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Colon Carcinoma

Colon carcinoma is identified as the most frequent malignancy of the gastrointestinal tract. The clinical presentation, comprised of abdominal pain, nausea, vomiting, anemia and weight loss is frequently insidious, thus the diagnosis is delayed in the majority of patients. Both noninvasive and invasive imaging studies, as well as biopsy with the histopathological examination, are used to define the clinical stage and prognosis.


Presentation

With almost 100,000 new cases estimated to occur in the United States in 2017 (with equal gender predilection), colon carcinoma is among the most commonly diagnosed malignant diseases in the Western World [1] [2]. The incidence rate seems to be highest among the elderly individuals (between 60-70 years of age), and several risk factors have been established, most important being physical inactivity, obesity and increased body weight, cigarette smoking, overt alcohol consumption and certain dietary habits, such as excessive intake of animal fats and reduced fiber in nutrition [3] [4] [5]. Countries belonging to the developed world (Canada, Denmark, Sweden, the United States, and several other) report the highest prevalence rates [3] [4] [5] The clinical presentation of colon carcinoma is usually nonspecific and up to several months may pass before the diagnosis is even suspected [6] [7]. One of the reasons is the insidious and nonspecific onset of gastrointestinal complaints such as abdominal pain, fatigue, weakness, and changes in bowel habits (both constipation and diarrhea) [4] [5] [8]. This is typical for right-sided colonic cancers, whereas left-sided carcinomas of the colon more frequently produce symptoms that are highly suggestive of a neoplastic process in the large intestine - rectal bleeding and anemia [4] [9]. In addition, cramping, anorexia, and abdominal discomfort may be reported [4] [8]. As anemia becomes more severe and clearly stems from iron depletion due to continuous bleeding, cardiac manifestations (angina pectoris and palpitations) can appear, in which case immediate suspicion toward colon carcinoma, especially in elderly men and women, should be mounted [4] [5].

Fatigue
  • One of the reasons is the insidious and nonspecific onset of gastrointestinal complaints such as abdominal pain, fatigue, weakness, and changes in bowel habits (both constipation and diarrhea).[symptoma.com]
  • Symptoms that may require attention are fatigue from anaemia, visceral pain from liver metastases and, less commonly, somatic pain from bone metastases. If lung metastases are present there may be pleural effusions causing breathlessness.[healthengine.com.au]
  • Symptoms that may require attention are fatigue from anaemia , visceral pain from liver metastases and, less commonly, somatic pain from bone metastases . If lung metastases are present there may be pleural effusions causing breathlessness .[myvmc.com]
  • The secondary outcomes will be: physical measurements, QoL, level of physical activity, executive functions, fatigue, body composition, blood test, energy expenditure.[clinicaltrials.gov]
  • The patient also reported fatigue and weight-loss over the past 6 months. Examination revealed a 5 cm X 3 cm well-defined firm lump in the right iliac fossa. Hematological investigations showed normocytic normochromic anemia with a raised ESR.[saudijgastro.com]
Thyroid Nodule
  • There was no pathologic FDG uptake other than the thyroid nodule in PET-CT. Fine needle aspiration of the thyroid nodule revealed a follicular neoplasia.[ncbi.nlm.nih.gov]
Constipation
  • The presenting symptoms varied and included abdominal pain, nausea, vomiting, diarrhea, constipation, and hematochezia, with symptom duration ranging from a few days to 4 months. No patient had a predisposing disease or syndrome.[ncbi.nlm.nih.gov]
  • One of the reasons is the insidious and nonspecific onset of gastrointestinal complaints such as abdominal pain, fatigue, weakness, and changes in bowel habits (both constipation and diarrhea).[symptoma.com]
  • Uncomplicated, the symptoms are those of gradually increasing constipation, rare diarrhea, almost never bloody stools, and often no loss of weight.[pubs.rsna.org]
  • Constipation : When bowel movements are infrequent or difficult.[m.webmd.com]
  • People may experience some chronic pain and anemia along with intermittent constipation.[livestrong.com]
Abdominal Pain
  • The clinical presentation, comprised of abdominal pain, nausea, vomiting, anemia and weight loss is frequently insidious, thus the diagnosis is delayed in the majority of patients.[symptoma.com]
  • A 50-year-old woman was admitted with right abdominal pain, fever and chills. The initial diagnosis was a pyogenic liver abscess. Subsequent CT scan and colonoscopy evidenced a hepatic flexure colon cancer abscessed within segment 6 of the liver.[ncbi.nlm.nih.gov]
Rectal Bleeding
  • A 69-year-old man presented with rectal bleeding. Colonoscopy revealed a rectal tumor, whereas biopsy specimens revealed a poorly differentiated carcinoma. During the preoperative evaluation, pancytopenia was detected.[ncbi.nlm.nih.gov]
  • This is typical for right-sided colonic cancers, whereas left-sided carcinomas of the colon more frequently produce symptoms that are highly suggestive of a neoplastic process in the large intestine - rectal bleeding and anemia.[symptoma.com]
  • We herein report a case of such a tumor in a 42-year-old male who presented with rectal bleeding and pain abdomen. A circumferential growth occluding the lumen at the hepatic flexure was visualized on colonoscopy.[ccij-online.org]
  • Rectal bleeding may be coming from around the anus, commonly haemorrhoids (piles) or a fissure. Polyps, rather than cancer, may produce rectal bleeding or iron deficiency anaemia.[netdoctor.co.uk]
Nausea
  • The presenting symptoms varied and included abdominal pain, nausea, vomiting, diarrhea, constipation, and hematochezia, with symptom duration ranging from a few days to 4 months. No patient had a predisposing disease or syndrome.[ncbi.nlm.nih.gov]
  • The clinical presentation, comprised of abdominal pain, nausea, vomiting, anemia and weight loss is frequently insidious, thus the diagnosis is delayed in the majority of patients.[symptoma.com]
  • Case Report A 35-year-old male presented with a 3-month history of intermittent abdominal pain, weight loss, dyspepsia, intermittent fever, and nausea. No history of bloody diarrhea.[jdrntruhs.org]
  • He presented with asthenia and 10-day progression of abdominal pain, nausea, vomiting, absence of bowel transit, and great abdominal distension. Plain x-ray showed marked small bowel dilation.[revistagastroenterologiamexico.org]
Abdominal Mass
  • Pregnant women with suspicious abdominal mass should be evaluated for a possible colorectal carcinoma even in the absence of any other gastrointestinal symptoms associated with it and undergo rectal examination and sigmoidoscopy.[ncbi.nlm.nih.gov]
  • […] sessile serrated adenoma esp. with dysplasia Syndromes familial adenomatous polyposis, Lynch syndrome, Peutz-Jeghers syndrome, Juvenile polyposis syndrome, serrated polyposis syndrome, MUTYH polyposis syndrome, Cowden syndrome Signs /-blood in stools, /-abdominal[librepathology.org]
  • Of any age with a right lower abdominal mass consistent with involvement of the large bowel.[patient.info]
  • Tumor invasion in a 71-year-old woman with a palpable abdominal mass. Contrast-enhanced CT scan shows a large, circumferential soft-tissue mass in the cecum, a finding compatible with carcinoma.[pubs.rsna.org]
Subcutaneous Nodule
  • Physical examination revealed two subcutaneous nodules on the glans penis. Biopsy of the nodules showed that penile metastasis of sigmoid colon carcinoma.[ncbi.nlm.nih.gov]
Cesarean Section
  • We presented a woman with metachronous metastatic ovarian tumor existing 1 year after surgical removal of perforated sigmoid colon carcinoma encountered during cesarean section of woman of 36-week gestation for fetal distress.[ncbi.nlm.nih.gov]
Swelling of the Scrotum
  • A 67-year-old man with a 2-year history of swelling of the scrotum and a breast lump was referred to us for surgical treatment of an irreducible left inguinal hernia and a right breast tumor. Blood examination results showed severe anemia.[ncbi.nlm.nih.gov]

Workup

Early recognition of colon carcinoma is favored, especially if we know that 5-year survival rates range between 40%-60%, depending on the stage [1] [6] [7] [8]. In fact, the degree of tumor invasion and infiltration of adjacent lymph nodes or distant organs are the two predictors of mortality in this patient population, suggesting that advanced stages of the disease carry a poorer prognosis undoubtedly [4]. In all patients with non-specific gastrointestinal (GI) complaints, a thoroughly obtained patient history and a meticulous physical examination can provide sufficient clues to investigate colon carcinoma as a potential cause, especially among the elderly. A complete blood count (CBC) and basic biochemical workup will often identify sideropenic anemia, in which case a fecal occult blood test must be performed. If the test is positive, imaging studies should be employed. Several studies have been listed in the literature as possible modalities for visualization of the tumor, including barium enema and computed tomographic colonography (CTC), but optical colonoscopy (OC) remains the cornerstone in diagnosing colon carcinoma [1] [10]. Moreover, fluorodeoxyglucose positron emission tomography (FDG-PET), magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI), ultrasonography, computed tomography (CT) as well as contrast-enhanced MRI have also been mentioned as valuable procedures in determining the stage of the tumor [1] [4]. A definite diagnosis, however, is made after a biopsy sample is obtained during colonoscopy for microscopic evaluation, and the tumor is classified according to the degree of local (but also distant) tissue invasion by the TNM classification [4] [5]:

  • Stage I - Tumor invasion of the mucosa or submucosa (T1 and T2, respectively), without nodal (N0) or metastatic spread (M0).
  • Stage II - Proliferation either into the muscularis propria (T3) or the adjacent organs and the peritoneum (T4) with N0 and M0 (also known as stages IIA and IIB).
  • Stage III - In the setting of tumor infiltration into 1-3 lymph nodes (N1) and the mucosa/submucosa (T1/T2), the tumor is classified as stage IIIA. In the setting of deeper local invasion (T3/T4), the stage IIIB is reached, and if four or more lymph nodes are infiltrated by the tumor (N2), regardless of the local tissue invasion, colon carcinoma has reached stage IIIC.
  • Stage IV - The presence of distant metastases denotes the most advanced stage of the tumor, carrying a very poor prognosis.
Fusarium
  • Abstract Zearalenone (ZEN) and Aflatoxin B1 (AFB1) are fungal secondary metabolites produced by Fusarium and Aspergillus genera, respectively. These mycotoxins are found world-wide as corn and wheat contaminants.[ncbi.nlm.nih.gov]
Clostridium Perfringens
  • The Clostridium perfringens enterotoxin (CPE) is a pore-forming toxin with selective cytotoxicity. The transmembrane tight junction proteins claudin-3 and -4 are known high affinity CPE receptors.[ncbi.nlm.nih.gov]

Treatment

  • Novel treatment strategies such as immunotherapy are being evaluated to further improve the outcomes of colorectal cancer patients.[ncbi.nlm.nih.gov]

Prognosis

  • KEYWORDS: Colon carcinoma; Metastasis; Prognosis; Transglutaminase 2; mRNA[ncbi.nlm.nih.gov]
  • Stage IV - The presence of distant metastases denotes the most advanced stage of the tumor, carrying a very poor prognosis.[symptoma.com]
  • Metastases from the urinary tract are CK7 /CK20 / Prognosis Too few cases have been reported to assess prognosis. References 1 Sakamoto K, Watanabe M, De La Cruz C, et al. Primary invasive micropapillary carcinoma of the colon.[e-immunohistochemistry.info]

Etiology

  • The etiology is usually considered as traumatic. Carcinoma of the splenic angle is consistently one of the rarest of colon carcinomata, that of the descending colon alone being more rare.[pubs.rsna.org]
  • This prompted us to report these two cases and review the possibility of an etiological relationship between the two pathological conditions.[saudijgastro.com]
  • Background Neuroendocrine tumors represent an expansive group of neoplasms that share an etiology of epithelial origin with neuroendocrine differentiation and potential for hormone release.[bmcneurol.biomedcentral.com]
  • Tumor markers were done and CA125 was 172.4U/ml (Normal Endometriosis is a common gynaecological disorder with varied etiologies and presentations involving pelvic and extrapelvic organs.[jmidlifehealth.org]

Epidemiology

  • Abstract Epidemiology and evidence have demonstrated that colon carcinoma is one of the most common gastrointestinal tumors in the clinic.[ncbi.nlm.nih.gov]
  • Information about the Study Design: International epidemiological observational non-interventional study Study population: Patients with pancreas or colorectal carcinoma undergoing surgery Number of patients: 100 participants First patient in: April 2019[centogene.com]
  • Abbreviations SEER: Surveillance, epidemiology and end results CK: Cytokertin FOLFOX: Fluorouracil with leucovorin plus oxaliplatin TS-1: Tegafur, gimeracil and oteracil.[bmcsurg.biomedcentral.com]
  • Sciences Research Biennial Book Clinical Trials About Clinical Trials ECRU About Clinical Trials & Epidemiological Sciences Clinical Trials Office Biostatistics and Epidemiology Unit SingHealth Research Education & Training Back to Home Overview Professional[nccs.com.sg]
  • Found ( 762 ) clinical trials Phase Phase Biofilm Epidemiology and Mechanisms in Colon Cancer This research is being done to learn more about why people get colon cancer.[centerwatch.com]
Sex distribution
Age distribution

Pathophysiology

  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 126. National Cancer Institute website.[nlm.nih.gov]
  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management . 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 126. National Cancer Institute website.[medlineplus.gov]
  • Although constipation, fecal incontinence and several other associated benign conditions increase in frequency with aging, a paucity of information exists regarding the normal aging effect on gastrointestinal pathophysiology Tumor is an abnormal growth[colorectal-cancer.imedpub.com]
  • Pathophysiology Genetically, colorectal cancer represents a complex disease, and genetic alterations are often associated with progression from premalignant lesion (adenoma) to invasive adenocarcinoma.[emedicine.medscape.com]

Prevention

  • Abstract Oxymatrine (OMT), one of the main active components of extracts from the dry roots of Sophora flavescens, has been reported to possess many pharmacological properties including cancer-preventive and anti-cancer effects.[ncbi.nlm.nih.gov]

References

Article

  1. Kekelidze M, D’Errico L, Pansini M, Tyndall A, Hohmann J. Colorectal cancer: Current imaging methods and future perspectives for the diagnosis, staging and therapeutic response evaluation. World J Gastroenterol. 2013;19(46):8502-8514.
  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7-30.
  3. Haggar FA, Boushey RP. Colorectal Cancer Epidemiology: Incidence, Mortality, Survival, and Risk Factors. Clinics in Colon and Rectal Surgery. 2009;22(4):191-197.
  4. Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e. New York, NY: McGraw-Hill; 2016.
  5. Aster, JC, Abbas, AK, Robbins, SL, Kumar, V. Robbins basic pathology. Ninth edition. Philadelphia, PA: Elsevier Saunders; 2013.
  6. Vega P, Valentín F, Cubiella J. Colorectal cancer diagnosis: Pitfalls and opportunities. World J Gastrointest Oncol. 2015;7(12):422-433.
  7. Halligan S, Wooldrage K, Dadswell E, et al. Computed tomographic colonography versus barium enema for diagnosis of colorectal cancer or large polyps in symptomatic patients (SIGGAR):a multicentre randomised trial. Lancet. 2013;381:1185–1193.
  8. Smith D, Ballal M, Hodder R, Soin G, Selvachandran S, Cade D. Symptomatic Presentation of Early Colorectal Cancer. Ann R Coll Surg Engl. 2006;88(2):185-190.
  9. Fletcher RH. The diagnosis of colorectal cancer in patients with symptoms: finding a needle in a haystack. BMC Medicine. 2009;7:18.
  10. Esteva M, Leiva A, Ramos M, et al. Factors related with symptom duration until diagnosis and treatment of symptomatic colorectal cancer. BMC Cancer. 2013;13:87.

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Last updated: 2019-07-11 21:51