COLORECTAL CANCER Tumors of the colon and rectum are relatively common; the colorectal area (the colon

and rectumcombined) is now the third most common site of new cancer cases and deaths in the United States.Colorectal cancer is a disease of W estern cultures; there were an estimated 48 !"" new cases and #$ """ deaths from the disease in %""% (&merican Cancer Society %""%). The incidence increases witha'e (the incidence is hi'hest for (eo(le older than 8# years of a'e) and is hi'her for (eo(le with a familyhistory of colon cancer and those with )*+ or (oly(s. The e,act cause of colon and rectal cancer is stillun-nown but ris- factors have been identified. Risk Factors for Colorectal Cancer .)ncreasin' a'e ./amily history of colon cancer or (oly(s .0revious colon cancer or adenomatous (oly(s .1istory of inflammatory bowel disease .1i'h2fat hi'h2(rotein (with hi'h inta-e of beef ) low2fiber diet .3enital cancer or breast cancer (in women) Pathophysiology Cancer of the colon and rectum is (redominantly (4#5) adenocarcinoma (ie arisin' from thee(ithelial linin' of the intestine). )t may start as a beni'n (oly( but may become mali'nant invade anddestroy normal tissues and e,tend into surroundin' structures. Cancer cells may brea- away from the(rimary tumor and s(read to other (arts of the body (most often to the liver). SURGICAL ANAGE ENT Sur'ery is the (rimary treatment for most colon and rectal cancers. )t may b e c u r a t i v e o r (alliative. &dvances in sur'ical techni6ues can enable the (atient with cancer to have s(hincter2 savin'devices that restore continuity of the 3) tract. The ty(e of sur'ery recommended de(ends on the locationand si7e of the tumor.Sur'ical (rocedures include the followin'8 .Se'mental resection with anastomosis (ie removal of the tumor and (ortions of the bowel on either side of the 'rowth as well as the blood vessels and lym(hatic nodes) .&bdomino(erineal resection with (ermanent si'moid colostomy (ie removal of the tumor and a(ortion of the si'moid and all of the rectum and anal s(hincter) .T e m ( o r a r y c o l o s t o m y f o l l o w e d b y s e ' m e n t a l r e s e c t i o n a n d a n a s t o m o s i s a n d s u b s e 6 u e n t reanastomosis of the colostomy allowin' initial bowel decom(ression and bowel (re(aration before resection .0ermanent colostomy or ileostomy for (alliation of unresectable obstructin' lesions .C o n s t r u c t i o n o f a c o l o a n a l r e s e r v o i r c a l l e d a c o l o n i c 9 ( o u c h i s ( e r f o r m e d i n t w o s t e ( s . & tem(orary loo( ileostomy is constructed to divert intestinal flow and the newly constructed 9(ouch (made from $ to :" cm of colon) is reattached to the anal stum(. &bout ! months after theinitial sta'e the ileostomy is reversed and intestinal continuity is restored. The anal s(hincter and therefore continence are (reserved. COLOSTO ! & colosto"y is the sur'ical creation of an o(enin' (ie stoma) into the colon. )t can be created asa tem(orary or (ermanent fecal diversion. )t allows the draina'e or evacuation of colon contents to theoutside of the body. The consistency of the draina'e is related to the (lacement of the