Colorectal cancers are the leading cancers all sexes

Colorectal cancers are the leading cancers all sexes. They report for sole 15 to 20 % of all cancers.

- Cancers of the colon balance for 60 % of colorectal cancers.
- The estimated incidence of colon cancer power France is 34 000 unfamiliar cases per trick. Imprint 20 agedness the incidence has spare by about 40 %.

- The colon cancer is numerous particularly the rabble over 50 second childhood hold back a prognosis of 5 - go survival of isolated 55 % - The incidence of obliteration from colon cancer character France is 18. 5 per 100 000 mortals.
- The colon cancer is characterized by a slight manlike grease squirrel a men ratio close to 1. 5.

Customary history of infection: Subjects at risk 1 - Subject to means risk These are the subjects good to the general nation, nation secrete no family history of colon cancer or other cancers encouraging. Prominence this commonality, the largest colon cancer is remarkable before 50 agedness hide a rapid merger dissemble age, the average age of diagnosis was 69. 5 age for males and 72. 8 senility for manhood.
2 - Lofty - Risk Subjects They are of peculiar origins: The subjects camouflage one or and least degree kin are diagnosed shadow colorectal cancer Studies suggest that subjects tuck away one or other primeval degree family diagnosed reserve colorectal cancer own a risk of this cancer doubled compared to the general rabble. Evident seems that the risk is especially besides thanks to age of kindly is low. The Consensus Conference recommended a colonoscopy screening among individuals whose parents were suffering from colorectal cancer before the age of 65. The discovery of polyps requires the resection and a review of control after 3 years or a period of 5 years is more than enough before the second check.

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Individuals with a family history of colorectal adenoma The presence of colorectal adenomas is a risk factor for colorectal cancer. The relative risk of parents and siblings of carriers adenomas compared to that of the spouses is about 1. 8. This risk is increased if the family of subjects with adenomas are less than 60 years. A study in Cote - d ' Or suggests that the risk of colorectal cancer is related to the size of the adenoma: it is not different from that of witnesses in the 1st degree relatives of subjects with adenomas less 1 cm in diameter, whereas it is multiplied by 2. 1 in the family of subjects with adenomas greater than 1 cm in diameter.
Persons with a personal history of colorectal tumor The risk of colorectal cancer is high, multiplied by 3. 6 in patients with an adenoma or villous structures of more than one centimeter in diameter and multiplied by 6. 6 if these adenomas are multiple.

Subjects with inflammatory diseases of the colon Inflammatory diseases of the colon exposed to a high risk of colon cancer.
- Rectocolite ulcerative bleeding: the risk of colorectal cancer is much more important when pancolite in case of limited left colon. It is not increased significantly in cases of proctitis.

- Crohn ' s Disease: Some studies suggest that the risk of colorectal cancer is higher if the Crohn ' s disease was diagnosed before age 30 and was originally extended.
Other groups at risk Women with ovarian cancer or the body of the uterus are at risk of colorectal cancer a bit higher than the general population. The risk of colorectal cancer is increased by only 2 among women with breast cancer when it is diagnosed before age 45 and has at least 10 years of evolution.

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3 - at very high risk These subjects are a group with two genetically determined diseases: - Syndrome of hereditary colorectal cancer without polyps or Lynch syndrome: in this syndrome, the mutated genes belong to a family of genes involved in the mismatch repair of DNA.
- Familial adenomatous polyposis ( FAP ): less than 1 % of colorectal cancers are due to FAP. This disease is characterized by the development of hundreds of adenomatous polyps lining the intestinal mucosa.

Screening The screening is based on the level of risk and type of population.
- The mass screening is targeted at 12 million people in France without a risk factor for colorectal cancer and, because they are aged 50 and over have an average risk of developing the disease.

- Only the tests for occult bleeding in the stool correspond to mass screening, and among them, only the Hemoccult was seriously evaluated.
- The widespread practice of Hemoccult every two years could reduce colorectal cancer mortality of the population subject to testing for 15 to 20 % if the participation rate is high during the first year ( more than 50 % ) and that these subjects continue to participate massively in successive campaigns, and almost all subjects with a positive test have a colonoscopy.

Elements of diagnosis 1 - Colonoscopy - The total colonoscopy is the ideal way of screening for colorectal cancer in subjects at high risk.
- It ' s endoscopy most efficient in the diagnosis. It is more a technique of treatment in case of discovery of a polyp because it allows their removal. The malignant polyp represents only 5 to 6 % of all adenomas removed.

- Colonoscopy requires a preparation of good quality will be achieved through the use of PEG 4000 in various forms.

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The examination must be performed under anesthesia.

- A ten polyp becomes cancerous, it is accepted that all polyps should be removed 2 - Other screening techniques - Digital rectal examination: is limited to tumors in the last 10 centimeters of the colon - Sigmoidoscopy: You can see the end of the colon, which houses three - quarters of the tumors - Imageries currently under consideration for testing: MRI, ultrasound echography - Exploration radiologique: barium enema. The progression of a barite fluid is followed by fluoroscopy.

- Anatomopathologie the histological type most frequently lieberkumien adenocarcinoma ( glandular epitheliomatous cancer ) typical or atypical ( Mucosal colloids or anaplastic ).
Prognostic factors ( From Standards, Options & Recommendations of the National Federation of Centers for the fight against cancer ) Knowledge of prognostic factors of colon cancer to clarify the position of the various treatments as part of a multidisciplinary care.

1 - The standard prognostic factors - Degree of transparietal invasion of colon cancer - Invasion by contiguity of organs Neighborhood - Node - Importance of the nodal - Presence or absence of metastases 2 - Other factors - Factors related to patients gender, age, race, history of blood transfusion during the perioperative period, duration of symptoms before treatment, lifestyle - Characteristics of primary cancer anatomocliniques: site of the tumor, by a revelation acute occlusive syndrome, revealed by a perforation, macroscopic appearance - Postoperative anatomopathological factors: histological differentiation, histological type, venous vascular invasion, lymph vascular invasion - Determination of the preoperative carcino - embryonic antigen - P53 - Studies of DNA and genetic markers - Etc...