Colon Cancer

Colon cancer, or colorectal cancer as it is often referred to, is a cancer that originates in the large intestine (colon) or the rectum (end of the colon). When doctors refer to colorectal cancer they are talking about colon cancer that starts in the glands that are present in the lining of the colon and rectum.

There are other types of cancers that can also affect the colon. They include lymphoma, carcinoid tumors, melanoma and sarcomas. These other cancers are rare. When we use the term “colon cancer” we will be referring only to colon carcinoma.

The American Cancer Society states that colorectal cancer is one of the leading causes of death related to cancer. However, when it is diagnosed early, it most often leads to a complete cure. Almost all colon cancers begin as benign (non-cancerous) polyps, which if untreated, eventually and slowly will develop into cancer.

There is a higher risk for colon cancer with the following conditions:

What is the colon?

The colon is also known as the large intestine or large bowel, and is located in the lower part of the digestive tract. It is a muscular tube about five feet long that travels around the borders of the abdominal cavity. This long tubular organ consists of the colon (large intestine) and the rectum, which is the last segment of the colon.

Once food is swallowed it starts to become digested in the stomach. Following that, it then empties into the small intestine, where the nutritional part of the food is absorbed. The remaining waste then travels through the colon into the rectum where it becomes expelled from the body. Both the colon and rectum absorb water, form stool, and hold the waste until it is ready to be expelled.

Muscles run across and around the colon. They will contract and relax rhythmically in order to propel the stool along. Water is absorbed along the way as the stool goes from a liquid to a solid. The route it travels is up the ascending (right) colon, across the transverse colon, and down the descending (left) colon to the curved and looped sigmoid colon. The stool is stored there until such time that it is conveniently passed outside. It will exit through the rectum, which is the last six inches of the colon. The blood and lymph vessels connected to the colon are referred to as the mesentery.

Symptoms

Many cases of colon cancer will not have any symptoms. When symptoms do occur they may present the following:

Causes

In most cases, the cause of colon cancer is not known. What we do know is that colon cancer occurs when healthy cells in the colon become altered. Under normal conditions, healthy cells will grow and divide in an orderly way to keep the body functioning normally. The growth of the cells can get out of control, they don’t die, and the cells will continue to divide even though new cells are not needed. This exaggerated growth can cause precancerous cells to form in the lining of the intestine. Over a period of years, these cells can become cancerous.

Potential causes for colon cancer include:

Gene mutations include:

Genetic testing can detect both FAP and HNPCC. If there is a history of colon cancer in your family it is advisable to discuss the possibility of having genetic testing to screen for these disorders.

Screening

Colon cancer is most curable when it is detected before symptoms develop. Proper screening in most cases will detect cancer. The various methods of screening include:

PHYSICAL EXAM – This will rarely show any problems other than a lump (mass) which the doctor will feel when he presses on the belly area. A rectal exam could reveal changes in the rectal lining or a mass.

BLOOD TESTS – Small amounts of blood in the stool could possibly indicate the presence of colon cancer. A fecal occult blood test (FOBT) is performed to check for blood in the stool that can’t be seen by the naked eye. Hidden blood is often the sign of colon polyps or cancer. This test should also be performed with a colonoscopy or sigmoidoscopy. The carcinoembryonic antigen (CEA) test measures the amount of a protein that may appear in the blood of some people who have certain kinds of cancers, especially large intestine (colon and rectal) cancer.

COLONOSCOPY – The best screening test for colon cancer since it is the only one that provides an inside view of the entire colon and will discover colorectal polyps. This is an outpatient procedure performed under local anesthesia.

This test is performed in the hospital on an outpatient basis. The day before the test you have to do a bowel prep to clean out the bowel. Before the test, you are given medication to put you to sleep. A long, flexible lighted tube called a colonoscope is inserted into the rectum. It is slowly guided by the doctor so that the entire colon is visible.

Polyps located on the wall of the colon or rectum are removed during the colonoscopy through the colonoscope. They are sent to the lab for testing. If a polyp cannot be removed during the colonoscopy because of its size, shape or location, it will be removed at a later time with surgery. However, a biopsy (tissue sample) of the polyp may be taken during the colonoscopy and sent to a lab for testing. Biopsy of a polyp doesn’t always detect cancer. The most accurate method is to remove the entire polyp during surgery and then have it tested.

During a colonoscopy, a growth that is obviously cancer can be discovered and it will have to be removed with surgery.

The risks of a colonoscopy include:

SIGMOIDOSCOPY –This procedure examines the lower third section of the colon (rectum and sigmoid colon). A flexible lighted tube (sigmoidoscope) is inserted into the rectum and images of the rectum and sigmoid colon are shown on a video screen. This procedure can be performed in the physician’s office.

IMAGING

Treatment

The treatments performed are in part determined by the stage of cancer and the purpose is to stop the spread of the cancer and reduce the possibilities of it returning.

The treatments can include:

These Treatments include:

Complication Following Treatments

Complications that can occur after the treatments include:

When to call the doctor after treatments

Give us a call if any of the following occurs:

Prognosis

When caught early, colon cancer is a treatable disease. When treated early, many patients survive at least five years after the diagnosis. How well you will do after the diagnosis depends on many variables including the stage of the cancer. When the cancer does not return within five years, it is considered cured. Stages 1, 2 and 3 are considered curable. While Stage 4 Is not considered curable, the survival rate at five years is less than 1 percent.

Preparing for Surgery

Surgery (Colon Resection)

Colon surgery is performed to remove the affected section of the colon. The portion of the colon above the area that is resected is then reattached to the portion of the colon just below the resected area. This “re-attachment” is called an anastomosis and it is accomplished with the use of a suture and stapling device. This procedure can last for 2 – 4 hours,
or longer depending on the amount of colon that has to be removed, the location of the tumor, the amount of previous scarring, and the technique used.

Laparoscopic Colon Resection

Most laparoscopic colon resections are performed through 5 – 6 small incisions that are about a quarter inch each. A canula, a narrow tube-like instrument, is used to enter the abdomen. A laparoscope, a tiny telescope connected to a video camera, is inserted through the canula. This allows your surgeon to have a magnified view of the patient’s internal organs on a high definition television monitor. Several other canulas are inserted through the incisions to allow your surgeon to work inside the abdomen and remove part of the colon.

Advantages of Laparoscopic Colon Resection

Open Colon Surgery

The traditional “open” proc edure is highly invasive and patients often require a longer recovery time. Generally open colon surgeries require long incisions and that results in a hospital stay of 5 – 8 days and may require up to a six week recovery period. The factors that may cause the surgery to be performed with the open method include:

Possible Complications

There is a risk of a complication with this procedure as there is with any operation.

These complications include:

Ostomy

After some surgeries the colon and rectum may have the need to be kept free of stool while they heal. In some surgeries the rectum has to be removed and therefore can’t be reconnected to the rest of the colon. In either of these scenarios, an ostomy will be needed. A new opening in the abdomen will be created which will enable waste to leave the body. This
may be a temporary procedure or a permanent one.

There are two different types of ostomies that can be performed:

Adjusting to a colostomy or ileostomy can be frightening and overwhelming. Prior to leaving the hospital, you will receive instructions on how the ostomy works, and how to care for it. You will continue to receive support after you return home. Caring for your ostomy will eventually become part of your daily routine if there is a need for it to be permanent. We are always available, if the need arises, to help with any problems and provide any advice you may want. It is a good suggestion that an appointment be set up with a specified ostomy nurse. They can help with ordering supplies, tips to help manage and adjust to living with an ostomy. Most hospitals have staff available to assist patients with this adjustment.

Day of Surgery

It is imperative that you arrive on time. You will be asked to change into a patient’s hospital gown, You will be given an IV to provide fluids and medication. Prior to the surgery you will meet with and talk to your anesthesiologist. Before surgery begins you are given a general anesthesia to put you into a deep sleep. A soft tube (catheter) may be placed into the
bladder to drain urine.

After Surgery

You will be sent to a recovery room after the surgery and transferred to a regular hospital room when your vital signs are stable. Your family will be permitted to visit with you when you are in the room. Pain medication will be made available.

If you were given a urinary catheter, it will probably be removed following surgery. The IV line will remain for a few days to provide fluids. You may find a thin plastic tube in your nose that will go down into your stomach to remove any air or fluid that could make you sick or uncomfortable. As soon as your bowels start working, usually 4 – 5 days after surgery, the tube will be removed. Once the tube is removed you will start on a liquid diet and eventually advance to regular food when you are capable of tolerating it. You will be assisted out of bed the morning after surgery and activities will gradually be introduced. It is important to do so in order to prevent complications like blood clots and pneumonia. Your abdomen might be slightly bruised and swollen. You may also have metal clips or staples on the surface’ depending on the type of procedure you had.

You will have to a make a follow up appointment to check your progress and address any issues you may have.

At Home

When to Call the Doctor

Prevention

Due to increased awareness and screening (colonoscopy) the death rate for colon cancer has dropped approximately twenty percent during the last fifteen years.

Almost all men and women over age fifty should have a colonoscopy. Patients at risk may require earlier screening. Colon cancer can almost always be caught by a colonoscopy when it is in the earlier treatable stage. The colonoscopy can find polyps before they become cancerous and removing them may prevent the adevelopment of colon cancer.

Low fat and high fiber diets have been known to reduce the risk of colon cancer. Fresh fruits, vegetables, whole grains, fish and lean chicken are healthy foods for your diet.

It is recommended that you stay active since studies have shown that regular exercise can help reduce the risk of cancer.

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