COLON CANCER

Shalini Kanneganti MD, FACS, FASCRSColon and Rectal Surgery

Anatomy

Blood supply

Hopkinscoloncancercentcencenter.org

Colon cancer

n SECOND most common cause of cancer deaths in US

n 107,000 new patient each yearn 50,000 deaths each yearn 5% develop colon cancer in their

lifetime

Colon cancer Deaths

RISK FACTORS

n AGE > 50n FAMILY HISTORYn UC/ CROHNS DISEASEn DIETn LIFESTYLEn SMOKINGn FAPn HNPCC

Pathophysiology

Colon polyps

SYMPTOMS

n Change in bowel habits

n Abdominal painn Rectal bleedingn Weight lossn Weakness/Fatigue

Prevention

n Decrease Fat and red meat

n Increase Fibern Increase fruits and

vegetablesn More research

Fiber

n Normalizes bowel movements

n Helps Bowel healthn Lowers Cholestroln 25gms/day

COLON CANCER MANAGEMENT

COLONOSCOPY

PATHOLOGY & MOLECULAR BIOLOGY

IMAGING – CT CHEST ABD PELVIS

SURGERY

CHEMOTHERAPY

Colonoscopy

n Safe and effectiven Diagnosisn Treatment

Image source - Medicinenet.com

STAGING

n STAGE 1 - T1-2n STAGE 2 - T3-4n STAGE 3 - Any Nn STAGE 4 - Mets

CHALLENGES

I - DIAGNOSISII - STAGINGIII - SURGICAL TECHNIQUE

SURGERY

RIGHT HEMICOLECTOMY: A MINIMALLY INVASIVE & TECHNICALLY

PROFICIENT APPROACH

Benefits

n Shorter hospital stayn Faster return of bowel functionn Less painn Smaller incision

PROCEDURAL STEPS

PREPARATIONn Bowel prep

n Preop nutrition

n Preop abxs

TROCHAR PLACEMENTn Open Hasan§Supraumbilical

n Triangulate ports5mm

12mm

12mm

ILEOCOLIC PEDICLEn omentum

n cecum

n vascular

pedicle

ILEOCOLIC PEDICLE

ILEOCOLIC PEDICLE

ILEOCOLIC PEDICLE

Mobilize Right colon

n Cecum/Appendix:

n Ascending colon:

n Hepatic flexure:

Transverse Colon

Adequate Mobility

EXTRACTION

ILEAL TRANSECTION

TRANSVERSE COLON TRANSECTION

MESENTERIC LIGATION

SPECIMEN

ILEOCOLIC ANASTOMOSIS

APR + VRAM FLAP

ALGORYTHM

CAREFUL ASSESSMENT OF SYMPTOMS↓

EARLY DIGNOSIS ↓

ACCURATE STAGING↓

TREATMENT

Local Recurrence

n Circumferential margin

n Distal marginn Removal of lymph

nodesn YOUR SURGEON

FUTURE

Colon and Rectal Cancer Teamn Gastroenterologistn Medical oncologistn Colon and rectal surgeonn Hepatobiliary surgeonn Thorasic surgeonn Plastic surgeonn Radiation oncologistn GI pathologistn Interventional and Diagnostic radiologistn Genetic counselorn Ostomy nursesn Nutritionistn Clinical social workern Research nurses and coordinators

Goal of Cancer Care

Coordinated

Competent

Compassionate

Thank You