A CLINICO PATHOLOGICAL STUDY AND MANAGEMENT OF CARCINOMA COLON-ORIGINAL ARTICLE

DR. SARIPALLI AMMAJI; DR.AKKIDAS. SUVARCHALA

Volume : VI, Issue : IV, April - 2017

A CLINICO PATHOLOGICAL STUDY AND MANAGEMENT OF CARCINOMA COLON-ORIGINAL ARTICLE

Dr. Saripalli Ammaji, Dr. Akkidas. Suvarchala

Abstract :

INTRODUCTION: Colorectal carcinoma is the third most frequently diagnosed malignancy as well as third most common cause of cancer related deaths. Survival rate for patients with colorectal cancers have not improved substantially in the past twenty years even with advances in the anaesthetic and surgical techniques, as majority of cases present at an advanced stage, curative resection is not possible and 5 year survival drops drastically. THE AIMS OF THIS STUDY: To Study the Age, Sex distribution and various Clinical Presentations Of Colorectal malignancies. MATERIALS AND METHODS: 62 cases of colorectal malignancies admitted in Surgical Units, King George hospital, Visakhapatnam and referals from RIMS SRIKAKULAM between July2013 to August 2015 were studied. Diagnosis was established using history, clinical examination, ultrasound, C.T. scan , colonoscopy and pathological examination. Operative details included a) site of tumor b) mobility c) presence of lymph node enlargement, and d) other visceral status.All resected specimens were preserved in 10% Formalin and sent for histo-pathological studies. ANALYSIS AND RESULTS:Number of cases included in my study were 62. Analysis of these cases with respect to distribution regarding age, sex, site of the tumor, clinical presentations and various surgical procedures done.Cancer involving the right colon is seen at a relatively earlier age than left colon and rectum. M: F = 2.8:1Though there are no established extra risk factors for male, colorectal cancer more commonly seen in males compared to females. In this analysis male to female ratio is 2.8: 1. Most common presenting symptom – Bleeding per rectum. Mode of presentation: 16 percent of cases presented as an emergency.Majority of left side colonic cancers and all of the rectal cancers are presented with bleeding as the presenting symptom. Apart from bleeding they also have history of passing mucus in stools and tenesmus. Most common presentation of cancer involving caecum, ascending colon and hepatic flexure is altered bowel habit like constipation and diarrhoea with weakness and loss of weight some cases specially growth involving the hepatic flexure presented with obstruction. 4 cases with perforation both involving the sigmoid colon. Lesion in the sigmoid colon is usually a stricture involving in circumferential pattern. Among 62 cases followed in detail 52 cases diagnosed and planned for an elective procedure. 10 cases presented as emergencies and of which 6 cases with obstruction and 4 cases with perforation at the site of growth and peritonitis.All these patients have symptoms like weakness, pallor, loss of appetite and weight losMajority of the colorectal cancers are proliferative growths. Stricture type of growth is common in the sigmoid and rectosigmoid region though the lesions in the right colon are of proliferative type obstruction as the presentation is rare because of the liquid consistency of stool.Tumor stage (Dukes (Classification) stage A NIL cases, stage B-16 cases, stage -C 34 cases were identified. Among the 62 cases followed at Laparotomy in 16 cases the lesion found to be limited to the bowel wall. Majority of cases (54.8%) are presented at a stage where tumor already spread to paracolonic and pararectal tissues and lymphnodes. In about 20% of cases distant metastasis to liver, peritoneum and omentum is seen. Nature of procedure : For 8cases right hemicolectomy done, 4cases left hemicolectomy, for 26 cases abdominoperineal resection done, for 3 cases anterior resection,3- cases palliative resection, 7-Transvere colostomy,4- cases sigmoid colostomy, 7- sigmoidectomy done. Of the 62 cases followed there were three deaths accounting for 4.8% mortality of which 2 cases presented for emergency surgery with feacal peritonitis and 1 case following APR.Cause of death post operative septic shock. Follow up: Of the cases followed for two years - four cases had local recurrence after 6 months, One case had bone secondaries after 6 months, three cases had liver secondaries after 6 months.