Colon and rectal cancer, one of the most common types of cancer, is a disease in which malignant (cancer) cells form in the tissues of the colon. It usually begins in the cells of the mucosa which lines the internal wall of the colon. With this type of cancer it is the extent to which the tumor penetrates the colon wall, and not necessarily its size which is the most important aspect in determining its severity. The incidence of this cancer is higher among older individuals, with more than 80% of cases are diagnosed in individuals over the age of 60.
Colon Cancer: Symptoms, Diagnosis and Treatment
Colon and rectal cancer
Symptoms of the Disease
Symptoms of colon and rectal cancer include:
- Dark blood and mucus in stool
- Irregular bowel movements and varying viscosity in stool texture
- Abdominal pain
Early diagnosis greatly improves survival rates.
There are various diagnostic tests, including:
- Fecal Occult Blood Test: Enables identification of blood in stool which is invisible to the naked eye. Although blood in stool does not necessarily indicate colon cancer, positive results warrant further examination.
- Endoscopic Examination: Sigmoidoscopy and colonoscopy enable visualization of the colon, biopsy and polyp removal.
- Double-Contrast Barium Enema: Enables visualization of the colonic mucosa and other regions of impaired function which may indicate colon cancer. Biopsies cannot be taken with this examination, and occasionally, the rectum is not clearly visualized. Therefore, often times endoscopy will be performed in conjunction with this examination.
- Imaging Scan: Scan of the colon (recommended for those individuals at high risk for developing the disease) may aid in identifying regions with impaired functioning before the disease develops.
If a tumor is discovered, there are a number of treatment options depending on the size of the tumor and its stage of development.
If the cancer is small and in its early stages, treatment recommendations may consist of the following:
- Removing polyps during colonoscopy. If the cancer is small, localized in a polyp, and in a very early stage, the doctor may be able to remove it completely during a colonoscopy.
- Endoscopic mucosal resection. Removing larger polyps may require also taking a small amount of the lining of the colon in a procedure called endoscopic mucosal resection.
- Minimally invasive surgery. Polyps that can’t be removed during colonoscopy may be removed using laparoscopic surgery.
If the cancer has progressed, treatment recommendations will be determined based on tumor grade and the extent to which it has metastasized. The three primary treatment options are surgery, chemotherapy, and radiation therapy.
- Surgery is usually the first line of treatment and includes removal of the affected portion of the colon along with the lymph nodes draining it. The scope of surgery and whether there is a need to remove the colon itself is determined in accordance with the size of the tumor and its exact location in the colon.
When a malignant tumor is located at the beginning of the rectum, the affected portion of the intestine can be removed and anastomosis can be performed to connect the two remaining segments of the intestines. When the cancer is located deep in the rectum, the anus must be removed and closed, and an artificial anus is created.
Either complete or partial colectomy may be performed. In partial colectomy, only the portion of the colon which contains the tumor is removed, which in most cases includes the sigmoid (sigmoidectomy; removal of the final segment of the colon which leads to the rectum), or cecum (cecetomy; the upper portion of the colon which connects to the small intestines and which gives rise to the duodenum; also called the “blind pouch”).
Complete removal of the colon is called colectomy. Either complete or partial colectomy may be performed in open surgery, which consists of an incision along the abdomen, or laparoscopically.
Laparoscopic surgery consists of four to five small incisions in the abdominal wall for the insertion of a small camera called a laparoscope through one of the incisions. At the conclusion of the procedure, one of the incisions is widened in order to remove that portion of the colon which contains the cancer. Recovery from this type of surgery is relatively easy in comparison to recovery from regular “open” surgery.
- Chemotherapy, either adjuvant or prophylactic, will be required by most patients, excluding those who were diagnosed in the very early stages of the disease. It is usually given after surgery if the cancer has spread to the lymph nodes or prior to surgery to reduce the size of growth. Chemotherapy can also be given to relieve symptoms of colon cancer that have spread to other areas of the body.
- Radiation therapy is rarely used in early-stage colon cancer, but is a routine part of treating rectal cancer, especially if the cancer has penetrated through the wall of the rectum or traveled to nearby lymph nodes.
In Safe Hands
Tel Aviv Sourasky Medical Center (Ichilov) tailors its colon cancer treatment to achieve optimal results with the most appropriate treatment regimen. The multidisciplinary team of experts treating you is among the best in Israel and the world. At Ichilov you will find exceptional quality medical care delivered by world-class specialists. You will be in safe hands here!