Extended right hemicolectomy because of 3 colon carcinomas:
3 carcinomas of the colon in one patient are extremely rare!
In developed countries the incidence of colon cancer has increased significantly in the last 30 years. With an annual incidence of 30-35 per 100,000 people colon cancer is one of the most common malignant diseases in Central Europe and is responsible for about 15% of all cancer deaths. The worldwide incidence is estimated at one million new cases per year. Men are affected slightly more often than women, this concerns mainly rectal cancer (sex ratio 60:40).
In Germany colon cancer was the second most common form of cancer in 2005 for both new cancers and cancer deaths in men and women. More than 20,000 people from colon cancer. The Society of Cancer Registries states an even higher number: 30,000 deaths per year. 90% of colorectal cancers occur after the patient is 50 years old. The average age at diagnosis is 65 years of age. The lifelong risk of a German to get cancer is about 6%, to die from it about 2.5-3%
Risk factors
The most important risk factors are advanced age and colon polyps. These can degenerate. More uncommon risk factors include genetic predisposition and genetic syndromes associated with an increased risk for developing colon cancer.
Diseases and syndromes
Familial adenomatous polyposis is a rare obligate precancerous lesion (disease that inevitably leads to cancer), where there are lots of polyps inside the colon at a relatively young age. This disease has an autosomal dominant pattern of inheritance. Cause for the development of up to 1000 polyps in the colon is a disturbance of normal cell cycle (the mutation of the APC tumor suppressor gene on chromosome 5).
A total surgical removal of the colon (colectomy) is recommended up to 20 years of age. Other syndromes with significantly increased risk are Gardner syndrome, an autosomal dominant form of polyposis characterized by the presence of multiple polyps in the colon together with tumors outside the colon, and Turcot syndrome, also a rare genetic disease that leads to polyposis of the colon and brain tumors.
Even less often polyps associated with Peutz-Jeghers syndrome, a rare genetic disease that leads to hamartomatous polyps in the gastrointestinal tract and hyperpigmented macules on the lips and oral mucosa, degenerate. [Juvenile polyposis polyps, the most common cause for polyposis in childhood, in which the polyps are usually located in the rectum, leads most seldom to degeneration of polyps.]
Another hereditary disease that is associated with a significantly increased risk for developing colon cancer, is the hereditary non-polyposis colorectal cancer (HNPCC). This autosomal dominant disease leads to, aside from malignant intestinal tumors, breast cancer, endometrial cancer and ovarian cancer. The cancer occurs in relatively young (45 y.o.) patients with HNPCC and is most commonly located in the ascending part of the colon.
Ulcerative colitis is also associated with an increased risk of malignancy (facultative precancerous lesion), especially if it infests the entire colon. Compared to the total population, patients with Crohn's disease also have a slightly increased risk of colorectal cancer.
