The following are the most important diseases or complications that can be caused by colon carcinoma (colorectal cancer):
Blood, blood-forming organs – Immune system (D50-D90).
Endocrine, nutritional, and metabolic diseases (E00-E90).
- Weight loss
Circulatory system (I00-I99)
- Increased cardiovascular mortality (because of cardiotoxic cytostatics (heart-damaging drugs that inhibit cell growth or division), eg, fluorouracil (FU), capecitabine); especially patients with hypertension (high blood pressure) and diabetes mellitus); 2-3-fold more common:
- Apoplexy (stroke)
- Heart failure (cardiac insufficiency)
- Coronary artery disease (CAD; coronary artery disease).
Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).
- Intestinal perforation – intestinal rupture resulting in peritonitis (inflammation of the peritoneum).
- Diarrhea (diarrhea)
- Ileus (intestinal obstruction)
- Constipation (constipation)
Neoplasms – tumor diseases (C00-D48)
- Mesenteric fibromatosis – usually benign (benign) connective tissue growths (fibroblasts); triggered by colon cancer surgery.
- Metastasis (formation of daughter tumors):
- Hematogenous (“in the bloodstream”) via the portal vein to the liver, from there metastasis to the lungs and skeletonNote: Larger liver metastases can themselves in turn release intact tumor cells, so that further metastases can develop as a result.
- Into the peritoneum (peritoneal carcinomatosis/ascites (abdominal dropsy); in up to 15% of all patients with metastatic colorectal cancer).
Symptoms and abnormal clinical and laboratory parameters, not elsewhere classified (R00-R99).
- Cachexia (emaciation; very severe emaciation).
- Suicidality (suicidal tendency).
Lymphogenic metastasis in relation to the location of rectal cancer
- Carcinomas of the upper third: spread:
- Paraaortic lymph nodes
- Carcinomas in the middle third: spread:
- Paraaortic lymph nodes
- Lymph nodes of the pelvic wall
- Carcinomas in the lower third: spread:
- Paraaortic lymph nodes
- Lymph nodes of the pelvic wall
- Inguinal lymph nodes
Prognostic factors
- BMI (body mass index; body mass index): no effect on progression-free survival; regarding overall survival, one study demonstrated a significant association of increased BMI with prolonged survival:
- Normal weight (BMI 20-24.9): patients died an average of 21.1 months after starting therapy
- Overweight (BMI 25-29): patients survived an average of 23.5 months.
- Obesity (BMI 30-35): patients had an average survival of 24 months.
- Higher-grade obesity (BMI > 35): patients now had a survival time of only 23.7 months.
- Mortality (death rate) is significantly higher in the overweight (about 17%) and the obese (almost 20%) than in the normal weight.
- Rapid as well as long-term weight loss is characterized unfavorable colorectal cancer prognosis; it died by the 10th year:
- 30% of patients with weight loss
- 14% of patients with stable weight
- 13% of patients with increased weight
- Laboratory parameters
- Mild hypoalbuminemia (serum albumin ≤ 3.5 g/dL) preoperatively resulted in an increase in postoperative complications and, in particular, increased pulmonary complications:
- Hospital stay longer than 30 days (adjusted odds ratio (AOR): 1.77).
- Deep vein thrombosis (DVT) (AOR: 1.64).
- Unplanned intubation (AOR: 1.42)
- Dependence on ventilator for more than 48 hours (AOR: 1.30)
- BRAF mutations: these are associated with a worse prognosis than BRAF wild-type tumors in colorectal cancer.
- CD3-positive tumor-infiltrating lymphocytes (TILs) are associated with a good prognosis
- KI-67 (KI67; synonym: MIB1, proliferation marker for objectifying and confirming grading, allows conclusions to be drawn about growth behavior) [strong expression of Ki-67: risk of death increased by 50%; see below Laboratory diagnostics/laboratory parameters 2nd order (diagnostics, follow-up/therapy monitoring)].
- Microsatellite instability (MSI-H; length changes within short, repetitive DNA sequences) in the tumor – MSI-H is associated with better long-term prognosis, even with BRAF mutations in the tumorNote: Adjuvant chemotherapy* should be avoided in patients with early colon cancer (stage II) with MSI-H status [S3 guideline]. * Adjuvant chemotherapy is used to combat metastasis (formation of daughter tumors) or micrometastasis after complete surgical removal of the tumor to improve chances of cure, quality of life, or life expectancy.
- Mild hypoalbuminemia (serum albumin ≤ 3.5 g/dL) preoperatively resulted in an increase in postoperative complications and, in particular, increased pulmonary complications:
