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House Call: Colorectal Cancer Awareness – Surgical Intervention

Surgical intervention is most often the first line of treatment upon a colorectal cancer diagnosis. Surgical intervention of colorectal cancer is not only used to remove the malignant mass, but to also remove surrounding lymph nodes to stage the tumor.

Laparoscopic procedures are most often used to remove the cancerous tumors found in the colon. The main benefits of laparoscopic surgery include less pain, faster recovery and improved cosmetic outcomes. Laparoscopic surgery patients also often have shorter hospital stays, usually need less narcotic pain medications and have lowered risk factors of complications from surgery.

In later stages of colorectal cancer, malignancies have often spread to other parts of the body; most often to the lymph nodes and the liver.

At Cone Health Cancer Center, the exceptional team of general surgeons and surgical oncologists have the ability to operate on all stages of colorectal cancer, as long as the patient is a proper candidate for surgery.

By combining surgical intervention and the advanced chemotherapy and radiation treatments, we are seeing significantly prolonged survivorship in late stage colorectal cancer patients.

Physician Background:

Dr. Douglas Blackman is a general surgeon and member of Cone Health Medical Staff.  Dr. Blackman is a 1995 graduate of University of North Carolina Medical School. He completed his residency in general surgery at New Hanover Regional Medical Center in Wilmington, NC and he is a Fellow with American College of Surgeons.

Colon Cancer [i]-

Definition:

Colon, or colorectal cancer is cancer that starts in the large intestine (colon) or the rectum (end of the colon).

Other types of cancer can affect the colon, such as lymphoma , carcinoid tumors, melanoma , and sarcomas. These are rare. In this article, use of the term “colon cancer” refers to colon carcinoma only.

Causes, incidence, and risk factors:

According to the American Cancer Society, colorectal cancer is one of the leading causes of cancer-related deaths in the United States. However, early diagnosis often leads to a complete cure.

Almost all colon cancer starts in glands in the lining of the colon and rectum. When doctors talk about colorectal cancer, this is usually what they are talking about.

There is no single cause of colon cancer. Nearly all colon cancers begin as noncancerous (benign) polyps, which slowly develop into cancer.

You have a higher risk for colon cancer if you:

  • Are older than 60
  • Are African American of eastern European descent
  • Eat a diet high in red or processed meats
  • Have cancer elsewhere in the body
  • Have colorectal polyps
  • Have inflammatory bowel disease (Crohn’s disease or ulcerative colitis )
  • Have a family history of colon cancer
  • Have a personal history of breast cancer

Certain genetic syndromes also increase the risk of developing colon cancer. Two of the most common are:

  • Familial adenomatous polyposis (FAP)
  • Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome

What you eat may play a role in your risk of colon cancer. Colon cancer may be associated with a high-fat , low-fiber diet and red meat. However, some studies have found that the risk does not drop if you switch to a high-fiber diet, so this link is not yet clear.

Smoking cigarettes and drinking alcohol are other risk factors for colorectal cancer.

Symptoms:

Many cases of colon cancer have no symptoms. The following symptoms, however, may indicate colon cancer:

Signs and tests:

With proper screening, colon cancer can be detected before symptoms develop, when it is most curable.

Your doctor will perform a physical exam and press on your belly area. The physical exam rarely shows any problems, although the doctor may feel a lump in the abdomen. A rectal exam may reveal a mass in patients with rectal cancer, but not colon cancer.

A fecal occult blood test (FOBT) may detect small amounts of blood in the stool, which could suggest colon cancer. However, this test is often negative in patients with colon cancer. For this reason, a FOBT must be done along with colonoscopy or sigmoidoscopy. It is also important to note that a positive FOBT doesn’t necessarily mean you have cancer.

Imaging tests to screen for and potentially diagnose colorectal cancer include:

If your doctor learns that you do have colorectal cancer, more tests will be done to see if the cancer has spread. This is called staging. CT or MRI scans of the abdomen, pelvic area, chest, or brain may be used to stage the cancer. Sometimes, PET scans are also used.

Stages of colon cancer are:

Stage 0: Very early cancer on the innermost layer of the intestine

Stage I: Cancer is in the inner layers of the colon

Stage II: Cancer has spread through the muscle wall of the colon

Stage III: Cancer has spread to the lymph nodes

Stage IV: Cancer has spread to other organs

Blood tests to detect tumor markers, including carcinoembryonic antigen (CEA) and CA 19-9, may help your physician follow you during and after treatment.

Treatment:

Treatment depends partly on the stage of the cancer.

SURGERY

Stage 0 colon cancer may be treated by removing the cancer cells, often during a colonoscopy. For stages I, II, and III cancer, more extensive surgery is needed to remove the part of the colon that is cancerous.

There is some debate as to whether patients with stage II colon cancer should receive chemotherapy after surgery. You should discuss this with your oncologist.

CHEMOTHERAPY

Almost all patients with stage III colon cancer should receive chemotherapy after surgery for approximately 6 – 8 months. The chemotherapy drug 5-fluorouracil has been shown to increase the chance of a cure in certain patients.

Chemotherapy is also used to improve symptoms and prolong survival in patients with stage IV colon cancer.

  • Irinotecan, oxaliplatin, capecitabine, and 5-fluorouracil are the three most commonly used drugs.
  • Monoclonal antibodies, including cetuximab (Erbitux), panitumumab (Vectibix), bevacizumab (Avastin), and other drugs have been used alone or in combination with chemotherapy.

**You may receive just one type, or a combination of these drugs.

RADIATION

Although radiation therapy is occasionally used in patients with colon cancer, it is usually used in combination with chemotherapy for patients with stage III rectal cancer.

For patients with stage IV disease that has spread to the liver, various treatments directed specifically at the liver can be used. This may include:

  • Burning the cancer (ablation)
  • Delivering chemotherapy or radiation directly into the liver
  • Freezing the cancer (cryotherapy)
  • Surgery

Calling your health care provider if you experience:

Black, tar-like stools

Blood during a bowel movement

Change in bowel habits

Prevention:

The death rate for colon cancer has dropped in the last 15 years. This may be due to increased awareness and screening by colonoscopy.

Colon cancer can almost always be caught by colonoscopy in its earliest and most curable stages. Almost all men and women age 50 and older should have a colon cancer screening. Patients at risk may need earlier screening.

Colon cancer screening can often find polyps before they become cancerous. Removing these polyps may prevent colon cancer.

Changing your diet and lifestyle is important. Some evidence suggests that low-fat and high-fiber diets may reduce your risk of colon cancer.

  • Some studies have reported that NSAIDs (aspirin, ibuprofen, naproxen, celecoxib) may help reduce the risk of colorectal cancer. However, these medicines can increase your risk for bleeding and heart problems. Most expert organizations do not recommend that most people take these medicines to prevent colon cancer.

Talk to your health care provider about this issue.

To learn more about Colorectal and Colon Cancer and the services offered at Cone Health Cancer Center visit http://www.conehealth.com/cone-health-cancer-center or call 336-832-1100

Cone Health Cancer Center is located on the campus of Wesley Long Hospital at 501 N. Elam Avenue
Greensboro, NC 27403


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