00:01
Our topic now is colon cancer.
00:03
It's the fourth most
common cause of cancer
in the United States.
00:06
And the second most common
cause of cancer death.
00:09
Dr. Raj,
I thought this was a number three.
00:12
Yeah, it is.
00:13
What do you mean?
How could we both?
Listen, if you were to separate
the genders and the sexes,
males and females.
00:22
Mortality.
00:23
Males:
Number one, lung cancer;
number two, prostate;
number three, colorectal cancer.
00:31
Females. Mortality.
Number one, lung cancer.
00:37
Number two, breast cancer.
Number three colorectal cancer.
00:42
So, you just don't use
third, correct?
But if you combine your genders...
Oh...
00:50
When combined for both genders,
it becomes the second most
common cause of cancer death.
00:54
That's up there.
00:56
Age: greater than 40.
01:01
Low fiber, high fat diet.
01:05
Personal history of
colonic adenoma or cancer.
01:10
History is big.
01:11
Long-standing.
01:15
Such as inflammatory bowel disease,
especially ulcerative colitis.
01:20
No joke.
01:22
Family history: Sporadic
colon cancer, and HNPCC.
01:27
Hereditary nonpolyposis
colorectal cancer
Nonpolyposis.
01:34
Now, pause here for a second.
01:37
I want to bring
two things to light here
so that we're clear moving forward.
01:43
HNPCC.
Remember that colorectal cancer
What do you want to do?
You want to divide this
into really two types.
01:49
Just like we did for
primary gastric adenocarcinoma.
01:52
We talked about two types there.
01:55
You have two types here.
01:56
But two types here.
01:58
literally, anatomically,
location wise.
02:01
You have left sided, right sided.
02:04
Left sided, descending colon;
right sided, ascending colon.
02:10
Genetically, amazingly,
pay attention.
02:14
HNPCC. Hereditary Nonpolyposis
Colorectal Cancer.
02:19
Remember biochemistry,
microsatellite instability.
02:22
You've heard of MLH and MSH
and such.
02:26
That will give rise to much more,
so, right side of colorectal cancer.
02:30
Memorize that.
02:32
Whereas, if it's
Familial adenomatous polyposis
then it'll be
left side of colorectal cancer.
02:38
What do you know about FAP?
100% of going on to
colorectal cancer.
02:42
No joke.
No, the genetics here big time.
02:48
Diagnosis: Slow growing tumor may
present as iron deficiency,
especially if it's right sided.
02:56
Could you find blood
with left sided?
Remember, you've heard a
napkin ring or circumferential?
So you have a ring around a napkin
squeezing the napkin,
"the napkin is the colon."
Left sided, the descending colon.
03:11
You're squeezing strangulating it.
Is that clear?
That's left sided.
03:14
So the circumferential pattern,
and napkin ring
is the left side, apple core.
03:20
Once again.
Could you find beating there?
Sure, but that's more
altered bowel habit.
03:26
On the right side,
we'll talk about the description
it's called polypoid.
03:31
And with the polypoid,
much more so
involved with bleeding
and iron deficiency.
03:38
Abdominal pain,
change in bowel habits
much more so with left sided.
03:43
Perforation is a complication
we're worried about,
and rectal bleeding obviously
will be taking place with both.
03:49
But much more so with right,
and therefore iron deficiency.
03:55
Your tests for diagnosis include
colonoscopy is the test
of choice here.
04:00
Remember the colonoscopy,
you want to use prudently.
04:03
And a patient that made them present
with diverticular disease acutely.
04:07
But in colorectal cancer,
my goodness, it is detested choice.
04:11
And your tumor marker,
not sensitive,
but prognostic evaluation
is important known as CEA.
04:18
Carcinoembryonic antigen.
04:21
And of course,
some of the new things
that you want to pay attention
colorectal cancer
include your KRAS.
04:28
And with management, remember,
not only
would you have drugs such as
your Leucovorin and company,
but then you have
a drug cost cetuximab
which is then addressing your
receptor tyrosine kinase.
04:39
Those are molecular pharmacology
that you want to be familiar with.
04:44
Let's talk about colonoscopy in
colon cancer, test of choice.
04:49
With the colonoscopy very rarely
would ever ask you anything
about sigmoidoscopy?
Because if you were to only do and
examine or investigate the sigmoid,
what if you had a cancer
on the right side?
What if you had a polyp
on the right side?
You would miss it completely.
05:03
And hat makes no sense.
05:04
We know for a fact that a
second leading killer overall
third, leading killer
individually engenders.
05:13
So, therefore, never
choose sigmoidoscopy,
when you're dealing
with a colonoscopy.
05:16
You do a full colonoscopy
to make sure that you catch
anything on the right side.
05:22
This particular lower colonoscopy
is showing you
decreased caliber of
the lumen of your colon.
05:31
And you see a little bit
of blood as well.
05:33
You notice here,
but this colonoscopy
that you would have
altered bowel habits
as you're coming down
the descending limb.
05:42
The left side we show you
what's known as circumferential.
05:45
The left side oftentimes
referred to as being, apple core.
05:49
And you might have heard this
being used as napkin ring.
05:55
Colon cancer prognosis,
it's important that you
pay attention to staging.
05:59
On a boards, nowadays,
whatever board that you're taking,
I understand the staging
becomes important
because it tells you,
well, prognosis goes from relatively
maybe decent, to absolutely poor.
06:12
The staging system for colon cancer
is known as the SEER system.
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And it's based on three categories.
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Localized: where there's no sign of
spread outside the colon or rectum.
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Regional:
where the cancer has spread
to nearby tissues or structures.
06:25
Or distant: Where the cancer
spread to distant parts of the body
such as the liver or lungs.
06:30
And their survival rates
are 91%, 72%, and 14%.
06:36
Once you get the D,
you're gone.
06:38
What that means is that
metastasis taking place,
and with colorectal cancer,
you can either choose
hematogenous or lymphatic spread.
06:47
And if it chooses
hematogenous spread
therefore, the number one place
that metastasized
to colon to the liver.
06:55
Alright? Colon to the liver.
06:58
From the liver, then maybe
perhaps up into the lungs.
07:02
Management:
surgery with wide resection,
adjuvant chemotherapy,
radiation therapy,
especially when you
start getting into Duke staging...
07:10
B B B as in boy.
07:14
Prevention:
screening, screening, screening.
07:17
Age 50 years of age,
a general population.
07:19
Keep in mind because of low fiber,
high fat diet type of issue.
07:23
Age 40 years, 10 years,
prior to diagnosis,
if you're thinking about a patient,
and the relative
is in fact affected
10 years younger.
07:32
So, kind of behaves
like you're mammography
and a female with breast cancer,
doesn't it?
Beginning eight years
if you're thinking about a patient
with the inflammatory bowel disease
of the ulcerative colitis type
Prevention:
Test for screening, colonoscopy.
07:51
A cold blood testing,
and virtual colonoscopy.
07:54
Nowadays, of course,
is playing a major role.