Colon Cancer
Colorectal cancer is a type of cancer that forms in the digestive system of the body. The large intestine is one of the main organs used in digestion. The first 6 feet of the large intestine make up the colon and the last few inches are the rectum. Colon cancer occurs when cancer cells develop in the colon. In comparison, colorectal cancer refers to any cancer that may occur in the colon or rectum.
Colon cancer is highly curable if detected in early stages through screening methods, like colonoscopy. Colon and rectal cancers together are the fourth most common cancers in the United States. About 1 in 20 (5%) Americans will develop colorectal cancer during their lifetime. Colorectal polyps (benign abnormal growths) affect about 20% to 30% of American adults.
Risk Factors
While the exact cause of colorectal cancer is unknown, the following factors can increase the risk of colon cancer.
- Age (nearly 90% of rectal cancer is detected in patients 50 and older)
- Family history of colorectal cancer (especially parents or siblings)
- Personal history of Crohn’s disease or ulcerative colitis for eight years or longer
- Presence of colorectal polyps
- Personal history of breast, uterine or ovarian cancer
Colorectal cancer is preventable. Nearly all cases of colorectal cancer develop from polyps, which are benign growths on the inner lining of the colon or rectum. Detection and removal of polyps through colonoscopy reduce the risk of colorectal cancer. Colorectal cancer screening recommendations are based on medical and family history. Screening typically starts at age 50 in patients with average risk. Those at higher risk are advised to receive their first screening at a younger age.
While it is not definitive, there is some evidence that diet may play a significant role in preventing colorectal cancer. A diet high in fiber (whole grains, fruits, vegetables and nuts) and low in fat may help prevent colorectal cancer.
Colorectal cancer often causes no symptoms and is detected during routine screenings. It is important to note that other common health problems can cause some of the same symptoms. For example, hemorrhoids are a common cause of rectal bleeding but do not cause or indicate colorectal cancer.
Colorectal cancer symptoms include:
- A change in bowel habits (e.g., constipation or diarrhea)
- Narrow shaped stools
- Bright red or very dark blood in the stool
- Ongoing pelvic or lower abdominal pain (e.g., gas, bloating or pain)
- Unexplained weight loss
- Nausea or vomiting
- Feeling tired all the time
Abdominal pain and weight loss are typically late symptoms, indicating possible extensive disease. Anyone who experiences any of the above symptoms should see a physician as soon as possible.
Most colorectal polyps do not cause any symptoms, which is why screening for colorectal polyps and cancer is so important. The presence of polyps can cause blood in the stool in some patients. Excess mucus production, changes in bowel frequency, and abdominal pain are less common symptoms associated with the presence of colorectal polyps.
The following are used to develop a diagnosis and treatment plan:
- Medical history
- Physical exam
- Blood tests
- Digital rectal exam (DRE) – Insertion of a gloved, lubricated finger into the rectum to check for abnormalities
- Proctoscopy – Examination of the anal cavity and rectum using a narrow instrument called a proctoscope
- Colonoscopy – Examination of the entire colon with a long, flexible instrument called a colonoscope
- Biopsy – Taking samples of tissues to view under a microscope for signs of cancer
Colorectal Cancer Staging Tests
Your physician will use a combination of the following tests to provide information about the staging or extent of cancer:
- Computed tomography (CT) scan – This highly sensitive X-ray test allows physicians to see “inside” the body and look at all of the organs. It can help detect the presence of cancer that has spread outside the colon or rectum.
- Positron emission tomography (PET) scan – This imaging test uses a special dye that has radioactive tracers. It allows physicians to identify areas where cancer may have spread outside the colon or rectum.
- CEA assay – Carcinoembryonic antigen is a substance in the blood that may be elevated if cancer is present. Although not completely conclusive on its own, this test is used to help monitor patients after their cancer has been treated.
- Magnetic resonance imaging (MRI) – This imaging test uses a magnetic field and pulses of radio-wave energy to create pictures of organs and structures inside the body. This helps determine if the tumor has spread through the wall of the colon or rectum and invaded nearby bodily structures.
- Abdominal ultrasound – A procedure in which a transducer is moved along the skin over the abdomen, this test looks for tumors that may have spread to the liver, gallbladder, pancreas or elsewhere in the abdomen.
The extent of cancer (clinical stage) is linked to treatment decision-making and post-treatment patient outcome. Staging is based on whether the tumor has invaded nearby tissues or lymph nodes, and/or cancer has spread to other parts of the body. The exact stage often is not determined until after surgery.
Treatment Options
As part of a multidisciplinary approach to care, Orlando Health Colon & Rectal Institute works together with specialists at Orlando Health Cancer Institute to offer a range of proven treatments. Your team of doctors will recommend a combination of therapies that will give you the most benefits based on your diagnosis, the stage of your cancer and your personal preferences.
Our expert surgeons are skilled in a variety of oncology techniques, including minimally invasive surgeries and traditional open surgeries. Minimally invasive surgeries, some with robotic assistance, require smaller incisions and patients experience several benefits including shorter recovery times.
For most patients with colon cancer, surgery to remove the colorectal cancer is a key element of treatment. Minimally invasive surgical techniques may be used by trained surgeons based on each individual case. Your surgeon will discuss this with you prior to surgery and decide on the best approach.
Surgeons at Orlando Health are leaders in robotic colorectal surgery. As a recognized epicenter for da Vinci® robotic colorectal surgery, Orlando Health is visited by doctors from across the country to receive training from our skilled surgeons in robotic colon and rectal surgery.
Your surgeon may perform one of these procedures:
- Local excision – If your cancer is in an early stage, your doctor may be able to avoid cutting through the abdominal wall and instead insert a tube into the rectum up to the colon to cut out the cancer.
- Robotic colectomy – A colectomy, also called a colon resection, is performed to treat colon cancer. In a partial colectomy, only part of the colon is removed. In a total colectomy, all of the colon is removed. When a colectomy is required to treat a cancerous tumor, the surgeon must remove the tumor as well as the vascular and lymph structures connected to that portion of the colon. Depending on the stage of the cancer, this surgery can be curative.
- Resection of the colon with colostomy – If, after removing the cancer, the surgeon cannot reconnect the two pieces of the colon, an opening is made outside the body for waste to pass through.
In cases where the cancer has spread from the colon or rectum to other parts of the body, our highly trained team of surgeons, radiation oncologists and radiologists will determine if they can pursue other local measures. If so, they can use any of the many procedures designed to remove or kill these masses including:
- Radiofrequency ablation – In this procedure, a probe with tiny electrodes is placed into the tumor.
- Microwave ablation – This procedure uses microwaves that are created from a needle and placed in the tumor.
- Surgical resection – This procedure to remove a tumor and normal tissue around it.
- Cryosurgery – This procedure utilizes an instrument that freezes the cancer cells.
An ostomy may be necessary in some surgeries to treat colorectal cancer. An ostomy, or stoma, is a surgically created opening between the intestines and the abdominal wall. The most common types of ostomies connect either the small intestines (ileostomy or jejunostomy) or the large intestine (colostomy) to the abdominal wall. After an ostomy is created, bowel movements pass through the opening in the abdominal wall or stoma and into the ostomy appliance. Ostomies can be temporary or permanent. Your surgeon can advise you about this possibility and how to prepare for it.
Chemotherapy or radiation therapy may be offered either before or after surgery, depending on the stage of the cancer. Radiation uses high-energy X-rays to kill or stop the growth of cancer cells. Radiation therapy can be performed with an external machine or internally with a radioactive substance sealed in needles, seeds, wires or catheters targeting the cancer. Chemotherapy uses medicines to kill the dividing cancer cells and may be administered through IV therapy.
Cytoreductive Surgery and HIPEC
If your cancer already has spread within the abdominal cavity, you may be a candidate for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). This two-step procedure involves surgery to remove all visible tumor followed by heated chemotherapy drugs that are placed in the abdomen. The patient lies on a cooling blanket to keep body temperature at a safe level, and surgeons rock the patient during the procedure. Afterward, the chemotherapy is removed from the body.
HIPEC has several advantages over traditional chemotherapy:
- Direct placement of the agent means the drug is better able to access cancer cells at this concentration.
- Depending on tumor type, the patient may only need a single dose that is administered in the operating room.
- Because most of the drug stays in the abdomen, typical chemotherapy side effects may be avoided.
MRI-Guided Radiation Therapy
Advanced technology available at Orlando Health allows for more precise treatment of cancer tumors through real-time magnetic resonance imaging (MRI) during radiation therapy.
Called MRIdian®, the system enables physicians to target tumors in real time instead of relying on static images taken minutes or even days before a patient’s radiation session. Real-time visualization offers physicians the advantage of more accurate treatment as the location of a tumor inside the body may shift during subtle natural movements, such as when a patient breathes or digests food.
For more information on MRIdian®, MRI-guided radiation therapy, click here. (Hyperlinked to: https://www.orlandohealth.com/services-and-specialties/orlando-health-cancer-institute/specialty-centers/advanced-radiation-therapy/mridian)
Outcomes
Early detection through screening methods (like colonoscopy) is crucial. Patient outcome is strongly associated with the rectal cancer stage at the time of diagnosis, including:
- Cancer stage (how advanced the cancer is)
- Cancer location in the colon or rectum
- Whether the bowel is blocked or has a hole in it
- Whether all of the tumor can be removed surgically
- Patient’s general health and ability to tolerate different treatments
- Whether the cancer is newly diagnosed or has recurred (come back)
Post-Treatment Follow-Up
Follow-up care after treatment for colorectal cancer is important. Even when the cancer appears to have been completely removed or destroyed, the disease may recur.
Colorectal Cancer Screening Guidelines
Screening can help detect colorectal cancer at its earliest stage, before you experience symptoms and when it is most treatable. Screening guidelines are general recommendations and may vary depending on a person’s individual set of circumstances including age, family history, personal medical history and genetic testing results. Based on your personal risk factors, your primary care physician will determine the most appropriate screening plan that is right for you.
