You are on page 1of 16

Colorectal Carcinoma

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

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

and breast cancers) 2nd most common cause of cancer death (after lung cancer) .Epidemiologi  one of the most common cancers in the world  US:  4th most common cancer (after lung. prostate.

Typical sites of incidence and symptoms of colon cancer .

Polyps  Sedentary lifestyle. Obesity  Family History of CRC  Inflammatory Bowel Disease (IBD) Hereditary Syndromes  (familial adenomatous polyposis (FAP))  .Risk Factors  Age  Adenomas. Diet.

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) .

propria.Staging of CRC Dukes staging system A Mucosa 80% B Into or through M. propria C1Into M. propria. + LN! D distant metastatic spread 50% 40% 12% <5% . + LN ! C2Through M.

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 .

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

Multisteps carcinogenesis of Colon Ca (Vogelstein Model) .

Mutations in the APC pathway cause increased proliferation .

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

Thank You .