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nullAssociated with race, life condition, diet. Patients with inflammatory bowel disease, especially ulcerative colitis, at high risk for the development of a malignancyAssociated with race, life condition, diet. Patients with inflammatory bowel disease, especially ulcerative colitis, at high risk for the development of a malignancyCOLONIC CARCINOMAETIOLOGYMacroscopically 1.Phymatoid type. 2.Infiltrative type 3.Ulcerative type. Microscopical types: adenocarcinoma, mucous cancer, signet ring cancer. Macroscopically 1.Phymatoid type. 2.Infiltrative type 3.Ulcerative type. Microscopical types: adenocarcinoma, mucous cancer, signet ring cancer. PATHOLOG ICAL CLASSIFICATIONIn clinic, Duke's stages is used for tumor staging. Duke's A: confined to the bowel wall. Duke's B: penetrating the bowel wall, without lymph node metastasis. Duke's C: penetrating the bowel wall with lymph node metastasis. Duke's D: with distant metastasis, peritoneal seeding, or metastasis beyond surgical resection.In clinic, Duke's stages is used for tumor staging. Duke's A: confined to the bowel wall. Duke's B: penetrating the bowel wall, without lymph node metastasis. Duke's C: penetrating the bowel wall with lymph node metastasis. Duke's D: with distant metastasis, peritoneal seeding, or metastasis beyond surgical resection.CLINICOPATHOLOGICAL STAGESTUMOR SPREAD Direct extension: 1. grows circumferentially 2. Longitudinal submucosal extension 3. penetrates the outer layersTUMOR SPREAD Direct extension: 1. grows circumferentially 2. Longitudinal submucosal extension 3. penetrates the outer layers Hematogenous metastasis: Colonic veins, portal vein, hepatic metastasis. Lumbar,vertebral veins to the lungs and elsewhere. Regional lymph node metastasis: the most common form of tumor spread. Transperitoneal metastasis: extended through the serosa, peritoneal seeding. Hematogenous metastasis: Colonic veins, portal vein, hepatic metastasis. Lumbar,vertebral veins to the lungs and elsewhere. Regional lymph node metastasis: the most common form of tumor spread. Transperitoneal metastasis: extended through the serosa, peritoneal seeding. SYMPTOMS AND SIGNS 1.Change in bowel habits and nature of stool 2.Abdominal pain 3.A palpable or visible abdominal mass 4.Intestinal obstruction 5.Systemic SymptomsSYMPTOMS AND SIGNS 1.Change in bowel habits and nature of stool 2.Abdominal pain 3.A palpable or visible abdominal mass 4.Intestinal obstruction 5.Systemic SymptomsSymptoms depend on the anatomic location of the lesion, its type and extent, complications, perforation, obstruction, hemorrhage. Different in right and left colon.Symptoms depend on the anatomic location of the lesion, its type and extent, complications, perforation, obstruction, hemorrhage. Different in right and left colon.Duration of symptoms The average delay 7-9 months. The risk factors: 1.change in bowel habit or continuous abdominal discomfort, insidious pain and distention. 2.Feces (stool) blended with blood and mucus. 3.progressive anemia and loss of weight and strength. 4.abdominal mass.Duration of symptoms The average delay 7-9 months. The risk factors: 1.change in bowel habit or continuous abdominal discomfort, insidious pain and distention. 2.Feces (stool) blended with blood and mucus. 3.progressive anemia and loss of weight and strength. 4.abdominal mass.DIAGNOSISDigital examination. The physician hesitate to make the necessary examination because it involes soiling the fingers. It is important to detect colorectal cancer within reach of the examiner's finger. Digital examination. The physician hesitate to make the necessary examination because it involes soiling the fingers. It is important to detect colorectal cancer within reach of the examiner's finger. Proctosigmoidoscopy One of the most valuable diagnostic methods. Flexible fiberoptic colonoscopy total colonoscopy in every patient with suspected or known cancer. a cancer is found and biopsied; synchronous lesions are excluded; operation is planned . Proctosigmoidoscopy One of the most valuable diagnostic methods. Flexible fiberoptic colonoscopy total colonoscopy in every patient with suspected or known cancer. a cancer is found and biopsied; synchronous lesions are excluded; operation is planned . Barium enema Helpful to identify other more proximal lesions. Colonoscopy is still necessary to prove that the defect is neoplastic and, more importantly , to detect synchronous polys or cancer.Barium enema Helpful to identify other more proximal lesions. Colonoscopy is still necessary to prove that the defect is neoplastic and, more importantly , to detect synchronous polys or cancer.Ultrasonography and CT Helpful to confirm the mass, enlarged lymph nodes and liver metastases. CEA increase in 60% of patients with colonic cancer. Though its specificity is not satisfactory, CEA is helpful to judge the prognosis and recurrence.Ultrasonography and CT Helpful to confirm the mass, enlarged lymph nodes and liver metastases. CEA increase in 60% of patients with colonic cancer. Though its specificity is not satisfactory, CEA is helpful to judge the prognosis and recurrence.TREATMENT Wide surgical resection of the lesion and its regional lymphatic drainage. The primary tumor is resected, even if distant metastases have occurred, since prevention of obstruction or bleeding may offer palliation for long periods.TREATMENT Wide surgical resection of the lesion and its regional lymphatic drainage. The primary tumor is resected, even if distant metastases have occurred, since prevention of obstruction or bleeding may offer palliation for long periods.Preoperative preparation 1.appropriate dietary restriction, 2.mechanic cleansing, 3.nonabsorbable antibiotics.Preoperative preparation 1.appropriate dietary restriction, 2.mechanic cleansing, 3.nonabsorbable antibiotics.Right hemicolectomy cecum,ascending colon,hepatic flexure Left hemicolectomy diastal transverse,splenic flexure,descending colon Sigmoid colectomy or high anterior resectionRight hemicolectomy cecum,ascending colon,hepatic flexure Left hemicolectomy diastal transverse,splenic flexure,descending colon Sigmoid colectomy or high anterior resectionTreatment of obstruction Obstructing lesions of the right colon resection and anastomosis in one stage. Obstructing lesions of the left colon resection, anastomosis postponed, temporary end colostomy. With the development of surgical procedures, antibiotics, and intra-operative lavage, resection and anastomosis can be performed in one stage.Treatment of obstruction Obstructing lesions of the right colon resection and anastomosis in one stage. Obstructing lesions of the left colon resection, anastomosis postponed, temporary end colostomy. With the development of surgical procedures, antibiotics, and intra-operative lavage, resection and anastomosis can be performed in one stage.PROGNOSIS The prognosis is better The 5 year survival rate of the patients with Duke's A, B, C stage tumor is 80%, 65%, 30% respectively. PROGNOSIS The prognosis is better The 5 year survival rate of the patients with Duke's A, B, C stage tumor is 80%, 65%, 30% respectively.