Colorectal Cancer

If you’ve been recently diagnosed with colorectal (colon) cancer, you and your family might be overwhelmed with questions and concerns. Your first decision is where to get treatment.

You want a place where you can get the most advanced treatment options available. A place where you are supported by a team of compassionate experts. A place where you are treated as a whole person.

MultiCare Regional Cancer Center is that place. We have the region’s best health care providers in the field on oncology. Our world-class treatment facility offers cutting-edge technology in a welcoming and positive healing environment.

Learn about our comprehensive treatment approach, our cancer care teamor more about colorectal cancer in the tabs below.

Colorectal Cancer Facts

Colorectal cancer is the third most common cancer in men and women in the United States. It occurs most often in people who are older than 50. When it is caught in its early stages, it is easily treated and often cured. But because it is usually not discovered early, it is the second leading cause of cancer deaths in the United States.

In colorectal cancer, abnormal cells grow in the large intestine (colon and rectum). Cancers of the colon and the rectum are often talked about together as colorectal cancer because they have so much in common.

Causes

Most cases begin as polyps, which are small growths inside the colon or rectum. Colon polyps are very common, and most of them do not turn into cancer. But doctors cannot tell ahead of time which polyps will turn into cancer. This is why people older than 50 need regular tests to find out if they have any polyps and then have them removed.

Symptoms

Colorectal cancer in its early stages usually doesn't cause any symptoms. Symptoms occur later, when the cancer may be more difficult to treat. The most common symptoms include:

• Pain in the belly
• Blood in your stool or very dark stool
• A change in your bowel habits (such as more frequent stools or a feeling that your bowels are not emptying completely)
• Constant tiredness (fatigue)
• In rare cases, unexplained weight loss.

Colorectal cancer may not cause symptoms you notice in the early stages. When there are symptoms, they may depend on where the cancer is in your colon.

Having these symptoms does not mean you have cancer. A number of other medical problems could cause similar symptoms, including:

• Irritable bowel syndrome
• Other growths (polyps) in the large intestine
• Diverticulitis
• Infections that cause diarrhea, such as salmonella
• Inflammatory bowel disease, such as Crohn's disease and ulcerative colitis
• Bleeding hemorrhoids
• Ulcers of the rectum

Prevention

Risk Factors

A risk factor is anything that makes you more likely to get a particular disease. Being older than 50 is the main risk factor for colorectal cancer. Colorectal cancer occurrence rates are highest among African Americans.

You are more likely to get colorectal cancer if one of your parents, brothers, sisters, or children has had the disease.

You have a very strong family history if all of the following are true:

• You have at least three relatives who have had colorectal cancer, and at least one of them is a parent, brother or sister.
• Those relatives are spread over two generations in a row (for example, a grandparent and a parent).
• One of those relatives had cancer before age 50.

If you have a very strong family history of colorectal and related cancers, you may want to have genetic testing. Certain people who are younger than 50 need regular tests if their medical history puts them at increased risk for colorectal cancer.

Early Screening & Prevention

Some tests can prevent colorectal cancer. Screening tests look for a certain disease or condition before any symptoms appear.

Experts recommend routine colorectal cancer testing for everyone age 50 and older who has a normal risk for colorectal cancer. Screening tests could include:

• Stool test, such as the fecal occult blood test (FOBT), fecal immunochemical test (FIT), or stool DNA test (sDNA)
• Sigmoidoscopy
• Colonoscopy
• Computed tomographic colonography (CTC), also called a virtual colonoscopy

Here are other things you can do to help prevent colorectal cancer:
 

• Watch your weight. Being very overweight may increase your risk. And carrying extra fat around the waist seems to be more of a risk than carrying extra fat in the hips or thighs.
• Eat well. Healthy eating includes a variety of foods. Eat more whole grains, fruits, vegetables, poultry, and fish. And eat less red meat, refined grains, and sweets.
• Limit drinking. Drink less than 2 alcohol drinks a day. People who drink 2 or more alcohol drinks a day have a slightly higher risk for colorectal cancer.
• Get active. Keep up a physically active lifestyle. Being fit leads to an improved sense of well-being, improved appearance and increased stamina and strength.
• Quit smoking. If you smoke cigarettes, quit smoking to reduce your risk.

Detection & Diagnosis

Initial Tests to Detect colorectal Cancer

If your doctor thinks you may have colorectal cancer, he or she will ask you questions about your medical history and give you a physical exam. Other tests may include:

• Colonoscopy: a test in which your doctor uses a lighted scope to view the inside of your entire colon. A colonoscopy may be done to look into symptoms such as unexplained bleeding from the rectum, constant diarrhea or constipation, blood in the stool, or pain in the lower abdomen. A colonoscopy is recommended when another screening test shows you may have colorectal cancer.
• Sigmoidoscopy: a test in which your doctor uses a lighted scope to view the lower part of your intestine. A sigmoidoscopy may be done to look into symptoms such as unexplained bleeding from the rectum, constant diarrhea or constipation, blood in the stool or pain in the lower abdomen. Doctors can also remove polyps during this test.
• Barium Enema: in which a whitish liquid with barium is inserted through your rectum into your intestine. The barium outlines the inside of the colon so that it can be seen on an X-ray.
• Biopsy: in which a sample of tissue is taken from the inside of your intestine and examined under a microscope. A doctor called a pathologist can look at the tissue sample and see if it contains cancer.
• Complete Blood Count (CBC): which is a blood test. It is used to look into symptoms such as fatigue, weakness, anemia, bruising or weight loss.

For people who have an increased risk for colorectal cancer, regular colonoscopy is the recommended screening test because it allows your doctor to remove polyps (polypectomy) and take tissue samples at the same time.

Next Steps

When you are diagnosed with colorectal cancer, your doctor may order other tests to find out whether the cancer has spread. These tests include:

• CT scan to see if the cancer has spread to your liver, lungs, or abdomen.
• A chest X-ray to see if the cancer has spread to your lungs.
• An MRI or PET scan to see if the cancer has spread into your chest or organs in the abdomen or pelvis.
• An ultrasound to find the cause of abdominal pain or increased abdominal girth or to see if the cancer has spread to your liver. An endoscopic ultrasound is used to see how far rectal cancer may have spread.
• A blood chemistry panel to see if the cancer has spread to your liver and bones.
• A carcinoembryonic antigen (CEA) blood test to check the level of this tumor marker.

After the cancer has been examined under a microscope, it will be staged. Staging is a way for your doctor to tell how far, if at all, your cancer has spread. It also helps your doctor decide what your treatment should be.

There are several different types of staging systems, so it's important to ask your doctor to explain carefully what stage your cancer is in and what that means.

Treatments

Initial Treatment

You and your doctor will work together to decide what your treatment should be. You will consider your own preferences and your general health, but the stage of your cancer is the most important tool for choosing your treatment.

Surgery

Surgery is almost always used to remove colorectal cancer. Your doctor may use one of the following types of surgery:

• Local incision: When the cancer is still just in a polyp, it will be removed during colonoscopy or sigmoidoscopy.
• Resection: If your cancer is larger, your doctor will remove the cancer and a small amount of healthy tissue. The healthy ends of the colon or rectum are then sewn back together. During this operation, your doctor will also remove some of your lymph nodes for testing.
• Resection and colostomy: Sometimes it isn't possible to rejoin the ends of the colon or rectum after the cancer is removed. Your doctor will do a colostomy and make an opening on the outside of your abdomen where waste can pass through into a colostomy bag. The colostomy may be temporary until your colon heals. Or it may be permanent if the entire lower colon or rectum was removed.
• Laparoscopic surgery: Sometimes it is possible to have this surgery done to remove the cancer. Very small incisions are made in the belly. A tiny camera and special instruments are used to remove the cancer. For the best results, it is important to have an experienced surgeon and to have this surgery at a hospital where many of these surgeries are done.

Even after removing all the cancer that can be found with surgery, your doctor may say you need other treatment. This may be chemotherapy, radiation or both (chemoradiation).

Chemotherapy

Chemotherapy uses medicines — given either as pills or through a needle — to destroy cancer cells throughout the body. Several medicines are often used together. Research studies continue to look for the best combinations of medicines. Your doctor will recommend treatment based on the type and stage of cancer that you have.

Radiation

Radiation therapy, which uses X-rays to destroy cancer cells, is standard treatment for some types of cancer in the rectum. Radiation therapy is often combined with surgery or chemotherapy. Radiation may be given from a machine outside the body that targets the cancer (external radiation). Or it may be given inside the body, with radiation sealed in seeds or wires (internal radiation).

Supportive and Integrative Therapies

In addition to the therapies described above, we offer complementary therapies such as nutritional therapy, physical therapy, yoga, massage and emotional counseling. Many of these therapies are remarkably effective in addressing the side effects of chemotherapy, surgery and radiation by easing tension, reducing pain and improving quality of life.