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Samuel Onedes S.
Alexander B. A.
Denny Setyadi
Intestinal tumors
Non-neoplastic Polyps
Hyperplastic polyps
Hamartomatous polyps
Juvenile polyps
Peutz-Jeghers polyps
worldwide distribution
highest incidence rates in United States,
Canada, Australia, New Zealand, Denmark,
Sweden, and other developed countries
Risk Factors
Genetic Predisposition:
◦ Hereditary Polyposis Syndrome:
Familial Adenomatous Polyposis (FAP)
Gardner’s syndrome (osteoma, skin tumor, intestine polyposis)
Turcot’s syndrome (colonic tumors and brain tumors, is also
linked to medulloblastoma)
◦ Hereditary Nonpolyposis Syndrome (HNPCC):
Lynch I (limited to the colorectum)
Lynch II (coexist with extracolonic tumors, typically endometrial
cancer)
Risk Factors
Premalignant conditions:
◦ Inflammatory Bowel Disease
◦ Ulcerative colitis
Incidence of neoplasia in pancolitis patients is 10% by 20
years’ duration of disease
More difficult to find in early stage 35% are Dukes C
and D lesions
◦ Granulomatous colitis:
Crohn’s disease
Overall incidence is 7% over 20 years’ duration of Crohn’s
disease
Predisposing Medical
Condisions
Non-Cancer Surgery:
◦ Some studies suggest that cholecystectomy
increases the incidence of colorectal cancer. The
relationship between cholecystectomy and
colorectal carcinoma is controversial.
Etiology
environmental influences:
◦ dietary practices
low content of unabsorbable vegetable fiber
corresponding high content of refined carbohydrates
high fat content
decreased intake of protective micronutrients (vitamins A, C,
and E)
◦ use of Aspirin® and other NSAIDs: protective effect
against colon cancer?
cyclooxygenase-2 & prostaglandin E2
Carcinogenesis
Tumor (T)
spread by direct extension into T0 = none evident
Tis = in situ (limited to mucosa)
adjacent structures and by T1 = invasion of lamina propria or submucosa
metastasis through lymphatics T2 = invasion of muscularis propria
T3 = invasion through muscularis propria into
and blood vessels subserosa or nonperitonealized perimuscular
tissue
favored sites for metastasis: T4 = invasion of other organs or structures
regional lymph nodes
Lymph Nodes (N)
liver 0 = none evident
1 = 1 to 3 positive pericolic nodes
lungs 2 = 4 or more positive pericolic nodes
bones 3 = any positive node along a named blood vessel
other sites including serosal Distant Metastases (M)
membrane of the peritoneal 0 = none evident
1 = any distant metastasis
cavity
carcinomas of the anal region → 5-Year Survival Rates
T1 = 97%
locally invasive, metastasize to T2 = 90%
regional lymph nodes and T3 = 78%
T4 = 63%
distant sites Any T; N1; M0 = 66%
Any T; N2; M0 = 37%
Any T; N3; M0 = data not available
Any M1 = 4%
Clinical Features
chemotherapy
radiotherapy
radical surgery
gene therapy
True or false?
http://www.liebertonline.com/doi/abs/10.1089/pho.2008.2238
http://clincancerres.aacrjournals.org/cgi/content/abstract/5/9/2359
Elsevier. Kumar et al: Robbins Basic Pathology 8e