Cancer

Cancer is an abnormal, uncontrolled growth of cells. When cancerous cells grow uncontrollably, these cells form tumors. Tumors can cause other body tissues to be destroyed.

Not all tumors are cancerous. A benign tumor is not cancerous. These tumors do not spread to other parts of the body. Malignant tumors are cancerous and can invade surrounding tissue. Through metastasis, malignant cells travel to different parts of the body where the cells can multiply and form tumors or metastases.

Colorectal Cancer

Facts:

• Colorectal cancer is the second leading cause of cancer death.
• Colorectal cancer is the fourth most common malignancy in the United States.
• Colon cancer is the third most common cancer in women and men.
• The American Cancer Society estimates that in 2005 approximately 56,660 women and 48,290 men diagnosed with colon cancer.
• The American Cancer Society also estimates that in 2005 approximately 16,810 women and 23,530 men diagnosed rectal cancer.
• About 75% of all new cases of colon cancer occur in people with no known risk factors for this disease.
• Screening for colorectal cancer and polyps has decreased the incidence of this disease by nearly 2% per year during the past decade.

The colon and rectum are part of the digestive system. Together, they form a long muscular tube known as the large intestine or bowel. The upper 4-6 feet of the large intestine is the colon, and the lower 5-6 inches is the rectum. Cancer occurs when cells of the colon or rectum become abnormal and grow uncontrollably, interfering with the function of these organs. The majority of colorectal cancers arise from the cells lining the inside wall of the colon and rectum. This lining is called the mucosa.

Polyps are non-cancerous growths that can occur anywhere in the colon or rectum. Though they are not cancer, polyps should be removed because they can become cancerous. Individuals who have had a colon or rectal polyp are likely to develop more and should be examined regularly by a doctor.

Colon and rectal cancer are often asymptomatic. As a tumor grows, symptoms that may be indicative of cancer include:

• Bright red blood in the stool
• Persistent diarrhea or constant constipation
• Crampy pain in the abdominal region which does not subside
• Continuing decrease in the size of stool
• Frequent feeling of bloating in the abdominal or bowel region
• Unexplained weight loss
• Unexplained fatigue

Colon Cancer
When colon cancer is detected in its early phase, surgery is normally performed in order to remove the affected part(s) of your colon. Surrounding tissue is also removed to assure that associated lymph nodes (which may control cancer cells) are removed. This procedure is called a colectomy. Additional therapy may be required if pathology reports indicate that surrounding tissue and/or lymph nodes contain cancer cells. Consultation with a medical oncologist will be advised for discussions regarding the risks and benefits of adjuvant chemotherapy. Adjuvant chemotherapy works by destroying cancer cells that may have spread from the original cancer site.

Rectal Cancer
Rectal cancer occurs in the lower 5-6 inches of the large intestine. Historically many patients with rectal cancer were treated with removal of the rectum and anus, and formation of a permanent colostomy. Our surgeons utilize advanced techniques in anal sphincter preservation with rectal reconstruction. These techniques help in minimizing the need for a colostomy. Great care is taken to identify and preserve the nerves that control bladder and bowel function to maximize quality of life after surgery.

Cancer that occurs in the very low portion of the rectum may require removal of the anus. In order to allow waste to exit the body, an opening called a stoma is created in the abdomen. A special bag covers the stoma so that waste may be collected. If a colostomy is needed, our patients are assisted by enterostomal therapists who work closely with patients teaching them how to care for their colostomy.

Anal Cancer
Anal cancer is relatively uncommon, accounting for 1.5 percent of all gastrointestinal cancers in the United States. Treatment typically involves chemo and radiation therapy, and close follow-up. The Center for Colorectal and Pelvic Floor Disorders has an on-site laboratory with state-of-the-art equipment that allows careful follow-up of patients who have been treated with anal cancer. Surgery is not usually required for this type of cancer.

Therapy

Chemotherapy – Chemotherapy is a form of drug which is used to eliminate cancer cells. It is given through the veins with the use of an IV which can be kept in place for the duration of treatment.

Adjuvant chemotherapy – This type of therapy is used after surgery has been performed. Adjuvant chemotherapy removes cancer cells that may have traveled to other sites of the body.

Neoadjuvant chemotherapy – This type of therapy is used before surgery takes place in order to shrink the size of the cancerous tumor.

Radiation Therapy - Radiation therapy is used mainly with rectal cancers. This form of therapy does not remove cancer cells which may have spread to other sites of the body. It is used before surgery for tumor shrinkage, and after surgery for prevention of local recurrence.

Colorectal Cancer Screening
Screening for colorectal cancer has been proven to decrease mortality in randomized clinical trials. Unfortunately, most individuals are not screened due to either fear or lack of adequate education regarding the benefits. Recommendations for screening begin at age 50 for the average risk population, and at 40 years of age (or younger) for higher risk groups.

Fecal Occult Blood Test (FOBT) – This screening uses a guaiac-based test with dietary restriction or an immunochemical test without dietary restriction. Two samples from each of 3 consecutive stools will be examined without rehydration. Patients with a positive test on any specimen should be followed up with colonoscopy.

Colonoscopy – This short preventative procedure allows your physician to look inside your large intestine using a colonoscope, to look for early warning signs of colon or rectal cancer. If anything abnormal is seen in your colon such as a polyp or inflamed tissue, the physician can remove all or part of it using tiny instruments passed through the scope. That tissue (biopsy) is then sent to a lab for testing. Colonoscopy takes 30 to 60 minutes.

Flexible Sigmoidoscopy – A thin lighted tube called a sigmoidscope is utilized to look inside the rectum and lower colon for polyps, tumors or other abnormalities. Only the lower ¼ to 1/3 of the colon is visualized.

Double Contrast Barium Enema - This test is used to obtain an x-ray of the colon and rectum. It consists of a white, chalky substance given to patients prior to the x-ray. The barium outlines the colon and rectum on the x-rays to help the doctor see tumors or other abnormal tissue. The doctor may also expand the colon by gently pumping air during the test to look for small tumors.

Screening Modalities Under Investigation: