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There is an inner beauty about a woman who believes in herself, who knows she is capable of anything that she puts her mind to. There is a beauty in the strength and determination of a woman who follows her own path, who isn't thrown off by obstacles along the way. There is a beauty about a woman whose confidence comes from experiences; who knows she can fall, pick herself up, and move on

3112 8am presentation

Monday, June 1, 2009

Bowel resection=colostomy
A surgical procedure to remove the cancerous part of the descending colon.
Creating an opening between the colon and the abdominal wall.
On the left lower abdomen
Most common type of colostomy surgery and generally produce stool that is semi-formed to well-formed

(**overall surgical cure is possible in 70% of these patients
The proximal end of the colon is sutured to the skin**)

Barriers to cancer prevention and early detection
Age
Cultural
Income
Health insurance
Socioeconomic status
Inadequate and inaccurate health information
Attitudinal barriers
Dr patient communication patterns.

Summary of warning signs for colon cancer
Rectal bleeding
Change in bowel habits—persistent constipation and diarrhea.
Abdominal distention and discomfort
Difficulty or pain during defecation
Unexplained fatigue or weight loss
Bowel perforation, or bowel obstruction

(**1. Change in bowel habits. A colon cancer can cause partial obstruction of the colon leading to “holdup’ of faeces and a delay in passing motion. It can also irritate the colon resulting in frequent loose stools. In short, a person with a change in bowel habits of more than 6 to 8 weeks should consult a doctor.
2. Rectal bleeding. the most common
A rectal cancer can present with fairly fresh bleeding separate from faeces due to its proximity to the anus. It can be mistaken for bleeding from piles. Bleeding from colon cancer is usually darker and mixed with the stools. Rectal bleeding is a serious symptom and must be investigated especially in individuals above 40 years old.
3. Abdominal distension and discomfort. This is a vague symptom which can also be due to other abdominal problems e.g. irritable bowel syndrome, gallstones.
4. Difficulty or pain during defaecation. This applies to rectal cancer which obstructs the passage of faeces and considerable force is needed to pass motion. There is also a painful sensation of incomplete emptying called tenesmus due to the presence of a tumour in the rectum.
5. Presence of anaemia and weight loss. Anemia is often associated with a right sided colon tumour which has bled unnoticed for a long time (occult bleeding). Anaemia may result in giddiness, weakness & fainting spells. Significant unexplained weight loss can be often due to a serious illness e.g. cancer.
6. Presence of an abdominal mass. A right sided colon cancer can present with an abdominal mass which is uncomfortable and detected by the patient.
7. Colorectal cancer can present acutely as an emergency in two situations:

a. Bowel perforation. An advanced CRC can erode through the colon wall and cause a perforation with leakage of faeces causing peritonitis and septicaemia.

b. Bowel Obstruction. Left sided colon cancer often grows around the colon and cause total obstruction. The patient complains of constipation, abdominal distension and vomiting over a period of few days. An emergency operation is required. Both acute presentations are associated with poor survival even after treatment of the CRC.**)

rick factor
Advancing age
race
Family history
A personal history of colon CA
Inflammatory bowel disease , such ulcerative colitis
Diet in high fat and low in fiber
Obesity
DM
Sedentary lifestyle

(**What are the risk factors?
1. Males and females > 50 years old
2. Chinese has a higher risk among the races in Singapore
3. Family History
Some individuals inherit a rare disease called familial polyposis in which many colorectal polyps develop at a young age. The risk of developing CRC is very high (80 to 100%). Such individuals should consider having the colon removed before the age of 40 years old. Another type of inheritance is an individual with a relative with polyps or CRC. He/she is also at a higher risk of CRC (although the risk is low compared to a familial polyposis individual).
4. Ulcerative Colitis (UC)
This is a disease affecting the bowels leading to inflammation and cancerous change in the long term. People with UC has a significant risk of CRC.
5. Dietary Habits
Research has identified certain types of food and food supplements which can affect our risk of CRC:
Food that increase the risk
Explanation
Meat, cooked at high temperature
It contained chemicals, e.g. heterocyclic amines that are carcinogenic
Animal fat
Fat is converted to bile acids which can promote cancer change in the mucosa of the colon
Diet high in refined carbohydrate==transit in the colon is slow, as a result, the extended presence of bile acids may result in the carcinogenic effects on the bowel tissue
Tobacco and Alcohol
Tobacco has been shown to increase polyp formation
Food that reduce the risk
Explanation
Fibre (vegetables, fruits, bran)
Fibre help to reduce the transit time of faeces and to dilute the carcinogens in the colon
Vitamin Supplement (especially folate)
Studies have shown that regular multivites & folate can reduce CRC risk
Mineral intake esp calcium
Calcuim can bind to fatty acids and bile acids and reduce our risk.
6. Drugs Current users of HRT (hormone replacement therapy) are at a lower risk of CRC and this protection disappear within 5 years of stopping the HRT.
Aspirin and NSAID (a strong painkiller drug) are known to reduce the risk from CRC. However it is too early at this stage of research to recommend the routine use of these drugs for this purpose.
7. Sedentary lifestyle and obesity These two related factors increase the risk of CRC. Physical Activity helps to regulate the transit time of faeces in the colon and hence can reduce the risk.
8. Past history of colorectal polyp or colorectal cancer. Despite knowing all these risk factors, the exact cause of CRC remains unknown. It is estimated that 50% of CRC patients have no known risk factors.**)