Gastroenterology Book

http://www.fpnotebook.com/

Colorectal Cancer

Aka: Colorectal Cancer, Colon Cancer
  1. Epidemiology
    1. Accounts for 8.5% of all new cancer cases
    2. Incidence (2014, U.S.): 137,000/year
    3. Mortality (2014, U.S.): 50,000/year
    4. Highest Incidence of Colon Cancer
      1. North America
      2. Western Europe
      3. Australia and New Zealand
      4. Japan
  2. Risk Factors
    1. See Colon Cancer Risk Factors
  3. Management: Non-resectable hepatic metastases
    1. Radiofrequency Ablation
      1. Small trials suggest prolonged survival or cure
      2. Wong (2001) Am J Surg 182:552-7 [PubMed]
  4. Prevention
    1. See Colorectal Cancer Prevention
    2. See Colorectal Cancer Screening
  5. Course
    1. Recurrence risk
      1. Highest risk within first 5 years post-resection
  6. Complications
    1. Colorectal Cancer recurrence (typically in first 5 years after treatment)
    2. Second primary Colorectal Cancer
    3. Gastrointestinal adverse effects
      1. Diarrhea
        1. Dietary Fiber supplementation
        2. Periodic Imodium use
      2. Abdominal Pain
      3. Fecal Incontinence
      4. Radiation Proctitis
      5. Ostomy care
    4. Fatigue
      1. Common in Colorectal Cancer survivors
      2. Consider evaluating for alternative Fatigue cause (e.g Anemia, Hypothyroidism)
  7. Protocol: Monitoring post-resection
    1. See Cancer Survivor Care
    2. Colonoscopy
      1. Perform at one year and 3 years (if year 1 normal) post-resection
      2. Then, repeat every 5 years
    3. Intensive monitoring protocol for Stage T3/T4 or positive nodes
      1. Colonoscopy as above
      2. Clinical examination and Carcinoembryonic Antigen (CEA-125)
        1. Initially repeat every 3 months for 2 years
        2. Later repeat every 6 months for up to 5 years
        3. Focus areas
          1. Ostomy problems or Stool Incontinence
          2. Radiation Proctitis
          3. Bowel adhesions
      3. Chest, Abdomen and pelvic CT
        1. Repeat every year for 5 years
  8. References
    1. Short (2014) Am Fam Physician 91(2): 93-100 [PubMed]
    2. Sunga (2005) Am Fam Physician 71:699-714 [PubMed]
    3. Wilbur (2014) Am Fam Physician 91(1):29-36 [PubMed]

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