Diagnosing Colorectal Cancer
To help find the cause of symptoms, the doctor evaluates a person's medical history. The doctor also performs a physical exam and may order one or more diagnostic tests.
X-rays of the large intestine, such as the DCBE, 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.
Stages of Colorectal Cancer
If the diagnosis is cancer, the doctor needs to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to what parts of the body. More tests may be performed to help determine the stage. Knowing the stage of the disease helps the doctor plan treatment. Listed below are descriptions of the various stages of colorectal cancer.
· Stage 0. The cancer is very early. It is found only in the innermost lining of the colon or rectum.
· Stage I. The cancer involves more of the inner wall of the colon or rectum.
· Stage II. The cancer has spread outside the colon or rectum to nearby tissue, but not to the lymph nodes. (Lymph nodes are small, bean-shaped structures that are part of the body's immune system.)
· Stage III. The cancer has spread to nearby lymph nodes, but not to other parts of the body.
· Stage IV. The cancer has spread to other parts of the body. Colorectal cancer tends to spread to the liver and/or lungs.
· Recurrent. Recurrent cancer means the cancer has come back after treatment. The disease may recur in the colon or rectum or in another part of the body.
Treatment
Treatment depends mainly on the size, location, and extent of the tumour, 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. Sometimes different treatments are combined.
Surgery to remove the tumour is the most common treatment for colorectal cancer. Generally, the surgeon removes the tumour 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. When the surgeon cannot reconnect the healthy portions, a temporary or permanent colostomy is necessary. Colostomy, a surgical opening (stoma) through the wall of the abdomen into the colon, provides a new path for waste material to leave the body. After a colostomy, the patient wears a special bag to collect body waste. Some patients need a temporary colostomy to allow the lower colon or rectum to heal after surgery. About 15 percent of
colorectal cancer patients require a permanent colostomy.
Chemotherapy is the use of anticancer drugs to kill cancer cells. Chemotherapy may be given to destroy any cancerous cells that may remain in the body after surgery, to control tumour growth, or to relieve symptoms of the disease. Chemotherapy is a systemic therapy, meaning that the drugs enter the bloodstream and travel through the body. Most anticancer drugs are given by injection directly into a vein (IV) or by means of a catheter, a thin tube that is placed into a large vein and remains there as long as it is needed. Some anticancer drugs are given in the form of a pill.
Radiation therapy, also called radiotherapy, involves the use of high-energy x-rays to kill cancer cells. Radiation therapy is a local therapy, meaning that it affects the cancer cells only in the treated area. Most often it is used in patients whose cancer is in the rectum. Doctors may use radiation therapy before surgery (to shrink a tumour so that it is easier to remove) 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 (external radiation) or from an implant (a small container of radioactive material) placed directly into or near the tumour (internal radiation). Some patients have both kinds of radiation therapy.
Biological therapy, also called immunotherapy, uses the body's immune system to fight cancer. The immune system finds cancer cells in the body and works to destroy them. 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 (IV).
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.
Making decisions about treatment
Sometimes it is difficult to make decisions about what is the right treatment for you. You may feel that everything is happening so fast that you do not have time to think things through. Some people find that waiting for test results and for treatment to begin is very difficult.
While some people feel they are overwhelmed with information, other may feel that they do not have enough. You need to make sure that you understand enough about your illness, the possible treatment and side effects to make your own decisions.
If you are offered a choice of treatments, you will need to weigh up the advantages and disadvantages of each treatment. If only one type of treatment is recommended, ask your doctor to explain why other treatment choices have not been advised.
Some people with more advanced cancer will always choose treatment, even if it only offers a small chance of cure. Others want to make sure that the benefits of treatment outweigh any side effects. Still others will choose the treatment they consider offers them the best quality of life. Some may choose not to have treatment but to have their symptoms managed as they arise in order to maintain the best possible quality of life.
Talking with doctors
You may want to see your doctor a few times before making a final decision on treatment. The first consultation when you are told you have cancer is usually stressful and you may not remember very much. It is often difficult to take everything in, and you may need to ask the same question more than once. You always have the right to find out what a suggested treatment means for you, and the right to accept or refuse it.
Before you see the doctor, it may help to write down your questions. There is a list of questions to ask your doctor at the end of this section, which may assist you. Taking notes during the session can also help. Many people like to have a family member or friend to go with them, to take part in the discussion, take notes, or simply listen. Some people find it is helpful to tape record the discussion.
Talking with others
Once you have discussed treatment options with your doctor, you may want to talk them over with family or friends, or your own religious or spiritual adviser. Talking it over can help to sort out what course of action is right for you.
A second opinion
You may want to ask for a second opinion from another specialist. This is understandable and can be a valuable part of your decision-making process. Your specialist or local doctor can refer you to another specialist and you can ask for you records to be sent to the second-opinion doctor. You can still ask or a second opinion even if you have already started treatment or still want to be treated by your first doctor.
Taking part in a clinical trial
You doctor may suggest that you consider taking part in a clinical trial.
Clinical trials are a vital part of the search to find better treatments for cancer. Doctors conduct clinical trials to test new or modified treatments and see if they are better than existing treatments. Many people all over the world have taken part in clinical trials that have resulted in improvements to cancer treatment. However the decision to take part in a clinical trial is always yours.
If your doctor asks you to take part in a clinical trial, make sure that you fully understand the reasons for the trial and what it means for you. Before deciding whether or not to join the trial, you may wish to ask your doctor:
What treatments are being tested and why?
What tests are involved?
What are the possible risks or side effects?
How long will the trial last?
Will I need to go into hospital for treatment?
What will I do if any problems occur while I am in the trial?
If you decide to join a randomised clinical trial, you will be given either the best existing treatment or a promising new treatment. You will be chosen at random to receive one treatment or the other, but it will always be the best treatment available.
If you do join a clinical trial, you have the right to withdraw at any time. Doing so will not jeopardise your treatment for cancer.
It is always your decision to take part in a clinical trial. If you do not want to take part, your doctor will discuss the best current treatment choices with you.
Side Effects
The side effects of cancer treatment depend on the type of treatment and may be different for each person. Most often the side effects are temporary. Doctors and nurses can explain the possible side effects of treatment. Patients should report severe side effects to their doctor. Doctors can suggest ways to help relieve symptoms that may occur during and after treatment.
Surgery causes short-term pain and tenderness in the area of the operation. Surgery for colorectal cancer may also cause temporary constipation or diarrhoea. Patients who have a colostomy may have irritation of the skin around the stoma. The doctor, nurse, or enterostomal therapist can teach the patient how to clean the area and prevent irritation and infection.
Chemotherapy affects normal as well as cancer cells. Side effects depend largely on the specific drugs and the dose (amount of drug given). Common side effects of chemotherapy include nausea and vomiting, hair loss, mouth sores, diarrhoea, and fatigue. Less often, serious side effects may occur, such as infection or bleeding.
Radiation therapy, like chemotherapy, affects normal as well as cancer cells. Side effects of radiation therapy depend mainly on the treatment dose and the part of the body that is treated. Common side effects of radiation therapy are fatigue, skin changes at the site where the treatment is given, loss of appetite, nausea, and diarrhoea. Sometimes, radiation therapy can cause bleeding through the rectum (bloody stools).
Biological therapy may cause side effects that vary with the specific type of treatment. Often, treatments cause flu-like symptoms, such as chills, fever, weakness, and nausea.
The Importance of Follow-up Care
Follow-up care after treatment for colorectal cancer is important. Regular checkups ensure that changes in health are noticed. If the cancer returns or a new cancer develops, it can be treated as soon as possible. Checkups may include a physical exam, a faecal occult blood test, a colonoscopy, chest x-rays, and lab tests. Between scheduled checkups, a person who has had colorectal cancer should report any health problems to the doctor as soon as they appear.
Diagnosing Colorectal Cancer
To help find the cause of symptoms, the doctor evaluates a person's medical history. The doctor also performs a physical exam and may order one or more diagnostic tests.
X-rays of the large intestine, such as the DCBE, 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.
Stages of Colorectal Cancer
If the diagnosis is cancer, the doctor needs to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to what parts of the body. More tests may be performed to help determine the stage. Knowing the stage of the disease helps the doctor plan treatment. Listed below are descriptions of the various stages of colorectal cancer.
· Stage 0. The cancer is very early. It is found only in the innermost lining of the colon or rectum.
· Stage I. The cancer involves more of the inner wall of the colon or rectum.
· Stage II. The cancer has spread outside the colon or rectum to nearby tissue, but not to the lymph nodes. (Lymph nodes are small, bean-shaped structures that are part of the body's immune system.)
· Stage III. The cancer has spread to nearby lymph nodes, but not to other parts of the body.
· Stage IV. The cancer has spread to other parts of the body. Colorectal cancer tends to spread to the liver and/or lungs.
· Recurrent. Recurrent cancer means the cancer has come back after treatment. The disease may recur in the colon or rectum or in another part of the body.
Treatment
Treatment depends mainly on the size, location, and extent of the tumour, 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. Sometimes different treatments are combined.
Surgery to remove the tumour is the most common treatment for colorectal cancer. Generally, the surgeon removes the tumour 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. When the surgeon cannot reconnect the healthy portions, a temporary or permanent colostomy is necessary. Colostomy, a surgical opening (stoma) through the wall of the abdomen into the colon, provides a new path for waste material to leave the body. After a colostomy, the patient wears a special bag to collect body waste. Some patients need a temporary colostomy to allow the lower colon or rectum to heal after surgery. About 15 percent of
colorectal cancer patients require a permanent colostomy.
Chemotherapy is the use of anticancer drugs to kill cancer cells. Chemotherapy may be given to destroy any cancerous cells that may remain in the body after surgery, to control tumour growth, or to relieve symptoms of the disease. Chemotherapy is a systemic therapy, meaning that the drugs enter the bloodstream and travel through the body. Most anticancer drugs are given by injection directly into a vein (IV) or by means of a catheter, a thin tube that is placed into a large vein and remains there as long as it is needed. Some anticancer drugs are given in the form of a pill.
Radiation therapy, also called radiotherapy, involves the use of high-energy x-rays to kill cancer cells. Radiation therapy is a local therapy, meaning that it affects the cancer cells only in the treated area. Most often it is used in patients whose cancer is in the rectum. Doctors may use radiation therapy before surgery (to shrink a tumour so that it is easier to remove) 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 (external radiation) or from an implant (a small container of radioactive material) placed directly into or near the tumour (internal radiation). Some patients have both kinds of radiation therapy.
Biological therapy, also called immunotherapy, uses the body's immune system to fight cancer. The immune system finds cancer cells in the body and works to destroy them. 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 (IV).
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.
Making decisions about treatment
Sometimes it is difficult to make decisions about what is the right treatment for you. You may feel that everything is happening so fast that you do not have time to think things through. Some people find that waiting for test results and for treatment to begin is very difficult.
While some people feel they are overwhelmed with information, other may feel that they do not have enough. You need to make sure that you understand enough about your illness, the possible treatment and side effects to make your own decisions.
If you are offered a choice of treatments, you will need to weigh up the advantages and disadvantages of each treatment. If only one type of treatment is recommended, ask your doctor to explain why other treatment choices have not been advised.
Some people with more advanced cancer will always choose treatment, even if it only offers a small chance of cure. Others want to make sure that the benefits of treatment outweigh any side effects. Still others will choose the treatment they consider offers them the best quality of life. Some may choose not to have treatment but to have their symptoms managed as they arise in order to maintain the best possible quality of life.
Talking with doctors
You may want to see your doctor a few times before making a final decision on treatment. The first consultation when you are told you have cancer is usually stressful and you may not remember very much. It is often difficult to take everything in, and you may need to ask the same question more than once. You always have the right to find out what a suggested treatment means for you, and the right to accept or refuse it.
Before you see the doctor, it may help to write down your questions. There is a list of questions to ask your doctor at the end of this section, which may assist you. Taking notes during the session can also help. Many people like to have a family member or friend to go with them, to take part in the discussion, take notes, or simply listen. Some people find it is helpful to tape record the discussion.
Talking with others
Once you have discussed treatment options with your doctor, you may want to talk them over with family or friends, or your own religious or spiritual adviser. Talking it over can help to sort out what course of action is right for you.
A second opinion
You may want to ask for a second opinion from another specialist. This is understandable and can be a valuable part of your decision-making process. Your specialist or local doctor can refer you to another specialist and you can ask for you records to be sent to the second-opinion doctor. You can still ask or a second opinion even if you have already started treatment or still want to be treated by your first doctor.
Taking part in a clinical trial
You doctor may suggest that you consider taking part in a clinical trial.
Clinical trials are a vital part of the search to find better treatments for cancer. Doctors conduct clinical trials to test new or modified treatments and see if they are better than existing treatments. Many people all over the world have taken part in clinical trials that have resulted in improvements to cancer treatment. However the decision to take part in a clinical trial is always yours.
If your doctor asks you to take part in a clinical trial, make sure that you fully understand the reasons for the trial and what it means for you. Before deciding whether or not to join the trial, you may wish to ask your doctor:
What treatments are being tested and why?
What tests are involved?
What are the possible risks or side effects?
How long will the trial last?
Will I need to go into hospital for treatment?
What will I do if any problems occur while I am in the trial?
If you decide to join a randomised clinical trial, you will be given either the best existing treatment or a promising new treatment. You will be chosen at random to receive one treatment or the other, but it will always be the best treatment available.
If you do join a clinical trial, you have the right to withdraw at any time. Doing so will not jeopardise your treatment for cancer.
It is always your decision to take part in a clinical trial. If you do not want to take part, your doctor will discuss the best current treatment choices with you.
Side Effects
The side effects of cancer treatment depend on the type of treatment and may be different for each person. Most often the side effects are temporary. Doctors and nurses can explain the possible side effects of treatment. Patients should report severe side effects to their doctor. Doctors can suggest ways to help relieve symptoms that may occur during and after treatment.
Surgery causes short-term pain and tenderness in the area of the operation. Surgery for colorectal cancer may also cause temporary constipation or diarrhoea. Patients who have a colostomy may have irritation of the skin around the stoma. The doctor, nurse, or enterostomal therapist can teach the patient how to clean the area and prevent irritation and infection.
Chemotherapy affects normal as well as cancer cells. Side effects depend largely on the specific drugs and the dose (amount of drug given). Common side effects of chemotherapy include nausea and vomiting, hair loss, mouth sores, diarrhoea, and fatigue. Less often, serious side effects may occur, such as infection or bleeding.
Radiation therapy, like chemotherapy, affects normal as well as cancer cells. Side effects of radiation therapy depend mainly on the treatment dose and the part of the body that is treated. Common side effects of radiation therapy are fatigue, skin changes at the site where the treatment is given, loss of appetite, nausea, and diarrhoea. Sometimes, radiation therapy can cause bleeding through the rectum (bloody stools).
Biological therapy may cause side effects that vary with the specific type of treatment. Often, treatments cause flu-like symptoms, such as chills, fever, weakness, and nausea.
The Importance of Follow-up Care
Follow-up care after treatment for colorectal cancer is important. Regular checkups ensure that changes in health are noticed. If the cancer returns or a new cancer develops, it can be treated as soon as possible. Checkups may include a physical exam, a faecal occult blood test, a colonoscopy, chest x-rays, and lab tests. Between scheduled checkups, a person who has had colorectal cancer should report any health problems to the doctor as soon as they appear.
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