Colon And Rectum

Cancer of Colon and Rectum

Colon and rectum are part of large intestine and from terminal part of alimentary tract. Colorectal cancer (CRC) is common cancer worldwide. The age standardized rate for CRC in India is low at7.2 per 100,000 population in males and 5.1 per 100,000 population in women. However, in a country with a population of a billion plus people, the absolute number of patients suffering from CRC is large.

Signs and symptoms:

Colorectal cancer might not cause symptoms right away, but if it does, it may cause one or more of these symptoms:

  • A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days
  • A feeling that you need to have a bowel movement that's not relieved by having one
  • Rectal bleeding with bright red blood
  • Blood in the stool, which may make the stool look dark
  • Cramping or abdominal (belly) pain
  • Weakness and fatigue
  • Unintended weight loss
  • Colorectal cancers can often bleed into the digestive tract. Sometimes the blood can be seen in the stool or make it look darker, but often the stool looks normal. But over time, the blood loss can build up and can lead to low haemoglobin (anemia). Sometimes the first sign of colorectal cancer is a blood test showing a low red blood cell count.
  • Many of these symptoms can be caused by conditions other than colorectal cancer, such as infection, hemorrhoids, or irritable bowel syndrome. Still, if you have any of these problems, it’s important to see your doctor right away so the cause can be found and treated, if needed.

Tests to diagnose and stage colorectal cancer:
  • Medical history and physical examination
  • Tests to look for blood in your stool: Fecal occult blood test (FOBT) or fecal immunochemical test (FIT).
  • Blood tests: Complete blood count, liver function test and tumour marker (CEA).
  • Colonoscopy and biopsy
  • CT Scan of abdomen and thorax
  • MRI (in rectal cancer)
  • Endoscopic ultrasound

Treatment of colon cancer:
  • Surgery : depends on part of colon involved by cancer. It can be right hemicolectomy, extended right hemicolectomy, left hemicolectomy, extended left hemicolectomy, sigmoid colectomy depending on segment of colon involved.
  • Chemotherapy : In high risk tumours for recurrence postoperative chemotherapy if given.

Treatment of Rectal cancer:

Surgery : Type of surgical procedure performed for rectal cancer depends on how far tumour is from anal verge and whether external sphincters are involved or not. For upper third rectal cancer anterior resection and colorectal anastomosis is performed. For middle and lower third rectal cancer low anterior resection is done if sphincters are free and sufficient distal margin can be achieved.Tumour involving external sphincter and within 2 cm of anal verge usually require abdominoperineal resection and permanent colostomy. Continence can be preserved in selected cases of low rectal cancer by intersphincteric resection and coloanal anastomosis.

Radiotherapy : Radiotherapy is usually used in locally advanced tumours for better loco-regional control of cancer.

Chemotherapy : Chemotherapy is used in locally advanced tumours after surgical resection.

What after treatment of colorectal cancer?

After completing treatment for colorectal cancer you have to come for regular follow up at interval of 3 months for initial 3 years and then 6 monthly up to five years. Despite adequate treatment of colorectal cancer chances of recurrence exist. Purpose of follow up is to pick up recurrence at early stage so that adequate salvage treatment can be implemented timely.