Anatomy of colon

The colon is about six feet long and is the part of the body's digestive system that moves waste material from the small intestine to the rectum. The small intestine sucks the nutrients out of what you eat and then pours the leftover sludge into the cecum. This sludgy waste then moves from the cecum to the colon for further processing.
Cecum (proximal right colon)--6 x 9 cm pouch covered with peritoneum Appendix--a vermiform

(wormlike) diverticulum located in the lower cecum Ascending colon--20-25 cm long, located behind the peritoneum Hepatic flexure--lies under right lobe of liver Transverse colon--lies
anterior in abdomen, attached to gastrocolic ligamentSplenic flexure--near tail of pancreas and spleenDescending colon--10-15 cm long, located behind the peritoneumSigmoid
colon-loop extending distally from border of left posterior major psoas muscleRectosigmoid segment--between 10 and 15 cm from anal verge Rectum--12 cm long, upper third covered by
peritoneum; no peritoneum on lower third which is also calledthe rectal ampulla.
About 10 cm of the rectum lies below the lower edge of the peritoneum (below the peritoneal reflection), outside the peritoneal cavity.Anal canal most distal 4-5 cm to anal verge.

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what is cancer colon

Doctors are certain that colorectal cancer is not contagious (a person cannot catch the disease from a cancer patient). Some people are more likely to develop colorectal cancer than others. Factors that increase a person's risk of colorectal cancer include high fat intake, a family history of colorectal cancer and polyps, the presence of polyps in the large intestine, and chronic ulcerative.

The colon is the part of the digestive system where the waste material is stored. The rectum is the end of the colon adjacent to the anus. Together, they form a long, muscular tube called the large intestine. Tumors of the colon and rectum are growths arising from the inner wall of the large intestine. Malignant tumors of the large intestine are called cancers. Most of the cancers of the large intestine are believed to have developed from polyps. Cancer of the colon and rectum (also referred to as colorectal cancer) can invade and damage adjacent tissues and organs.

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Sign and symptomps

The symptoms of cancer of the large bowel may include any of the following:
• A change in your normal bowel habit (such as diarrhoea or constipation) for no obvious reason, lasting longer than six weeks
• Unexplained weight loss
• Blood in, or on, the stools (bowel motions) – the blood may be bright red or dark in colour
• Pain in the tummy (abdomen) or back passage
• A feeling of not having emptied your bowel properly after a bowel motion.
• Gas and Bloating

Sometimes tiredness (fatigue) is a symptom of a bowel cancer. This can happen if the bowel tumour has been bleeding and caused a shortage of red blood cells (anaemia). Anaemia may also make you feel breathless.
Sometimes the cancer can cause a blockage (obstruction) in the bowel. The symptoms of this are:
• Being sick (vomiting)
• Constipation
• Pain in the abdomen
• A bloated feeling

Further tests for cancer colon :

The following additional tests are most often used with cancer colon
1. Abdominal ultrasound scan
2. CT scan
3. Waiting for your test results
4. Blood test
5. Chest X-ray
6. PET Scan

1. Abdominal Ultrasound
An ultrasound scan uses sound waves to look at internal organs, such as the liver and the colon, to see whether the cancer has spread to other organs. You will usually be asked not to eat or drink for at least six hours before the test. Once you are lying comfortably on your back, a gel is spread onto your abdomen. A small device that produces sound waves is passed over the area. The sound waves are then converted into a picture by a computer.

2. CT scan
A CT (computerised tomography) scan takes a series of x-rays, which builds up a three-dimensional picture of the inside of the body. It can show the size of the tumour in the colon and whether it has spread beyond the bowel. The scan is painless but takes longer than an ordinary x-ray (from 10–30 minutes). CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

3. Waiting for your Test
It will probably take from several days to a couple of weeks for the results of your tests to be ready. The results of the tests will show the grade and the stage of the cancer colon. This information will be used by a team of doctors and nurses.

4. Blood Test
Collection of sample blood to check The protein is called carcinoembryonic antigen (CEA) and is also known as a tumour marker.

5. Chest X-ray
Chest x-rays are often taken to check the health of your heart and lungs.

6. PET scan
PET (positron emission tomography) scans are a newer type of scan. They are not always necessary , whether one would be useful in your case. PET scans can be used to accurately define the cancer colon and find out if it has spread to other parts of the body.

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Staging of cancer colon

Generally, cancer of the large bowel is divided into four stages:

• Small and localised (stage A)
• Spread into surrounding structures (stages B and C)
• Or spread to other parts of the body (stage D).
  

TNM staging system

The Dukes system is gradually being replaced by the TNM staging system.

• T Describes the size of the tumour and if it has spread into the bowel wall.
• N Describes whether the cancer has spread to the lymph nodes.
• M Describes whether the cancer has spread to another part of the body, such as the liver or the lungs (secondary or metastatic cancer).

The Dukes staging system

• Dukes A The cancer is contained within the bowel wall.
• Dukes B The cancer has spread through the muscle of the bowel wall, but the lymph nodes are not affected.
• Dukes C The cancer has spread to one or more of the lymph nodes close to the bowel. Lymph nodes are usually the first place the cancer spreads to.
• Dukes D The cancer has spread to another part of the body such as the liver or the lungs (secondary cancer).

The stage system :

• Stage 0: The cancer is found only in the innermost lining of the colon or rectum. Carcinoma in situ is another name for Stage 0 colorectal cancer.
• Stage I: The tumor has grown into the inner wall of the colon or rectum. The tumor has not grown through the wall.
• Stage II: The tumor extends more deeply into or through the wall of the colon or rectum. It may have invaded nearby tissue, but cancer cells have not spread to the lymph nodes.
• Stage III: The cancer has spread to nearby lymph nodes, but not to other parts of the body.
• Stage IV: The cancer has spread to other parts of the body, such as the liver or lungs.
• Recurrence: This is cancer that has been treated and has returned after a period of time when the cancer could not be detected. The disease may return in the colon or rectum, or in another part of the body.

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Treatment of colon cancer :

Most patients with colon cancer are treated with surgery. Some people have both surgery and chemotherapy. Some with advanced disease get biological therapy.
A colostomy is seldom needed for people with colon cancer. Although radiation therapy is rarely used to treat colon cancer, sometimes it is used to relieve pain and other symptoms.

1. Surgery
a. Open surgery: The surgeon makes a large cut into your abdomen to remove the tumor and part of the healthy colon or rectum. Some nearby lymph nodes are also removed. The surgeon checks the rest of your intestine and your liver to see if the cancer has spread.
b. Laparoscopy: Early colon cancer may be removed with the aid of a thin, lighted tube (laparoscope). Three or four tiny cuts are made into your abdomen. The surgeon sees inside your abdomen with the laparoscope. The tumor and part of the healthy colon are removed. Nearby lymph nodes also may be removed. The surgeon checks the rest of your intestine and your liver to see if the cancer has spread
c. Colonoscopy: A small malignant polyp may be removed from your colon or upper rectum with a colonoscope. Some small tumors in the lower rectum can be removed through your anus without a colonoscope.

The long-term prognosis after surgery depends on whether the cancer has spread to other organs (metastasis). The risk of metastasis is proportional to the depth of penetration of the cancer into the bowel wall. In patients with early colon cancer which is limited to the superficial layer of the bowel wall, surgery is often the only treatment needed.

The time it takes to heal after surgery is different for each person. You may be uncomfortable for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.
It is common to feel tired or weak for a while. Also, surgery sometimes causes constipation or diarrhea. Your health care team monitors you for signs of bleeding, infection, or other problems requiring immediate treatment.

2. Chemotherapy
Anticancer drugs are usually given through a vein, but some may be given by mouth. You may be treated in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a hospital stay may be needed.
Chemotherapy for colorectal cancer can cause the skin on the palms of the hands and bottoms of the feet to become red and painful. The skin may peel off.

3. Biological Therapy
Some people with colorectal cancer that has spread receive a monoclonal antibody, a type of biological therapy. The monoclonal antibodies bind to colorectal cancer cells. They interfere with cancer cell growth and the spread of cancer. People receive monoclonal antibodies through a vein at the doctor's office, hospital, or clinic

4. Radiation Therapy
Radiation therapy in colorectal cancer has been limited to treating cancer of the rectum. There is a decreased local recurrence of rectal cancer in patients receiving radiation either prior to or after surgery. Without radiation, the risk of rectal cancer recurrence is close to 50%. With radiation, the risk is lowered to approximately 7%. Side effects of radiation treatment include fatigue, temporary or permanent pelvic hair loss, and skin irritation in the treated areas.
a. Intraoperative radiation therapy (IORT): In some cases, radiation is given during surgery.
b. internal radiation (implant radiation or brachytherapy): The radiation comes from radioactive material placed in thin tubes put directly into or near the tumor. The patient stays in the hospital, and the implants generally remain in place for several days. Usually they are removed before the patient goes home.
c. External radiation: The radiation comes from a machine. The most common type of machine used for radiation therapy is called a linear accelerator. Most patients go to the hospital or clinic for their treatment, generally 5 days a week for several weeks.

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Oxaliplatin (Eloxatin®)
Oxaliplatin is a platinum-based chemotherapy drugin the same family as cisplatin and carboplatin. It is typically administered in combination with fluorouracil and leucovorin in a combination known as FOLFOX for the treatment of colorectal cancer. Oxaliplatin is a colourless fluid after being dissolved from powdered form. Chemotherapy is usually given as a course of several cycles of treatment. The treatment plan for oxaliplatin depends on which type of cancer you are being treated for.

Side effect of oxaliplatin
Each person's reaction to oxaliplatin is different. Some people have very few side effects, while others may experience more

1. Numbness or tingling in hands or feet , Oxaliplatin can have an effect on the nerve endings, which is known as peripheral neuropathy. This may result in feelings of numbness or tingling, especially in the hands, feet, neck or throat. Sometimes the tingling or numbness may not happen with the first treatment, but after several treatments. This is known as a cumulative effect and should improve after the treatment has finished.
2. Lowered resistance to infection
3. Bruising or bleeding
4. Tiredness and feeling weak
5. Diarrhoea
6. Nausea (feeling sick) and vomiting
7. Anaemia (low number of red blood cells)
8. Bruising or bleeding
9. Difficulty swallowing and breathing problems
10. Sore mouth and ulcers
11. Allergic reaction
12. Taste changes

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