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ColorectalWhite

ColorectalWhite

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Colon & Rectal Cancer

GEORGE G. LIM, MD, FPSCRS, FPSGS, FPCS
Associate Professor 3
Department of Surgery
Faculty of Medicine & Surgery
University of Santo Tomas

Colon cancer: highest and lowest rates worldwide (Men)
Colon cancer: highest and lowest rates worldwide (Women)
Colorectal cancer incidence by age in the US
Colorectal cancer death rates in men in US, by age
Concepts of environmental cause of colon cancer
2
Abnormal proliferation is a hallmark of neoplasia
Genetic alterations in progression to colorectal cancer
Familial colon cancer in Ashkenazi
Jewish persons
APC
Genetic
polymorphism

hMSH2, hMLH1, hPMS1, hPMS2, hMSH6, hMSH3

MMR genes:
TP53, DCC, APC
Tumor suppressor
genes:
myc, ras, src, erbB2
Sporadic disease
Oncogenes:
Somatic
HNPCC (Lynch syndrome)
MMR
Familial adenomatous polyposis
APC
Germline
Type of Disease Caused
Genes Involved
Mutation Type
Gene mutations that cause colon cancer
Amsterdam Criteria
At least three relatives with colon cancer and all of the following:
One affected person is a first-degree relative of the other two

affected persons
Two successive generations affected
At least one case of colon cancer diagnosed before age 50 years
Familial adenomatous polyposis excluded

Hereditary nonpolyposis colorectal cancer
Modified Amsterdam Criteria

Same as the Amsterdam criteria, except that cancer must be
associated with HNPCC (colon, endometrium, small bowel,
ureter, renal pelvis) instead of specifically colon cancer

Bethesda Criteria
The Amsterdam criteria or one of the following:
Two cases of HNPCC-associated cancer in one patient, including
synchronous or metachronous cancer

Colon cancer and a first-degree relative with HNPCC-associated
cancer and/or colonic adenoma (one case of cancer
diagnosed before age 45 years and adenoma diagnosed
before age 40 years)

Colon or endometrial cancer diagnosed before age 45 years
Right-sided colon cancer that has an undifferentiated pattern
(solid-cribriform) or signet-cell histopathologic
characteristics diagnosed before age 45 years

Adenomas diagnosed before age 40 years
Hereditary nonpolyposis colorectal cancer
Inheritance in family with cancer family syndrome
3
HNPCC clinical characteristics
17
79
RER + %
Infrequent
Common
Mucinous and poorly
differentiated cancers
No
Yes
Excess malignancies at other
sites
35
72.3
Proximal location, %
1 -5
24.3
Metachronous
3 -6
18.1
Synchronous
4 - 11
34.5
Multiple colon cancers, %
67
44.6
Mean age at diagnosis,y
Sporadic
HNPCC
Characteristics
TABLE 3 - 13. HNPCC CLINICAL CHARACTERISTICS
Multiple pedunculated polyps
Large pedunculated polyp
Large sessile polyp
Tubular adenoma of the colon cut in cross section
Tubulovillous and villous adenomas (A)

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