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| Colorectal Cancer (CRC) is a common, lethal,
and preventable disease |
CRC is the second leading cause of cancer death in both
sexes, accounting for 10 to 11 percent of cancer deaths overall; it is
third most common in men and women separately. Approximately one in three
people who develop CRC die of this disease.
Colorectal Cancer is another frequent neoplasia in the republic of
El Salvador representing the fourth most frequent Cancer according
to national statistics, with its incidence on the rise. The clinical course
of colon cancer is usually silent and initially without
symptoms until the disease has reached an advanced stage. In order to
find cancerous or pre-cancerous lesions at an early, curable stage
a total video-colonoscopy
is recommended at 5 year intervals, for any person 30 years and up.
For patients with family history of colon cancer or colon polyps a yearly
screening is advised. Unfortunately, most people do not follow
these recommendations, putting themselves at risk of dying of colon cancer
or living with bothersome cololostomy for the rest of their lives.
One of the main purposes of the colonoscopy is the screenning for polyps.
Polyps are small or medium sized tumors which grow without
symptoms some of them may evolve into cancer.if these are detected early
they can be removed endoscopicaly with a procedure call polypectomy.
Adenoma-carcinoma sequence — Most colorectal cancers
arise from adenomatous polyps, some of which progress from small (<5
mm) to large polyps (>1.0 cm), and then to dysplasia and cancer.
This progression probably takes at least 10 years in most people;
the distribution of progression times is not precisely known because
polyps are ordinarily removed when they are found. Neoplastic changes
are accompanied by, and probably result from, an accumulation of genetic
defects. Some cancers also apparently arise from adenomas that are
not polypoid.Large flat adenomas were more likely to contain dysplastic
changes than small ones, as is the case for polypoid adenomas. The
true proportion and clinical significance of adenomas that are flat
is uncertain.
Two-thirds of polyps are adenomas. The prevalence of adenomas is about
25 percent by age 50 and 50 percent by age 70. Large adenomatous polyps
(>1 cm), the size most likely to progress to cancer, are less common
(3 to 5 percent) than small adenomas.
The risk of CRC increases with polyp size, number, and histology (eg,
villous worse than tubular architecture). The characteristics of an
individual polyp are a marker for the colon as a whole; thus, the
polyp examined is representative of the individual's propensity to
form polyps and cancer.
A cancer is an uncontrolled proliferation of cells.
Is very common, usually occurring after the age of 50. The existence
of polyps (protrusions of tissue from the wall of the bowel into the
lumen) generally precedes the development of colorectal cancer. Polyps
are painless but can bleed, causing blood to be present in the stool.
The progression to cancer usually does not occur until after the age
of 40 unless there is a genetic-linked familial disorder. Routine
medical examination helps detect colorectal cancer at early stages,
thereby improving the likelihood of successful treatment. Simple tests
to chemically detect small amounts of blood in the stool that are
not visible to the eye can be easily performed in the home.
Both polyps and colon cancer occur much more frequently
in Western societies where the diets are low in fruits, vegetables,
protein from vegetable sources and fiber. Smoking and drinking alcoholic
beverages appear to increase the risk of polyp formation. Evidence
suggests that diets high in calcium, folic acid and fiber act as
chemopreventive agents, reducing the risk of colorectal cancer.
There is evidence that use of some nonsteroidal anti-inflammatory
drugs (NSAIDs) prevents polyp progression to cancer in certain people.
Determining risk — Before deciding how to screen, clinicians
should decide whether the individual patient is at average or increased
risk. A few simple questions are all that is necessary: Do
you have a family history of colorectal cancer? If so, in first
degree relatives, at what age of onset, and how many?
Have you had a personal history of colorectal cancer or adenomatous
polyps?
Have you had inflammatory bowel disease?
The patient is considered average risk if the answer to all these
questions is "no." Patients answering yes to any of these
questions need to be evaluated further.
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Colonoscopic Image.
Rectal Carcinoma, 86 Year old female with rectal bleeding
Please click the image to download the video clip and configure the media
player in
reapeat and press Alt + Enter to see full screen.(Windows Media) and for
Real Player Ctrl and 3.
Summary Points
Bowel cancer is often curable cure is more likely if the cancer
is treated at an early stage it is important that people should report
unusual bowel symptoms quickly cancer is often preceded by a polyp removal
of polyps is important to prevent cancer chemotherapy in addition to surgery
for cancer is useful for some patients close relatives of younger patients
with bowel cancer should be screened
Colonoscopic image.
Metachcronous Carcinoma.
Carcinoma of the Transverse colon, proximal to the splecnic angle,
69 year old male who undergone colon surgery thirteen years ago for adenocarcinoma
of the cecum. (Right Hemicolectomy) he have not following any control
after his surgery, he had anemia and arrived to our clinic for the first
time prepared for Colonoscopy by his daughter who is a nurse.(The same
daughter towards three years had surgery for colon cancer).
The incidence of Metachcronous Carcinoma is in 2% to 4%, periodic examination
of the large bowel with Colonoscopy every 1 to 3 years provides the most
accurate results. 
Colonoscopic Image.
31 year old male with Carcinoma of the cecum that towards two and
half years I performed polipectomy of adenoma velloso of great size in
the rectal area between the first and second valve. At that time I recomended
a control with a full colonoscopy to screnning the complete colon, but
in spite of have explained him the importance of the colonoscopy the patient
did not attend his appointment HOWEVER two years and a half, he made an
appointment and we found the carcinoma displayed in the image and the
video clip.
Rectal Carcinoma , the forceps biopsy is observed with a small
fragment of the tumor.
Cecum Cacinoma, the ileocecal valve is observed.
Same tumor as above, the ileocecal valve is observed, with
some activity of secretion.
Cancer of the rectum of 33 year old male that was using application
of a hemorroidal cream for hemorrhoids (auto prescription)
Ulcerated Rectal Carcinoma, With the morphologic structure impress
that
becomes from a polyp which degenerated into a cancer.
See how the cancer comes
Rectal Carcinoma.
73 year old female, rectal bleeding and weight loss
she had for long time autoprecription treatment for supposed hemorrhoids
we found Rectal adenocarcinoma of the first rectal valve.
81 year old male who came to our clinics
who is accompanied by his daughter who is Medical Doctor Pediatrician
he had diarrea for three months we found Rectal adenocarcinoma
of the second rectal valve that infiltrate the third valve and one rectal
malign node after the pectine line.
67 Year old male, weight loss and anemia Hb. 7.2 he has been taken five
negative guayaco stool test for ocult bleedind weight loss more than 20
pounds. Adenocarcinoma of the ascending colon.
Same image as above case, anemia screning digestive diseases must be exclueded,
Colon Cancer produces severe anemia, (right colon).
Cecum Carcinoma. 56 year old female with long standing pain in
the right iliac fossa who had received prolonged medical treatment for
a supposed irritable bowel syndrome during more than a year. She came
to our clinic and the next day we performed a full colonoscopy. For more
endoscopic details please download the video clip by clicking on the image.
Female of 62 year old, Rectum Adenocarcinoma
76 year old female, enterorragia , Rectum Adenocarcinoma
95 year old female having a carcinoma of the ascending colon near
to the cecum. Patient had severe anemia.
Same Case of above.
Same case as above.
77 year old woman with rectal carcinoma. For more endoscopic details
please download the video clip clicking on the image. To appreciate the
video in full screen: 1. Wait to download the video "complete". 2. Click
on the windows media. 3. Press Alt and Enter.
52 years old male with rectal bleeding and weight loss more than 20 pounds.
Rectal Adenocarcinoma.
51 year old woman, with carcinoma at the sigmoid at the recto-sigmoid
junction. The carcinoma infiltrated the urinary bladder. For more details
please download the video clip clicking on the image .
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