Colon cancer

The colon is the name of the large intestine part of the digestive system that begins in the continuation of the small intestine and extends to the last 12 cm part called the rectum. Although it is generally referred to as a column, it is divided into 7 sections within itself. From the right, these are the cecum, ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, and sigmoid colon. The rectosigmoid junction is the name of the region where the sigmoid colon connects to the rectum, rather than being part of the colon.

Cancers that develop here are called colon cancer. According to the location of the tumor, the first symptoms of the patients may vary. Tumors located on the right side may present with complaints such as anemia, weakness, and tumors located on the left side with complaints such as constipation-diarrhea, changes in bowel movements, rectal bleeding, abdominal pain and bloating. Apart from this, it can also be detected in screening colonoscopy or in examinations such as tomography, MR or PET-CT taken for another purpose.

Colon cancer main diagnostic method is colonoscopic examination. In colonoscopy, a biopsy is performed from the tumor tissue (piece removal), and a tissue sample is provided for pathological examination. In addition, it can be understood whether the tumor is at a very early stage, as well as the presence of concomitant lesions in other parts of the large intestine or whether there is familial polyposis syndrome.

Before planning colon cancer treatment, staging should be done. In staging:

  • Upper abdomen (abdominal) tomography

  • Lower abdomen (abdominal) tomography

  • Thorax (lung) tomography should be taken.

  • Upper abdomen MRI (It should be done in those with suspected liver metastasis)

PET-CT is not routinely recommended for colon cancer staging, it is only recommended for the evaluation of patients with suspected metastasis (spread, spread).

Although blood values ​​coded as CEA and Ca 19-9 are not used in staging, it is recommended to be studied at the time of first diagnosis in order to predict the course of the disease and to follow up the recurrence after treatment.

Colon cancer treatment is planned according to the tumor stage. Below you can see the main treatment options by stage:

Stage1:

-Colonoscopic intervention (endoscopic submucosal dissection – ESD)

-Colorectal surgery (open, laparoscopic, robotic)

Stage 2 / Stage 3

-Colorectal surgery (open, laparoscopic, robotic)

Stage 4: (Distant organ metastasis)

– Chemotherapy

Additional treatments may be considered depending on the site of metastasis. In patients with only lung or liver metastases, if all can be removed, rectal surgery and removal of metastases can be planned simultaneously or at different times. In patients with peritoneal (peritoneal membrane) metastases, HIPEC (warm chemotherapy) can be applied together with cytoreductive surgery after chemotherapy or immediately after diagnosis. Even in case of simultaneous metastases in many regions, surgical interventions can be planned.

Treatment planning at all stages should be decided in the light of current scientific data and considering the characteristics of the patient and tumor in the multidisciplinary oncology council attended by colorectal surgeon, medical oncology, pathologist, radiologist and other related branches.

The basic rule in colon cancer surgery is to cut the intestine at least 10 cm from the tumor, and to tie the main vessel(s) feeding the tumor at the root. Based on the areas where the ligated vessels carry blood, in some cases it may be necessary to go up to 20-30 cm from the tumor.

In recent years, the embryological structure surrounding the large intestine, thus trapping the tumor and surrounding lymph nodes like a sheath, has been revealed. In this direction, it is recommended to perform an operation without allowing tumor scattering, together with the large intestine sheath, which is called complete mesocolic excision.

During colon cancer surgery, it is important not only to remove the tumor without fragmentation, but also not to damage the surrounding tissues and organs. According to the location of the tumor, the duodenum, stomach, pancreas, spleen, kidneys, upper urinary tract, vessels and nerves feeding the intestines, gall bladder and liver are organs that should be protected as long as the tumor does not progress. must be removed as a whole.

Colon cancer surgery can be performed with the traditional (open) method, laparoscopically or robotically, provided that all these surgical rules are followed.

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