COLON CANCER TREATMENT PATIENT GUIDE
Today, colon cancer is the second most common cancer type in women and the third most common cancer type in men. As with most cancer types, early diagnosis saves lives, and with the screening methods it is possible to prevent the disease even before its development. Based on the fact that 90% of all colon cancers develop from a polyp in the intestine, colon cancer can be prevented before developing with procedures such as colonoscopic and endoscopic polyp removal. The only recovery method in the treatment of colon cancer is surgery. In early stage disease, the chance of complete recovery with a successful surgery is 90%. The principle of surgical treatment in colon cancer is to remove the cancerous bowel segment and the lymph nodes of that segment. However, if the cancer is spread to adjacent organs, all cancerous tissues must be removed and intestinal continuity must be provided in order for a successful surgery.
There are different surgeries applied to intestine cancer and they are decided based on Which type of operation is most suitable for you;
Where is your cancer is located at;
Type and size of the cancer;
Whether the cancer has spread other locations or not.
Some cancers are less aggressive and they may be present only at the beginning of the polyp. Such cancer types, which do not spread to lymphatic system, blood vessels or nervous system, can be removed just by local excision. In order to protect the patient from unnecessary and large scale surgery, such cancers can be removed by colonoscopy. Colonoscopy is the visual examination of the whole inner surface of the large bowel by inserting and advancing a long and flexible tube with a light source and a video camera on its tip into the rectum from the anus and small cancers detected along the way can be removed simultaneously (local excision). Removed tissue is sent to the pathology laboratory for evaluation. Specialist pathology doctors examine the cells under microscope. If the defect detected in the cells is identified as high degree or cancer cells continue at the back, your surgeon, with a second operation, will remove a larger intestine part which has the potential to contain cancer cells. When performed with a suitable method, local excision is a safe and effective procedure.
In the presence of large bowel cancer, the part of the colon that contains the tumor can be removed with a surgical procedure called colectomy. Length of the colon to be removed is decided based on the localization of the tumor and its size. After the cancerous part of your intestine is removed, both ends of the intestine are connected back with sutures or staplers. This ligation procedure is called anastomosis. All lymph nodes in the cancerous region that the disease may spread to are also included in the removed tissue. Colectomy operation can be performed with open or closed (laparoscopic) surgery methods. Duration of colectomy operation may vary between 2 to 5 hours and you have to stay at the hospital for some time (generally 5-7 days) for recovery.
Removal of the left part of the colon is called left hemicolectomy.
Removal of the right part of the colon is called right hemicolectomy.
Removal of the sigmoid, the last portion of the colon, is called sigmoid colectomy.
Depending on the localization and extent of the tumor, majority of the colon (subtotal colectomy) or entire colon (total colectomy) may be removed. In such cases, intestine continuity can be maintained with an anastomosis between the tip of the small intestine and sigmoid colon or rectum.
OPEN AND LAPAROSCOPIC METHOD IN COLON CANCER
Open Surgery; This method means that your operation will be performed through a large incision on your abdominal region. After opening the abdominal cavity with an incision, surgeon removes the cancerous region of the intestine and lymph nodes within the surrounding tissues. Then intestinal continuity is maintained by connecting the two ends of the cut intestine.
Laparoscopic Surgery; In this method, operation is performed by inserting special surgical tools and a video camera with a light source on its tip into the abdominal region through several small incisions. After the procedure is completed, cancerous tissue is removed from the abdominal region from a small incision. Results obtained by laparoscopic surgery in colon cancer are almost equal to the open surgery results. Less post-op pain, reduced hospitalization duration and fast recovery period are some of the advantages of this method.
Laparoscopic technique is considered as the golden standard in surgical treatment of colon cancer. However, open surgery method may be preferred for patients with advanced stage cancer who need multiple organ removal.
WHY LYMPH NODE DISSECTION IS IMPORTANT IN COLON CANCER?
During colon resection, lymph nodes in that region are also required to be removed and this procedure is called lymph node dissection or lymphadenectomy. In order for the procedure to be considered as adequate, at least 12 of the lymph nodes in that region must be removed and examined in pathology laboratory even though they appear healthy. There are two main purposes of lymph node removal. In the primary purpose, stage of the cancer is determined by examining if the disease has spread to lymph nodes and suitable medication treatment for that stage is planned. Secondary purpose is to remove lymph nodes where cancer has spread and reduce the relapse risk.
CAN METASTASES BE TREATED IN COLON CANCER?
In approximately 10-20% of patients diagnosed with colorectal cancer, tumor has spread to other parts of the body at the time of first diagnosis. Colon cancer most frequently spreads to liver, however, lungs, kidneys, and the pelvic region containing duodena, pancreas and bladder are other metastasis regions. Having tumor metastasis at the time of diagnosis does not mean that the patient has no chance of treatment. Metastases are defined as the spread of cancer to distant tissues and organs and surgical removal of these is called metastasectomy. However, not all metastases are suitable for this procedure. Patients are evaluated based on the number of organ metastases and their locations, and decision is made accordingly. In tumors with multiple metastases (e.g. liver and lung metastases), first line treatment is generally systemic chemotherapy. In case of a single organ metastasis or if the cancer relapses in the region where the cancer had originated in the first place, patients are evaluated as candidates for surgical treatment.
TREATMENT OF LIVER METASTASES IN COLON CANCER
In the presence of liver metastases of colon cancer, treatment vary depending on the number of these tumors in the liver, their locations and sizes.
If there is a widespread metastasis in both lobes of the liver, the most frequent primary treatment is chemotherapy. The purpose is to reduce the cancerous tissue and keep it under control for as long as possible.
In some cases, the parts of the liver with metastases are suitable for surgical removal by metastasectomy or liver resection methods. This procedure may be a complete treatment for the patient. This operation can be performed simultaneously with the colon cancer surgery or separately.
In cases where metastasis cannot be reduced to a surgically removable size despite systemic chemotherapy administration or if they have locations that do not enable surgical removal, local treatment options must be evaluated as alternatives. Radiofrequency ablation that destroys cancerous cells with high temperature, cryotherapy that destroys excessive cold, and chemotherapy and radiotherapy application directly into the vessels going to the liver are among these alternative treatments.
A healthy individual can live a healthy life by having %75 of the liver removed. Therefore, provided that there are no liver tumors left behind, disease can be treated and survival can be extended with large scale liver resections in liver metastases of the colon cancer.
In the presence of certain condition in colon cancer that spread to the lungs, removal of the metastasis in the lung can provide important benefits to the patients like in the liver.
WHAT IS PALLIATIVE SURGERY IN COLON CANCER?
Palliative surgery is a treatment method that aims to eliminate or reduce the complaints of the disease such as pain, instead of treating the disease. The purpose is to increase the comfort of the patient. In an advanced stage colon cancer, palliative surgery may be decided in order to remove bleeding, obstruction or other cancer-related complaints. Removal of the intestine segment containing the tumor or forming a poach to extract stool are examples of palliative treatment.
BOWEL OBSTRUCTION IN COLON CANCER
Sometimes cancer causes a significant narrowing that leads to obstruction or difficult passage in the intestines. Patients complain from abdominal pain, nausea and vomiting. If such condition develops, need for an emergency operation occurs. Placement of a tube called stent into the region with the tumor can be preferred in order to relieve the obstruction. This way patients are relieved and then operated under suitable conditions. Another option is to perform emergency surgery.