Tumore del Colon

Colorectal cancer

Colorectal cancer is one of the main causes of mortality for cancer in the Western World, with 678.000 new cases per year in the world, 150.000 in Europe and e 30.000 in Italy. In our country the incidence is of about 30-50/100.000 new cases per year .
It typically starts as a benign tumor, often in the form of a polyp, which over time becomes cancerous.
Recommended screening test are: fecal occult blood tests and colonoscopy.

Main risk factor is family history of the disease.

Signs and symptoms

The classic signs of rectal cancer include: worsening constipation, blood in the stool, rectal bleeding. Other warning symptoms are loss of appetite and weight loss, asthenia caused by chronic anemia.Unfortunately, this cancer can be completely asymptomatic and diagnosed only at a later stage (bowel occlusion, metastases, locally advanced cancer). For this reason, screening is typically recommended at the age of 50 years old, and for those at high risk screening usually begins at the age of 35-40.

Diagnosis

Both polyps and colorectal cancers can bleed, and fecal occult blood test checks for tiny amounts of blood in feces (stool) that cannot be seen visually. If the test is positive, it is then necessary to perform a colonoscopy.

In presence of symptomatic cases, we will proceed directly to colonoscopy, which enables the identification and sampling of areas of the colon suspicious for possible tumor development.
If the diagnosis of cancer is confirmed, a disease extent is usually determined by a CT scan of the chest, abdomen and pelvis.

Management

Small polyps can be removed during colonoscopy. For voluminous polyps or malignant tumors it is mandatory to proceed with surgery.
 
The type of procedure depends on the localization of the lesion.

• Right hemi colectomy for tumors of the ceacum, right colon and first portion of transverse colon-
• Trasversecolectomy or estende right hemicolectomy for tumors of the medium transverse colon.
• Left hemicolectomy for tumors of the splenic flexure and descending colon.
• Sigmoidectomy for tumors of descending colon and sigma.

 
The surgeon removes the part of the colon containing the tumour and the lymph nodes closest to the bowel, in case any cancer cells have spread ther, in order evaluate the extent and to select the appropriate postoperative treatment, to reduce the risk of recurrence.

Surgical approach

The procedure can be performed in open surgery or with a mini-invasive approach. Evidence shows that mini-invasive surgery is a safe as laparotomy in oncological surgery.
Laparoscopic approach allows to perform surgery using smaller incisions, determining a less post operative discomfort, , a quicker recovery time, shorter hospital stay, earlier return to full activities, with a rapid return to their daily activities.