Dr. Victor Emanuel MD

Dr. Victor Emanuel MD

COLORECTAL CANCER: WHAT IS IT

Colorectal cancer is the third most frequently diagnosed cancer in men and women and the second highest cause of cancer deaths in the U.S. Numbers are similar in Dominica. Yes, when found early, it is highly curable. This type of cancer occurs when abnormal cells grow in the lining of the large intestine (colon) or rectum.

Let’s learn about who gets colorectal cancer, how it is detected, and what the latest treatments can accomplish.

COLORECTAL CANCER: HOW IT STARTS

They often begin as polyps – benign growths on the interior surface of the colon. The two most common types of intestinal polyps are adenomas and hyperplastic polyps. They develop when there are errors in the way cells grow and repair the lining of the colon. Most polyps remain benign, but some can turn cancerous. Removing them early prevents colorectal cancer.

RISK FACTORS YOU CAN’T CONTROL

These factors depend on genetics and lifestyle. Factors you can’t control include:

• Age – most patients are older that 50.
• Polyps or inflammatory bowel disease
• Family history of colorectal cancer
• History of ovarian or breast cancer

RISK FACTORS YOU CAN CONTROL

These include:

• Diet high in red or processed meats, or meats cooked at high temperatures.
• Being overweight (especially with excess fat around the waist)
• Exercising too little
• Smoking or drinking alcohol

COLORECTAL CANCER WARNING SIGNS

There are usually no early warning signs for colorectal cancer. This is why it’s important to get screened. Detecting cancer means it’s more curable. As the disease progresses, patients may notice blood in the stool, abdominal pain, a change in bowel habits (such as constipation or diarrhea), unexplained weight loss, or fatigue. By the time these symptoms appear, tumors tend to be larger and less amendable to treatment.

COLORECTAL CANCER SCREENING

Because this cancer is stealthy, screenings are the key to early detection. Beginning at age 50, most people should have a colonoscopy every 10 years. These tests not only find tumors early, but can actually prevent colorectal cancer by removing polyps.

VIRTUAL COLONOSCOPY

This alternative to colonoscopy uses CT Scan images to construct a 3-D model of your colon. Called virtual colonoscopy, the procedure can reveal polyps or other abnormalities without actually inserting a camera inside your body. The main disadvantage is that if polyps are found, a real colonoscopy will still be needed to remove and evaluate them.

X-RAYS OF THE COLON (LOWER GI)

These X-Rays – using a chalky liquid known as barium as a contrast agent – allow your doctor a glimpse at the interior of the colon and rectum, offering another way to detect polyps, tumors, and changes in the intestinal tissue. Like the virtual colonoscopy, any abnormalities that appear on the X-Rays will need to be followed up with a conventional colonoscopy.

DIAGNOSING COLORECTAL CANCER

If testing reveals a possible tumor the nest step is a biopsy. During a colonoscopy, your doctor will remove polyps and the tissue samples from any parts of the colon that look unusual. The tissue is examined under a microscope to determine whether or not it is cancerous.

STAGING COLORECTAL CANCER

Any cancer that’s detected is “staged,” a process of finding out how far the cancer has spread. Tumor size may not correlate with the stage of cancer. Staging also enables doc to determine what type of treatment you will receive.

• Stage 0 – Cancer is only in the innermost lining of the colon or rectum.
• Stage I – Cancer has not spread beyond the inner wall of the colon or rectum.
• Stage II – Cancer has spread into the muscle layer of the colon or rectum.
• Stage III – Cancer has spread to one or more lymph nodes in the area
• Stage IV – Cancer has spread to other parts of the body, such as the liver, lung, or bones. This stage does NOT depend on how deep the tumor has penetrated or if the disease has spread to the lymph nodes near the tumor.

COLORECTAL CANCER SURVIVAL RATES

The prognosis depends on the stage of your cancer, with higher stages meaning more serious cancer. The five-year survival rate refers to the percentage of patients who live at least five years after being diagnosed. Stage I has a 74% five-year survival rate which Stage IV has only a 6% survival rate.

COLORECTAL CANCER SURGERY

In all but the last stage of this cancer, the usual treatment is surgery to remove the tumor and surrounding tissue. In the case of large tumors, it may be necessary to remove an entire section of the colon or rectum. The good news is that surgery has a very high cure rate in the early stages. If the cancer has spread to the liver, lungs or other organs, surgery is not likely to offer a cure – but removing the additional tumors, when possible, may reduce symptoms.

TREATING ADVANCES COLORECTAL CANCER

If your cancer is at Stage III, it can still sometimes be cured. Treatment typically involves a combination of surgery, radiation, and chemotherapy. If the cancer returns after initial treatment or spreads to other organs, it becomes much more difficult to cure. But radiation and chemotherapy may still relieve symptoms and help patients live longer.

COPING WITH CHEMOTHERAPY

Chemotherapy has come a long way from the days of turning people’s stomachs. Newer drugs are less likely to cause this problem, and there are also medications to control nausea if it does occur. Research continues for chemotherapy drugs that are more effective and tolerable.

RADIOFREQUENCY ABLATION

Radiofrequency ablation (RFA) uses intense heat to burn away tumors. Guided by a CT Scan, a doctor inserts a needle-like device that delivers heat directly to a tumor and the surrounding area. This offers an alternative for destroying tumors that cannot be surgically removed. In patients with a limited number of liver metastases that cannot be removed by surgery, chemotherapy is sometimes combined with RFA for tumor destruction.

PREVENTING COLON CANCER: DIET

You can take steps to dramatically reduce your odds of developing colorectal cancer. Researchers estimate that eating a nutritious diet, getting enough exercise, and controlling body fat could prevent 45% of colorectal cancers. It is recommended that one consumes a low-fat diet that includes plenty of fiber and at least five servings of fruits and vegetables per day.

PREVENTING CANCER WITH EXERCISE

Physical activity appears to be a crucial weapon in the defense against colorectal cancer. In one study, the most active participants were 24% less likely to have the cancer than the least active people. It didn’t matter whether the activity was linked to work or play. The American Cancer Society recommends exercising five or more days a week for at least 30 minutes a day.

See you next week.