Become acquainted with the warning signs, risk factors and available treatment options.
The third most common cancer in the United States, colorectal cancer affects 1.3 million individuals across the globe each year and is the fourth most common cause of cancer death. In the U.S., 150,000 new cases will be diagnosed annually, and approximately one-fourth of adults older than age 50 will have at least one colorectal polyp, a precursor to cancer.
What is Colorectal Cancer?
The colon is a muscular tube between four and six feet long that resides between the small intestine and the rectum. It absorbs water, stores food and processes waste. Together, the rectum and colon form the large intestine.
Millions of cells compose the smooth lining of the colon and the rectum. Changes in these cells can lead to growths known as polyps, which can be malignant (cancerous) or benign (non-cancerous). Benign cells may become cancerous, especially as a polyp grows larger over time. As the cells multiply, the formation of a cancerous tumor may take place. Over time, cancerous cells can spread to neighboring organs or to glands outside the colon and rectum, known as lymph nodes, which produce cells that help the body ward off infection. Cancer may also spread to other areas of the body through a process called metastasis.
Classifying colorectal cancer into stages helps determine if it has spread to other areas of the body—and to what extent. Stage-one cancer is limited to the colon’s inside wall. In stage two, the cancer has begun to move through the wall of the colon, and once it has spread to the lymph nodes, it is classified as stage three. In the fourth and final stage, cancer has migrated to various parts of the body and vital organs, such as the liver and lungs. This is the most challenging stage to treat.
As colorectal cancer progresses into the later stages, individuals may experience persistent constipation and diarrhea; rectal cramping or bleeding; dark patches of blood in the stool; abdominal discomfort or bloating; unexplained fatigue; loss of appetite or weight loss; or pelvic pain, which occurs in the latest stages of the disease. Most colorectal cancers, however, do not cause early symptoms and can only be found by colonoscopy.
Knowing the Risk Factors
Science cannot fully explain what causes colorectal cancer, although some data point to diets high in red meat and animal fat and low in fiber. Those who learn to pinpoint certain risk factors will be able to take early steps to diagnosis and treatment.
Individuals over the age of 50 are at greater risk for the disease, which is why doctors recommend a first colonoscopy at age 50 for the average person. This risk continues to increase with age. Another major risk factor is a personal or family history of colon polyps or cancer; colonoscopy may be needed earlier in these individuals. A prior case of colon cancer—especially before age 60—can increase the risk of a second diagnosis. In addition, excessive alcohol use, Type 2 diabetes, smoking, obesity and lack of exercise can place a person at risk for colorectal cancer. Although there is less evidence, heavy exposure to radiation or chemicals, including small amounts of chlorine in drinking water, may also play a part in its development. Individuals should discuss risk factors with their physician to determine their likelihood of confronting the disease.
Detecting Polyps and Cancer
Screening colonoscopy is the most effective way to prevent colorectal cancer by the early detection and removal of polyps before they become cancer. Everyone ages 50 and older should have a colonoscopy at least every 10 years to detect polyp formation. Persons with a family history of colorectal cancer should have a colonoscopy beginning at age 40 or earlier.
A colonoscopy is usually performed as an outpatient procedure after the colon is cleaned out the night before. Most always, patients receive sedation to obtain a twilight sleep so that most do not remember the procedure itself. Once a patient is comfortable, the physician inserts a flexible lighted tube called a colonoscope into the rectum, enabling him or her to view the entire colon. The physician then removes any polyps detected so they can be tested by a pathology lab. Due to their size, shape or location, some polyps cannot be removed through the colonoscope and must be removed through surgery.
Advanced Surgical Treatment
Early removal of polyps can halt the spread of cancer in malignant tumors and prevent cancer from forming in benign tumors. Large polyps or tumors, whether cancerous or not, are most often removed through surgery. Some patients may also require chemotherapy or radiation. Surgery for colorectal cancer is often performed by board-certified colon and rectal surgeons, who have not only completed general surgical training, but have also completed advanced training in treating both benign and malignant polyps in the colon and rectum, as well as performing routine screenings for cancerous tumors.
Many techniques are available for the surgical treatment of colorectal diseases. The Peoria area is fortunate to have many surgeons skilled in minimally invasive techniques, which allow for surgery to be performed with almost no incisions. Robotic surgery utilizing special equipment made by da Vinci is one option. During da Vinci surgery, state-of-the-art technology provides high-definition, 3D-vision and a magnified view of the colon and/or rectum. Controlled entirely by the surgeon, the da Vinci “robot” translates the surgeon’s movements into smaller movements of tiny instruments inside the body. Using robotic or laparoscopic techniques, surgeons can perform complex procedures with only a few tiny incisions, allowing for a quick recovery so patients can minimize their hospital stay and return to their normal routine.
Certain types of surgery may require patients to wear an ostomy, a special bag or appliance designed to keep the colon and rectum clear of stool as they heal, or when the rectum has been removed or cannot be reconnected to the colon. In the hands of a board-certified colorectal surgeon, few patients require a permanent ostomy.
Keeping Cancer at Bay
Prevention is the best method for combating colorectal cancer. Individuals should exercise regularly and eat diets high in fiber and fruits and vegetables, and low in red meat and saturated fat. Certain types of aspirin may also prevent cancerous cells from forming. Knowing about your family’s history is important. Colonoscopy remains the best single measure to prevent colorectal cancer. Individuals should speak with their doctor regarding prevention. iBi
Dr. Steven S. Tsoraides is a board-certified colon and rectal surgeon and general surgeon with Peoria Surgical Group, and medical director of the UnityPoint Methodist Colorectal Cancer Clinic. Call (309) 495-0200 or visit peoriasurgical.com for more information.