结肠癌.pptVIP

* * Associated with race, life condition, diet.Patients with inflammatory bowel disease, especially ulcerative colitis, at high risk for the development of a malignancy COLONIC CARCINOMA ETIOLOGY Macroscopically  1.Phymatoid type.  2.Infiltrative type  3.Ulcerative type.Microscopical types: adenocarcinoma, mucous cancer, signet ring cancer. PATHOLOG ICAL CLASSIFICATION In clinic, Dukes stages is used for tumor staging. Dukes A: confined to the bowel wall. Dukes B: penetrating the bowel wall,  without lymph node metastasis.  Dukes C: penetrating the bowel wall  with lymph node metastasis. Dukes D: with distant metastasis,  peritoneal seeding, or metastasis beyond surgical resection. CLINICOPATHOLOGICAL STAGES TUMOR SPREAD Direct extension: 1. grows circumferentially2. Longitudinal submucosal extension3. penetrates the outer layers Hematogenous metastasis: Colonic veins, portal vein, hepatic metastasis. Lumbar,vertebral veins to the lungs and elsewhere.Regional lymph node metastasis: the most common form of tumor spread. Transperitoneal metastasis:  extended through the serosa, peritoneal seeding. SYMPTOMS AND SIGNS1.Change in bowel habits and nature of stool2.Abdominal pain 3.A palpable or visible abdominal mass 4.Intestinal obstruction5.Systemic Symptoms Symptoms depend on  the anatomic location of the lesion, its type and extent, complications, perforation, obstruction, hemorrhage.  Different in right and left colon. Duration of symptoms The average delay 7-9 months.The risk factors: 1.change in bowel habit or continuous abdominal discomfort, insidious pain and distention.2.Feces (stool) blended with blood and mucus.3.progressive anemia and loss of weight and strength. 4.abdominal mass. DIAGNOSIS Digital examination. The physician hesitate to make the necessary examination because it involes soiling the fingers.