Colorectal cancer is the second most common malignant tumor in developed countries, considering both sexes, and occupies the first place as a cause of tumor death. In men it is the second cause of death due to cancer after lung cancer. In Spain the prevalence is 26,500 cases/year.
There is experimental, epidemiological and clinical evidence that demonstrates that the diet influences the development of colorectal cancer. The diet contains multiple mutagens and carcinogenic, which can derive from natural chemical compounds, such as alkaloid, pesticide and food additives, aromatic polycyclic hydrocarbons and heterocyclic amines derived from food cooking. High consumption of red meat increases the risk of colorectal cancer by increasing nitrosamine formation. Diets with a large amount of fiber produce feces with an accelerated transit time and decreases the contact time between the potential carcinogenic agent and the carclic mucosa. Calcium, selenium and other micronutrients such as vitamins A, C and E and carotenoids, contained in small amounts in water, grains, fruit and vegetables, decrease the risk of colorectal cancer.
The relationship between colorectal cancer and alcohol consumption has been described, and doubles risk, in subjects with daily consumption. The relationship between tobacco and the development of colon adenomas and carcinomas has been demonstrated and the risk increases in relation to the number of cigarettes and exposure time. It is estimated that 12% of colorectal tumors are caused by tobacco. Obesity is a recognized risk factor, instead physical activity seems to reduce the incidence of colon cancer.
It has been calculated that without screening campaigns or preventive actions, in Western countries, one person in 17 will develop a colorectal tumor in his life. Colorectal carcinoma can be prevented by detecting and resecting asymptomatic adenomatous polyps and early adenocarcinoma diagnosis can reduce the mortality rate. For all these reasons a screening campaign in asymptomatic people is necessary. 75% of colorectal cancers develop in patients without risk factors and 15% in patients with intermediate risk (family history of colorectal cancer). In people without risk factors, a screening test (hidden blood test in feces) is recommended from 50 years old). Patients with first -degree relatives with colorectal tumor or adenomatous polyps have to start screening at 40 years or 10 years before the presentation date at the family, if it was before the age of 40.
There is currently an increase in the percentage of patients diagnosed in an asymptomatic phase due to the practice of screening or by the realization of colonoscopy before a mild rectorrhagia. However, the diagnosis of cancer established with the characteristic clinical pictures persists. In right colon cancer, the presence of anemia, palpable mass, alteration of the defecation habit or pain, if neighboring structures invades, they are characteristic.On the other hand, the left colon cancer will be presented more frequently with rectorrhagia, constipation with possible intestinal occlusion, and less frequency of palpable tumor.
The diagnosis of colon cancer is established by colonoscopy and biopsy. Colonoscopy must be complete for the evaluation of possible synchronous injuries. Preoperative staging with the CT allows the evaluation of the actual location of the tumor, the eventual invasion or threat of neighboring structures and the detection of remote metastases.
Multidisciplinary discussion is important for treatment selection. The basic treatment of colon cancer with healing intent is the surgical removal of the primary tumor and lymph nodes. The laparoscopic approach compared to the traditional open path has shown to have advantages in terms of more early postoperative rehabilitation, with similar cancer results when the exeresis is correct.
On the prognosis of colon cancer influence numerous variables related to the patient's medical history, the pathological characteristics of cancer and the surgeon factor. The surgeon factor influences the results in the long and short term after cancer colon resection. Hospitals and surgeons with greater volume have less morbidity and postoperative mortality, lower recurrence rate and greater survival. An expert surgeon can improve oncological results by resection of the block piece in larger tumors avoiding drilling.
Integrated in the Surgery Team, the HLAHERMOSA HLA Coloproctology Unit, has the most sophisticated media for the treatment of the tumor pathology of the colon and rectum. Patients are intervened by laparoscopic route obtaining excellent results in terms of postoperative, early high and quality of the surgical piece that will allow adequate management by the Oncology Service.
