BeyHealth Quarterly Journal (BHQJ) BHQJ 2018: 001:1 (May 2018) - Page 27

CLINICAL UPDATE Diagnosis anastomosis, figure 5) may be A diagnosis of colorectal cancer is based on a attempted good history. Weight loss, rectal bleeding (any clearance margin of at least two colour, frequency or quantity), change in bowel centimetres is achieved. However, habit, incomplete oncological clearance of a tumour emptying), anaemia, abdominal pain and/or should always take precedence distension or palpable abdominal mass on over any attempt to save the physical examination. sphincters in which case an Remember that a good clinical assessment abdominoperineal excision of the includes a rectal examination (PR) and rectum examination permanent colostomy must be tenesmus (feeling with a of rigid or flexible provided with a formation distal of a sigmoidoscope and is completed by direct undertaken. All excised specimens visualisation of the entire colon at colonoscopy are staged histologically (Duke’s (gold standard) or indirectly with barium studies and TNM classification) as the (obsolete in developed countries). results confirm curative surgical One must ensure that colonoscopy is resection performed recommend further adjuvant or by a suitably qualified gastroenterologist or gastrointestinal surgeon or the need Fig 2: Right hemicolectomy and ileo-colic anastomosis for right sided lesion to palliative treatment. who is trained to intubate the caecum (confirmation of a complete examination) and Adjuvant Treatment to recognise both normal and abnormal for Colorectal Cancer findings. The rationale behind adjuvant CT pneumocolon / virtual colonoscopy is a treatment for colorectal cancer is modern alternative where the risk of colonoscopy is unacceptably high or cannot be threefold; 1. Surgery alone has failed to tolerated by the frail patient. Histological significantly improve overall confirmation of cancer from tumour sample is survival from the disease. required before staging investigation with a CT scan of the chest, abdomen and pelvis, MRI for 2. Micrometastasis of cancer cells is thought to be the reason for rectal cancer and an endo-anal ultrasound to failure of surgery alone. define early rectal cancer that may be 3. A better understanding of amenable to local excision. tumour cell cycle indicates that Treatment susceptible to destruction by Surgery Fig 3: Extended right hemicolectomy and ileo- transverse anastomosis for transverse micrometastases are colon lesion chemotherapy agents. Surgery offers most people a realistic chance Adjuvant treatment is usually in the form of of disease cure – 80% of patients survive five chemotherapy, years following curative resection (stage 1&2) radiotherapy. radiotherapy or chemo- CPD UPDATE • There are 750,000 new cases of colorectal cancer per annum and histological findings indicate that no further worldwide and nearly 300,000 treatment is necessary. Surgical options for Chemotherapy early colon cancer include a right, extended or Adjuvant chemotherapy has significant 3-5- left hemicolectomy with primary anastomosis year survival benefits in patients with node- for lesions in the right, transverse or left colon positive disease. The main cytotoxic agents are respectively (figure 2-4). 5-Fluorouracil with Folinic acid, Oxaliplatin and 44 years (compared to 67 years in Western Europe) deaths • Peak age of incidence of colorectal cancer in Nigeria is approximately A high anterior resection is performed for recto- Irinotecan in various combinations administered sigmoid tumours while total mesorectal as an infusion over 306 months. The recent excision (TME) usually with a temporary loop addition of immunotherapy agents such as ileostomy is the gold standard operation for cetuximab, panitumumab or bevacizumab compared to just 30% of the rectal tumours. In very low rectal cancers, a confers additional survival benefits in this cohort screened population in Western sphincter-saving operation (colo-pouch anal of patients. Europe Issue 1 | MAY 2018 | • 75% of patients in Nigeria present with advanced disease (stages 3 & 4) 27