A 56-year-old female presented with abdominal pain, R/O colitis. There is a long segment of asymmetrical wall thickening seen involving the ascending colon just above the ileocaecal region to proximal third of transverse colon associated with luminal narrowing and significant surrounding fat stranding and enlarged regional lymph node.
56-year-old female presented with abdominal pain, R/O colitis.
There is a long segment of asymmetrical wall thickening seen involving the ascending colon just above the ileocaecal region to proximal third of transverse colon associated with luminal narrowing and significant surrounding fat stranding and enlarged regional lymph node.
There is small focal collection noted measuring about 3 x 2 x 2.3 cm in the AP, transverse and craniocaudal diameter situated inferior to the proximal portion of the transverse colon.
There is no associated proximal wall dilatation or bowel obstruction. Diverticulosis of the left hemicolon is noted.
Right colon removed along with lymphnodes.
Adenocarcimona, moderately differentiated, ulcerated.
All most all colon cancers are primary adenocarcinomas, which are the third most common cancer in both men and women in North America and Western Europe.
Colon cancers are the most common gastrointestinal (GI) carcinomas and have the best
prognosis. The 5-year survival rates of approximately 50 percent may be improved by screening and removal of adenomatous polyp.
The prognosis of patients with colon cancer relates to the stage of the disease at the time of diagnosis and to initial treatment. Although a tumor, node, metastasis(TNM)–based international classification and a computed tomography (CT) staging system have been developed, the Dukes classification (or one of its modifications) is widely used. Prognosis is also affected by the histologic grade of the tumor.
The complications of colon cancer include obstruction (common), perforation (uncommon), intussusception and ischemic colitis proximal to an obstructing tumor (rare), and fistula formation in the small bowel, bladder, or vagina (rare).
Table 1. Dukes Classification and 5-Year Survival (modified from Zinkin)
|A||Limited to the bowel wall||83%|
|B||Extension to pericolic fat; no nodes||70%|
|C||Regional lymph node metastases||30%|
|D||Distant metastases (liver, lung, bone)||10%|
Table 2. CT Scan Staging System for Colon Cancer
* Modified from Thoeni.
|T1||Intraluminal polypoid mass; no thickening of bowel wall|
|T2||Thickened colon wall > 6 mm; no periodic extension|
|T3a||Thickened colon wall plus invasion of adjacent muscle or organs|
|T3b||Thickened colon wall plus invasion of pelvic side wall or abdominal wall|
|T4||Distant metastases, usually liver, lung, or adrenal glands|
Table 3. TNM/Modified Dukes Classification System
*American Joint Committee on Cancer
|TNM Stage||Modified Dukes Stage||Description|
|T1 N0 M0||A||Limited to submucosa|
|T2 N0 M0||B1||Limited to muscularis propria|
|T3 N0 M0||B2||Transmural extension|
|T2 N1 M0||C1||T2, enlarged mesenteric nodes|
|T3 N1 M0||C2||T3, enlarged mesenteric nodes|
|T4||C2||Invasion of adjacent organs|
|Any T M1||D||Distant metastases|
Sushila Ladumor, MD, FRCR, Consultant Radiologist with Multi-modality Imaging experience, working in Medical Imaging Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
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