Colorectal Cancer
Colorectal cancer is the second most common cancer in the United States, striking 140,000 people annually and causing 60,000 deaths. That is a staggering figure considering the disease is potentially curable if it is diagnosed in the early stages.
Who is at Risk?
Though colorectal cancer may occur at any age, more than 90% of the patients are over the age of 40, at which point the risk doubles every ten years. In addition to age, other high risk factors include a family history of colorectal cancer or polyps and a personal history of ulcerative colitis, colon polyps, or cancer of other organs, especially of the breast or uterus.What are the Symptoms?
The most common symptoms are rectal bleeding and changes in bowel habits, such as constipation or diarrhea. These symptoms are also common in other diseases so it is important you receive a thorough examination should you experience them. Abdominal pain and weight loss are usually late symptoms possibly indicating more extensive disease.
Unfortunately, many polyps and early cancers fail to produce symptoms. They often do not bleed or cause a change in bowel habits, and they do not hurt. Therefore, it is important that your routine physical examination after the age of fifty include colorectal cancer detection procedures.
How Does it Start?
Nearly all colorectal cancer begins in benign polyps. These are small growths that occur on the bowel wall and may eventually increase in size and become cancerous. Colon polyps are very common, but few become cancerous. However, at this time it is not possible to identify which ones will become cancerous. Therefore, it is generally recommended that all polyps that are discovered be removed to prevent the development of cancer.Do Hemorrhoids Lead to Colon Cancer?
No, but hemorrhoids may produce symptoms similar to colon polyps or cancer. Should you experience bleeding or a change in bowel habits, you should be examined and evaluated by a doctor. Although most bright red blood seen on the toilet tissue or in the toilet water is due to an anal condition such as hemorrhoids, similar type bleeding can also be due to a low lying rectal cancer. Therefore, no particular type or amount of bleeding can be considered ‘normal’ and everyone who has experienced rectal bleeding should be examined to determine the cause.Can Colorectal Cancer be Prevented?
There are steps that reduce the risk of developing colorectal cancer. Regular screening examinations and removal of any polyps have been shown to reduce the risk of colon cancer. Once you reach 50 years of age, or sooner if you have a family history of colon cancer, you should have a thorough screening of your entire colon. There are a variety of options for this screening to include colonoscopy, virtual colonoscopy and barium enema (an x-ray study of the colon). Barium enema is the least effective and reliable method and is rarely recommended as a screening procedure these days. Virtual colonoscopy is a specialized CT scan of the colon which requires a full bowel prep similar to a colonoscopy. Virtual colonoscopy has been found to be very effective in locating colon cancers and large colon polyps. The down side of the procedure is that if an abnormality is identified the patient then has to undergo another prep on another day for a colonoscopy to verify and biopsy the abnormality. The doctors at Fairfax Colon and Rectal Surgery unanimously agree that the most efficacious method of colon screening is a colonoscopy which can not only identify growths but also biopsy or remove them at the same procedure. Don’t let the fear of cancer or the possible treatment prevent you from having a screening examination. When found early the cancers are highly curable and in the vast majority of cases do not result in the need for a permanent stoma.
Though not definitely proven, there is some evidence that diet may play a significant role in preventing colorectal cancer. Much research is being done about the relationship of diet to colon cancer. At the present time a low fat and high fiber diet is recommended. Eating more cruciferous vegetables, such as broccoli and cauliflower, may add additional protection.
There is some evidence to suggest that taking aspirin on a regular basis protects against colon cancer. Other preventative medications are currently being investigated. It is important that you check with your doctor before beginning any medication.
What Tests are Performed before Treatment?
Treatment of colorectal cancer depends on the location and extent of the tumor. Before any treatment is started, tests are done to check the colon and rectum for other cancers or polyps. This can be done through colonoscopy (looking inside the colon with a lighted flexible tube) or a barium enema x-ray of the colon. Other tests that might be used include blood tests, a chest x-ray, or scans of the abdomen to determine if the disease has spread. For cancers in the rectum, an ultrasound probe can be inserted into the rectum to provide a picture of how far into the bowel wall the tumor has grown and whether it involves any nearby lymph glands. Once these results are available, a treatment plan is chosen.How is Colorectal Cancer Treated?
The large intestine is composed of the colon and rectum. The colon is the upper portion of the large intestine. The rectum is the lower 15 centimeters of the large intestine.
Colon Cancer
The main treatment of the cancer is surgery. The surgeon removes the section of colon containing the tumor. The two ends of the colon are then reconnected. The tissue next to the colon contains the lymph nodes. These nodes are removed because the lymph system is one of the ways cancer cells spread to other parts of the body. The pathologist carefully examines the removed tissue to determine the extent of the cancer in the colon wall and in the lymph nodes. If cancer is found in the lymph nodes, chemotherapy may be recommended after surgery.
Rectal Cancer
Major abdominal surgery is still necessary for most patients. Cancer of the rectum behaves somewhat differently than cancer of the colon. The risk of local recurrence of the tumor in the pelvis following excision of the cancer is greater in rectal cancer than in colon cancer. This is particularly true if the preoperative testing reveals that the tumor has either grown through the wall of the rectum or has gotten into the surrounding lymph nodes. In these patients, radiation and chemotherapy is often recommended prior to the surgery. This can result in shrinking the tumor, making the operation easier, and decreasing the rate of pelvic recurrence. Because the rectum lies within the bony confines of the pelvis and is at the end of the gastrointestinal tract removing cancers in this portion of the bowel is technically more challenging. In the majority of these patients the surgeon can succeed in getting out all of the cancer and yet leave enough of the lowest end of the rectum in place to allow the two ends of the bowel to be reattached. Although a reconnection is done, frequently a portion of the bowel upstream from the colon is brought out onto the abdominal wall as a stoma (an artifical opening of the bowel onto the abdominal skin through which the stool will now empty into a bag). This is done to allow for safer healing of the rectal reconnection. This isa temporary stoma and will eventually be closed in the months to come.
Unfortunately, if the cancer arises in the lowest aspect of the rectum there may not be sufficient distance between the tumor and the anal sphincter muscles to allow the surgeon to reattach the two ends of the bowel. In this case the entire rectum and anal canal will need to be removed to get the entire cancer out. Therefore, the surgeon must remove the entire rectum and anus and use the end of the colon to construct a colostomy. A colostomy is made by bringing the end of the colon through a hole in the abdominal wall and sewing it to the skin edges. An appliance or bag is worn over the colostomy to collect the stool and gas that is eliminated. Modern appliances, improved surgical technique and patient education help people maintain their colostomy easily and discreetly and to lead normal lives.
Infrequently, patients may be diagnosed with very early, small cancers that are low in the rectum. In some of these cases, the tumor is able to be removed through the anal opening without having to resort to an abdominal operation. There are advantages and disadvantages to this form of treatment which will be discussed by your doctor. Depending on the final microscopic examination of the tissue removed, further treatment with radiation is sometimes recommended.
Sometimes the cancer will be found to have already metastasized (spread to other organs) when it is first diagnosed. In such cases, an individual treatment plan is made after extensive testing. Surgery, radiation and chemotherapy may all be used where appropriate.
Prognosis
Survival after colorectal cancer is related to the extent of the disease when it is first found. Early detection means that minimal treatments may be possible and that the survival rate is better. If found in an early stage, there is a 90% survival rate. If the cancer is more extensive, survival rates fall to approximately 50%.Follow-Up Care
A person with a history of colorectal cancer is at risk for recurrence of the cancer and for the development of new polyps or cancers in the remaining colon. For these reasons follow-up examinations are important. Colonoscopy is done to identify new growths early so that they can be removed without surgery. These examinations are generally necessary every 3-5 years unless an individual is forming many polyps. Other tests may be done to detect recurrence. The exact tests depend upon the location of the original cancer, the person's general health, and the treatment plan used. Your doctor will discuss the exact follow-up with you.Fairfax Colon and Rectal Surgery’s Approach
The surgeons in our practice are all experts in the treatment of colon and rectal cancers. We have an extensive experience in operating on patients with this disease from the earliest stages to the very advanced tumors. We understand the anxiety the diagnosis of a colorectal cancer can give rise to and make every effort to provide the patient with a thorough, yet expeditious, evaluation. If a transrectal ultrasound is needed for evaluation of a rectal cancer it is readily available at our office. We believe the patient deserves and is best served by a thorough discussion of the treatment options available and an explanation of what they will experience as they go through their particular treatment. Many of the operations that we do for colon cancer can be done laproscopically. This will be discussed with the patient during their counseling session. Any and all questions or concerns the patient or family may have will be answered by your surgeon during your pre-operative office visit.
In summary, colorectal cancer is unfortunately a common disease in this country. Fortunately, it can be prevented or detected early by routine screening exams. If detected early, the treatment is straightforward and the survival rate is good.