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DNB (Surgical gastroenterology, MS( General Surgery), MBBS, Fellowship in Minimal Access Surgery, Diploma in Minimal Access Surgery, Fellow of International College of Robotic Surgeons
Surgical Gastroenterologist, Delhi
The most common indicators of colorectal cancers are sudden change in bowel habits, blood in stools, anorexia, significant loss of weight ( > 10 kg in 6 months or > 5 kg in one month) without making an effort to do so, significant loosening of clothes, abdominal pain, family history of colorectal cancer, pre-existing inflammatory bowel disease, tenesmus( feeling of "need to defecate" without actually passing stools) etc. If you have any of these symptoms or condition you should consult a gastrointestinal surgeon. The medical community often suggests generally healthy people undergo the tests for colorectal cancer. An early detection helps to counter the condition better. An early screening also increases the odds of survival. While people with no family history of cancer should ideally undergo this tests at the age of 50, people with a greater risk of cancer should undertake the tests at 45 or before. Depending on the stage of cancer, the treatment plan is designed by the doctor.
Diagnosis of colorectal cancer in the early stages
Colonoscopy: This is a test that uses a long and slender tube that is inserted into the body through the rectum. It helps to have a clear view of the rectum and colon, through a video camera that is attached to the tube. A doctor might pass surgical tool to take a sample tissue so that it can be tested for cancer.
CT scan: A contrast-enhanced CT scan is used to accurately stage colorectal cancer. Staging is important with regard to decide on the modality of treatment and determine the prognosis. MRI Pelvis: In cases of the rectum, MRI of the pelvis is recommended to accurately stage the disease.
PET-CT Scan: Its used to rule out a distant spread of tumor beyond the large intestine eg into the lung and liver. If the Distant spread is present then treatment modality is different and the prognosis is worse. Blood tests: Serum CEA levels may be elevated in colorectal cancer but not in all cases.
Serum CEA may be monitored after curative surgery to look for recurrence of cancer. Other blood tests may be required to assess the general condition of the patient with regard to pre-anaesthetic checkup.
Stages of colon cancer:
Stage 1: In this stage, cancer grows through the superficial lining of the rectum or the colon.
Stage 2: This is the stage where cancer grows through the wall of the colon and the rectum.
Stage 3: In this stage, the cancer cells grows through the lymph nodes.
Stage 4: This is the worst form of colorectal cancer, where cancer spreads to other organs.
These stages of cancer are progressive stages on a continuum that means early diagnosis may catch cancer at an earlier stage and hence there are higher chances of cure and better prognosis. Later stages have lower chances of cure and poorer prognosis. Screening programs help us to catch colorectal cancer at an earlier stage. In India, due to lack of robust screening programs, colorectal cancer usually are a little more advanced as compared to Western countries and the Far East.
Treatment options for colorectal cancer
Early stage surgery to treat colorectal cancer:
Colonoscopy: This is a small medical procedure where the doctor removes the cancer cell or the polyp with a colonoscopy.
Mucosal resection: An endoscopic mucosal resection is a procedure that involves taking out polyps along with the lining of the rectum and the colon. Colonoscopic removal of polyp and Mucosal resection is usually only possible in very early cancers caught on screening colonoscopies which is usually not the scenario in India. Patient present for a colonoscopy only when symptomatic by which time these treatment options are not usually recommended.
Minimally invasive surgery: This is a procedure where the surgeon performs numerous incisions in the abdominal wall. Instruments are inserted along with cameras to view and do the surgery.
For invasive colorectal cancer:
Surgery for invasive colorectal cancer include Right hemicolectomy ( open or laparoscopic ), Left Hemicolectomy ( open or laparoscopic), Low anterior resection ( OPen or laparoscopic ) with total mesorectal excision, Total colectomy ( Open or Lap) and their variations. The affected bowel is resected along with adequate proximal and distal margin and all surrounding lymph node tissue to ensure adequate clearance of tumor mass. The surgeon may choose to restore the bowel continuity or perform an ostomy depending on multiple other factors and which is usually reversible later.
For advanced colorectal cancer:
In case of an advanced stage colorectal cancer, a surgeon might perform a procedure to remove the blockage from the rectum or the colon to relieve the symptoms. Chemotherapy is deployed after the procedure to destroy the cancer cells. Depending on the stage of cancer, a doctor might also suggest a radiation therapy to shrink the area of the cancer cells, so the procedure has better chances of becoming successful. Other methods such as targeted drug therapy and immunotherapy are also employed to keep the cancer growth under control.
For all stages of cancer surgical resection of all tumor mass provides the best chance of sure regardless of their response to chemo or radiotherapy. Hence it is essential that adequate removal of tumor mass with surrounding tissue is done in competent hands to ensure the best outcome.