COLON CANCER: CURRENT SURGICAL MANAGEMENT OPTIONS.

1. COLON CANCER: CURRENT SURGICAL MANAGEMENT OPTIONS. ANTHONY D.I. SIBIYA, MD., GABORONE PRIVATE HOSPITAL

2. COLON CANCER: CURRENT SURGICAL OPTIONS. • THE EXACT INCIDENCE OF COLORECTAL CANCER IN BOTSWANA REMAINS UNKNOWN. • IN COUNTRIES WHERE STATISTICS ARE AVAILABLE, COLORECTAL CANCER IS THE THIRD MOST FREQUENTLY DIAGNOSED, AND THE SECOND MOST FATAL CANCER.

3. COLON CANCER: CURRENT SURGICAL OPTIONS • THE PEAK INCIDENCE OF THE DISEASE IS IN THE SIXTH DECADE OF LIFE. EARLIER ONSET IS HOWEVER FOUND IN THOSE WITH CERTAIN GENETIC SYNDROMES (HNPCC, FAP, PJS, JPS, COWDEN DISEASE AND RUVALCABA-MYRE-SMITH SYNDROME) • THERE IS ANEDOCTAL EVIDENCE TO SUGGEST THAT IN HIV, THE RISK IS SIGNIFICANTLY INCREASED.

4. COLON CANCER: CURRENT SURGICAL OPTIONS • EARLY DETECTION AND TREATMENT REMAIN THE MOST IMPORTANT FACTORS IN PROGNOSIS. • EARLY DETECTION REQUIRES A HIGH INDEX OF SUSPICION WITH CERTAIN PRESENTING SYPMTOMS, AND A LOW THRESHOLD FOR BOTH BIOCHEMICAL AND PHYSICAL TESTING

5. COLON CANCER: CURRENT SURGICAL OPTIONS • HISTORY, PHYSICAL EXAMINATION (INCLUDING COLONOSCOPY) AND RADIOLOGICAL EXAMINATION REMAIN THE MAINSTAYS OF DIAGNOSIS AND STAGING. FOR RECTAL CANCERS, ENDORECTAL ULTRASOUND AND MRI, ESPECIALLY PHASED ARRAY MRI, ARE IMPORTANT TOOLS IN STAGING.

6. COLON CANCER: CURRENT SURGICAL OPTIONS. • THE AIMS OF SURGICAL TREATMENT OF ALL CANCERS WHICH ARE AMENABLE TO THIS MODALITY ARE: - COMPLETE EXCISION OF TUMOR AND NODAL BASIN DRAINING THE AREA. - COMPLETE EXCISION OF METASTATIC DEPOSITS WHERE FEASIBLE. - PALLIATION WHERE THE ABOVE CANNOT BE ACHIEVED

7. COLON CANCER: CURRENT SURGICAL OPTIONS • THE DISTRIBUTION OF COLON CANCERS.

8. COLON CANCER: CURRENT SURGICAL OPTIONS

9. COLON CANCER: CURRENT SURGICAL OPTIONS • THE CHANCE OF CURE IN COLORECTAL CARCINOMA IS DEPENDENT ON SEVERAL FACTORS, THE MOST IMPORTANT OF WHICH IS STAGE OF THE DISEASE. STAGE 5 YEAR SURVIVAL I 90% II 75% III 50% IV <5%

10. COLON CANCER: CURRENT SURGICAL OPTIONS • STAGING OF COLON CANCER PRIMARY TUMOR REGIONAL NODES DISTANT METASTASES TX-CANNOT ASSESS NX-CANNOT ASSESS MX CANNOT ASSESS TO- NO PRIMARY TUMOR NO-NO METS RN MO- NO DISTANT METS TIS- TUMOR IN SITU N1-METS 1-3 RN M1- DISTANT METS T1- INVADES SUBMUCOSA N2- METS >3 RN T2- INVADES MUSCULARIS T3-INVADES THROUGH MUSCULARIS PROPIA INTO SUBSEROSA OR ONTO NON-PERITONIALISED PERICOLIC OR PERIRECTAL TISSUES T4-DIRECTLY INVADES OTHER ORGANS OR STRUCTURES AND/OR PERFORATES VISCERAL PERITONEUM

11. COLON CANCER: CURRENT SURGICAL OPTIONS. • STAGE GROUPING STAGE T N M DUKES MAC 0 TIS NO MO - - I T1 NO MO A A T2 NO MO A B1 IIA T3 NO MO B B2 IIB T4 NO MO B B3 IIIA TI-T2 NI MO C CI IIIB T3-T4 NI MO C C2/C3 IIIC ANY T N2 MO C C1/C2/C3 IV ANY T ANY N MI D

12. COLON CANCER: CURRENT SURGICAL OPTIONS • STAGE I AND II COLON CANCERS ARE CURABLE BY SURGERY ALONE. THUS THE COMPLETENESS OF SURGICAL RESECTION IS PARAMOUNT, AS IS GOOD TECHNIQUE. -ADEQUATE MOBILISATION. -ADEQUATE MARGINS. -ADEQUATE NODAL BASIN RESECTION. - REESTABLISHMENT OF BOWEL CONTINUITY

13. COLON CANCER: CURRENT SURGICAL OPTIONS. • STAGE 4 CANCERS IN WHICH THE TUMOR IS TI-T3, WITH HEPATIC METASTASES CAN BE RESECTED, WITH SIMULTANEOUS RESECTION OF THE LIVER METASTASES.

14. COLON CANCER: CURRENT SURGICAL OPTIONS • OBSTRUCTING CANCERS - USUALLY RIGHT SIDED. - RESECTION, ANASTOMOSIS - ON THE LEFT SIDE DIVERTING STOMA, RESECTION, OR INTRA-OP COLONIC LAVAGE WITH ANASTOMOSIS • PERFORATING CARCINOMAS - CAN BE FROM EROSION OR PERFORATION SECONDARY TO OBSTRUCTION. WASHOUT, RESECTION AND ANASTOMOSIS IF FEASIBLE

15. COLON CANCER: CURRENT SURGICAL OPTIONS • SYNCHRONOUS CANCERS • RECTAL CANCER • NEW AVENUES -LAPAROSCOPY