P03.006 Colorectal tumors

Colorectal tumors are among the most prevalent cancers worldwide, with significant morbidity and mortality. They arise from the epithelial lining of the colon and rectum and can vary widely in presentation, behavior, and treatment implications.

Types of Colorectal Tumors

1. Adenomas: Benign tumors that can progress to adenocarcinoma.
2. Adenocarcinoma: The most common type of colorectal cancer originating from glandular cells.
3. Carcinoid Tumors: Neuroendocrine tumors that can occur in the rectum.
4. Gastrointestinal Stromal Tumors (GISTs): Rare tumors that may arise in the colon or rectum.
5. Lymphomas: Can rarely affect the colorectal region.
6. Metastatic Tumors: Secondary tumors from other primary sites.

Pathophysiology and Risk Factors

• Genetic Factors: Hereditary syndromes like Lynch syndrome (HNPCC) and familial adenomatous polyposis (FAP).
• Age: Incidence increases with age, typically diagnosed after 50 years.
• Dietary Factors: High red meat and low fiber intake increase risk.
• Inflammatory Bowel Disease (IBD): Long-standing ulcerative colitis or Crohn’s disease predisposes to colorectal cancer.

Clinical Presentation

• Change in Bowel Habits: Persistent diarrhea, constipation, or changes in stool caliber.
• Rectal Bleeding: Often a late symptom but can be an early indicator.
• Abdominal Pain: Cramping or discomfort.
• Anemia: Due to chronic blood loss.
• Weight Loss: Unexplained weight loss despite normal diet.

Diagnosis

• Colonoscopy: Gold standard for visualizing the colon and rectum, biopsies for histological confirmation.
• Imaging: CT scan or MRI for staging and assessment of metastasis.
• Tumor Markers: CEA (carcinoembryonic antigen) for monitoring treatment response.

Management

• Surgery: Curative resection for localized disease.
• Chemotherapy: Adjuvant therapy for advanced or metastatic disease.
• Radiotherapy: Used in combination with surgery or chemotherapy, especially for rectal cancer.
• Palliative Care: Focuses on symptom management and quality of life in advanced cases.

Prognosis

• Stage at Diagnosis: Early detection improves outcomes.
• Tumor Grade: Higher grades indicate more aggressive behavior.
• Response to Treatment: Influences long-term survival.

Points to Remember

• A colonoscopy is the primary diagnostic tool.
• CEA is a tumor marker used for monitoring.
• Screening is crucial for early detection, starting at age 50 in average-risk individuals.
• Family History and genetic syndromes increase risk.
• Multidisciplinary Approach: Involves surgeons, oncologists, and gastroenterologists for optimal management.

References

• American Cancer Society. Colorectal Cancer Facts & Figures 2023-2025.
• National Comprehensive Cancer Network (NCCN) Guidelines. Colorectal Cancer Screening and Treatment.
• UpToDate. Colorectal Cancer: Epidemiology, Risk Factors, and Protective Factors.