Abdominal Stomas

Colorectal cancer: management

Management strategies depend on the tumour's location, stage, histological type, and the patient's overall health status.

Staging

All patients with newly diagnosed colorectal cancer should have the following for staging:

• carcinoembryonic antigen (CEA)
• CT of the chest, abdomen and pelvis
• their entire colon should have been evaluated with colonoscopy or CT colonography
• patients whose tumours lie below the peritoneal reflection should have their mesorectum evaluated with MRI.

The TNM (Tumour, Node, Metastasis) staging system is commonly used to stage CRC, aiding in prognosis and treatment planning. Once their staging is complete patients should be discussed within a dedicated colorectal MDT meeting and a treatment plan formulated.

Treatment of colonic cancer

Surgery

• Cancer of the colon is nearly always treated with surgery
• Resectional surgery is the only option for cure in patients with colon cancer.
• The procedure is tailored to the patient and the tumour location as detailed below
• Some patients may have confounding factors that will govern the choice of procedure, for example a tumour in a patient from a HNPCC family may be better served with a panproctocolectomy rather than segmental resection.
• Anastomosis
  • Following resection the decision has to be made regarding restoration of continuity.
  • For an anastomosis to heal the key technical factors include; adequate blood supply, mucosal apposition and no tissue tension
• Obstruction
  • When a colonic cancer presents with an obstructing lesion; the options are to either stent it or resect
  • In modern practice it is unusual to simply defunction a colonic tumour with a proximal loop stoma. This differs from the situation in the rectum (see below).

The operations for cancer are segmental resections based on blood supply and lymphatic drainage: