Colorectal Tumors
Colorectal Tumors
Colorectal Tumors
Neoplastic epithelial
Benign tumors polyps
Mesenchymal tumors
A polyp is a well circumscribed tissue mass that protrudes
into the lumen of the colon.
o Pedunculated, sessile, flat or depressed
Juvenile polyps:
o congenital polyp, retention polyp, juvenile adenoma.
o usually occurs in children under 10 years of age, M>F.
o It is the most frequent colorectal tumor in children.
o Nearly 80% occur in the rectum but they may be scattered
throughout the colon.
o The majority of these polyps are larger than 1 cm in
diameter.
Juvenile polyposis syndrome:
Lymphoid polyps:
o occur typically where clusters of lymphoid follicles are
present (terminal ileum, rectum).
o Rectal lesions may lack symptoms while colonic polyps may
cause bleeding, abdominal pain, changing bowel habits and
intussusception above all in children.
o Removal is important in order to differentiate the condition
from other polyps.
Neoplastic epithelial polyp
1. Size
o Polyps <1 cm: 1% malignant
o Polyps 1–2 cm in size: 10% malignant
o Polyps >2 cm in size: 50% malignant
2. Histologic type
o Tubular: 5% malignant
o Tubulovillous: 20% malignant
o Villous: 40% malignant
3. Grade of atypia
o Mild: 5% malignant
o Moderate: 20% malignant
o Severe: 35% malignant
Lipoma
Leiomyoma
Mesenchymal tumors
Neuroma
Hemangioma
Angioma Lymphangioma
Mesenchymal lesions
Lipoma:
o the second most common benign tumor of the colon after
adenomatous polyps.
o The most common intramural tumor.
o They are mostly diagnosed with colonoscopy (cushion sign).
o As long as asymptomatic they do not require treatment.
o However with size in excess of 2 cm they give rise to some
symptoms: constipation, diarrhea, abdominal pain, rectal
bleeding and intussusception
o Colonoscopic resection is the treatment of choice.
Leiomyoma:
o The tumor may be an incidental finding in asymptomatic
individual.
o Patients sometimes present with pain, intestinal
obstruction, hemorrhage or resistance in the abdomen.
o The mitotic rate is the single most important criterion for a
diagnosis of malignancy.
o Recurrences are frequent, mostly due to malignant
transformation
Neuroma:
o Neuroma, neurofibroma are rare histologies found in the
colon and rectum.
o Visceral involvement in disseminated neurofibromatosis von
Recklinhausen is an extremely rare appearance of the
disease.
o Gastrointestinal bleeding or intestinal obstruction are the
main symptoms.
o Treatment has been local excision, if possible or resection.
Angioma
Hemangioma
o The pathogenesis is probably congenital.
o Capillary hemangiomas consist of small, thin walled.
o Cavernous hemangiomas are composed of large thin
vessels.
o Thrombosis is common in cavernous hemangiomas;
calcification frequently occurs.
o The most common complication of colonic hemangiomas is
bleeding (60 to 90%).
o Resection of a bleeding one is the optimal treatment, rectal
hemangiomas may be treated by sclerosing therapy.
o Radiation therapy in the rectum may be an alternative
approach.
Lymphangioma:
o Lymphangiomas may be pedunculated, can be safely
removed via the colonoscope.
o Limited resection should be considered for all sessile
tumors.
Colo-rectal cancer
Incidence
Most common malignancy in GIT
Third most common cancer over all
Second most common cause of cancer death
Incidence increases with age starting at age 40, rapid
increase at 50 years and peak at 60–79 years of age.
The lifetime risk is about 5%.
This risk is slightly higher in male than in female.
Types
Adenocarcinomas: represents more than 95% of colorectal
cancers.
Blood tests:
o Complete blood count (CBC): to look if there is anemia.
o Liver enzymes: to look for liver metastasis.
Tumor markers:
o The most common tumor markers for colorectal cancer are
carcinoembryonic antigen (CEA).
o Used to monitor patients who already have been diagnosed
with or treated for colorectal cancer.
o These tumor markers are not used to screen for or
diagnose colorectal cancer.
o can sometimes be normal in a person who has cancer
o higher levels may be found in patients with ulcerative
colitis, non-cancerous tumors of the intestines, or some
types of liver disease or chronic lung disease
If symptoms/signs or blood tests suggest that colorectal cancer
might be present:
o Colonoscopy+Biopsy: Usually if a suspected colorectal
cancer is found by any diagnostic test, it is biopsied during a
colonoscopy.
o Computed tomography (CT) scan: can help tell if colon
cancer has spread into your liver or other organs.
o Ultrasound: can be used to look for tumors in liver,
gallbladder, pancreas, or elsewhere in abdomen, it is often
done if the CT shows tumors in the liver.
Two special types of ultrasound exams are sometimes used to
evaluate colon and rectal cancers.
o Endorectal ultrasound: used to see how far cancer
penetration through the rectal wall and whether it has
spread to nearby organs or tissues such as lymph nodes.
o Intraoperative ultrasound: This exam is done intra-
operatively to look for liver spread.
Magnetic resonance imaging (MRI) scan: can be helpful in
rectal cancers to look for nearby structures spread, also
sometimes useful in looking at abnormal areas in the liver.
Chest x-ray: to see if cancer has spread to the lungs.
Positron emission tomography (PET) scan A PET scan can help
give the doctor a better idea of whether an abnormal area seen
on another imaging test is a tumor or not. also be useful if
doctor thinks the cancer may have spread but doesn't know
where.
PET/CT scan: This allows to compare areas of higher
radioactivity on the PET with the more detailed picture of that
area on the CT.
Angiography: can help to decide if the liver tumors can be
removed and also planning other treatments, like embolization
Staging
Lymphatic spread:
Epicolic, paracolic, para aortic lymph nodes.
Transcoelomic spread
Grades of colorectal cancer
It describes how closely the cancer looks like normal tissue
when seen under a microscope, affect outlook for survival
The scale used for grading colorectal cancers goes from 1 to 4.
o Grade 1 (G1) means the cancer looks much like normal
colorectal tissue.
o Grade 4 (G4) means the cancer looks very abnormal.
o Grades 2 and 3 (G2 and G3) fall somewhere in between.
The grade is often simplified as either low grade (G1 or G2) or
high grade (G3 or G4).
Low-grade cancers tend to grow and spread more slowly than
high-grade cancers.
Clinicopathological staging
Dukes’ staging:
o A ic not breaching muscularis propria
o B ic breaching muscularis propria
o C ic involving lymph nodes
o D ic with distant metastasis
Treatment
Lt hemicolectomy
Sigmoid colectomy
Anterior resection