HEGAZY SURGERY

1. The Ins and Outs
of
ColoRectal Cancer
By
Kelly Hann

2. Anatomy
The Body’s Digestive System
– Esophagus, Stomach, Small Intestine &
Large Intestine
1st 6 feet = large bowel or colon
Last 6 inches = rectum & anal canal
The anal canal ends at the anus

3. American Cancer Society

4. Signs & Symptoms
• Change in bowel habits
• Blood in Stool
– Bright red
– Very dark red
– Black/Tarry Stool
• Diarrhea
• Constipation
• Does your bowel feel like
it emptied completely?
• General abdominal
discomfort
– Gas pains
– Bloating
– Fullness
– Cramps
• Weight loss w/ no
explained reason
• Constant tiredness
• Vomiting (coffee grounds)

5. Tests that examine…
Rectum, Rectal Tissue, & Blood
Aids in diagnosing & preventing colon cancer

6. Physical Exam
• General Medical History
– Includes self health habits
– Past self illnesses
– Various treatments used for previous issues
– Family health history
• If patient reports problems with respect to signs
and symptoms related to common bowel change
habits…
• Are symptoms affecting your everyday life?

7. Fecal occult blood test
• Check stool for evidence of blood
• Method
– Small samples of stool are placed on special
cards and returned to the Dr. or Lab for
testing under a microscope
• Potential harms
– False-positive & false negative results
(uncommon…serious

8. Digital Rectal Exam
• The doctor or nurse inserts a lubricated,
GLOVED finger into the rectum to feel for
lumps or abnormal areas.

9. Barium Enema
• Barium is a liquid, that contains a silver-
white compound, inserted into the rectum
• The barium coats the lower GI tract and a
series of x-rays are taken of the lower GI
tract
• AKA = a lower GI series

10. What does a Barium Enema do?
• Detects
– Ulcers
– Narrowed areas (strictures)
– Growth of the lining (polyps)
– Small pouches in the wall of the intestine
• Diverticula
– Cancer
– abnormalities

11. How can one prepare for this test?
• Colon must be completely empty
– Prescribed laxatives or enema (pre-exam)
• Special Diet to follow (2 days prior)
– Clear liquids
– Tea or coffee without milk or cream
– Any juice without pulp (NO OJ or Tomato)
– Broth
– Carbonated beverages

12. Types of Barium Enemas
• Single Column
– Lie on side on Xray table
– Enema tube inserted into rectum
– Barium bag is delivered into colon
– May feel urge to have a bowel movement….DON’T
– Though, a small balloon will keep it inside you
– Take long deep breaths through mouth…helps relax
– May be asked to turn & rotate to evenly coat all colon
– Then the radiologist will take a number of X-ray images
from various angles

13. Air Contrast (Double contrast)
• Similar to single-column
• Big difference…Air is inflated with air in
addition to the barium to expand and
improve the quality of the images
• Polyps can be seen easier, among other
abnormalities

14. Post Barium Enema instructions
• You will be able to go to the restroom
immediately following the procedure to expell
the remaining barium
• Over next few days your stool will be white, gray,
or pink
• Might be given a cleansing enema, laxatives,
and told to drink a lot of liquids
• The remaining barium can cause constipation.
• Refer back to MD if you don’t return to normal in
3-4 days

15. Results
• Negative = no
abnormalities are
found
• Positive =
abnormalities found,
such as polyps.
• If positive you may
be scheduled for
further testing.

16. Pros of Barium Enema
• Pros
– No sedation, complications are slight
(perforation of colorectal wall)
– If 50+ Medicare covers this every four years
for colorectal cancer screening as an
alternative to colonoscopy
– If you are high risk, covered every two years,
though colonoscopy is preferred

17. Cons of Barium Enema
• miss small polyps or sometimes even
small cancers
• Biopsy and polyp removal cannot be done
during testing
• you may need to follow up with a
colonoscopy
• Preparing for the procedure (emptying the
colon) and the procedure itself can be
unpleasant

18. Sigmoidoscopy
• Views the rectum and
sigmoid colon areas for
polyps, abnormalities, or
cancer
• A sigmoidoscope is a thin
lighted tube is inserted into
rectum & up through the
sigmoid colon
• May remove polyps or
tissue samples for biopsy

19. Procedure Detection
• The cause of diarrhea, abdominal pain, or
constipation
• Detect early signs of cancer in descending
(sigmoid) colon and rectum
• can see bleeding, inflammation, abnormal
growths, and ulcers
• not sufficient to detect polyps or cancer in
the ascending or transverse colon (two-
thirds of the colon).

20. Preparation Complications
• Liquid diet
• Most likely given an
enema pre-procedure
• Air is pumped into
colon to help expand
and see more surface
area
• Duration is 10-20
minutes
• Though very
uncommon
• It is likely that
bleeding or a
puncture of the colon
could result during
procedure

21. Polyp………...Removal

22. Colonoscopy
• Procedure to look into entire length of
large intestine (colon) to detect
abnormalities
• Preparation, procedure, & results same as
sigmoidoscopy
• New virtual colonoscopy as alternative
procedure

23. Virtual or (CT) Colonography
• a series of x-rays called computed
tomography to make a series of pictures of
the colon
• Computer then puts these pictures
together to create a detailed image that
shows polyps, etc.

24. Prognosis (chances of recovery)
• Depends on
– Stage : in the inner lining of colon only, whole
colon? Spread to other places in body
– Has it blocked or created a hole in the colon?
– Blood levels of carcinoembryonic antigen
(CEA); a substance in the blood that may be
increased when cancer is present, before
treatment begins.
– Has cancer recurred?
– Patient’s general health?

25. Treatment Options
• Surgery (main treatment)
• Radiation Therapy
• Chemotherapy
• Newer targeted therapies
– Monoclonal antibodies
• Depending on stage of cancer, it is likely
that 2-3 types of treatment may be utilized
at the same time or one after the other

26. Surgery
• Removal of cancer and normal area of
colon on either side, as well as nearby
lymph nodes
• Then sewn back together
• Colostomy (bag to catch the waste kept
outside the body)
• If cancer is found early, a colonscope can
be used without cutting the abdomen

27. Surgery for Rectal Cancer
• Surgery is main treatment, along with a combination of
radiation therapy
• Polypectomy, local excision, and local transanal
resection) can be done with instruments placed into the
anus,
• Stage I, II, & III rectal cancers, other types of surgery
may be done
• A low anterior resection is used for cancers near the
upper part of the rectum, close to where it connects with
the colon.
• Abdominoperineal resection is done for cancers located
close near the lower rectum-anal conjunction. After this
surgery, a colostomy is needed

28. • Pelvic Exenteration:
– the surgeon removes the rectum as well as
nearby organs such as the bladder, prostate,
or uterus if the cancer has spread to these
organs. A colostomy is needed after this
operation. If the bladder is removed, a
urostomy (opening to collect urine) is needed

29. Radiation Therapy
• high-energy rays (such as x-rays) to kill or shrink
cancer cells
• external radiation
• internal or implant radiation; placed directly into
tumor
• Radiation can also be used to ease symptoms of
advanced cancer such as intestinal blockage,
bleeding, or pain
• Main uses is for those where cancer had
attached to an internal organ or the lining of the
abdomen
• can be aimed through the anus and reaches the
rectum without passing through the skin of the
abdomen

30. Chemotherapy
• use of anticancer drugs injected into a vein or
given by mouth
• treatment useful for cancers that have spread to
distant organs
• increase the survival rate for patients with some
stages of colorectal cancer (will kill normal cells
also)
• Side effects depend on amount, length, & type of
drugs given (i.e. diarrhea, nausea, vomiting, loss
of appetite & hair, mouth sores, increased
chance of infections, bruising & bleeding after
minor cuts or injuries & overall increased fatigue

31. Risk Factors
• Age 50 or older
• Obesity (fat in waist area increases)
• 30%-40% of smokers diagnosed with cancer will die
• A family history of cancer of the colon or rectum.
• A personal history of cancer of the colon, rectum, ovary,
endometrium, or breast.
• A history of polyps or ulcerative colitis (ulcers in the lining
of the large intestine) or Crohn’s disease.
• Certain hereditary conditions, such as familial
adenomatous polyposis and hereditary nonpolyposis
colon cancer (HNPCC; Lynch Syndrome)
• Heavy use of Alcohol has been linked to this cancer

32. Dietary Risk Factors
• eat plenty of fruits, vegetables, and whole grain
foods
• to limit high-fat foods (especially from animal
sources) and limit excessive alcohol
consumption
• studies suggest that taking a daily multivitamin
containing folic acid or folate can lower risk
• Other studies suggest that getting more calcium
with supplements or low-fat dairy products can
help
• Getting enough exercise is important as well 30
min of physical activity on 5+ days per week.

33. Survival Rates
• 9 of 10 people whose cancer is found & treated
at early stage (before spreading) will live at least
5 years
• Spread to nearby organs/lymph nodes= 5years
– 66% survival rate
• Spread to lungs/liver= 5 year – 9%
• (5 yr is based on percentage of patients that
were alive 5 yrs after diagnosis. Leaving out
those who died of other causes)

34. Closing Points
• These numbers provide an overall picture, but keep in
mind that every person’s situation is unique and the
statistics can’t predict exactly what will happen in your
case.
• Don’t “strain” yourself…use more fiber in your diet
(supplements work well when you can’t get it through
your food intake ~ just drink lots of water & not within 1
hour of laying down)
• Eat healthy food when on the run pack your
lunch/snacks
• Increase your Healthy lifestyle potential
• Parents/Grandparents
• Increase awareness that it is ok to get screened
• Mark it on your to do list in 25-30 years as a birthday
present to yourself and family.

35. Dedicated to
• FRANCIS HARRY COMPTON CRICK
•
• 1962 Nobel Laureate in Medicine
• for their discoveries concerning the molecular structure of nuclear acids and its significance for information transfer
in living material.
• Background
• Born: 1916
• Died: 7/29/2004 Died Today of Colon Cancer (88 yrs old)
• Residence: Great Britain
Affiliation: Institute of Molecular Biology, Cambridge