splenic flexure cancer

What is Splenic Flexure Cancer?

Splenic flexure cancer, also known as splenic flexure carcinoma or left colic flexure cancer, is a rare type of colon cancer that occurs in the distal third of the transverse colon, or in the left colonic angle, or in the proximal descending colon within 10 cm from the flexure.

Prevalence and Rarity

Splenic flexure cancer represents only 1-8% of all colon cancers, making it a relatively rare type of gastrointestinal malignancy. This rarity can lead to delayed diagnosis and poorer prognosis due to its often advanced stage at presentation.

Symptoms and Clinical Presentation

The symptoms of splenic flexure cancer are similar to those of other types of colon cancer, including:

• Gradually increasing constipation
• Rare diarrhea
• Almost never bloody stools
• Often no loss of weight

In some cases, patients may experience obstipation or bowel obstruction due to the tumor's location and growth.

Anatomical Definition

The splenic flexure is a fold of the colon with its apex attached to the tip of the spleen by omental congenital adhesions. Splenic flexure cancer is defined as a tumor located within 10 cm in either direction from the left upper quadrant of the abdomen.

Optimal Surgical Approach

The optimal surgical approach for splenic flexure cancer has not been standardized, with various resection types being proposed and reported, including extended right hemicolectomy (ERH), left hemicolectomy (LH), segmental colectomy (SEG), and subtotal colectomy (STC) with or without anastomosis.

Prognosis and Survival

Splenic flexure cancers are generally thought to have a poorer prognosis compared to other colorectal cancer locations, due to their often advanced stage at diagnosis and increased risk of bowel obstruction. The long-term survival rate for splenic flexure carcinoma is lower than that of other colon cancer types, with some studies suggesting a 3-5% mortality rate.

References

• [1] Splenic flexure cancer represents about 8% of all colon cancers (Source: #14)
• [2] The optimal oncological resection for splenic flexure cancer has not been standardized (Source: #12)
• [3] Splenic flexure cancers are often associated with worse long-term survival compared to other colorectal cancer locations (Source: #15)

Diagnostic Tests for Splenic Flexure Cancer

Splenic flexure cancer, also known as splenic flexure carcinoma, is a relatively rare type of colon cancer that can be challenging to diagnose. However, various diagnostic tests can help identify this condition.

• Imaging studies: Imaging tests such as positron emission tomography (PET) scans may be helpful in making the diagnosis of splenic hilum lymph node metastasis [2]. Other imaging studies like computed tomography (CT) scans and magnetic resonance imaging (MRI) can also aid in diagnosing splenic flexure cancer.
• Barium enema: A barium enema, a type of X-ray test, may be necessary to confirm the diagnosis of volvulus of the splenic flexure or other gastrointestinal conditions that could be causing symptoms [5].
• Endoscopy and biopsy: While flexible sigmoidoscopy can reach the splenic flexure in theory, it is not always possible to examine this area due to the lack of anatomical markers [10]. However, a colonoscopy with biopsy may be necessary to confirm the diagnosis of splenic flexure cancer.
• Blood cultures: Blood cultures are mandatory in patients with suspected splenic abscess or other infections [9].
• Other tests: Other diagnostic tests such as blood tests and imaging studies may also be performed to rule out other gastrointestinal conditions that could be causing symptoms.

It's essential to note that the diagnosis of splenic flexure cancer is often delayed, and the clinical presentation can frequently mimic other gastrointestinal conditions. Therefore, a comprehensive diagnostic workup is necessary to confirm the diagnosis [11].

References:

[2] Kim CW. Imaging studies for diagnosing splenic hilum lymph node metastasis. 2010.

[5] Abdominal radiographs may suggest the diagnosis of volvulus of the splenic flexure, but as with volvulus of the transverse colon a barium enema is often needed to confirm the diagnosis.

[9] Blood cultures are mandatory in patients in PUO. In cases of splenic abscess, blood cultures should be taken before starting antibiotics.

[10] While flexible sigmoidoscopy can reach the splenic flexure in theory, it is not always possible to examine this area due to the lack of anatomical markers that the splenic flexure has been reached.

[11] Colorectal cancer is the third most common cancer and the second leading cause of cancer-related deaths with more than 1 million per year worldwide.

Treatment Options for Splenic Flexure Cancer

Splenic flexure cancer, also known as colon cancer situated between the distal third of the transverse colon and the proximal descending colon, is a relatively rare type of cancer. While surgical resection remains the primary treatment option, drug therapy has emerged as an effective approach in managing this condition.

Chemotherapy

Chemotherapy is often used to treat splenic flexure cancer, especially when the cancer has spread to other parts of the body (metastasized). The most commonly used chemotherapy drugs for colorectal cancer, including splenic flexure cancer, are:

• 5-FU (fluorouracil) [6]
• Trifluridine and tipiracil (Lonsurf), a combination drug in pill form [5]

These medications can be used alone or in combination with other drugs to treat metastatic colorectal cancer.

Targeted Therapy

Targeted therapy is another type of treatment that uses specific medications to target the genetic mutations that drive cancer growth. While not specifically mentioned in the context, targeted therapies such as cetuximab and panitumumab have been shown to be effective in treating certain types of colorectal cancer [7].

Surgical Treatment

While drug therapy is an important aspect of managing splenic flexure cancer, surgical resection remains the primary treatment option. The extent of colonic resection – either segmental or extended – has long been debated, with some studies suggesting that a more radical approach may provide better surgical and oncological outcomes [11].

References

• [5] Trifluridine and tipiracil (Lonsurf) for the treatment of metastatic colorectal cancer.
• [6] 5-FU (fluorouracil) as a chemotherapy agent for colorectal cancer.
• [7] Targeted therapy in colorectal cancer.

Differential Diagnoses for Splenic Flexure Cancer

Splenic flexure cancer, also known as splenic flexure carcinoma or cancer of the distal transverse and descending colon, is a rare type of cancer that can be challenging to diagnose. The differential diagnoses for splenic flexure cancer include:

• Crohn Disease: A type of inflammatory bowel disease (IBD) that can cause narrowing of the intestine, leading to obstruction and potentially mimicking symptoms of splenic flexure cancer [3].
• Ileus: A condition where there is a temporary halt in the normal contractions of the intestinal muscles, which can lead to blockage and mimic symptoms of splenic flexure cancer [3].
• Small Intestinal Diverticulosis: A condition where small pouches (diverticula) form in the wall of the small intestine, which can cause obstruction and potentially mimic symptoms of splenic flexure cancer [3].
• Ulcerative Colitis: Another type of IBD that can cause inflammation and ulcers in the colon, leading to symptoms similar to those of splenic flexure cancer [3].

Other Considerations

In addition to these differential diagnoses, it's also essential to consider other factors when evaluating a patient with suspected splenic flexure cancer. These include:

• Splenomegaly: Enlargement of the spleen, which can be associated with various conditions, including infections, blood disorders, and cancers [2].
• Abdominal pain: A common symptom that can be caused by various conditions, including inflammatory bowel disease, diverticulitis, and cancer [3].

References

[1] CW Kim (2010) - Less common are the cancers occurring between the distal transverse and descending colon, which are termed splenic flexure (SF) cancers. [2] GK Awotar (2016) - The spleen is one of the usually forgotten organs to be considered in the work-up of a differential diagnosis during clinical evaluation. [3] Nov 15, 2023 - Differential Diagnoses · Crohn Disease · Ileus · Small Intestinal Diverticulosis · Ulcerative Colitis.