Colon-rectum(Colorectal) Cancer

Dr. Deepak Chhabra

MS. (Bom), DNB, M.R.C.S. (Edin. UK)

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FAQ

  1. What is cancer
  2. Cancer Risk factors
  3. Stages of Cancer
  4. Early signs of Cancer
  5. Early detection of Cancer

The world knows this man as a consultant oncosurgeon with vast experience in Gastrointestinal and Hepatobiliary-Pancreatic cancers,who specializes in stapled anastomosis for bowel cancers and sphincter saving resections for rectal cancers. In short, he is the person to be contacted for all kinds of cancer related cases.

Richa AgrawalPancreatic Cancer

Thank you Dr Deepak for all you have done for mum, for putting the smile back of her face. I wish you success in all your future endeavors and know that you will continue to touch peoples lives and help them be healthy - the way you have done for my mum….. and me.

Nicola MathiasStomach Cancer

For 67years I've led a very healthy life and thank the "Almighty" for it. However as I said all good things come to an end some time and so be it. Out of the blues was detected the dreadful illness "C" which had shown no signs or symptoms whatsoever..... Time had now come for me to choose a very efficient Oncologist for my treatment.

Patient

My mother was diagnosed of colon cancer, and I was recommended to see Dr Deepak Chhabra for consultation.
The first impression of Dr Chhabra was… he is so young! But after consulting him we realized his level of experience and there was a sense of confidence he spilt over us.We knew we could trust him.....

Neelu GroverColon Cancer
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About Colon

The Intestine is the longest part of the digestive system (the ‘gut’). The digestive system is the long tube that runs from the back of the mouth, forms the stomach and intestine, and then ends at the anus. It winds around inside the body. Food passes through it and is digested and absorbed. The waste products are passed out as Intestine motions. The intestine is made up of two sections. The small intestine is where food is absorbed. This leads into the large intestine, where only water and salts are absorbed. The large intestine has two parts:

The colon, which is about one and a half metres long, and

The rectum, which is about 15 centimetres long. The rectum leads to the outside of the body through the anus.

About

What is cancer of intestines?

Glands in the wall of the oesophagus produce mucous to help food to slide down more easily when you swallow. It is the cells of these glands that have a tendency to become cancerous. The cells may multiply and form a lump that can block the passage of food and also difficulty in swallowing.

The inner lining of the oesophagus is made of different cells. The lower part has more gland cells and ‘adenocarcinoma’ is common at this site while ‘squamous cell carcinoma’ begins in squamous cells that line the middle and upper parts. The treatment of squamous carcinoma is different from adenocarcinoma.

There are lymph glands around the oesophagus. The lymph nodes are often the first place that cancer cells spread to when they break away from a tumour. So surgeons often remove them during cancer surgery and send them to the lab where a pathologist examines them to see if they contain any cancer cells.

The presence of cancer cells in the lymph nodes is part of the staging of the cancer. The stage is important because it helps the doctor to decide a suitable treatment for you.

Which part of the intestine is affected with cancer?

Intestine cancer generally affects the colon or rectum. Cancer of the small intestine is rare. It starts in the lining of the intestine (the mucosa). If untreated it spreads deeper into the wall of the intestine. From there, it can spread to lymph nodes in the area. Later, intestine cancer can spread to the liver or lungs.

Sometimes intestine cancer starts in polyps, a small out-pouching from the inner lining of the intestine, which grow and look like small mushrooms.

These polyps are quite common in people over the age of 50 and are usually benign (not cancerous). However, some polyps can grow and become cancerous.

Causes

What are the causes of Intestine cancer?

The causes of Intestine cancer are not clearly understood. Some risk factors make it more likely that a person will develop this cancer. These include:

  •  Ageing: Intestine cancer more commonly affects people over the age of 50
  • Behavioural risk factors: diet high in saturated fats, obesity, physical inactivity, smoking, alcohol
  • A personal or family history of intestine cancer
  • inheriting one of the uncommon genetic disorders:
    familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (HNPCC)
  • Having ulcerative colitis, where the lining of the colon is inflamed, for more than eight to ten years.

Symptoms

What are the common symptoms of Intestine cancer?

  • Blood in motions (either bright red or very dark in colour)
  • Mucus in motions
  • Diarrhoea, constipation or feeling that the intestine does not empty completely, particularly if this is a change from normal habits
  • General discomfort in the abdomen (feelings of bloating, fullness and/or cramps)
  • Constant tiredness, weakness and paleness.
    If you have not been diagnosed with intestine cancer and are just looking through this site, please be aware that many of these symptoms occur without any serious disease being present.

However, if you have any of the symptoms for more than two weeks, see your doctor for a check-up. A faecal occult blood test (FOBT, a test to examine for small quantities of blood in stools) is available to test for early signs of Intestine cancer. People aged 50 with no symptoms or family history should do a FOBT every two years.

This test is only a screening test to detect any source of bleeding from some part of the intestine and not a confirmatory test. Colorectal cancer can be one of the underlying causes of such a bleeding. Your doctor will give you more information on what you could have for which the test is positive.

Tests

What tests are carried out by a doctor to diagnose Intestine cancer?

This section lists common tests. It is not necessary for all the tests to be performed and your doctor will select the tests that will provide maximum information about the tumor/ disease.

Rectal examination

This test helps the doctor to check the last six to eight centimetres of your intestine. Your doctor will insert a gloved finger into your anus to feel inside your rectum for anything unusual. The test will be a little uncomfortable and may make you feel like you are going to open your intestines, but you won’t lose control.

Sigmoidoscopy / Colonoscopy

A flexible lighted tube fitted with a camera (endoscope) will be put into your anus to see the lining of your Intestine. If the doctor sees anything unusual, they can pass small tools into the scope and take out some tissue. The tissue can be examined under a microscope for a diagnosis.

Biopsy

A biopsy is nothing but diagnosis made under a microscope by a pathologist using a small bit of tissue removed from a suspicious area or lump that is found to be abnormal. During the colonoscopy if the doctor sees anything unusual, they can pass small tools into the scope and take out some tissue that can then be examined under a microscope. This test gives a confirmation of cancer.

Computerised tomography (CT) scan

A CT scan is a type of x-ray that gives a picture of organs and other structures (including any tumours) in your body. It is used to see more details of a cancer and its relation to the surrounding organs in your body. It also gives information related to cancer spread into the lymph nodes, liver or lungs.

Magnetic resonance imaging (MRI)

This test is like a CT scan, but it uses magnetism instead of x-rays to build up pictures of the organs in your abdomen. Like a CT scan, MRI is painless and the magnetism is harmless. MRI scan may be more informative in cases of low rectal cancers.

Endorectal ultrasound scan

If a cancer is found in the rectum by other tests, your doctor may ask you to have a special ultrasound of the rectum for more detailed information about the local spread of the tumor.

Positron emission tomography (PET) scan

This test is combined with a CT scan by injecting a radioactive material in the body to highlight all areas where the tumor has or can spread. This test may be used to build up more information after an MRI or CT scan. PET scan is not necessary for all patients. Your doctor will decide if you need to undergo this scan.

Blood Tests

Apart from haemoglobin and routine blood tests, a specific tumor marker test called CEA (carcinoembryonic antigen) will also be done. This blood test looks for a substance (CEA) that is produced in high quantities by intestine cancer cells.

Treatment

What is the treatment of colon cancer?

Many years of treating cancer patients and testing treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer.

You will be advised on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread and your general health.

The most common treatment options for colon cancer are surgery, and chemotherapy.

If your cancer hasn’t spread, you will almost certainly be offered surgery to remove the colon. Unlike other cancers of gastrointestinal system, cases where in colon cancer has spread to other areas, surgery is performed and is of proven benefit. This is very unique to colon cancers treatment.

What is the treatment of rectum cancer?

Many years of treating cancer patients and testing treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer.You will be advised on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread and your general health.

The most common treatment options for rectal cancer are surgery, and chemotherapy.

You may have radiotherapy or chemo-radiotherapy to shrink a tumour before surgery and make it easier to remove. It also reduces the chance of the cancer coming back in the rectum after surgery. Your surgeon will be the best judge to decide this for you.

If your rectal cancer isn’t bulky and hasn’t spread, you will almost certainly be offered surgery to remove the rectum. Unlike other cancers of gastrointestinal system, cases where in rectal cancer has spread to other areas; surgery is performed and is of proven benefit. This is very unique to rectal cancers treatment.

Surgery

Surgery for Colon Cancer:

Though cancer surgeries are extensive and take longer hours; with advanced medical care, surgeries have become safer and better equipments are now available to perform surgeries. Improved techniques of anaesthesia and post-operative monitoring have significantly contributed to overall safety of surgical procedures for cancers.

Surgery for Rectum Cancer:

Though cancer surgeries are extensive and take longer hours; with advanced medical care, surgeries have become safer and better equipments are now available to perform surgeries. Improved techniques of anaesthesia and post-operative monitoring have significantly contributed to overall safety of surgical procedures for cancers

If you are found suitable for the surgery, you will be usually admitted one or two days prior to the proposed date of surgery. There may be dietary restrictions and you may be given laxatives to evacuate your bowels prior to surgery.

Your blood group will be checked and blood is usually reserved for all major abdominal surgeries. It is always a good idea to start with deep breathing exercises once you are admitted to the hospital.

Your doctor may summon a physiotherapist to assist you with the same. You will have most of your body parts shaved for the surgery. You will be given a consent form for your signature.

The form would have details of the procedure to be performed on you by your treating surgeon. In case you have any doubts you should feel free to ask them to the surgical team.

The position of the tumour in the colon will determine how much of colon is removed. If the left side of the colon is removed, it is called a left hemi colectomy.

If the middle part of the bowel is removed (the transverse colon) it is called a transverse colectomy

If the right side of the colon is removed, it is called a right hemi colectomy.

If the sigmoid colon is removed it is called a sigmoid colectomy.

After your surgeon removes the part of the bowel containing the tumour, they join the ends of the colon back together. The place where they join is called an anastomosis.

Sometimes, to give the area time to heal, the surgeon makes a temporary colostomy or ileostomy (diversion of stools) higher up the bowel. You have the temporary stoma repaired in another operation a few months later. This is called a stoma reversal. In the meantime, you have a colostomy bag over the opening of the bowel.

Removal Lymph nodes close to colon

During the surgery all the lymph nodes around the colon will be taken out. This is called Lymphadenectomy. The surgeon takes out lymph nodes because they may contain cancer cells that have broken away from the main cancer.

Taking them out reduces the risk of your cancer coming back in the future. The lymph nodes will be sent to the laboratory and checked. This will help your doctor work out the stage of your cancer. And the stage helps to decide which treatment is best for you.

Bypass surgery

Sometimes the cancer may be very large and may be attached to some vital organs within the abdomen that prevents its removal. If this happens, the surgeon may make a connection between the intestine before and after the blocked site so as to allow digestive matter to bypass the blockage.

This is known as bypass surgery and will not cure the cancer, but can relieve symptoms.

You will be transferred to the Intensive care unit after the surgery. Your recovery will depend on the magnitude of surgery performed. After the operation, the patient is usually monitored in the ICU for 48 to 72 hrs and the overall hospital stay (if no complications) is usually between 10–14 days. Your pain and discomfort will be taken care of by the anaesthetic team.

You will be given pain-killers and an intravenous infusion (drip) to replace your body’s fluids until you are able to drink and eat again after a few days. You will also have a naso-gastric (NG) tube in place. This is a thin tube that passes down your nose into your stomach or small intestine and allows any fluids to be removed so that you don’t feel sick. It is usually taken out within 48 hours. Sometimes a small tube (catheter) is put into the bladder to drain your urine into a collecting bag.

After your operation you will be encouraged to start moving about as soon as possible. This is an essential part of your recovery. If you have to stay in bed the nurses will encourage you to do regular leg movements and deep breathing exercises. You will be seen by a physiotherapist who can help you to do the exercises.

Drinking and eating after surgery

After an anaesthetic, the movement of the bowel slows down and usually takes about 72 hours to get back to normal. After about 48-72 hours you will probably be ready to start taking small sips of water, however your doctors will tell you when it is appropriate for you to start drinking some fluids.

This will be gradually increased after a couple of days until you are able to eat a light diet, usually four or five days after your operation.

Going home

You will probably be ready to go home in about two weeks after your operation and once your stitches have been removed. If deemed appropriate your doctor may send you home with stitches and call you later to remove the stitches.

By and large you should be able to climb several flights of stairs after your discharge from the hospital and you will be given diet instructions.

Before you leave hospital you will be given an appointment for a post-operative check-up at the outpatient clinic.

Diet after colon surgery

There is no restriction on the type of food you eat after a colon surgery and you should be able to eat all that you did before surgery.

At first you may notice that certain foods upset the normal action of your intestine or your colostomy if you have one. Foods such as fruit and vegetables may give you loose stools and make your colostomy act more often than normal. This is often temporary and after a while you may find that the same foods do not have any effect.

There are no set rules about the types of food to avoid and each person needs to experiment. Some foods that disagree with one person may be fine for another. If you continue to have problems, it may help to talk to a dietician at the hospital.

Depending on the type and extent of the surgery you have had, you may have more frequent motions. Tell your doctor if this happens as they can give you medicine to help control it

Try keeping a food diary if you are having problems you think are related to your diet. Take a small notebook and draw a line down the centre of each page. Write down what you eat and when on the left of the page. Write down any symptoms you get and when on the other side of the page. After a few days, you may be able to spot which foods cause which symptoms.