Week 19: Colorectal Cancer

The Colon

The Colon

1. In which part of the colon do cancers most commonly occur?

The descending, or right sided, colon, exposed to more toxins over a life time.

2. What does Duke’s B staging mean?

Duke’s staging is

A: within the bowel, not breaching the muscularis propria
B: Breaching the muscular bowel wall
C: Lymph node metastases
D: (not in the original calssification) Distant metastases.

3. After surgery, is chemotherapy useful? If so, in which patients? Which chemotherapy would you use?

It is useful in the adjuvant setting for patients with Duke’s C cancer, reducing their risk of recurrence from 50% to 40%, and in some Duke B patients, for example if vascular or lymphatic invasion is seen at pathological assessment.

Chemotherapy most widely used is Capecitabine, an oral 5FU based agent, an antimetabolite, plus in some cases Oxalipatin, a platinum based agent. The paper in the NEJM introducing Oxaliplatin to the adjuvant setting was published in 2004.

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