Colorectal Carcinoma

Combined Degree
General Surgery
Udayana Medical Faculty-Sanglah
General Hospital
October 29th 2014

Starring:

1. Prisca Oriana S
2. Andreasta Ginting
3. Ryandi Satrio
4. I.G.Tuban Eling
5. Gede Kusuma Winarta
6. Daniel Oktavianus Dau
7. Kadek Fajar Mahendra
8. I.B.Yudha Prasistha
9. A.A.A Oka Kusuma Dewi
10. I.G.B Dharma Prakasa
11. Made Dharmendra
12. Budiman Ritonga
13. Komang Fujiama

Epidemiologi

one of the most common cancers in the world

US:

4th most common cancer (after lung,

prostate, and breast cancers)
2nd most common cause of cancer death
(after lung cancer)

Typical sites of incidence and symptoms of colon cancer

Risk Factors

Age

Adenomas, Polyps

Sedentary lifestyle, Diet, Obesity

Family History of CRC

Inflammatory Bowel Disease (IBD)

Hereditary Syndromes
(familial adenomatous polyposis (FAP))

Development of CRC

result of interplay between environmental and

genetic factors

Central environmental factors:

diet and lifestyle

35% of all cancers are attributable to diet

50%-75% of CRC in the US may be preventable

through dietary modifications

Dietary factors implicated in

colorectal carcinogenesis

consumption of red meat

animal and saturated fat
increased risk

refined carbohydrates
alcohol

Dietary factors implicated in

colorectal carcinogenesis
dietary fiber
vegetables
fruits
decreased risk

antioxidant vitamins
calcium
folate (B Vitamin)

Staging of CRC
Dukes staging system
A Mucosa
80%
B Into or through M. propria
C1Into M. propria, + LN !
C2Through M. propria, + LN!
D distant metastatic spread

50%
40%
12%
<5%

Sites of metastasis
Via blood
Liver

Via lymphatics
Lymph nodes

Per continuitatem

Lung

Abdominal wall

Brain

Nerves

Bones

Vessels

Molecular Biology & Pathology

CRCs arise from a series of histopathological and
molecular changes that transform normal epithelial cells
Intermediate step is the adenomatous polyp
Adenoma-Carcinoma-Sequence (Vogelstein & Kinzler)
Polyps occur universally in FAP,
but FAP accounts for only 1% of CRCs
Adenomatous Polyps in general population:
33% at age 50
70% at age 70

Carcinogenesis
Is a very rare process in which a normal cell
is converted to a cancer cell via multiple
steps of cellular evolution, which
correspond to various pre-neoplastic and
neoplastic phenotypes and genotypes.
Include: hyperplasia, dysplasia, anaplasia,
drug-resistance, immortality, invasiveness,
metastasis, etc

Multisteps carcinogenesis of
Colon Ca (Vogelstein Model)

Mutations in the APC pathway cause increased proliferation

MMR defects give rise to TGF-beta RII mutations, which prevent

MMR
defects
give (p15)
rise to
TGF-beta
mutations,
prevent
cell cycle
inhibitor
and
proteaseRII
inhibitor
(PAI-1)which
expression

cell cycle inhibitor (p15) and protease inhibitor (PAI-1) expression

Thank You