Approximately one in 20 people in the US will develop cancer involving the colon or rectum in their lifetime. It's one of the top three most common cancers in the world, including breast and lung cancer. Many types are highly treatable or curable when caught early. Expert and timely surgery and endoscopy is key in all cases for treatment.
What is colorectal cancer?
Colorectal cancer (also called colon cancer) is cancer of the large intestine (colon) or rectum. This disease usually begins as a polyp, or small growth on the lining of the intestine that slowly turns into cancer over time. When found early with screening colonoscopy (inspection of the lining of the colon with an internal camera) these areas can be found and removed before they have a chance to turn into cancer. Biopsies can also be taken to diagnose colon cancer when it is still very early and easy to treat. About 90% of patients with early colon cancer can be successfully treated for cure.
Types of colorectal cancer
More than 95% of colorectal cancers are adenocarcinomas. These cancers start in the mucus forming cells that line the inside of the colon and rectum. Other less common types of colon cancer include:
- Appendiceal carcinoma. A type of colon cancer that begins in the appendix.
- Gastrointestinal stromal tumors (GIST). These start from specialized cells in the walls of your colon. They can be found anywhere in the digestive tract.
- Carcinoid tumors, which start from cells that produce hormones in the intestines.
- Lymphomas, which are cancers of the immune system. While these typically begin in lymph nodes, they can also start in the colon or rectum.
Causes of colorectal cancer
The exact causes of colorectal cancer are unknown. Having a family history of colon polyps or colorectal cancer in a blood relative is the most common and important factor increasing risk. Increasing age is very important, as more than 90% of cases happen in patients over the age of 50. Others include:
- Colon polyps left untreated
- Inflammatory bowel disease, such as Crohn’s disease or Ulcerative colitis
- Genetic mutation such as Familial adenomatous polyposis (FAP) or Lynch syndrome
- A diet low in fiber, or high in fat
- Alcohol consumption
- History of ovarian or breast cancer in women.
- Being overweight or obese.
- Tobacco use
- Lack of exercise
Symptoms of colorectal cancer
Colorectal polyps and cancer can develop in a person with no signs at all. This is why it’s important to get screened regularly to detect and treat polyps and cancer while they are easily removed and cured. Some symptoms may include:
- Blood visible in or on the stool (bowel movement)
- Dark, black, or tarry stool
- Abdominal pain or cramps that don’t go away
- Weight loss that is unexplained.
Many of the symptoms that accompany colorectal cancer may also be present with other conditions not involving cancer. It is important to see your doctor for a diagnosis if you've been experiencing any of these symptoms or haven’t been screened with colonoscopy.
Diagnosing Colorectal Cancers
People who are over 50 should have regular colonoscopies to screen for new polyps and cancer. After the first time, a second endoscopy might not be needed for 5 or 10 years or more if there is no evidence of problems. If you have a risk factor such as family history or inflammatory bowel disease, you might benefit from being screened earlier in life, as these patients tend to develop colon cancer sooner. Other tests used for screening such as fecal occult blood (testing the stool for blood) and flexible sigmoidoscopy (endoscopy for only the last part of the colon) should not be used as a substitute for full colonoscopy, as they can miss many polyps and cancers.
Colon cancer treatment
How colorectal cancer is treated will depend on factors that include the size and location of the cancer, its extent of spread, and your overall health. The best way to treat colon cancer is to remove it during screening colonoscopy (polypectomy) before a polyp has a chance to turn into cancer. This straightforward procedure makes colon cancer almost completely preventable for most people. Once cancer has formed, surgery is always needed to remove it and check for any spread of disease.
Surgery is usually performed through small incisions on the abdomen, using a lighted camera (Laparoscopic) or with the aid of a specialized robotic platform. Both of these techniques depend on the skill and experience of the surgeon, and are equal in terms of cure and recovery. Sometimes a larger incision is needed for cancers that are more advanced. In all cases, the part of the colon where the tumor is located is removed along with the lymph nodes connected with it. The lymph nodes are usually the first place that colon cancer can spread, and are important to look at to determine if any other treatment is needed. After the cancer is removed, your surgeon will reconnect the ends of the intestine to restore normal function. Surgical recovery usually requires 4-5 days in the hospital, followed by about 2 weeks of rest at home before return to normal activities. Most patients find it to be relatively pain free, and return to normal physical and intestinal function.
For early colon cancer not spread beyond the intestinal wall, surgery is considered curative. When the cancer grows and spreads outside the intestine, Chemotherapy is necessary to fully treat it and prevent recurrence and further spread. Sometimes the cancer can spread to surrounding organs or jump (metastasize) to the liver or lungs. For these cases, medications are given intravenously (chemotherapy) to destroy the cancer cells wherever they are. Patients usually do very well with these modern treatments and can have many years without cancer returning or even be cured completely depending on the tumor response.
Having an experienced and skilled surgeon to remove the cancer and guide treatment is the most important factor in determining a patient’s outcome. Our doctors at The Surgery Group provide the most optimal treatment options with colonoscopy and minimally invasive surgery. Please, call if you would like to talk about screening, or have a polyp or cancer that needs treatment. We’ll be happy to sit down and talk about the best options for your specific situation.