Information on Cancer, published by the United States National Cancer Institute “What You Need To Know About Cancer of the Colon and Rectum” based on the pamphlet Marmara University Oncology Specialist Professor Dr. It was compiled with contributions Serdar Turhal.
What Do We Know About the Large Intestine Cancer?
More than 150,000 people each year in the United States learn that colon cancer. Although there is no record of cancer in Turkey is a very healthy proportionally We estimate that about 30,000 people caught in colorectal cancer. Marmara University Faculty of Medicine, Oncology as we aim to give you information that may be important in this regard. This information signs of colon cancer, diagnosis, treatment and causes of these diseases include and how it can be prevented.
Colon and Rectum
Colon and rectum of the digestive system, “colon” is a portion called. The upper part of the large intestine of about 150-180 cm “column”, and the bottom 15-17 cm “rectum” is called.
Food comes from the large intestine after the stomach and digested in the small intestine. Here which is absorbed in the upper part of the digestive system in the body water content of the intestine sucked back ‘stool’ remains called solid part. Gaite is then excreted from the body through the anus by moving along the colon and rectum.
What is cancer?
Cancer is uncontrolled cell in the body multiply excessively, are scattering to various parts of the body. There are over 100 different types of cancer.
colon and rectum, as with all other organs in the body is composed of various types of cells. Normally, when cells proliferate but organisms that need them. In this case there is the development of the organism in a specific order, and thus remain healthy.
Although it is not necessary to dividing cells, a tissue mass that occurs in the region will increase. Extra composed this mass’ tumor (neoplasm) is called. These masses are benign (benign) or malignant (malignant) may be.
Benign (benign) tumors are not cancer. They do not spread to adjacent tissues and other organs. Benign tumors generally can be removed from the body. Rarely can be harmful.
Polyp, a benign tumor. It may occur in the colon or rectum wall. These polyps in the colon and rectum should be removed because of cancer turn into future possibilities. If a person polyps, a new polyps are more likely to occur. Therefore, these people should be treated as regular checks.
Malignant (malignant) tumors are called cancer. These tumors to adjacent tissues and organs romp, which can damage them. Cancer cells can break off from the cancerous tissue can enter the bloodstream or lymphatic vessels. The spread of cancer and the formation of tumors in other parts of the body will in this way. splash and spread of cancer “metastasis” is called.
Tumors can occur in any part of the colon and rectum. Cancer cells usually out of the colon and rectum lymph (lymph) are spread through. Colon and rectum cancers of the liver, lungs, brain, kidneys, and can spread to the bladder.
When cancer spreads to another area of the body, of the type that form a tumor in places where they spread in the region and referred to by the same name. For example bowel cancers, when spread to the liver from colorectal cancer and liver tumors formed in the cell. In this case “metastatic colorectal cancer” or “colorectal cancer that has metastasized to the liver” is called. “Liver cancer” is not called.
Cancer can be recognized sooner and treated so well received results. This is especially important for colorectal cancers. If treatment is taken from the best result from the spread of the disease it is made. people by fulfilling the following suggestions may provide early detection of colorectal cancer.
during regular check-ups, “You want rectal examination” implementation. This makes the finger rectal examination, examination by a doctor wearing gloves plowed gel to provide lubricity and detect abnormalities in the rectum.
once a year from the age of 50 “hidden blood in the stool” Have the test. This test allows us to detect hidden blood in the stool can be found. The doctor placed a plastic container with a small amount of stool can be done in an office or laboratory. This test helps us to determine the amount of bleeding caused by colorectal cancer, we can not see. Besides other reasons that can cause this kind of bleeding as well. A positive test does not indicate that this is always cancer.
every 3-5 years from the age of 50 “sigmoidoscopy” make the examination. This examination of the rectum with the aid of a lighted tube pipe is seen entering the lower part of the rectum and colon. Polyps in this part of the intestine through this lighted tube, visible tumors and other abnormalities.
Colon and the recommendation of the doctor about the risk of rectal cancer than people who have these tests may need to make some additional tests or taking more frequent.
Colorectal cancer can show a variety of symptoms. In case of occurrence of the following symptoms should be suspected colorectal cancer.
change in bowel habits,
Have diarrhea or constipation,
as a black discoloration of infected blood in the stool or feces tar,
diameter thinning of the stool,
General gastrointestinal symptoms (gas, bloating, pain or cramps)
Frequent gas pains,
not look like you did not completely empty stool at the end of the intestine,
Unknown cause weight loss,
These symptoms ulcer, intestinal inflammation, may also be other reasons, such as hemorrhoids. Your doctor will decide which specifies the reason. you should contact your doctor immediately if any of these symptoms. Your doctor may send you to another doctor specializing in this subject because these symptoms (such as gastroenterologists).
Your doctor to find the cause of the above findings will be asked a series of questions about you and your family will make a detailed examination and some tests will be like. In addition to the previously mentioned tests, your doctor may ask the following additional tests.
Displaying the intestinal tract: withdrawal transaction is after administration of X-rays by means of a solution containing the patient’s rectum barium (barium enema). The doctor can check whether barium colon and rectum allows the tumor or other abnormality recognition. Sometimes the doctor may need to expand in order to see a small bowel tumor. Therefore, air may be introduced into the intestine through the test carefully. This process “double-contrast barium film” is called.
Colonoscopy: Yet to examine the entire colon using a lighted tube. This process is the same as the flexible sigmoidoscopy but this time a luminous tube is longer.
If your doctor detects a polyp or abnormal growth can help it sigmoidoscopy or colonoscopy. Taken by sending this part of the pathology that allows the doctor to examine the part of the investigation of the cancer cell. The name of this process “taking biopsy” is. Most of the benign polyps (benign) d. But the only way to determine this is to take a biopsy. If the pathologist (pathologist) If cancer is detected, the patient’s doctor to stage this cancer, the size and want to know the extent. The staging process, cancer that has spread to other tissues and other organs help the doctor about the affect. How will the decision of the treatment is given based on these findings.
Staging of colorectal cancer is mostly due to the spread of X-rays lungs and liver, and is made by ultrasonography and computed tomography scanning of these organs. Your doctor may require additional blood tests to determine the liver function, as well as CEA (carcinoma embryogenic antigen) test may be requested. This test particularly where the spread of disease, colorectal cancer can be found in greater quantities in normal human blood.
The doctor will make the necessary treatment plan for each patient. Treatment of diseases of the colorectal tumor size, the settlement stage is dependent on the patient’s general state of health and other factors.
Most want to learn all the information about the disease and treatment options for cancer patients. They are doctors who can give you the best answers to their questions. when speaking about treatment options to patients and physicians about the disease studies (research) may want information about. These studies “clinical trials (clinical trials)” and the so-called cancer treatments are carried out for the better can be done.
before it appears in the patient doctor in case of preparing a list of questions they would ask him to help them. Patients can take notes, you can record spoken with their doctor says. Some patients visit the doctor to help them on their side in the presence of a friend or family member of one of the thinkers.
Some questions may want to ask the doctor before starting treatment, patients are:
What is the stage of the disease?
What are my treatment choices? Which do you recommend for me? Why?
Is there a clinical trial that would be appropriate for me?
What are the benefits we expect from each treatment?
What are the risks and possible side effects of each treatment?
What can be done about side effects?
I can do myself during treatment What kind of measures?
What will be the likely cost of treatment?
Naturally with information on the effectiveness of the treatment the patient or a relative may want to be. Sometimes they may want statistical information about how the patient remained completely healed or healing to life. It should be noted that these values are mean values obtained from large groups of patients. Using precise data about the prognosis of a particular person would not be appropriate. Because no two cancer patients are the same, even to each other. questions about the recovery and survival of people ask the doctor. But doctors may not know all the time what to expect. Doctors talking about the progress of the cancer, “completely pass the disease (cure)” instead of the term “recovery or controlling disease (remission)” The use of the term would be appropriate. Therefore, although the majority of patients fully heal doctors coming back because of the possibility of disease, “remission”, they use the term.
Cancer and its treatment has a lot to learn about. Patients may not understand all of them at once. Explanation of what they do not understand or to learn more should not hesitate to ask different questions.
Colon cancer is often surgery, chemotherapy and / or radiation (light) is treated with treatment. related to new treatment approaches such as biological therapy are underway. This treatment may require one or some combination of the shape for a patient.
Surgery is the most common form of therapy for colorectal cancer. type of operation varies depending on the location and size of disease. Most patients receiving a portion of the intestine (partial colectomy) is administered as a method. In this operation, a surgeon with cancerous part of the colon to remove a small amount of healthy tissue around it. Surgery is often the only treatment necessary in the early stage is a form of cancer.
Usually remove lymph nodes around the tumor helps in the stage of the cancer. Pathology experts have found out that the infection by examining them under a microscope for cancer, these lymph nodes. If the cancer has spread to the lymph nodes to other parts of the body it is likely to be spattered and this will require further treatment.
Most surgeons cases, after removal of tumors of the colon, they connect parts of the firm. This part of the surgical practice “anastomosis” is called. If the surgeon can not connect another solid portion of the large intestine “colostomy” by applying a process called, that helps out a hole in the abdominal wall of the large intestine contents by opening the bowels ties here. Patients wearing a bag of feces to accumulate in these holes allows the bag. Colostomy may be temporary or permanent.
Temporary colostomy; more of the following intestinal surgery after temporarily used for healing. Then connect a second operation the surgeon solid parts of the intestine and closes the stoma. The patients’ bowel function returns to normal.
Permanent colostomy; In rectal cancer it may be necessary. Cancer of the colon may need a permanent colostomy for patients in a small number lower. for approximately 15% of patients need a permanent colostomy.
Despite the colostomy take time to adapt to the majority of patients can return to normal life. A nurse or colostomy colostomy care to patients in the care of an experienced specialist and teaches ways to continue normal activities.
Some questions to ask before surgery, the patient’s doctor may ask:
What kind of surgery will be?
What will happen then? Will I have pain? How will you help me?
Will you need colostomy? is temporary, will be permanent?
How long will I in the hospital?
My special diet (diet I do) that? Who will give me your diet?
When I returned to my regular job?
Will I need additional treatment?
Chemotherapy is the use of drugs to kill cancer cells. after administration of chemotherapy, surgery is sometimes given to prevent the spread of the disease. This additional treatment “adjuvant chemotherapy” is called. Chemotherapy is given to prevent the formation of new tumor or tumor to be completely removed in order to eliminate their complaint form. The doctor may use one drug or several drugs together.
Chemotherapy alone gives nurses with special training in this regard. The number of cycles of chemotherapy administration, it stated (1 cure, such as 2 cycles) and usually a repeated the same drugs are given 21 or 28 days. Chemotherapy is usually given in an outpatient centers in the form of intravenous fluids or oral pills. Sometimes the disorder in the patient’s general, according to the medication or dosage forms of drugs in the treatment of hospitalized patients may need to take to the hospital. After each cycle, patients are checked in the medical oncology clinic. These controls, patients are examined, listened to complaints, questioned the side effects of the drug and asked some blood tests to investigate whether damage to other organs in the body. Each pre-curing of the blood count done and must be presented to the competent nurse giving chemotherapy in this census. One that patients receive chemotherapy after surgery, if you take determines the characteristics of the tumor in the pathology report will take several cycles. However, the patient’s age and general condition of the granting of these decisions also play an important role.
Chemotherapy “systemic treatment”, ie drugs mixed into the bloodstream and spreads throughout the body.
Clinical trials of chemotherapy drugs, researchers are trying to find ways to implement only area to be treated. Medicines for colon cancer spread to the liver can be given directly to the liver via the blood vessels (this treatment “intrahepatic chemotherapy” is called). In general, chemotherapy drugs to a person in the hospital, doctor’s office or take home. It had been given the drug and which depend on the general condition of the patient. Short-term hospital stay may be required.
Patients can ask these questions about chemotherapy:
The goal of the treatment, what is the purpose?
Which drugs will I receive? What will they do (what will not)?
Will there be a side effect of medication? What can I do in this situation?
How long will the treatment take?
Radiation therapy (radiotherapy or radiation therapy is called) based on the high-energy rays to damage the cancer cells and prevent their growth principle. Surgical treatment such as radiation therapy is a local treatment. Only affect cancer cells in the area being treated. Radiotherapy is sometimes used to provide easier to be shrinking tumors before surgery. More commonly used to destroy cancer cells remaining after surgery in the region. Pain or other symptoms occur in the tumor can not be removed by surgery can be used to eliminate them. Radiotherapy is usually in the hospital or outpatient clinic for 5 days a week during hospitalization may be several weeks.
Researchers are investigating more efficient ways of radiotherapy. For example, before and after surgery, radiotherapy (sandwich technique) benefits are being investigated administering radiation therapy or during surgery. Doctors alone in the spread of rectal cancer (surgery is exercised) are investigating the use of radiotherapy.
Some questions they wanted to ask patients before radiation therapy:
Radiation (rays) will be like?
What is the purpose and objective treatment?
When treatment is started, when will it end?
What should I do to myself during treatment?
What side effects may occur?
Is there a risk of infertility after treatment?
Biological treatment is to provide help to destroy cancer cells by activating the body’s defense system. Some patients used in conjunction with chemotherapy or biological therapy after surgery can be used as adjuvant therapy. In clinical trials, it has been used a new type of biological therapy. To be eligible for some type of biological therapy patients may need to stay in hospital.
Side Effects of Treatment
Implementation of chemotherapeutic drugs is difficult to ensure that only affect cancer cells. treated for the damage to healthy tissue may cause unwanted side effects.
Side effects of cancer treatment can vary from person to person and from treatment to treatment. Doctors tried to minimize these side effects. So when the doctor’s treatment and health problems that may occur after you must know very well.
surgical treatment in colorectal cancer and colostomy opening can cause temporary constipation and diarrhea patients. Doctors may recommend diet consists of these problems and some medications to minimize. After surgery, patients should tell the doctor that necessarily pain. Thus, the drug will be given by the doctor, the pain occurs will be addressed.
Physical activity should be restricted to ensure the healing of the wound after the operation. colostomy patients, the sensitivity of the skin around a colostomy may occur. Doctors and nurses protect the area from infection and this sensitivity by providing information about the care and cleaning of colostomy patients.
Chemotherapy patients must undergo medical examination in medical oncology clinic until about a week after each chemotherapy. This, the patient will be examined, listened to the complaints, the side effects of chemotherapy made necessary re-adjustments made in drug dose evaluated.
Side effects vary with the chemotherapy drugs. As a general rule chemotherapy affects proliferating cells. providing coagulation during bleeding, that our defense against disease and blood cells that carries oxygen to the organs in our body are rapidly proliferating cells. It takes about 1 week after chemotherapy, 10 days after blood cells are reduced in number and therefore may be bleeding after minor operations as quickly bruising or brushing your teeth. Because of our strong defense system normally does not cause disease because they reduce germs enter our bodies cells after chemotherapy allows us to capture our defense easily can cause fever. During this period, we had to wash raw fruits and vegetables (such as salad) should refrain from eating for at least 10 days. In this period to germs to people around you should also avoid crowded places available.
Please note that this is not due to any influence of the forbidden fruit and vegetables on your illness, your food, your yıkasa how clean is to avoid any possible microbes have remained on the fruit or vegetable. Pay attention to your food being cooked in this time period. If 38.50C in the above, please contact your doctor if you have an hour the fire. If you have a fever and your blood cells found in the blood is low, you need to take antibiotics. this decrease occurred in the number of your blood cells disappear spontaneously within a week to 10 days, and the cells reaches the normal number.
Another set of rapidly proliferating cells, gastrointestinal cells and hair root cells. Therefore, usually after chemotherapy hair is shed after the first week. Patients with poor appetite, nausea, vomiting, diarrhea and mouth sores may develop, can be controlled with medication, almost all of these side effects. These side effects are short-term, it would be passed before the start of the next chemotherapy complaints of patients. The severity of the side effects of said chemotherapy vary from patient to patient.
Today, with modern chemotherapy, long lasting side effects are rare to come across. However, some chemotherapy drugs can adversely affect the heart, patients using these drugs and doctors want to examine periodically to see if your heart is affected. the number of doses of chemotherapy drugs and chemotherapy treatments used today is not the size that will have an adverse effect on the heart. Some cancer medicaments are killed by egg cell by affecting the ovaries, thus ovaries can not produce the female hormones estrogen and patients with menopause. Quantities may stop or sparse and women become pregnant in this case. Infertility caused by chemotherapy, especially over 35 to 40 years is permanent. Pieces are cut during chemotherapy in younger patients can return to normal after a while.
Chemotherapy drugs often could damage over time to the vessel and they are administered intravenously, can cause erectile dysfunction and vascular become recognizable visually from the outside. redness, swelling of the arm that received the next day or take drugs while having chemotherapy and burn if you should notify your doctor immediately.
Do not use any painkillers while chemotherapy therefore consult your doctor if necessary. Because some painkillers can cause a reduction in number or function of blood cells in the body. Apart from that heart, you use for your lung and kidney disease, and you can continue your drug during chemotherapy, which is vital. You have to use these drugs would be appropriate to ask whether you do not mind showing visits to your doctor.
Abdomen to radiation therapy in patients with nausea, vomiting and diarrhea. Radiation therapy in colorectal cancer can cause loss of hair in the pelvic area. This effect may be permanent or temporary. During the treatment, the skin may redden, can be dry, sensitive and can be scratched. Patients should avoid tight clothing, should choose cotton garments. Doctors should not be applied to the skin without definitely recommend lotion or cream. Patients often feel very tired during radiation therapy. Specifically weeks after the treatment can continue even in this case. Although patients patients relax as much as possible in this process should move away from normal activities.
Although several cases often flu-like side effects of biological therapy, chills, fever, fatigue, nausea, vomiting, diarrhea and sometimes rash may occur.
Other Side Effects
Cancer may cause loss of appetite. In some patients, unpleasantness occurs in the mouth. Often the treatment of side effects of nausea, vomiting, sores in the mouth, making it difficult for the patient to eat. But nutrition is very important. Meals should necessarily contain enough calories and protein. Thus, the weight loss achieved and tissue to repair itself again.
Treatment, patients will feel more energetic and well organized and they are fed enough and the side effects will be seen less.
Sometimes colorectal cancer treatment can affect the sexual life of the patient. some nerves during surgery and as a result of incurring losses due to the treatment of the arteries can occur temporary or permanent impotence. Radiation therapy to the abdomen can sometimes lead to erectile dysfunction in men. In women undergoing surgery for colorectal tumors sexual problems may occur. Radiation therapy may also cause dryness and sensitivity in the vagina temporarily. Doctors and nurses can make proposals for the elimination of this problem.
and during your treatment to continue as before to after the sexual life is not a drawback. the mutagenic chemotherapy on ovarian cells (could be serious abnormalities in the baby) is one method of birth control to prevent pregnancy during treatment because of the effects should be preferred. Impairs the functioning of the ovary, most of the chemotherapy drugs, but this degree of this effect varies from patient to patient.
After the diagnosis, treatment plan, you live with physical and mental problems, disease or treatment-related fatigue, weakness, feeling your sex life, desires, and emotions such as excitement may affect your hearing. Sexual such problems with your life, you live in this period and after treatment will pass in time as the other issues.
The colostomy is a special concern about the sexual life of the patient. being ready to sexual union before it can take time to get used to the stoma. Some patients understand their thoughts and emotions in a match in this case, they can share a friend or therapist to address the concerns. Enterostoma experts can help me to adapt to colostomy in patients’ sex life. take a number of measures to keep their sex life can suggest.
You’re concerned about your sex life and you receive medical treatment in chemotherapy unit you would like to help in this regard and do not hesitate to report to the nurse.
Regular follow-up of patients with colorectal cancer after treatment is very important. Cancer may reoccur in the same or neighboring area or can spread to another part of the body. The doctors if the cancer coming back by closely monitoring the patient as soon as possible will treat it again.
Follow-up physical examination, fecal occult blood test, sigmoidoscopy, colonoscopy, chest x-ray, blood tests and CEA are various measurement. CEA levels in patients prior to surgery often is high and the tumor surgically removed after normalization within weeks. If CEA levels begin to rise again, it may mean that the cancer coming back. Meanwhile, other tests should be done. Because it can also rise for other reasons other than cancer.
Colorectal cancer patients during the performance of the relevant controls may want to be checked for other types of cancer. Colon cancer in women with breast, ovarian, and increased risk for developing cervical cancer. The increase in prostate cancer occurs in men.
years in a minority of patients undergoing cancer treatment side effects may occur later. Patients may be may want to talk with the doctor about these side effects. Thus, patients will continue to have regular checkups and doctor give us any problems as they arise.
Causes and Prevention
Colorectal cancer is one of the most common cancers. Colorectal cancer formation can not be connected to a single cause. Several factors may play a role in colorectal cancer. Cancer is not contagious. Some people are at risk of colorectal cancer than others. In the following cases at increased risk:
Polyps: Most (almost all), colorectal cancer develops intestinal polyps. It is a benign polyp formation but can sometimes develop into cancer. Removing polyps is the most important way to prevent cancer formation.
Age: older than 50 years old is the age group with increased risk of colorectal cancer.
Family history: Having a close relative with bowel cancer increases the risk of cancer development. Even some types of colon cancer shows familial transmission.
Familial polyposis: This hereditary disease is manifested by the formation of hundreds of polyps in the colon. Over time, these polyps can develop into cancer. Untreated “familial polyposis” patients with cancer will surely after a while.
Diet: Diets high in fat, low-fiber foods, fruits and vegetables and low areas are more at risk of having colorectal cancer.
Ulcerative colitis: The disease is inflammatory bowel disease. These patients are more likely to get bowel cancer than other people.