What is colorectal cancer?
usually refers to colon cancer, which is the most common neoplastic disease in developed countries. Specifically, it is the 2nd most common cause of cancer-related death worldwide and the 3rd most common type of cancer after breast and lung cancer. It appears to be more common in men than in women, and in recent years, it has been increasingly diagnosed in people under the age of 60. Colorectal cancer can be either primary or secondary, meaning it can either originate in the colon or spread from another part of the body (metastatic).
The good news is that, with prevention, early diagnosis, and the application of advanced therapeutic techniques, colorectal cancer can now be effectively prevented and treated, offering a very good prognosis for recovery and survival.
What do we need to know?
- Colorectal cancer seems to develop over a long period of time.
- There are groups of people who are at higher risk for developing the disease, such as those with a history of intestinal polyps or a family history of cancer in other parts of the body.
Causes of colorectal cancer
There is no clear cause for the development of colorectal cancer. However, there are risk factors that statistically increase the likelihood of developing the disease:
- Obesity
- Smoking
- An unbalanced diet with frequent consumption of red meat, processed foods, saturated fats, and very few dietary fibers
- Alcohol consumption
- Sedentary lifestyle and lack of exercise
- Age
- Chronic inflammatory bowel diseases
Symptoms
Colorectal cancer often develops without any symptoms. There are non-specific clinical signs that are common to other conditions, which is why they need to be evaluated by an experienced and specialized doctor without delay. These clinical signs include:
- Blood in the stool
- Changes in bowel habits
- Persistent abdominal pain with bloating
- A feeling of incomplete bowel movement
- Persistent constipation
- Secondary anemia
- Other gastrointestinal symptoms (nausea, vomiting, etc.)
In some cases, the cancer (tumor or mass) can block the intestinal lumen, a condition called intestinal obstruction that requires urgent surgical intervention.
Symptoms of intestinal obstruction include:
- Intermittent severe abdominal pain related to food intake
- Unintentional weight loss
- Continuous bloating, often accompanied by pain
- A feeling of general discomfort
As mentioned, it is important that these symptoms be evaluated by an experienced and specialized doctor, who will combine them with clinical examination and other diagnostic tests to make an accurate diagnosis. The diagnostic process may include:
- Blood tests
- Imaging tests (abdominal X-ray, barium meal, ultrasound, CT scan, etc.)
- Endoscopy of the digestive tract (colonoscopy, sigmoidoscopy)
The treatment of colorectal cancer is multifactorial and depends on the location and stage of the disease. The leading role is held by surgery, which may be combined with chemotherapy, radiation, or targeted therapies depending on the situation.
If the cancer is removed early, the treatment is considered effective, the disease stops, and it is very likely that it will not return. Unfortunately, complete treatment and healing are not always achievable, and sometimes there is a risk that the cancer may recur. Healing is nearly impossible in advanced stages where the tumor cannot be surgically removed. However, even in these cases, treatments exist that can slow the cancer’s progression, control symptoms, and ensure quality of life in the final stages of the disease.
Surgical treatment of colorectal cancer
The colon consists of four sections: the ascending, transverse, descending, and rectum. The location of the cancer determines the type of surgery required to remove the tumor (colectomy, low anterior resection, abdominal-perineal resection). In every case, a part of the colon is removed along with lymph nodes, which are sent for histopathological examination (biopsy). The continuity of the colon is restored by suturing the two segments together. This is done with modern surgical instruments known as staplers.
Stoma
In some cases, it may not be technically feasible to rejoin the two segments of the colon after surgery, so a colostomy is created, i.e., an opening is made in the abdominal wall for the bowel. A special bag is attached to the stoma to collect stool. The possibility of a stoma is discussed with the patient by the doctor. The colostomy may be temporary (and restored in a second surgical procedure) or permanent. The patient will receive full support and care for the necessary adjustments required by the stoma, along with training from experienced staff on how to care for and maintain it.
The surgery can be performed:
- Open
- Laparoscopic
- Robotic
The open and laparoscopic methods are considered equivalent in terms of effectiveness, and they have similar risk rates for complications. With the use of rapid recovery programs, even with open surgery, patients can return home on the third day after surgery without pain and with full activity. Dr. Alexiou and his team, with extensive experience in rapid recovery surgical programs, guarantee the outcome.
Discuss your options with your surgeon to determine which method is best for you.
Surgical Complications
Colorectal surgeries are classified as major surgeries, meaning they are of high severity. Therefore, there is a relative risk of complications, including:
- Bleeding
- Postoperative infection
- Deep vein thrombosis
- Circulatory or respiratory problems
All of these surgeries also carry the risk of specific complications related to the particular procedures. One risk is that the anastomosis (suturing of the two segments of the colon) may fail to heal properly, leading to leakage of intestinal contents into the abdomen. This can occur in the first few postoperative days.
Another potential risk concerns rectal cancer cases. The nerves that control urinary and sexual functions are located near the rectum, and in some difficult surgical cases, these nerves may be damaged.
Many people who have surgery to remove rectal cancer may need to go to the bathroom very frequently at first, but this usually returns to a normal pattern within a few months.
Occasionally, some patients—particularly men—may experience symptoms of anxiety due to unpleasant discomfort, such as pelvic pain and constipation. With appropriate support from the medical team, the patient is trained to manage these symptoms until the body adapts to the changes that occurred from the loss of part of the intestinal tract.
Radiation Therapy
Radiation therapy for the treatment of colorectal cancer is given in various ways:
Preoperatively, to shrink the tumor in the rectum and increase the chances of complete tumor removal
As an alternative to surgery, to stop the disease from spreading in cases where surgery is not possible
As palliative treatment to control symptoms and slow the progression of the disease in advanced stages of cancer
Preoperative radiation for rectal cancer can be given either externally or internally (brachytherapy).
Radiation therapy may cause some short-term side effects that resolve once the sessions are completed, as well as some long-term ones. If you are of reproductive age and plan to have children, it would be advisable to discuss the possibility of sperm or egg storage before starting radiation therapy.
Chemotherapy
Similarly, chemotherapy may be administered depending on the case:
- Preoperatively
- Postoperatively
- As palliative therapy
Chemotherapy usually involves a combination of medicines aimed at destroying cancer cells.
Targeted Therapies
These involve medications designed to target one or more biological processes that cancer uses to spread in the body.
Often, these therapies are combined with chemotherapy, particularly in metastatic cancer.
Side effects from targeted therapies include:
- Skin reactions
- Diarrhea
- Dry eyes
- Allergic reactions
