Colorectal Cancer, Part 2: Diagnosis and Treatment

HealthLink is presenting a 2-part article on colorectal cancer. Part 1 focused on risk factors and screening for prevention, while this section, Part 2, discusses diagnosis and treatment of colorectal cancer.

Important Facts To Remember About Colorectal Cancer:

• Colorectal cancer is second only to lung cancer in causing cancer-related deaths in the US. There were about 148,300 new cases and 56,600 deaths from colorectal cancer in 2002.
• More than one-third of colorectal cancer deaths could be avoided if people over the age of 50 had regular screening tests; 92% of cases occur in people 50 and older.
• Most colorectal cancers begin as polyps. People who have polyps or colorectal cancer do not always have symptoms, so it’s possible to have either and not know it.
• Colorectal cancer is one of the most preventable cancers. Screening tests can help prevent colorectal cancer by finding pre-cancerous polyps so they can be removed before they turn into cancer.
• Screening tests can find colorectal cancer early, when treatment works best. When colorectal cancer is detected in the earliest stage of the disease, the survival rate is 96%.
• Both men and women are at risk. Some people think that women are not at risk for colorectal cancer; this isn’t true. Anyone may develop it.
• Medicare helps pay for colorectal cancer screening tests. People with Medicare Part B coverage who are age 50 or older are eligible for colorectal cancer screenings. In the case of colonoscopy, there is no age limit.

Diagnosing Colorectal Cancer
To help find the cause of any symptoms you might be experiencing, your doctor will perform a physical exam, evaluate your medical history and risk factors, and may order one or more of the following diagnostic tests.

• X-rays of the large intestine (such as the DCBE, described above), can reveal polyps or other changes.
• A sigmoidoscopy lets the doctor see inside the rectum and the lower colon and remove polyps or other abnormal tissue for examination under a microscope.
• A colonoscopy lets the doctor see inside the rectum and the entire colon and remove polyps or other abnormal tissue for examination under a microscope.
• A polypectomy is the removal of a polyp during a sigmoidoscopy or colonoscopy.
• A biopsy is the removal of a tissue sample for examination under a microscope by a pathologist to make a diagnosis.

Cancer Staging
Certain factors affect choice of treatment and prognosis. After colorectal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the colon or rectum or to other parts of the body; this process is called staging. The treatment choices and chance of recovery depend on the patient's general health and on the stage of the cancer.

Stage 0 (also called carcinoma in situ): Cancer is found only in the innermost lining of the colon or rectum.
Stage I: The cancer has spread beyond the innermost lining of the colon or rectum to the second and third layers and involves the inside wall, but it has not spread to the outer wall or outside the colon or rectum.
Stage II: The cancer has spread outside the colon or rectum 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 filter substances in a fluid called lymph and help fight infection and disease.
Stage III: Cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body.
Stage IV: The cancer has spread to other parts of the body, such as the liver or lungs.
Recurrent Cancer: The cancer has come back after it has been treated. Recurrent colorectal cancer may recur in the colon, rectum, or in other parts of the body.

Treatment Options
Treatment depends mainly on the size, location, and extent of the tumor, and on the patient's general health. Patients are often treated by a team of specialists, which may include a gastroenterologist, surgeon, medical oncologist and radiation oncologist. Several different types of treatment are used to treat colorectal cancer and sometimes the treatments are combined.

• Surgery to remove the tumor is the most common treatment for colorectal cancer. Generally, a surgeon removes the tumor along with part of the healthy colon or rectum and nearby lymph nodes. In most cases, the doctor is able to reconnect the healthy portions of the colon or rectum.
• Chemotherapy uses anticancer drugs to kill cancer cells. Chemotherapy may be given to destroy any cancerous cells that remain in the body after surgery, to control tumor growth, or to relieve symptoms of the disease. Most anticancer drugs are given by injection directly into a vein, although some are given in the form of a pill.
• Radiation therapy, or radiotherapy, uses high-energy x-rays to kill cancer cells. Doctors may use radiation therapy before surgery to shrink a tumor or after surgery to destroy any cancer cells that remain in the treated area. Radiation therapy is also used to relieve symptoms. The radiation may come from a machine or from an implant placed directly into or near the tumor.
• Biological therapy, or immunotherapy, uses the body's immune system to fight cancer. Biological therapies are used to repair, stimulate, or enhance the immune system's natural anticancer function. Biological therapy may be given after surgery, either alone or in combination with chemotherapy or radiation treatment. Most biological treatments are given by injection into a vein.
• Clinical trials (research studies) to evaluate new ways to treat cancer are an appropriate option for many patients with colorectal cancer. In some studies, all patients receive the new treatment. In others, doctors compare different therapies by giving the promising new treatment to one group of patients and the usual (standard) therapy to another group.

Choosing the most appropriate cancer treatment is a decision that should involve the patient, family and health care team. Research has led to real progress against this increasingly treatable disease, with a lower chance of death and an improved quality of life for the people who have it.

This article includes information from:
The National Cancer Institute. You can call the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237); or 1-800-332-8615 for deaf/hard of hearing callers.

The US Centers for Disease Control and Prevention.
Call the CDC's toll-free line at 1-888-842-6355 to order materials about colorectal cancer.

Medicare

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.