Colon Cancer, Rectal Bleeding, esophagus, stomach, small and large intestines, new york doctors

Colon Cancer

The colon is part of the body's digestive system. The purpose of the digestive system is to remove nutrients (vitamins, minerals, and proteins) from the food you eat and to store the waste until it passes out of the body. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The last six feet of intestine is called the large intestine (bowel) or colon.

When some of the normal cells of the colon undergo change, they can lead to the development of cancer. It is important to briefly discuss some theories about colon cancer formation. It seems that many people with colon cancer have one, or a series, of genetic abnormalities that may predispose to the development of colon cancer.

These genetic malfunctions may be inherited, as is the case of people with family histories of colon cancer, or induced by damage to the DNA of the colon cells. The cause of the latter may be primarily due to oxidative stress from the environment or diet, with a complex relationship being the body’s response to what we eat. What we do know is that most colon cancer start as polyps, small growths of precancerous tissue, that if left in place will go on to develop cancer. Colon cancer screening with colonoscopy is used to remove polyps before they become cancers, thus preventing it.

Stages of Colon Cancer

Once cancer of the colon is found (diagnosed), more tests will be done to find out if cancer cells have spread to other parts of the body (staging). Your doctor needs to know the stage of your disease to plan treatment. The following stages are used for cancer of the colon:

Stage 0 or Carcinoma In Situ Stage 0 cancer of the colon is very early cancer. The cancer is found only in the innermost lining of the colon. It may have arisen in a polyp which was removed, or directly from the lining of the colon.

Stage I (Dukes A) The cancer has spread beyond the innermost lining of the colon to the second and third layers and involves the inside wall of the colon, but has not spread to the outer wall of the colon or outside the colon.

Stage II (Dukes B) Cancer has spread outside the colon to nearby tissue, but it has not gone into the lymph nodes. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They produce and store cells that fight infection.)

Stage III (Dukes C) Cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They produce and store cells that fight infection.)

Stage IV (Dukes D) Cancer has spread to other parts of the body.

Recurrent Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the colon or in another part of the body. Recurrent cancer of the colon is often found in the liver and/or lungs.

Diagnosis Like most cancers, cancer of the colon is best treated when it is found (diagnosed) early. Because of this, screening tests (such as a rectal exam, proctoscopy, and colonoscopy) may be done regularly. In patients who are at higher risk to get cancer, such as those who have a family history of cancer of the colon, rectum, or of the female organs; who have had small noncancerous growths (polyps) in the colon; or who have a history of ulcerative colitis (ulcers in the lining of the large intestines), screening begins at age 40 to 50 years old. In people with no symptoms, screening typically begins at age 50. Your doctor may order these tests to look for cancer if you have a change in bowel habits or if you have any bleeding from your rectum.

Your doctor will usually begin by giving you a rectal exam. In a rectal exam a doctor, wearing thin gloves, puts a greased finger into the rectum and gently feels for lumps. Your doctor may then check the material to see if there is any blood in it.

Your doctor may also want to look inside the rectum and lower colon with a special instrument called a sigmoidoscope . This exam, called a sigmoidoscopy, finds about half of all colon and rectal cancers. The test is usually done in a doctor's office. You may feel some pressure, but you usually do not feel pain.

A more thorough examination of the entire colon (colonoscopy) is performed with a special instrument called a colonoscope. This test is typically done in a hospital outpatient department under a type of sedation called "conscious sedation". This form of sedation is not as deep as general anesthesia, but does make the test comfortable, and you may not remember having it done.

If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy. Your prognosis (chance of recovery) and choice of treatment depend on the stage of your cancer (whether it is just in the inner lining of your colon or if it has spread to other places) and your general state of health. After your treatment, you may have a blood test (to measure amounts of carcinoembryonic antigen or CEA in your blood) and x-ray tests to see if your cancer has come back.
Treatment

There are treatments for all patients with cancer of the colon. Three kinds of treatments are available:

• Surgery (taking out the cancer)
• Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
• Chemotherapy (using drugs to kill cancer cells).

Surgery is the most common treatment for all stages of cancer of the colon. Your doctor may take out the cancer from the colon using one of the following methods.

If your cancer is found at a very early stage, your doctor may take out the cancer without cutting into your abdomen. Instead, your doctor may put a tube through the rectum into the colon and cut the tumor out. This is called a local excision. If the cancer is found in a small bulging piece of tissue (called a polyp), the operation is called a polypectomy.

If your cancer is larger, your doctor will take out the cancer and a small amount of healthy tissue around it. The healthy parts of the colon are then sewn together (anastomosis). If only a small amount of tissue is removed, this is called a wedge resection. If a larger amount of tissue is removed, this is called a bowel resection. Your doctor will also take out lymph nodes near the intestine and look at them under the microscope to see if they contain cancer.

If your doctor is not able to sew your colon back together, he or she will make an opening (stoma) on the outside of the body for waste to pass out of the body. This is called a colostomy. Sometimes, the colostomy is only needed until the colon has healed, and then it can be reversed. However, your doctor may have to take out the entire lower colon, and the colostomy is permanent. If you have a colostomy, you will need to wear a special bag to collect body wastes. This special bag, which sticks to the skin around the stoma with a special glue, can be thrown away after it is used. This bag does not show under clothing, and most people take care of these bags themselves.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation can be used alone or in addition to surgery and/or chemotherapy.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein. You may be given chemotherapy through a tube that will be left in your vein while a small pump gives you constant treatment over a period of weeks. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the colon. If your cancer has spread to the liver, you may be given chemotherapy directly into the artery going to the liver.

If your doctor removes all the cancer that can be seen at the time of the operation, you may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after an operation to a person who has no cancer cells that can be seen is called adjuvant chemotherapy.

Biological treatment tries to get your own body to fight cancer. It uses materials made by your own body or made in a laboratory to boost, direct, or restore your body's natural defenses against disease. Biological treatment is sometimes called biological response modifier (BRM) therapy or immunotherapy.

Treatment by Stage

Treatments for cancer of the colon depend on the stage of your disease and your general health.

Stage 0 Colon Cancer Your treatment may be one of the following:

1. Local excision or simple polypectomy
2. Wedge resection(sometimes done with laparascope)

Stage I Colon Cancer Treatment is usually surgery (bowel resection) to remove the cancer and join the cut ends of the bowel.

Stage II Colon Cancer Your treatment may be one of the following:

1. Treatment is usually surgery (bowel resection) to remove the cancer.
2. Clinical trials of chemotherapy, radiation therapy, or biological therapy following surgery.
3. If your tumor has spread to nearby tissue, you may also receive chemotherapy or radiotherapy following surgery.

Stage III Colon Cancer Your treatment may be one of the following:

1. Treatment is usually surgery (bowel resection) to remove the cancer, followed by chemotherapy.
2. Clinical trials of chemotherapy, radiation therapy, and/or biological therapy following surgery.

Stage IV Colon Cancer Your treatment may be one of the following:

1. Surgery (bowel resection) to remove the cancer or to make the colon go around the cancer so that it can still work.
2. Surgery to remove affected parts of the body where the cancer may have spread.
3. Radiation therapy to relieve symptoms.
4. Chemotherapy.
5. Clinical trials of chemotherapy or biological therapy.

Recurrent Colon Cancer If the cancer has come back (recurred) in only one part of the body, treatment may consist of an operation to take out the cancer. If the cancer has spread to several parts of the body, your doctor may give you either chemotherapy or radiation therapy. You may also choose to participate in a clinical trial testing new chemotherapy drugs or biological therapy

Prevention
Possibly the most important aspect about colon cancer to consider is prevention. Please read our review on Nutrition and Colon Cancer prevention for further information.

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