الفهرس 
Surgical anatomy of the colon and rectumOnly 14 pages are availabe for public view
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Abstract
Colorectal cancer is the third most frequently diagnosed cancer in United States and has the second highest cancer-related mortality rate after lung cancer. Its incidence in developed countries is almost double that in developing countries. Cancer of the colon is equally frequent in men and women. Colorectal cancer in Egypt is characterized by an even distribution among different age groups and high prevalence in young people.
Incidence of cancer colon increases with increasing socioeconomic status. Diets high in meat and fat, low in fruit and vegetables are associated with an increased risk of colorectal cancer. A number of groups have an increased risk of developing colorectal cancer. At highest risk are those with either of the dominantly inherited conditions, familial adenomatous polyposis (FAP) and heridetary non polyposis colorectal cancer (HNPCC).
Most colorectal cancer arises in adenomatous polyps and their ablation arrests the development of cancer. Other groups at moderately increased risk include those with long standing ulcerative colitis or Crohn′s disease. Early detection of colorcetal cancer is actually prevented by detection and removal of adenomatous polyps.
History in a case of carcinoma of the colon or rectum may sometimes prove unhelpful in reaching a diagnosis, or actually misleading.Colorectal cancers remain asymptomatic for years; symptoms develop insidiously and frequently have been present for months , sometimes years , before diagnosis.
Because of the slow growth, regular screening tests can detect colorectal cancer in its earliest phase before any symptoms have occurred, several approaches are available for detection of colorectal neoplasia, including physical examination, digital rectal examination, fecal occult blood testing, serum carcinoembryonic antigen, standard sigmoidoscopy, fiber-optic sigmoidoscopy, full colonoscopy, single and double contrast barium enema, CT & MRI scans and combinations of these procedures.
Surgical treatment is the commonest in management of colorectal cancer as several types of operations are beying used, like; (right hemicolectomy, left hemicolectomy, transverse colectomy and even total abdominal colectomy) in colon cancer resection, and; (anterior resection, high anterior resection, Hartmann’s operation and abdominoperineal resection) in treatment of rectal tumours.
Surgical treatment techniques and outcome depending on the histopathological staging which is carried on resection specimen to obtain an estimate of prognosis.
Seventy percent of colorectal cancer patient present by apparently localized disease. In these patients surgery can be curative, but relapse after complete resection are frequent. Surgical management of the colorectal patients have rapidly changed over the last two decades in order to improve the outcome. Many trials including adjuvant chemotherapy, neoadjuvant chemotherapy, preoperative radiotherapy and immunotherapy have rapidly developed with the aim of decreasing the recurrence rate and increase the survival of the patients.
Important advances have been made in our understanding of the role of adiuvant therapy for colorectal cancer. Current standard 5FU-based regimens have been shown to reduce the incidence of recurrence and to prolong overall survival in patient with resected stage III colon cancer. Colon cancer patients with stage II disease have better overall prognosis than those with stage III, however, the relative merits of adjuvant treatment in these patients remain controvsersial.
The role of laparoscopic approaches to cancer resection remains unproven. Advocates the technique advantages in terms of smaller wound site, early postoperative mobilization, resolution of ileus and return to normal activity. However, such findings have not been consistently identified in clinical trials, and more recent randomized studies have suggested that any benefit may be small.
On the other hand, inadequate excision and increased morbidity are potential risks of laparoscopic approach. Moreover, preoperative radiotherapy may induce difficulties in pelvic dissection. The future place for laparoscopic resection of the colorectal cancer remains uncertain.
Modern cancer management is a team effort involving experts in surgery, chemotherapy, radiotherapy and palliative care. All of these disciplines have an important contribution to the management of locally recurrent colorectal cancer, recurrent colorectal cancer manifests in large variety of ways, and treatments need to be tailored to each individual.