COLON CANCER: ETIOLOGY, SYMPTOMS, DIAGNOSIS, AND TREATMENT

Colon cancer is the second most prevalent cancer in the United States, lung cancer being the first. It is also second to lung cancer in mortality rate (19:816). In 1990 there were about 155,000 new cases of colorectal cancer reported, and 61,000 deaths. The incidence in the general population is 5% (15:80). Although the number of cases is increasing, the rate is proportional to the population increase (8:301).

Yet in spite of the high incidence of colon cancer, we still do not have a sound basis for delineating the causes and mechanism of colon carcinoma growth (15:80). Nor do we have a means of curing the disease in every case. The five-year survival rate is about 50% (10:241). Nevertheless considerable advances have been made within the last 10 years in confirming the factors involved in the etiology (9:315), in early detection, in diagnostic techniques, and in treatment.

Endogenous etiological factors. It is now widely accepted that most carcinomas develop in previously benign adenomatous polyps, although some arise in normal, flat epithelium (10:242). Adenomas are pedunculated, sessile, or semi-sessile polyps that develop by increased cell division along the length of the crypt in the mucosal lining of the colon (6:4-6). Neoplasia is characterized by further increase in the rate of cell division, leading to decreased cell maturation. Adenomas can be distinguished from hyperplastic polyps which ar

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ed fecal material, gas bubbles, mucus, mineral oil, or excess fluid (which may dilute the barium sulfate or cause flaking of the contrast coating). Preparation of the patient includes a 24- to 48-hour clear liquid diet and a large intake of fluid just prior to the procedure. The former use of castor oil and enema have now been replaced by contact laxative suppositories such as Dulcolax. Atropine (1 mg) is given to counteract the discomfort of the enema and air insufflation. The second requirement is for adequate coating of the mucosa. The barium sulfate is mixed well to prevent flocculation, and carboxymethyl cellulose is added to increase the adhesion of the coating to the mucosa. Adequate filling, all the way through to the proximal colon and the cecum, should be the goal. If the right side is not reached, the procedure is repeated by oral administration of barium sulfate (peroral pneumocolon), to spare the patient further discomfort. In some cases obstruction (tortuosity or redundancy) prohibits filling of the right colon and it is necessary to resort to the oral method. Usually air insufflation by means of a Higginson's syringe (1800-2000 cc) commences as the contrast medium rounds the splenic flexure. A balloon tube
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Approximate Word count = 6673
Approximate Pages = 27 (250 words per page)

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