Colorectal

What is Colorectal Cancer

The colon and rectum are parts of the body’s digestive system and together form a long, muscular tube called the large intestine. The colon is the first 6 feet of the large intestine and the rectum is the last 8-10 inches. Colorectal cancer starts in the colon or the rectum. These cancers can also be called colon cancer or rectal cancer, depending on where they start. Colon cancer and rectal cancer are often grouped together because they have many features in common.

Colorectal Cancer Signs and Symptoms

Colorectal cancer does not always cause symptoms right away, and many signs and symptoms are shared with common conditions like hemorrhoids or irritable bowel syndrome. When cancer is suspected, symptoms have usually begun recently, are severe and long lasting, and change over time. Knowing what to look for can help catch colorectal cancers at an early stage when they are most treatable.

People with colorectal cancer may experience:

• A change in bowel habits, including diarrhea or constipation that lasts for more than a few days
• Stools that contain bright red or dark blood, or that look narrower than usual
• Abdominal pain or discomfort, such as frequent gas, bloating, fullness, or cramps
• Unexplained weight loss
• Fatigue
• Unexplained iron-deficiency

When Should I See a Doctor?

While these symptoms do not always indicate cancer, you should speak with your physician if your symptoms last for weeks, become more severe, or you experience any changes you are concerned about. The American Cancer Society recommends regular colon screening for people with an average cancer risk starting at the age of 45, but colorectal cancer can occur in younger people, or between screenings. Your doctor can determine whether you should have a colonoscopy or any other tests to determine the cause of the problem. If cancer is diagnosed, managing symptoms will be an important part of your cancer care treatment. Speak with your health care team about any symptoms you experience, including new symptoms and any change in symptoms.

Colorectal Cancer Staging

After you are diagnosed with colorectal cancer, your physician’s next step will be to look at the extent of the cancer and whether it has spread to other parts of the body. This process is called staging, and it will help your cancer care team determine how best to treat your cancer. Each cancer is unique, but cancers in the same stage share similar outlooks and approaches to treatment.

How is Colorectal Cancer Stage Determined?

Colorectal cancer is divided into numbered and lettered stages that begin at stage 0 and range through stage IV. Stages generally indicate how much the cancer has grown—lower numbered stages are early cancers with little growth, while higher numbers indicate more growth. The American Joint Committee on Cancer (AJCC) has developed a formal system to describe the growth and spread of cancer cells, based on three pieces of information:

• The size and location of the main tumor
• The spread to lymph nodes, which are small immune system organs found throughout the body
• The spread to other parts of the body, called metastasis

What are the Stages of Colorectal Cancer?

• Stage 0: This is the earliest stage of colorectal cancer. Cancer in this stage has not grown beyond the inner layer of the colon or rectum.
• Stage I: Cancers at this stage have grown into other layers of the colon or rectum but have not spread to nearby lymph nodes or to other parts of the body.
• Stage II: Cancers at this stage have grown into outer layers of the colon or rectum. They may have grown through the wall of the colon or rectum and into nearby tissues or organs. They have not spread into lymph nodes or more distant parts of the body.
• Stage III: Cancer has spread to lymph nodes or areas of fat near the lymph nodes. It may have spread to nearby tissues or organs. It has not spread to more distant parts of the body.
• Stage IV: Cancers at this stage have spread to distant lymph nodes, organs, or other parts of the body.

Colorectal Cancer Treatment

If you’ve been recently diagnosed with colorectal cancers, you may be feeling overwhelmed as you begin to explore treatment options. At Maryland Oncology Hematology, our multidisciplinary team of experts will work with you to design a treatment plan that best fits your cancer and your goals.

Who Will Treat My Colorectal Cancer?

Cancer care usually combines different types of treatments. Multidisciplinary cancer care teams can include different types of doctors who work together to form a patient’s overall treatment plan. For colorectal cancer, this may include:

• A surgical oncologist who specializes in using surgery to treat cancer or a colorectal surgeon who uses surgery to treat colon and rectal diseases
• A radiation oncologist who treats cancer with radiation therapy
• A medical oncologist who treats cancer with chemotherapy, immunotherapy, or targeted therapies
• A gastroenterologist who treats disorders of the gastrointestinal tract Your cancer care team may also include other clinical professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, and dietitians.

How is Colorectal Cancer Treated?

Treatment options for colorectal cancer depend on the type and stage of cancer, as well as the patient’s preferences and overall health. Your cancer care team at Maryland Oncology Hematology will work with you to choose a treatment plan that fits your goals for your care.

Surgery

Surgical removal of the tumor and some surrounding tissue is the most common treatment for colorectal cancer. It can be used as the primary treatment for your cancer or given in conjunction with chemotherapy, radiation therapy, or other treatments. Your surgical oncologist or colorectal surgeon will determine the appropriate type of surgery for you based on location and size of your cancer. Your surgeon may remove the cancer with one of the following types of surgery:

• Local excision: Early-stage cancers may be removed without cutting through the abdominal wall. Your surgeon may cut the cancer out by inserting a tube with a cutting tool through the rectum into the colon.
• Resection: Your surgeon may remove both the cancer and a small amount of healthy tissue around it, then connect the healthy parts of the colon together; this procedure is called anastomosis. If the surgeon is not able to connect the healthy parts of the colon, an opening, called a stoma, is made outside of the body for waste to pass through. A bag is placed around the stoma to collect the waste. This procedure is called a colostomy, and it can sometimes be reversed after the lower colon has healed. If the lower colon is entirely removed, the colostomy may be permanent.

Ablation

If the colorectal cancer has spread to other parts of the body, such as the liver or lungs, small tumors may be removed using ablation techniques.

• Radiofrequency ablation uses tiny electrodes to treat cancer cells. A special probe is inserted into the affected area either directly through the skin or through an incision in the abdomen.
• Microwave ablation treats cancer that has spread to the liver with electromagnetic microwaves. A needle-like probe is inserted into the tumor using imaging as a guide.
• Ethanol ablation injects concentrated alcohol directly into the tumor through a needle i1njected into the skin and guided by ultrasound or CT scans.
• Cryosurgery, also known as cryotherapy or cryoablation, treats the tumor by freezing it with very cold gas inserted by a probe. The probe is guided by ultrasound. This can be used to treat larger tumors than other ablation techniques.

Chemotherapy

Chemotherapy uses drugs to stop the growth of cancer cells and can be taken either by mouth or by injection. Chemotherapy can be used after surgery to treat any remaining cancer cells, before surgery to shrink the tumor so it is easier to remove, or to treat cancer that has spread to other organs.

Radiation Therapy

Radiation therapy uses high energy x-rays or other forms of radiation to treat cancer cells and stop their growth. External radiation therapy uses a machine to focus radiation onto the area of the body with cancer from outside of the body. Internal radiation therapy places the radiation directly into or near the tumor.

Radiation therapy is not commonly used for colon cancer but may be used before surgery to help shrink the tumor for easier removal, during or after surgery to treat any remaining cancer cells, in conjunction with chemotherapy to help control the cancer, and to ease symptoms of advanced colon cancer.

Radiation therapy is more commonly used for rectal cancer. It may be used before, after, or during surgery to treat additional cancer cells, or along with chemotherapy to keep cancer from returning. It may also be used either alone or with chemotherapy if you are not healthy enough for surgery, or to relieve symptoms. It can also be used to treat tumors that have spread to other parts of the body.

Targeted Therapy

Targeted therapies use drugs or other substances to identify and then treat specific cancer cells. These therapies may be used along with chemotherapy or if chemotherapy is no longer working. Many targeted therapies for colorectal cancer work by targeting and inhibiting proteins that help cancer cells grow.

Immunotherapy

Immunotherapy uses the patient’s immune system to fight cancer cells by boosting, directing, or restoring the body’s natural defenses. The body’s immune cells have proteins that serve as “checkpoints” that need to be turned on or off to start an immune response; this is how the body keeps itself from attacking healthy cells. Some colorectal cancer cells use these checkpoints to avoid being attacked by the immune system. Drugs targeting these proteins help restore the immune response against those cancer cells.