Colon and Rectal Cancer. El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Adenocarcinoma of the transverse colon. This is the case of a 42 year-old, male with no significant past medical history presented with abdominal pain and no weight loss was reported.

Video Endoscopic Sequence 1 of 15.

Adenocarcinoma of the Transverse Colon.

 This is the case of a 42 year-old male, with no significant
 past medical history presented with abdominal pain and no
 weight loss was reported.

 For more endoscopic details download the video clips by
 clicking on the endoscopic images, wait to be downloaded
 complete then press Alt and Enter; thus you can observe
 the video in full screen.

 All endoscopic images shown in this Atlas contain
 video clips.
Virtual Colonoscopy displays a large irregular mass in the transverse colon near to the splenic angle. Virtual colonoscopy takes the information produced by a CT scanner and processes this information to produce an image of the colon's inner surface. The examination is possible because of new, very fast CT scanners and the refinement of computer hardware and software that have been used to produce modern digital movies.

Video Endoscopic Sequence 2 of 15.

 Virtual Colonoscopy displays a large irregular mass in the
 transverse colon near to the splenic angle. (Comparison
 between both images, CT colonography and colonoscopy
 in our patient).

 Virtual colonoscopy method of screening the colon Virtual
 colonoscopy takes the information produced by a CT
 scanner and processes this information to produce an
 image of the colon's inner surface. The examination is
 possible because of new, very fast CT scanners and the
 refinement of computer hardware and software that have
 been used to produce modern digital movies.
Endoscopic Image of Colon Adenocarcinoma. Tumors of the colon arise as intramucosal epithelial lesions, usually in adenomatous polyps or glands. As cancers grow, they invade the muscularis mucosa and lymphatic and vascular structures to involve regional lymph nodes, adjacent structures, and distant sites, especially the liver.

Video Endoscopic Sequence 3 of 15.

 Endoscopic Image of Colon Adenocarcinoma

 Tumors of the colon arise as intramucosal epithelial lesions,
 usually in adenomatous polyps or glands. As cancers grow,
 they invade the muscularis mucosa and lymphatic and
 vascular structures to involve regional lymph nodes,
 adjacent structures, and distant sites, especially the liver.

 
Virtual colonoscopy image of the inside of a colon. Constricting adenocarcinoma and Nearly obstructing.

Video Endoscopic Sequence 4 of 15.

Virtual Colonoscopy image of the inside of a colon. (CT colonography)

There are similarities between both images in this endoscopic sequence.

 Constricting adenocarcinoma and nearly obstructing. 

 
The lumen of the colon was reduced in diameter. Colorectal cancers are the second most common cause of cancer-related deaths in developed countries and the most common GI cancer.

Video Endoscopic Sequence 5 of 15.

The lumen of the colon is reduced in diameter.

 Colorectal cancers are the second most common cause of
 cancer-related deaths in developed countries and the most
 common GI cancer.
Stenotic large mass, however the endoscope was advanced to the cecum. The incidence of colon cancer has risen since 1950, while the incidence of rectal cancer has remained stable. The increased incidence of colon cancer is believed to be a result of an increased intake of fat and beef and a decreased intake of fiber.

Video Endoscopic Sequence 6 of 15.

Stenotic large mass, however the endoscope was advanced to the cecum.

 The incidence of colon cancer has risen since 1950, while
 the incidence of rectal cancer has remained stable. The
 increased incidence of colon cancer is believed to be a
 result of an increased intake of fat and beef and a
 decreased intake of fiber.

 
The Cecum, the hole of the apendix is observed.

Video Endoscopic Sequence 7 of 15.

The Cecum, the hole of the apendix is observed.
Virtual Colonoscopy the cecum of our patient.

Video Endoscopic Sequence 8 of 15.

Virtual Colonoscopy the cecum of our patient.
Annular Carcinoma of the Transverse Colon Virtual Colonoscopy. Virtual colonoscopy is a new procedure that fuses computed tomography of the large bowel with advanced techniques for rendering three dimensional images to produce views of the colonic mucosa .

Video Endoscopic Sequence 9 of 15.

Annular Carcinoma of the Transverse Colon Virtual Colonoscopy.

 Virtual colonoscopy is a new procedure that fuses
 computed tomography of the large bowel with advanced
 techniques for rendering three dimensional images to
 produce views of the colonic mucosa.
This picture displays the surgical specimen at the operation room.

Video Endoscopic Sequence 10 of 15.

This picture displays the surgical specimen at the operation room.
A close up to the fragment of the colon with this tumor.

Video Endoscopic Sequence 11 of 15.

 A close up to the fragment of the colon with this tumor.
More images of the colon with the neoplasia.

Video Endoscopic Sequence 12 of 15.

More images of the colon with the neoplasia.
The surgical fragment containing the adenocarcinoma.

Video Endoscopic Sequence 13 of 15.

The surgical fragment containing the adenocarcinoma.
A large Ulcerated Mass.

Video Endoscopic Sequence 14 of 15.

 A large Ulcerated Mass
Colon Gross Adenocarcinoma with the gross napkin ring pattern or apple core pattern. Note how narrow the lumen becomes in the area of the carcinoma. The mucosa is nodular and erythematous in this region, and is ulcerated.

Video Endoscopic Sequence 15 of 15.

 Colon Gross Adenocarcinoma with the gross napkin ring
 pattern or apple core pattern. Note how narrow the lumen
 becomes in the area of the carcinoma. The mucosa is
 nodular and erythematous in this region, and is ulcerated.

 
Endoscopic Image of Rectal Adenocarcinoma. Rectal Adenocarcinoma near of the Dentate Line (Pectinate Line) retroflexed image. A 62 year-old male with rectal bleeding and thing feces no weight loss. The digital examination revealed a mass near of the dentate line.

Video Endoscopic Sequence 1 of 12.

 Endoscopic Image of Rectal Adenocarcinoma

 Rectal Adenocarcinoma near of the Dentate Line
 (Pectinate Line) retroflexed image.
 A 62 year-old male with rectal bleeding and thing feces no
 weight loss.
 The digital examination revealed a mass near of the
 dentate line.
Another image of this neoplasia, the colonoscope in retroflexed maneuver is appreciated. Adenocarcinoma of the colon is a primary cause of mortality and morbidity in North America and Western Europe. Colonic cancers are the most common GI carcinomas and have the best prognosis. The 5-year survival rate is approximately 50%. Survival rates may be improved by screening and removal of adenomatous polyps. Almost all colonic cancers are primary adenocarcinomas.

Video Endoscopic Sequence 2 of 12.

 Another image of this neoplasia, the colonoscope in
 retroflexed maneuver is appreciated.

 Adenocarcinoma of the colon is a primary cause of
 mortality and morbidity in North America and Western
 Europe. Colonic cancers are the most common GI
 carcinomas and have the best prognosis. The 5-year
 survival rate is approximately 50%. Survival rates may be
 improved by screening and removal of adenomatous
 polyps. Almost all colonic cancers are primary
 adenocarcinomas.                                                                              Medline.
Endoscopic Image of Rectal Cancer. The treatment for rectal cancer depends on the location and extent of the tumor.  The goals of treatment are to cure the malignancy and to do so without a permanent colostomy. Pathophysiology: Colonic tumors arise as intramucosal epithelial lesions, usually in adenomatous polyps or glands. As cancers grow, they invade the muscularis mucosa and lymphatic and vascular structures to involve regional lymph nodes, adjacent structures, and distant sites, especially the liver.

Video Endoscopic Sequence 3 of 12.

 Endoscopic Image of Rectal Cancer

 The treatment for rectal cancer depends on the location
 and extent of the tumor.  The goals of treatment are to cure
 the malignancy and to do so without a permanent
 colostomy.

 Pathophysiology: Colonic tumors arise as intramucosal epithelial
 lesions, usually in adenomatous polyps or glands. As cancers
 grow, they invade the muscularis mucosa and lymphatic and
 vascular structures to involve regional lymph nodes, adjacent
 structures, and distant sites, especially the liver.

A magnifying colonoscope was used. A magnifying image of some areas of the tumor.

Video Endoscopic Sequence 4 of 12.

 A magnifying colonoscope was used.
 A magnifying image of some areas of the tumor.
VIDEOCHROMOCOLONOSCOPY. Chromoendoscopy, the intravital staining of gastrointestinal epithelia, provides additional diagnostic information with respect to the epithelial morphology and pathophysiology.

Video Endoscopic Sequence 5 of 12.

Videochromocolonoscopy

 Chromoendoscopy, the intravital staining of gastrointestinal
 epithelia, provides additional diagnostic information with
 respect to the epithelial morphology and pathophysiology.
With the levels of magnification of the scope and structural enhancement image processing function of the processor set at maximal levels.

Video Endoscopic Sequence 6 of 12.

 With the levels of magnification of the scope and structural
 enhancement image processing function of the processor
 set at maximal levels.
Using magnifying chromoendoscopy, it is possible to establish a surface neoplastic profile that corresponds to the histological picture obtained with a vertical tissue section. Optical zooming increases the information yield (up to 150 ×) and provides images comparable to those obtained with a low-powered microscope.

Video Endoscopic Sequence 7 of 12.

 Using magnifying chromoendoscopy, it is possible to
 establish a surface neoplastic profile that corresponds to
 the histological picture obtained with a vertical tissue
 section. Optical zooming increases the information yield (up
 to 150 ×) and provides images comparable to those
 obtained with a low-powered microscope.
The pit pattern analysis of colorectal lesions by magnifying colonoscopy is a useful and objective tool for differentiating neoplastic from nonneoplastic lesions of the large bowel. In its current state of development, however, this technique is not a substitute for histology.

Video Endoscopic Sequence 8 of 12.

 The pit pattern analysis of colorectal lesions by magnifying
 colonoscopy is a useful and objective tool for differentiating
 neoplastic from nonneoplastic lesions of the large bowel.
 In its current state of development, however, this technique
 is not a substitute for histology.

This magnifying image displays polymorphism of this rectal adenocarcinoma.

Video Endoscopic Sequence 9 of 12.

 This magnifying image displays polymorphism of this
 rectal adenocarcinoma.
Rectal Endosonography (EUS). In this image made with the help of Endoscopic Ultrasound (EUS), the tumour is shown to have infiltrated all wall layers.

Video Endoscopic Sequence 10 of 12.

Rectal Endosonography (EUS).

 In this image made with the help of Endoscopic Ultrasound
 (EUS), the tumour is shown to have infiltrated all wall
 layers.

 See the video clip.
Rectal Endosonography. EUS can also obtain information about the layers of the intestinal wall as well as adjacent structures such as lymph nodes and the blood vessels.

 Video Endoscopic Sequence 11 of 12.

Rectal Endosonography.

 EUS can also obtain information about the layers of the
 intestinal wall as well as adjacent structures such as lymph
 nodes and the blood vessels.
Rectal Endosonography. Endoscopic Ultrasound (EUS). Different treatment concepts, including local excision, radical resection and multimodality therapy, are available for colorectal cancer depending on the tumour stage. Consequently, access to an accurate and reliable method for staging these tumours pre-operatively is essential if patients are to receive appropriate treatment. However, it is difficult to assess the depth of tumour invasion by the routine methods of barium enema, colonoscopy and CT. Endoscopic ultrasound (EUS) examination has added a new dimension to the evaluation of tumour invasion and lymph node involvement in gastrointestinal cancer.

Video Endoscopic Sequence12 of 12.

Rectal Endosonography.

 Endoscopic Ultrasound (EUS).
 Different treatment concepts, including local excision,
 radical resection and multimodality therapy, are available
 for colorectal cancer depending on the tumour stage.
 Consequently, access to an accurate and reliable method
 for staging these tumours pre-operatively is essential if
 patients are to receive appropriate treatment. However, it
 is difficult to assess the depth of tumour invasion by the
 routine methods of barium enema, colonoscopy and CT.
 Endoscopic ultrasound (EUS) examination has added a new
 dimension to the evaluation of tumour invasion and lymph
 node involvement in gastrointestinal cancer.

Endoscopic image of Adenocarcinoma of the Cecum.. A 69 year old female with weight loss of 20 pounds. Patient was referred to us with a barium enema showing irregular narrowing of the cecal lumen. There are some barium rest. The utility of double contrast barium radiography is dependent upon the skill of the radiologist in reading the subtleties of the resultant film. Additionally, successful studies are dependent upon the patient?s preparation and cooperation during the procedure.

Endoscopic image of Adenocarcinoma of the Cecum.

 A 69 year old female with weight loss of 20 pounds.
 Patient was referred to us with a barium enema showing
 irregular narrowing of the cecal lumen. At endoscopy, there
 are some barium rest.
 The utility of double contrast barium radiography is
 dependent upon the skill of the radiologist in reading the
 subtleties of the resultant film. Additionally, successful
 studies are dependent upon the patient’s preparation and
 cooperation during the procedure.

Endoscopy of rectal adenocarcinoma and internal. This 58 year-old male, believes that his rectal bleeding was due to hemorrhoids, in fact had internal hemorrhoids and also a rectal adenocarcinoma.

Video Endoscopic Sequence 1 of 10.

 Endoscopy of rectal adenocarcinoma and internal
 hemorrhoids

 This 58 year-old male, believes that his rectal bleeding
 was due to hemorrhoids, in fact has internal hemorrhoids
 and also a rectal adenocarcinoma.
Endoscopy of Rectal Adenocarcinoma. The first rectal valve shows the adenocarcinoma.

Video Endoscopic Sequence 2 of 10.

Endoscopy of Rectal Adenocarcinoma

The first rectal valve shows the adenocarcinoma.
38 months after the surgery, Patient initiates with progressive cough, the PA chest radiograph shows multiple metastastic nodules.

Video Endoscopic Sequence 3 of 10.

38 months after the surgery

 Patient initiates with progressive cough, the PA chest
 radiograph shows multiple metastastic nodules.

 
Left Lateral Chest Radiograph.

Video Endoscopic Sequence 4 of 10.

Left Lateral Chest Radiograph

 

 
Right Lateral Chest Radiograph.

Video Endoscopic Sequence 5 of 10.

Right Lateral Chest Radiograph

 
The abdominal CT scan shows no metastases, there are a hepatic cyst (simple cysts). The cause of simple liver cysts is not known Simple cysts generally cause no symptoms but may produce dull right upper quadrant pain if large in size. Patients with symptomatic simple liver cysts may also report abdominal bloating and early satiety. Occasionally, a cyst is large enough to produce a palpable abdominal mass. Jaundice caused by bile duct obstruction is rare, as is cyst rupture and acute torsion of a mobile cyst. Patients with cyst torsion may present with an acute abdomen. When simple cysts rupture, patients may develop secondary infection, leading to a presentation similar to a hepatic abscess with abdominal pain, fever, and leukocytosis.

Video Endoscopic Sequence 6 of 10.

The abdominal CT scan shows no metastases, there are a hepatic cyst (simple cysts).

 The cause of simple liver cysts is not known Simple cysts
 generally cause no symptoms but may produce dull right
 upper quadrant pain if large in size. Patients with
 symptomatic simple liver cysts may also report abdominal
 bloating and early satiety. Occasionally, a cyst is large
 enough to produce a palpable abdominal mass. Jaundice
 caused by bile duct obstruction is rare, as is cyst rupture
 and acute torsion of a mobile cyst. Patients with cyst
 torsion may present with an acute abdomen. When simple
 cysts rupture, patients may develop secondary infection,
 leading to a presentation similar to a hepatic abscess with
 abdominal pain, fever, and leukocytosis.
Colorectal carcinoma remains one of the most common neoplastic diseases. Of all patients who had curative resection, 10 to 20% will develop pulmonary metastases and 10% of them have the lung as the sole metastatic site.Pulmonary metastases from colorectal cancer are usually resected by wedge resection, usually accomplished through a thoracotomy, median sternotomy, or clam shell incision. The reported postresection 5-year survival ranges from 9 to 47% independently from the access employed. Introduction of video-assisted thoracoscopy (VAT) has increased interest in using this minimally invasive approach for many thoracic surgical procedures, including resection of metastatic lesions. Nevertheless, the main concern about this approach is that, although VAT allows an excellent exposure of the lung surfaces, it does not permit complete lung palpation to identify and remove metastatic lesions not detected by the radiologic imaging.

Video Endoscopic Sequence 7 of 10.

At the CT scan of the chest

 Carcinoma remains one of the most common neoplastic
 diseases. Of all patients who had curative resection, 10 to
 20% will develop pulmonary metastases and 10% of them
 have the lung as the sole metastatic site. Pulmonary
 metastases from colorectal cancer are usually resected by
 wedge resection, usually accomplished through a
 thoracotomy, median sternotomy, or clam shell incision.
 The reported postresection 5-year survival ranges from 9
 to 47% independently from the access employed.
 Introduction of video-assisted thoracoscopy (VAT) has
 increased interest in using this minimally invasive
 approach for many thoracic surgical procedures, including
 resection of metastatic lesions. Nevertheless, the main
 concern about this approach is that, although VAT allows
 an excellent exposure of the lung surfaces, it does not
 permit complete lung palpation to identify and remove
 metastatic lesions not detected by the radiologic imaging.
Colorectal carcinoma produces lung metastases that are often solitary, and in most of these patients, resection through thoracotomy fails to demonstrate additional foci of malignancy not detected by preoperative evaluation, video-assisted thoracoscopy VAT resection might therefore be fully justified if the ultimate outcome does not differ from that obtained after a more invasive approach.

Video Endoscopic Sequence 8 of 10.

 Carcinoma produces lung metastases that are often
 solitary, and in most of these patients, resection through
 thoracotomy fails to demonstrate additional foci of
 malignancy not detected by preoperative evaluation,
 video-assisted thoracoscopy VAT resection might therefore
 be fully justified if the ultimate outcome does not differ
 from that obtained after a more invasive approach.
Surgical metastasectomy has become a standard therapy in selected patients with lung tumor metastases. Complete resection proved to be the most important prognostic factor in these patients, who often underwent aggressive and iterative procedures to achieve this purpose. The frequent discovery of unexpected metastases at intraoperative manual palpation has provoked question as to whether video-assisted thoracoscopy (VAT) is adequate in this setting, since it does not allow bilateral manual palpation. Indeed, VAT has been proposed as a minimally invasive approach for the resection of unilateral metastases, but the advantages of the procedure may be frustrated by the inaccuracy in detecting nodules. To overcome this limitation, we recently developed a transxiphoid approach through which one can reach both hemithoraces in one operation without performing sternotomy. The low invasiveness and safety of this approach allowed us to routinely carry out bilateral manual palpation of the lung even in patients with radiologically unilateral disease.

Video Endoscopic Sequence 9 of 10.

 Surgical metastasectomy has become a standard therapy
 in selected patients with lung tumor metastases. Complete
 resection proved to be the most important prognostic
 factor in these patients, who often underwent aggressive
 and iterative procedures to achieve this purpose. The
 frequent discovery of unexpected metastases at
 intraoperative manual palpation has provoked question as
 to whether video-assisted thoracoscopy (VAT) is adequate
 in this setting, since it does not allow bilateral manual
 palpation. Indeed, VAT has been proposed as a minimally
 invasive approach for the resection of unilateral
 metastases, but the advantages of the procedure may be
 frustrated by the inaccuracy in detecting nodules. To
 overcome this limitation, we recently developed a
 transxiphoid approach through which one can reach both
 hemithoraces in one operation without performing
 sternotomy. The low invasiveness and safety of this
 approach allowed us to routinely carry out bilateral manual
 palpation of the lung even in patients with radiologically
 unilateral disease.

 
There is a high incidence of lung metastases in patients with rectal cancer, and thoracic computed tomographic scanning should be performed as part of a staging protocol in all patients before any form of treatment is planned. There is a higher incidence of lung metastases with higher T stage.

Video Endoscopic Sequence 10 of 10.

 There is a high incidence of lung metastases in patients
 with rectal cancer, and thoracic computed tomographic
 scanning should be performed as part of a staging protocol
 in all patients before any form of treatment is planned.
 There is a higher incidence of lung metastases with higher
 T stage.

 
Cecum Adenocarcinoma. An 80 year-old male that was under anemia screening.

Video Endoscopic Sequence 1 of 2.

Cecum Adenocarcinoma

An 80 year-old male that was under anemia screening.
More video clips.

Video Endoscopic Sequence 2 of 2.

Table 1. Dukes Classification and 5-Year Survival

Stage

Description

5-Year Survival

A

Limited to the bowel wall

83%

B

Extension to pericolic fat; no nodes

70%

C

Regional lymph node metastases

30%

D

Distant metastases (liver, lung, bone)

10%

Endoscopy of Adenocarcinoma of the Transverse colon. A 65 year-old woman, with weight lost of more than 20 pounds, with a palpable, a mobile mass that was detected in the epigastric by her family physician. Abdominal ultrasound and CT scan was performed, the radiologist detected a tumor that was suspected to be of the transverse colon.

Video Endoscopic Sequence 1 of 2.

Endoscopy of Adenocarcinoma of the Transverse colon.

 A 65 year-old woman, with weight lost of more than 20
 pounds, with a palpable, a mobile mass that was detected
 in the epigastric by her family physician. Abdominal
 ultrasound and CT scan was performed, the radiologist
 detected a tumor that was suspected to be of the
 transverse colon.

 Click here to appreciate the cat scan and the macroscopic
 specimens

 
Post surgical statust. Endoscopic image of termino-terminal anastomosis. One year after the surgery, we performed a full colonoscopy.

Video Endoscopic Sequence 2 of 2.

Post surgical statust.

 Endoscopic image of termino-terminal anastomosis.
 One year after the surgery, we performed a full
 colonoscopy.

 

A 43 year-old Salvadorean female living in the republic of Belize for more than 20 years. weight loss of more than 40 pounds and anemia with 9.2 gr./dl Physical examination found a palpable mass at right iliac fosa. The endoscopic image displays a Sub-mucosal masa Ultrasonographycaly that tumor mesured a 9.2 cm. long.

Video Endoscopic Sequence 1 of 2.

 A 43 year-old Salvadorean female living in the republic of
 Belize for more than 20 years.
 weight loss of more than 40 pounds and anemia with 9.2
 gr./dl
 Physical examination found a palpable mass at right iliac
 fosa.
 The endoscopic image displays a Sub-mucosal masa
 Ultrasonographycaly that tumor mesured a 9.2 cm. long.
   
Endoscopy of Adenocarcinoma of the Ascending Colon. An ulcerated adenocarcinoma at the ascending colon is displayed.

Video Endoscopic Sequence 2 of 2.

 Endoscopy of Adenocarcinoma of the Ascending Colon

 An ulcerated adenocarcinoma at the ascending colon is
 displayed.

 
Endoscopy of sigmoids Adenocarcinoma .This 76 year-old lady, who start with rectal bleeding, at the colonoscopy presented this large mass at the sigmoid.

Video Endoscopic Sequence 1 of 2.

 Endoscopy of sigmoids Adenocarcinoma

 This 76 year-old lady, who start with rectal bleeding, at the
 colonoscopy presented this large mass at the sigmoid.

Status after rubbed band treatment for hemorrhoids. One week previously a hemorrhoid was ligated.

Video Endoscopic Sequence 2 of 2.

Status after rubber band treatment for hemorrhoids.

One week previously a hemorrhoid was ligated.
Endoscopy of Adenocarcinoma of the Ascending Colon. This 40 year-old male, that has been suffering of severe abdominal pain and weigh loss of 40 pounds.

Video Endoscopic Sequence 1 of 2.

Endoscopy of Adenocarcinoma of the Ascending Colon.

This 40 year-old male, that has been suffering of severe abdominal pain and weigh loss of 40 pounds.
More images and video clips

Video Endoscopic Sequence 2 of 2.

Several factors increase the risk for colonic cancer.

 

  • High-fat, low-fiber diet
  • Patient age greater than 50 years
  • Personal history of colorectal adenoma or carcinoma (3-fold risk)
  • First-degree relative with colorectal cancer (3-fold risk)
  • Familial polyposis coli, Gardner syndrome, and Turcot syndrome (all patients develop colorectal carcinoma unless they undergo a colectomy)
  • Juvenile polyposis syndrome, Peutz-Jeghers syndrome, and Muir-Torre syndrome (risk increased slightly)
  • Hereditary nonpolyposis colorectal cancer (as many as 50% of patients are affected)
  • Inflammatory bowel disease
    • Ulcerative colitis (risk is 30% after 25 years)
    • Crohn disease (4- to 10-fold risk)
Endoscopic view of Ascending Colon Cancer. This is the case of a 74 year-old male, this mass was found in his colon screener colonoscopy.

Video Endoscopic Sequence 1 of 9.

Endoscopic view of Ascending Colon Cancer

This is the case of a 74 year-old male, this mass was found in his colon screener colonoscopy.

The tumor was found in the ascending colon limiting with the cecum.

Video Endoscopic Sequence 2 of 9.

The tumor was found in the ascending colon limiting with
the cecum.
Terminal ileum.

Video Endoscopic Sequence 3 of 9.

Terminal ileum.

 
Some biopsies were send to the pathologist. Colon cancers progress slowly and may be asymptomatic for as many as 5 years; however, patients usually have occult blood loss from their tumors.

Video Endoscopic Sequence 4 of 9.

Some biopsies were send to the pathologist.

 Colon cancers progress slowly and may be asymptomatic
 for as many as 5 years; however, patients usually have
 occult blood loss from their tumors.

 
Symptoms depend on the location of the primary tumor. Cancers of the cecum and ascending colon usually grow larger than left-sided tumors before symptoms occur. Fatigue, shortness of breath, and angina resulting from microcytic hypochromic anemia are common presenting features. Vague abdominal discomfort or a palpable mass may occur later, but obstruction is uncommon (unless the ileocecal junction is involved) because of the larger diameters of the cecum and ascending colon.

Video Endoscopic Sequence 5 of 9.

 Symptoms depend on the location of the primary tumor.
 Cancers of the cecum and ascending colon usually grow
 larger than left-sided tumors before symptoms occur.
 Fatigue, shortness of breath, and angina resulting from
 microcytic hypochromic anemia are common presenting
 features. Vague abdominal discomfort or a palpable mass
 may occur later, but obstruction is uncommon (unless the
 ileocecal junction is involved) because of the larger
 diameters of the cecum and ascending colon.
Cancers of the descending and sigmoid colons may present with large bowel obstruction. Perforation is rare but may occur as a result of distention proximal to the tumor (usually in the cecum) or locally (at the site of the tumor). The primary tumor may be palpable in the abdomen. Overt rectal bleeding is more common in tumors of the sigmoid colon, whereas occult bleeding is typical with proximal tumors. A change in bowel habits may be the only presenting feature. Weight loss, jaundice, and ascites are associated with advanced metastatic disease.

Video Endoscopic Sequence 6 of 9.

 Cancers of the descending and sigmoid colons may present
 with large bowel obstruction. Perforation is rare but may
 occur as a result of distention proximal to the tumor
 (usually in the cecum) or locally (at the site of the tumor).
 The primary tumor may be palpable in the abdomen. Overt
 rectal bleeding is more common in tumors of the sigmoid
 colon, whereas occult bleeding is typical with proximal
 tumors. A change in bowel habits may be the only
 presenting feature. Weight loss, jaundice, and ascites are
 associated with advanced metastatic disease.

 
CaSunc7

Video Endoscopic Sequence 7 of 9.

The macroscopic specimen

The patient undergone laparoscopic right hemicolectomy with transverse ileum.

An ulcerated adenocarcinoma is displayed.

Video Endoscopic Sequence 8 of 9.

An ulcerated adenocarcinoma is displayed.
CaSunc9

Video Endoscopic Sequence 9 of 9.

 Inmunohistochemistry for cytokeratine of the colonic
 adenocarcinoma.