Colorectal Cancer

Overview

Colorectal cancer is a form of cancer that develops in the large intestine (colon). The colon is the last portion of the digestive tract.

Colorectal cancer mainly affects older persons, although it may strike anybody at any age. It generally starts as tiny, noncancerous (benign) collections of cells called polyps that grow on the interior of the colon. Some of these polyps can develop into colorectal malignancies over time.

Colorectal cancer symptoms include, a consistent change in your bowel habits, such as diarrhea or constipation, or a change in the consistency of your feces, rectal hemorrhage or blood in your feces, consistent stomach discomfort, such as cramps, gas, or pain, the sensation that your bowel does not entirely empty, Weakness or unexplained weight loss.

Many therapies are available to help manage colorectal cancer, including surgery, radiation therapy, and drug treatments such as chemotherapy, targeted therapy, and immunotherapy.

What is Colorectal Cancer?

Colorectal cancer is a condition in which cells in the colon or rectum proliferate uncontrollably. Colon cancer is another term for colorectal cancer. The colon is also known as the large intestine or large gut. The rectum is the tunnel between the colon and the anus.

Polyps, or abnormal growths, can arise in the colon or rectum. Some polyps may develop into cancer over time. Polyps can be detected using screening tests and removed before they become cancerous. Screening also aids in the detection of colorectal cancer at an early stage, when therapy is most effective.

 Body Parts Affected By Colorectal Cancer

To understand colorectal cancer, it is helpful to understand what parts of the body are affected and how they work.

The colon is a five to six-foot-long tube that links the small intestine to the rectum. The colon, which is part of the large intestine together with the rectum, transports and digests food across your body and down towards the rectum, where it exits the body as feces. The colon is divided into numerous sections, including:

• Ascending colon: This is the region of the colon where undigested food begins its trip. Undigested food goes upwards through this portion, where fluid is more efficiently reabsorbed.
• Transverse colon: The transverse colon transports food from one side of the body to the other as it moves across the body (right to left).
• Descending colon: After passing through the transverse colon, food travels downward into the descending colon, which is usually on the left side.
• Sigmoid colon: It is the last segment of the colon, shaped like a "S," and is the last stop before the rectum.
• Rectum: It is a 5- to 6-inch-long chamber that links the colon with the anus. The rectum's role is to act as a storage unit, holding the stool until defecation (evacuation) happens.

How Does Colorectal Cancer Develop?

To keep the body healthy and functioning properly, all of the cells in the body normally grow, divide, and die. This procedure might go out of hand at times. Even when cells are supposed to die, they continue to grow and proliferate. Colorectal cancer can occur if the cells lining the colon and rectum proliferate uncontrollably.

Most colorectal malignancies, fortunately, begin as little precancerous (adenomatous or serrated) polyps. Typically, these polyps develop slowly and do not produce symptoms until they become big or malignant. This enables the diagnosis and treatment of pre-cancerous polyps prior to the formation of cancer.

Colorectal Cancer Signs & Symptoms

Colorectal polyps (abnormal growths in the colon or rectum that, if not removed, might develop into cancer) and colorectal cancer do not often produce symptoms, especially at first. Someone may have polyps or colorectal cancer without being aware of it. That is why it is critical to get frequent colorectal cancer screenings.

If you have symptoms, they may include:

• A change in bowel habits.
• Blood in or on your stool (bowel movement).
• Diarrhea, constipation, or feeling that the bowel does not empty all the way.
• Abdominal pain, aches, or cramps that don’t go away.
• Weight loss and you don’t know why.

Consult your doctor if you have any of these symptoms. They might be the result of something other than cancer. Seeing your doctor is the only way to find out what is causing them.

How to Prepare For Your Colorectal Surgery?

• You may be requested to follow a particular diet before to surgery to assist lessen your discomfort, and you should drink a plenty of water (eight 8-ounce glasses of water daily).
• Inform your doctor about any drugs you are taking, including OTC supplements. Some drugs must be removed from your system prior to surgery. 
• Before the treatment, your colon must be thoroughly cleaned. This is known as a "bowel prep." Your doctor may instruct you to perform this process at home or in the hospital. A variety of cleaning treatments, such as enemas or laxatives and a clear-liquid diet, may be utilized.
• You will be instructed not to consume any solid meals and to drink only clear liquids for 12 to 24 hours before your procedure. Broth, simple coffee, gelatin, and clear fruit juice are examples.
• After midnight the night before your procedure, take nothing by mouth ("NPO"). Water and chewing gum are examples of this. Your stomach must be completely empty. If your doctor has approved any needed drugs, such as antibiotic tablets, take them with a little sip of water.
• Make arrangements for a responsible adult to drive you home from the hospital.
• Arrange for home assistance for the first few days following surgery.
• Blood tests, an electrocardiogram (EKG), or a chest x-ray may be necessary prior to the procedure. 

Surgical Options for Colorectal Cancer

During an operation, the tumor and some surrounding healthy tissue are removed. It is also known as surgical resection. This is the most often used colorectal cancer therapy. A portion of the healthy colon or rectum, as well as adjacent lymph nodes, will be removed.

While both general surgeons and specialists may conduct colorectal surgery, many patients choose to speak with colorectal surgery experts who have extra training and expertise. A surgical oncologist is a specialist who specializes in the surgical treatment of cancer. A colorectal surgeon is a doctor who has specialized in the treatment of diseases of the colon, rectum, and anus. Proctologists were the old name for colorectal surgeons.

In addition to surgical resection, surgical options for colorectal cancer include:

1. Laparoscopic surgery. Laparoscopic colorectal cancer surgery may be an option for certain people. Several viewing scopes are introduced into the belly while the patient is under anesthesia. Anesthesia is a medication that prevents people from feeling pain. The incisions are smaller, and recovery times are frequently quicker than with traditional colon surgery. In terms of cancer removal, laparoscopic surgery is just as successful as traditional colon surgery. Laparoscopic surgeons have received specialized training in this procedure.
2. Colostomy for rectal cancer. A colostomy is used less frequently in those with rectal cancer. This is a surgical opening, or stoma, that connects the colon to the abdominal surface, allowing waste to escape the body. This waste is collected in a pouch worn by the patient. The colostomy may be temporary to enable the rectum to heal, or it may be permanent. Most persons who get treatment for rectal cancer do not require a permanent colostomy because of advanced surgical procedures and the use of radiation therapy and chemotherapy prior to surgery when necessary.
3. Radiofrequency ablation (RFA) or cryoablation. Some people may require surgery to remove colon cancer that has progressed to their liver or lungs. Optional therapies include employing radiofrequency waves to heat the tumors, known as RFA, or freezing the tumors, known as cryoablation. These methods cannot be used to treat all liver or lung cancers. RFA can be performed either via the skin or during surgery. While this can assist to prevent removing sections of the liver and lung tissue that would otherwise be removed during a standard surgery, there is also a potential that parts of the tumor will be left behind.

Staging of Colorectal Cancer & How it's Treated?

Colorectal cancer is clinically defined by the stages at which it is found. Colorectal cancer stages are characterized by the depth of invasion through the intestinal wall, the involvement of lymph nodes (the drainage nodules), and the dissemination to other organs (metastases). The stages of colorectal cancer and the treatments for each stage are described here. In most situations, the damaged portion of the intestine must be surgically removed (resection). Chemotherapy or, in the case of rectal malignancies, radiation are used to treat the condition.

Stage 0: Stage 0 lesions, also known as carcinoma in situ, have the disease contained inside the lining of the colon or rectum. Lesions are not malignancies since they are in the pre-cancerous stage. As a result, excision of the lesion, either by polypectomy by colonoscopy or surgery if the lesion is too big, may be sufficient therapy.

Stage I: Colorectal tumors at stage I have progressed through the intestine's wall but not beyond its muscular covering or into nearby lymph nodes. A colon resection alone is typically the conventional therapy for stage I colorectal cancer, in which the diseased area of the colon and associated lymph nodes are removed. The type of surgery performed to treat rectal cancer depends on where it is located, however it can be either a low anterior resection or an abdominoperineal resection.

Stage II: Stage II is broken into three sections. The cancer has progressed through the colon wall at the first stage, IIA. Colorectal cancer has spread beyond the muscular layers of the large intestine at stage IIB. By stage IIC, the cancer has progressed into neighboring tissue. The malignancy has not yet entered the lymph nodes in any stage II lesion. Surgical resection (removal) is usually the sole treatment for this stage of colorectal cancer, however chemotherapy may be administered following surgery. A surgical resection for stage II rectal cancer is sometimes preceded or followed by chemotherapy and/or radiation.

Stage III: A colorectal cancer at stage III is deemed progressed since the disease has spread to the lymph nodes. Stage III colorectal cancer is divided into three smaller phases. Cancer in Stage IIIA has gone beyond the colon wall to one to three lymph nodes or is a very early lesion in the colon wall that has expanded to four to six lymph nodes. More lymph nodes are damaged in the second stage, IIIB, or there is a more advanced lesion in the colon wall with one to three lymph nodes impacted.

In this stage, the cancer also affects the organs in the abdomen. In stage IIIC, the cancer has spread to neighboring lymph nodes and has begun to affect more adjacent tissue and organs in the abdomen. Colorectal cancer is often treated with colorectal surgery first, followed by chemotherapy. Chemotherapy and radiation may be used before or after surgery for stage III rectal cancer.

Stage IV: The disease has progressed (metastasized) to distant organs such as the liver, lungs, or ovaries in individuals with stage IV colorectal cancer. This level, too, is broken into three halves. Stage IVA cancer has progressed to an organ and lymph nodes located farther away from the colon. In stage IVB, the cancer has spread to several distant organs and lymph nodes. Stage IVC cancer has spread to not just distant organs and lymph nodes, but also abdominal tissue. When cancer has progressed to this stage, surgery is often employed to relieve or avoid consequences rather than cure the patient.

Occasionally, the cancer's spread is limited enough that it may completely be removed surgically. In the event of minor liver illness, the tumor may be treated with radiofrequency ablation (heat destruction), cryotherapy (freezing destruction), or intra-arterial chemotherapy. Chemotherapy, radiation treatment, or both may be used to ease, postpone, or prevent symptoms in stage IV cancer that cannot be surgically removed.

After Colorectal Cancer Surgery

You will be hospitalized for at least four to eight days. During your stay, you will be closely checked to ensure that you are healing properly and that your colon has resumed normal function.

To keep your stomach empty for a few days, a nasogastric (NG) tube may be inserted through your nose and into your stomach. A postoperative ileus will result from the procedure. This is a transient paralysis of the intestines that prevents food or drinks from passing through. To avoid difficulties, you should begin your diet gradually. During that period, you will be given fluids intravenously.

When you start passing gas, it means your colon is functioning again. The hospital will then put you on a liquid diet. If you tolerate the liquid diet without nausea or increased stomach pain, you will be moved to a soft diet within a day or two. You should stick to a soft diet for 2 to 8 weeks following surgery, depending on your recovery and what your doctor recommends. When you return home, we will supply you with a list of items to assist you pick a soft diet.

You should be able to walk again within a day or two of surgery. This will help your circulation and bowel function return to normal, perhaps preventing issues such as DVT and pulmonary embolism.

Do your breathing exercises to make sure you are inflating your lungs completely. It may be painful for your abdomen at first but it is important to do these exercises to clear any fluid that may be in your lungs from surgery, and prevent pneumonia.

Colorectal Cancer Prognosis

Everyone is unique and reacts differently to therapy. However, with prompt and appropriate treatment, a person with colorectal cancer has a good prognosis. The survival rate for persons with colorectal cancer is determined by the cancer's stage at the time of diagnosis as well as the individual's reaction to therapy. Furthermore, numerous recent findings have the potential to improve colorectal cancer therapy and prognosis.

Several factors influence how effectively a person recovers from colorectal cancer therapy. They are as follows:

1. Stage of the cancer: This is the most important factor. The stage of your cancer at the time of diagnosis influences the severity of the ailment. Cancers that have not progressed to other organs or lymph nodes are classified as lower staged (stages 0, I, II). Higher staged malignancies have a worse survival rate. For additional information on the various phases of colorectal cancer, speak with your healthcare professional.
2. The number of lymph nodes involved: The lymph system is a circulatory system composed of a vast network of lymph vessels and lymph nodes. The lymphatic system assists in the coordination of the immune system's work in order to defend the body against external toxins. The more lymph glands impacted by the malignancy, the more probable it may return. When lymph nodes are affected, chemotherapy is frequently required.
3. If the cancer has spread to other organs: Colorectal cancer can spread to other organs such as the liver or lungs if it is advanced. Additional chemotherapy or radiation may be required in this scenario to assist delay the spread of the malignancy.
4. Quality of the surgery: Having the correct operation performed by a skilled surgeon who has had colorectal surgery education. This is especially critical for rectal malignancies, which require more difficult surgery.

Conclusion

Colorectal cancer develops when the cells lining the colon or rectum become abnormal and out of control. Because symptoms may not always present until the disease has spread, it is critical to get routine colorectal cancer tests.

Certain screening tests are recommended for healthy adults who have no signs or symptoms in order to search for evidence of colorectal cancer or noncancerous colon polyps. Finding colorectal cancer at an early stage increases the chances of a cure. Screening has been demonstrated to lower your chances of dying from colorectal cancer.

The therapies that are most likely to help you are determined by your specific condition, such as the location of your cancer, its stage, and your other health issues. Colorectal cancer treatment generally include surgery to remove the malignancy. Other therapies, such as radiation therapy and chemotherapy, may be suggested as well.