Colorectal Cancer

 

Colon cancer is the third most common cancer diagnosed in both men and women in the United States. Colon cancer is found in the large intestine (colon)—the lower part of your digestive system. Rectal cancer is cancer of the last several inches of the colon. Together, they're often referred to as colorectal cancers. Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps develop into colon cancers. Polyps may be small and produce few, if any, symptoms. For this reason, Good Samaritan’s team of board certified surgeons who perform colon and rectal surgeries recommend regular screening tests to help prevent colon cancer by identifying polyps before they become cancerous.

Signs and Symptoms

Signs and symptoms of colon cancer include:

  • A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
  • Rectal bleeding or blood in your stool
  • Persistent abdominal discomfort, such as cramps, gas or pain
  • A feeling that your bowel doesn't empty completely
  • Weakness or fatigue
  • Unexplained weight loss

Many people with colon cancer experience no symptoms in the early stages of the disease. When symptoms appear, they are likely to vary, depending on the cancer's size and location.
When to see a doctor
If any symptoms of colon cancer occur, such as blood in stool or a persistent change in bowel habits, a patient should make an appointment with their physician or a member of Good Samaritan’s cancer team.
Guidelines generally recommend colon cancer screenings beginning at age 50. Your doctor may recommend more frequent or earlier screening if you have other risk factors, such as a family history of the disease.
Factors that may increase your risk of colon cancer include:

  • Age - about 90 percent of people diagnosed with colon cancer are older than 50.
  • Race - African-Americans have a greater risk of colon cancer
  • Personal history of colorectal cancer or polyps
  • Inflammatory intestinal conditions - such as ulcerative colitis and Crohn's disease
  • Inherited syndromes – such as familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, which is also known as Lynch syndrome.
  • Family history of colon cancer and colon polyps.
  • Low-fiber, high-fat diet
  • A sedentary lifestyle
  • Diabetes
  • Obesity
  • Smoking
  • Alcohol
  • Radiation therapy for previous cancers

Diagnosing colon cancer
If your signs and symptoms indicate that you could have colon cancer, your doctor may recommend one of more tests and procedures, including:

  • Blood tests
  • Colonoscopy - a long, flexible and slender tube attached to a video camera and monitor is used to view the entire colon and rectum and take tissue samples (biopsies) for analysis.
  • X-rays
  • Computerized Tomography (CT) scan

The type of treatment your Good Samaritan cancer team recommends will depend largely on the stage of your cancer. The three primary treatment options are: surgery, chemotherapy and radiation.

Surgery for early-stage colon cancer
If the cancer is small, has not spread and in a very early stage, a physician may be able to remove it completely during a colonoscopy. If the pathologist determines that the cancer in the polyp doesn't involve the base — where the polyp is attached to the bowel wall — then there's a good chance that the cancer has been completely eliminated.
Some larger polyps may be removed using laparoscopic surgery. In this procedure, a member of Good Samaritan’s team of board certified surgeons who perform colon and rectal surgeries performs the operation through several small incisions in your abdominal wall, inserting instruments with attached cameras that display the colon on a video monitor. The surgeon may also take samples from lymph nodes in the area where the cancer is located.

Surgery for invasive colon cancer
If colon cancer has grown into or through your colon, the cancer team may recommend a partial colectomy to remove the cancerous part of the colon, along with a margin of normal tissue on either side of the cancer. Also, nearby lymph nodes are usually removed and tested for cancer. In many cases, a surgeon is often able to reconnect the healthy portions of the colon or rectum.

Surgery for advanced cancer
If the cancer is very advanced or the patient’s overall health very poor, the cancer team may recommend an operation to relieve a blockage of the colon or other conditions in order to improve symptoms. This surgery isn't done to cure cancer, but instead to relieve signs and symptoms, such as bleeding and pain.
In specific cases, where the cancer has spread only to the liver, a doctor may recommend surgery to remove the cancerous lesion from the liver. Chemotherapy may be used before or after this type of surgery to improve your prognosis.

Chemotherapy
Chemotherapy uses drugs to destroy cancer cells before or after surgery, to control tumor growth or to relieve symptoms of colon cancer. A doctor may recommend chemotherapy if the cancer has spread beyond the wall of the colon or to the lymph nodes. In people with rectal cancer, chemotherapy is typically used along with radiation therapy.
Drugs that target specific defects that allow cancer cells to proliferate are available to people with advanced colon cancer, including bevacizumab, cetuximab and panitumumab. Targeted drugs can be given along with chemotherapy or alone for people with advanced colon cancer.

Radiation therapy
Good Samaritan’s Department of Radiation Oncology uses powerful energy sources, including the new Varian TrueBeam system, to eliminate any cancer cells that might remain after surgery, to shrink large tumors before an operation so that they can be removed more easily, or to relieve symptoms of colon and rectal cancer. Radiation therapy is rarely used in early-stage colon cancer, but is a routine part of treating rectal cancer, especially if the cancer has penetrated through the wall of the rectum or traveled to nearby lymph nodes. Good Samaritan’s cancer team may combine radiation therapy with chemotherapy after surgery to reduce the risk that the cancer may recur in the area of the rectum where it began.