Colon and Rectal Cancer

Colorectal Cancer (CRC) is a common problem.  Each year in America about 135,000 new cases are diagnosed.  Additionally, there is growing evidence that CRC is being found at increasing rates among men and women younger than age 50.  CRC is the second leading cause of cancer death in men and the third leading cause in women.   Early detection and proper treatment are very important factors in the prognosis of the disease.  The good news is that as a result of increasing Screening, death from CRC has been decreasing since 1990.

 

Symptoms of Colorectal Cancer

 

• Bleeding with bowel movement

• Abdominal pain

• Anemia (low blood Count)

• Weight loss, unexplained

• Feeling weak and tired

• Changes in bowel habit such as unexplained diarrhea or constipation

• Black or dark stools

*Bleeding with a bowel movement may be secondary to other causes such as hemorrhoids, anal fissures or colitis.  It is important to report blood with bowel movement to your doctor or colorectal surgeon to determine the cause.

Diagnosis

 

Your doctor may ask you to complete a colonoscopy if symptoms exist or due to a positive fecal occult blood test. This test demonstrates the presence of blood in the stool even though it is not seen in the bowel movement.  Colonoscopy is a test to look inside the colon and rectum.  During colonoscopy the location of the cancer is determined and a sample or biopsy is taken.  Most cancers arise from colon polyps.  Other polyps may be found and removed at the same time.  The most common type of CRC is adenocarcinoma. 

Staging

 

Once a CRC is diagnosed the next step is staging.  Staging is a system to describe the aggressiveness and spread of a cancer.  Most commonly a CT (Computed Tomography) scan of the abdomen and chest will be obtained.  For rectal cancer an MRI of the pelvis or a rectal ultrasound may be obtained.  These tests help determine if the cancer has spread from the colon or rectum.  The most common sites of spread are the lymph nodes next to the tumor, the liver, and the lungs.  Final staging is dependent by a pathologist, looking at the tissues under a microscope, removed at the time of surgery.  Stages range from I-IV. Stage one is early and stage four means the tumor has spread or “metastasized” to distant organs such as the liver and lungs.   Colon cancer Stages I-III are called “localized”.  Stage IV colon cancer is “advanced”.

 

Treatment

 

The initial treatment for localized colon cancer involves surgery.  During surgery the segment of colon containing the cancer is removed along with the adjacent lymph nodes.  In most cases the healthy cancer-free ends of the colon can be put together in an area called an anastomosis.  Bowel function after colon surgery is usually close to normal and diet is unchanged. In most situations, we perform surgery using minimally invasive techniques.

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In addition to traditional surgical technique, we specialize in minimally invasive colon and rectal surgery using state of the art laparoscopic and robotic technology (utilizing the Da Vinci Si & Xi robotic surgical platforms). This results in smaller incisions in comparison to traditional access, with the goal of less post-operative pain, shorter hospital stay, and faster return to your normal activities. http://pslmc.com/service/center-for-robotic-surgery

 

The initial treatment for rectal cancer may involve radiation/chemotherapy.  If chemo-radiation is given before surgery it is called “neoadjuvant". An Oncologist will direct the neoadjuvant treatment.  The decision to start with chemo-radiation therapy first or proceed directly to surgery without neoadjuvant therapy is often made at a multi-specialty Tumor Board conference. We provide surgical leadership to all of the Tumor Boards at our affiliated hospitals.   

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We manage  rectal cancer with the intention of cancer cure and anal muscle preservation. We are surgical specialists in avoiding permanent colostomy. However, in situations when the cancer is close to, or involves, the anal muscle, surgery may requires the creation of an ostomy.  An ostomy is where the colon or small bowel is sewn to an opening in the skin of the abdominal wall.  Colon sewn to the skin is called a colostomy.  Small bowel or Ileum sewn to the skin is called an ileostomy.  A sealed bag over the ostomy will collect the bowel movements.  The ostomy is often temporary and can be reconnected with another future surgery. A special nurse called an enterostomal nurse is an expert in helping patients and families care for a new ostomy. 

 

Following surgery for colon or rectal cancer, chemotherapy is recommended for people with Stage III disease (lymph nodes involved).  Chemotherapy is not recommended for Stage I or II. The goal of chemotherapy is to reduce the chances that the cancer will come back.  All of the known cancer is usually removed for cure at the time of surgery, however for stage III disease cancer cells could still be present in the body after surgery and chemotherapy is directed against these potential cells.  Chemotherapy after surgery is called ‘adjuvant”.  Chemotherapy in this situation is given over a period of 3-6 months.  An oncology doctor will direct the chemotherapy.

 

As colorectal surgeons we have been specially trained to treat CRC.  The best treatment involves coordination of care between your family doctor, your gastroenterologist, surgeons, radiologists, pathologists and oncologists.  Your colorectal surgeon will often be the doctor who helps coordinate care between these specialists.  The goals of treatment are cancer cure and to obtain the best quality of life.  We are committed to giving you the very best in communication, technical skills and compassion.  We insist that patients and families be knowledgeable and comfortable with all aspects of the treatment plan and welcome questions and discussion at all times.   The technical aspect of surgery is rewarding but what motivates us the most is seeing our patients do well and getting back to normal lives.