Colonic cancer: incidence, pattern &role of radical surgery in stage 11AND 111,in al nassiryia

Abstract

Background: Invasive colorectal cancer is a preventable disease. Early detection through widely applied screening programs is the most important factor in the recent decline of colorectal cancer in developed countries .Full implementation of the screening guideline scan decrease mortality rate from colorectal cancer in the United States by an estimated additional 50%; even greater reductions are estimated for countries where screening tests may not be widely available at present. New and more comprehensive screening strategies are also needed.^[1] Fundamental advances in understanding the biology and genetics of colorectal cancer are taking place. This knowledge is slowly making its way into the clinic and being employed to better stratify individual risks of developing colorectal cancer, discover better screening methodologies, allow for better prognostication, and improve one’s ability to predict benefit from new anticancer therapies.^[2] In the past 10 years, an unprecedented advance in systemic therapy for colorectal cancer has dramatically improved outcome for patients with metastatic disease. Until the mid-1990s, the only approved agent for colorectal cancer was 5-fluorouracil. New agents that became available in the past 10 years include cytotoxic agents such as irinotecan and oxaliplatin,oral fluoropyrimidines (capecitabine and tegafur), and biologic agents such as bevacizumab, cetuximab, and panitumumab.Though surgery remains the definitive treatment modality, these new agents will likely translate into improved cure rates for patients with early stage disease (stage II and III) and prolonged survival for those with stage IV disease. Further advances are likely to come from the development of new targeted agents and integration of those agents with other modalities such as surgery, radiation therapy, and liver-directed therapies.^[3] this study was done in Al Nassyria in Al Hussein teaching hospital through 2 years from April 2008 to March 2010  with 3 years fallow up on 32 patients complaining from stage 11 and stage 111  colonic cancer, 10 of them they arrived to the hospital as an emergency cases with intestinal obstruction or uncontrolled bleeding per rectum and 22 cases as an elective cases who presented from either sub acute intestinal obstruction, chronic loss of weight, chronic loss of appetite abdominal mass and or intermittent bleeding per rectum , ages of patients range between 30 to 80 years.18 patients males and 14 patients were females. Aim is To make screening for  stage 11& 111 colonic cancer admitted to our unit and role of radical surgery in emergency cases comparing with radical surgery in elective surgery . Ca. of rectum was excluded from the study. We get 84%(27 patients) above 50 years, males were more,18 patients, annular type were the commonest type (50%). , about histopathological study 18 patients (56.25%)were moderately differentiation ,9 patients (28.1%)poorly differentiation and 5 patients (15.6%) were well differentiation. There were no significant differences of radical surgery in elective and emergency presented cases in recurrence and post operative complications.