The Ins and Outs of ColoRectal Cancer

The Ins and Outs of ColoRectal Cancer By Kelly Hann Anatomy The Body’s Digestive System – Esophagus, Stomach, Small Intestine & Large Intestine 1st 6 feet = large bowel or colon Last 6 inches = rectum & anal canal The anal canal ends at the anus American Cancer Society Signs & Symptoms • Change in bowel habits • Blood in Stool – Bright red – Very dark red – Black/Tarry Stool • General abdominal discomfort – – – – Gas pains Bloating Fullness Cramps • Diarrhea • Constipation • Does your bowel feel like it emptied completely? • Weight loss w/ no explained reason • Constant tiredness • Vomiting (coffee grounds) Tests that examine… Rectum, Rectal Tissue, & Blood Aids in diagnosing & preventing colon cancer Physical Exam • General Medical History – – – – Includes self health habits Past self illnesses Various treatments used for previous issues Family health history • If patient reports problems with respect to signs and symptoms related to common bowel change habits… • Are symptoms affecting your everyday life? Fecal occult blood test • Check stool for evidence of blood • Method – Small samples of stool are placed on special cards and returned to the Dr. or Lab for testing under a microscope • Potential harms – False-positive & false negative results (uncommon…serious Digital Rectal Exam • The doctor or nurse inserts a lubricated, GLOVED finger into the rectum to feel for lumps or abnormal areas. Barium Enema • Barium is a liquid, that contains a silverwhite compound, inserted into the rectum • The barium coats the lower GI tract and a series of x-rays are taken of the lower GI tract • AKA = a lower GI series What does a Barium Enema do? • Detects – Ulcers – Narrowed areas (strictures) – Growth of the lining (polyps) – Small pouches in the wall of the intestine • Diverticula – Cancer – abnormalities How can one prepare for this test? • Colon must be completely empty – Prescribed laxatives or enema (pre-exam) • Special Diet to follow (2 days prior) – Clear liquids – Tea or coffee without milk or cream – Any juice without pulp (NO OJ or Tomato) – Broth – Carbonated beverages Types of Barium Enemas • Single Column – – – – – – – – Lie on side on Xray table Enema tube inserted into rectum Barium bag is delivered into colon May feel urge to have a bowel movement….DON’T Though, a small balloon will keep it inside you Take long deep breaths through mouth…helps relax May be asked to turn & rotate to evenly coat all colon Then the radiologist will take a number of X-ray images from various angles Air Contrast (Double contrast) • Similar to single-column • Big difference…Air is inflated with air in addition to the barium to expand and improve the quality of the images • Polyps can be seen easier, among other abnormalities Post Barium Enema instructions • You will be able to go to the restroom immediately following the procedure to expell the remaining barium • Over next few days your stool will be white, gray, or pink • Might be given a cleansing enema, laxatives, and told to drink a lot of liquids • The remaining barium can cause constipation. • Refer back to MD if you don’t return to normal in 3-4 days Results • Negative = no abnormalities are found • Positive = abnormalities found, such as polyps. • If positive you may be scheduled for further testing. Pros of Barium Enema • Pros – No sedation, complications are slight (perforation of colorectal wall) – If 50+ Medicare covers this every four years for colorectal cancer screening as an alternative to colonoscopy – If you are high risk, covered every two years, though colonoscopy is preferred Cons of Barium Enema • miss small polyps or sometimes even small cancers • Biopsy and polyp removal cannot be done during testing • you may need to follow up with a colonoscopy • Preparing for the procedure (emptying the colon) and the procedure itself can be unpleasant Sigmoidoscopy • Views the rectum and sigmoid colon areas for polyps, abnormalities, or cancer • A sigmoidoscope is a thin lighted tube is inserted into rectum & up through the sigmoid colon • May remove polyps or tissue samples for biopsy Procedure Detection • The cause of diarrhea, abdominal pain, or constipation • Detect early signs of cancer in descending (sigmoid) colon and rectum • can see bleeding, inflammation, abnormal growths, and ulcers • not sufficient to detect polyps or cancer in the ascending or transverse colon (twothirds of the colon). Preparation • Liquid diet • Most likely given an enema pre-procedure • Air is pumped into colon to help expand and see more surface area • Duration is 10-20 minutes Complications • Though very uncommon • It is likely that bleeding or a puncture of the colon could result during procedure Polyp………...Removal Colonoscopy • Procedure to look into entire length of large intestine (colon) to detect abnormalities • Preparation, procedure, & results same as sigmoidoscopy • New virtual colonoscopy as alternative procedure Virtual or (CT) Colonography • a series of x-rays called computed tomography to make a series of pictures of the colon • Computer then puts these pictures together to create a detailed image that shows polyps, etc. Prognosis (chances of recovery) • Depends on – Stage : in the inner lining of colon only, whole colon? Spread to other places in body – Has it blocked or created a hole in the colon? – Blood levels of carcinoembryonic antigen (CEA); a substance in the blood that may be increased when cancer is present, before treatment begins. – Has cancer recurred? – Patient’s general health? Treatment Options • • • • Surgery (main treatment) Radiation Therapy Chemotherapy Newer targeted therapies – Monoclonal antibodies • Depending on stage of cancer, it is likely that 2-3 types of treatment may be utilized at the same time or one after the other Surgery • Removal of cancer and normal area of colon on either side, as well as nearby lymph nodes • Then sewn back together • Colostomy (bag to catch the waste kept outside the body) • If cancer is found early, a colonscope can be used without cutting the abdomen Surgery for Rectal Cancer • Surgery is main treatment, along with a combination of radiation therapy • Polypectomy, local excision, and local transanal resection) can be done with instruments placed into the anus, • Stage I, II, & III rectal cancers, other types of surgery may be done • A low anterior resection is used for cancers near the upper part of the rectum, close to where it connects with the colon. • Abdominoperineal resection is done for cancers located close near the lower rectum-anal conjunction. After this surgery, a colostomy is needed • Pelvic Exenteration: – the surgeon removes the rectum as well as nearby organs such as the bladder, prostate, or uterus if the cancer has spread to these organs. A colostomy is needed after this operation. If the bladder is removed, a urostomy (opening to collect urine) is needed Radiation Therapy • high-energy rays (such as x-rays) to kill or shrink cancer cells • external radiation • internal or implant radiation; placed directly into tumor • Radiation can also be used to ease symptoms of advanced cancer such as intestinal blockage, bleeding, or pain • Main uses is for those where cancer had attached to an internal organ or the lining of the abdomen • can be aimed through the anus and reaches the rectum without passing through the skin of the abdomen Chemotherapy • use of anticancer drugs injected into a vein or given by mouth • treatment useful for cancers that have spread to distant organs • increase the survival rate for patients with some stages of colorectal cancer (will kill normal cells also) • Side effects depend on amount, length, & type of drugs given (i.e. diarrhea, nausea, vomiting, loss of appetite & hair, mouth sores, increased chance of infections, bruising & bleeding after minor cuts or injuries & overall increased fatigue Risk Factors • • • • • Age 50 or older Obesity (fat in waist area increases) 30%-40% of smokers diagnosed with cancer will die A family history of cancer of the colon or rectum. A personal history of cancer of the colon, rectum, ovary, endometrium, or breast. • A history of polyps or ulcerative colitis (ulcers in the lining of the large intestine) or Crohn’s disease. • Certain hereditary conditions, such as familial adenomatous polyposis and hereditary nonpolyposis colon cancer (HNPCC; Lynch Syndrome) • Heavy use of Alcohol has been linked to this cancer Dietary Risk Factors • eat plenty of fruits, vegetables, and whole grain foods • to limit high-fat foods (especially from animal sources) and limit excessive alcohol consumption • studies suggest that taking a daily multivitamin containing folic acid or folate can lower risk • Other studies suggest that getting more calcium with supplements or low-fat dairy products can help • Getting enough exercise is important as well 30 min of physical activity on 5+ days per week. Survival Rates • 9 of 10 people whose cancer is found & treated at early stage (before spreading) will live at least 5 years • Spread to nearby organs/lymph nodes= 5years – 66% survival rate • Spread to lungs/liver= 5 year – 9% • (5 yr is based on percentage of patients that were alive 5 yrs after diagnosis. Leaving out those who died of other causes) Closing Points • These numbers provide an overall picture, but keep in mind that every person’s situation is unique and the statistics can’t predict exactly what will happen in your case. • Don’t “strain” yourself…use more fiber in your diet (supplements work well when you can’t get it through your food intake ~ just drink lots of water & not within 1 hour of laying down) • Eat healthy food when on the run pack your lunch/snacks • Increase your Healthy lifestyle potential • Parents/Grandparents • Increase awareness that it is ok to get screened • Mark it on your to do list in 25-30 years as a birthday present to yourself and family. Dedicated to • FRANCIS HARRY COMPTON CRICK • • 1962 Nobel Laureate in Medicine • • • for their discoveries concerning the molecular structure of nuclear acids and its significance for information transfer in living material. Background Born: 1916 • • Died: 7/29/2004 Died Today of Colon Cancer (88 yrs old) Residence: Great Britain Affiliation: Institute of Molecular Biology, Cambridge