Carcinoma of Colon or Colorectal
Treatment
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Prognosis
Colorectal cancer is the third most common cancer in men and women. An estimated 131,000 Americans are diagnosed with this disease each year and some 55,000 die as a result of it. Certain genetic factors play a role in the development of this cancer. The specific cause of Colorectal cancer is unknown, however, environmental, genetic, familial factors and preexisting Ulcerative Colitis have been linked to the development of this cancer. It is more common among African-Americans.
Risk Factors
Age: Average age at the time of diagnosis is between 60-65, and the older we get the higher our risk of colorectal cancer.
Family History of colorectal cancer increases the risk of developing this illness in first- degree relatives. Certain familial conditions, like Familial Polyposis, is associated with a much higher risk.
Genetic factors clearly play a role in the development of colorectal cancers. Several genetic and inherited illnesses carry a very high risk of colorectal cancer: Familial Polyposis, Turcot syndrome, Gardner syndrome, Peutz-Jeghers syndrome, Juvenile Polyposis, Cowden's disease, Neurofibromatosis.
Ulcerative colitis High Dietary Fat and Low Dietary Fiber can each increase the risk of this cancer.
Signs and Symptoms
This cancer may exhibit no signs in its early stages. Gradually, as the disease progresses, any of the following may be seen;
- Blood in the stool
- Diarrhoea
- Constipation
- Bowel obstruction, causing nausea, vomiting and abdominal distention
- Abdominal pain
- Pelvic pain
- Anaemia due to blood Loss
- Weight loss
- Loss of appetite
- Fatigue
This cancer may be detected in its very early stages by any of the following screening tests:
Stool Occult Blood Test. Annual screening for colorectal cancer with a stool occult blood test for adults over age 50 is a must. Incidence of this cancer rises with age. This test is a rather simple test. Small amounts of stool are placed on a paper card and delivered to the physician's office for testing. A positive test mandates a complete work-up, including a Colonoscopy.
Flexible Sigmoidoscopy is a simple test that has a higher accuracy in detecting lower colon and rectal cancer. A tube is inserted inside the rectum and advanced into lower part of the large bowel. The performing physician can look for any abnormalities and take a biopsy from the abnormal area. Almost 50% of colorectal cancers are detected with this procedure.
Digital Rectal Examination is very simple to perform and can detect lesions in rectum and prostate. It should be done in a routine physical exam for adults. The physician examines the area by inserting his finger inside the rectum and feeling for abnormalities.
When colon cancer is suspected, a careful workup should be done to establish the diagnosis or to rule it out. It is empirical to visualize the entire colon and rectum. This is achieved by:
Barium Enema - A radiological study wherein patients are given a barium enema followed by a series of x-rays of the abdomen.
Colonoscopy -This is by far the best method for evaluating the colorectal area. Biopsies can be taken of any abnormal areas at the same time. A diagnosis is established by laboratory examination of the cancer tissue.
Staging:
What is the extent of cancer? How advanced is the cancer? What areas of the body are involved? Has the cancer spread to lymph glands, bones, liver, etc.? This step is referred to as staging. These important questions must be answered prior to treatment. The answers to these questions should be obtained by utilizing a minimal number of tests and least invasive methods.
Once the diagnosis is established, the next step is to determine the extent of the disease and to implement an appropriate treatment plan. A cancer specialist should be involved for proper planning of testing and studies. A chest x-ray is always a routine aspect of this workup. Further testing will rely on the findings of the physician and his intuition. Other x-rays, CT scans, Bone scan, MRI study , etc., will determine the extent of the cancer. CEA is a blood test which indicates the presence of the cancer.
Prognosis and treatment plans for colorectal cancer depend on the extent and pattern of spread of the cancer at the time of diagnosis. Staging workup is incomplete until the removed cancer is studied by a pathologist.
- Stage 1 or Duke A: When the cancer is limited to the inside of bowel
- Stage 2 or Duke B: When the cancer is larger and penetrates through the wall of the bowel to the outside layers
- Stage 3 or Duke C: When cancer has spread to the lymph glands in the abdomen
- Stage 4 or Duke D: When the cancer has spread to other organs -- liver, lungs, etc.
Patterns of spread
Colon cancer, if left untreated, or if it fails to respond to treatment, can spread and cause metastasis to the following organs:
- Liver
- Abdomen
- Lungs
- Bones
- Pleural space
- Brain
Treatment
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Prognosis
The survival rate in colorectal cancer is determined by the stage of the disease at the time of diagnosis and, to some degree, to the response to treatment Following is a current survival table for patients at various stages of this illness. The statisticians have taken into consideration the impact of proper treatment.
Stage 5 year survival
Duke A 85-90 %
Duke B 60-80 %
Duke C 40-45%
Duke D Less than 5 %
Special Situations
Patients with advanced colorectal cancer may develop any of the following complications:
- Spinal cord compression
- Brain metastasis
- Bone metastasis
- Para neoplastic syndromes
- High Calcium level
- Pain
- High Uric acid
- Pleural effusion
- Fluid in the abdomen
Survival
Survival of patients with colon cancer in whom a cure is not possible could vary from months to years, depending on the extent of the cancer, overall condition of the patient, response to treatments, and the duration of the response.
Family Member issues
First degree relatives of all patients with this cancer should be monitored carefully. This cancer has a tendency to run in families and be associated with genetic abnormalities, for which they can be tested for. Family members should consider genetic counseling to determine their risk and possible work up for early detection of the cancer.
Follow up
After completion of treatment, in any combination that might have taken place, patients need to remain under surveillance for possibility of recurrence of cancer. Follow-up should be scheduled on a regular basis, initially every one to three months for one to two years. The frequency of follow-up will depend on the condition of the patient and his/her disease. In each follow-up visit, patients are examined and normally a CEA, chest x-ray obtained every few months, along with a CT scan of the abdomen.
Treatment of recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are treated with the same chemotherapy drugs as mentioned in the previous treatment section. Radiation therapy may be helpful in managing painful or symptomatic areas where the cancer has spread. If patients experience pain, various pain medications may be used to alleviate pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from Hospice.
COLON CANCER
COLON CANCER
COLON CANCER
