Part Three: Colorectal Cancer Treatment

Colon cancer growth stagesWhat happens once cancer is diagnosed?
If you have colorectal cancer, a team of specialists will be there to help. The team will advise you to have blood tests and scans to determine what is known regarding the stage (extent) of the cancer. Not only will the size of the primary tumor be assessed thoroughly, but the team of specialists will also want to know if there is any sign of secondary spread. Armed with all the relevant information they have gathered about the cancer, the team of specialists will decide with you on the most appropriate treatment.

How are cancers of the colon and rectum treated?
Once tests have confirmed the cancer has not spread anywhere else, most colon cancers are treated by surgery. The surgery will usually involve removing the cancer together with the lymph glands in the bowel area. In most cases, the two ends of the bowel are joined together again (anastomosis). Once the colorectal cancer and surrounding tissue have been removed they will be examined under the microscope and only then will it be possible to fully determine the stage of the cancer. If the cancer is confined to the bowel wall, then surgical removal alone may be all that is needed. If there is any sign of spread to the local lymph glands, a course of chemotherapy post-operatively may well be advised.

Unless they are very small and can be removed by a local operation, most cancers of the rectum need to be checked very carefully pre-operatively by various scans. This will help decide whether or not the cancer should be treated by radiation therapy.

Will a colostomy be necessary?
A cancer of the rectum (very near the anal canal) will be difficult to remove completely and in this situation it may be necessary to remove the rectum and the anus, and make a permanent stoma (opening of the colon) into the skin of the abdomen — this is called a colostomy. Due to modern surgical techniques, the need for a stoma is less likely than it was in the past.

What happens after surgery?
While you are recovering, the specialist team will meet to consider whether further treatment is advisable. Such decisions are based largely on the information they have about how advanced the primary cancer was before removal. After the operation, the treatment options will be explained and if there is a need for further action — such as radiation therapy or chemotherapy — this will be arranged by the specialist team.

What protects against colorectal cancer?
A diet rich in fresh vegetables and fruit and low in red meat seems to help prevent colorectal cancer.

Does early diagnosis make a difference?
Achieving a complete cure of colorectal cancer depends on early detection. The larger the growth and the more widely it has spread, the less likely it is to be curable. If people wait too long before reporting symptoms, the opportunity to completely remove the cancer may be limited. An early diagnosis can also be made in the absence of symptoms through screening.

What is advanced colorectal cancer?
This is when the cancer has spread from the colon to other sites in the body. This occasionally will happen when the cancer is first diagnosed. Colorectal cancer most commonly spread to the liver. Chemotherapy in this situation can be effective in controlling symptoms and prolonging life.

Are there any implications for my family?
If a person is young (40 – 50 years old) when colorectal cancer is diagnosed, or if there is a family history of cancer, there may be an inherited genetic abnormality. In such circumstances, siblings and children may be referred to a specialist for advice. If the risk of inherited disease is high enough, some relatives may be advised to undergo regularly scheduled colonoscopies. There are uncommon and inherited conditions including familial adenomatous polyposis (FAP), in which numerous polyps develop throughout the bowel and the cancer risk is greatly increased. A person with FAP should be carefully screened.

For more information visit, Avera, the National Cancer Institute or the American Cancer Society websites. This concludes this series on colorectal cancer. Remember that early detection is key so please get screened based on your health care provider’s recommendation.

By Charlene Berke

Director of the Cancer Center at Avera Queen of Peace Hospital