rest are in those at high risk. Risk Factors Diet- red meat, animal fat, increased cholesterol in stool. Folate is protective. Decreased folate= Kras mutations. Calcium supplementation decrease new adenomas. Fiber- use not supported yet for protection from cancer. Meds-HRT, ASA, NSAIDS, COX2 protective and in some cases cause regression of polyps. Alcohol consumption increases risk. Risk Factors Polyps-Most cancers arise from them. Classified as neoplastic (adenomatous)which are benign or malignant, and nonneoplastic (hyperplastic, mucosal, inflammatory, hamartomaous). Adenomatous polyps found in 33% of people by age 50, 50% by age 70. Most lesions <1cm, 60% single, 40% multiple. Invasive cancer will develop in 24% when untreated. Colon Polyp Polyps Three variants: Tubular(75-87%), tubulovillous (8-15%), Villous(5-10%). Tubulovillous, villous(most in rectum) have most increased risk of cancer 20% and 40% respectively. Size, degree of dysplasia (46% cancer >2cm, 34% in severe dysplasia). Polyps Poor differentiation, lymphovascular invasion, submucosal, positive margin. Level of invasion 0-4 head to stalk (Haggitt level) Lymphatic channels do not penetrate above the muscularis mucosa, so level 4 most important. 8-17% of polyps with invasive carcinoma will have + nodes. A negative margin of resection associated with decreased adverse outcome (0.8%). 27% of patients with positive margins will have adverse outcomes. Treatment Endoscopic removal, surveillance every three years....
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Colon_Cancer - Colon Cancer Vic V. Vernenkar, D.O...

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