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Colon Cancer Treatment in India

Colon Cancer

Colorectal cancer is a cancer that starts in the colon or the rectum. These cancers can also be named colon cancer or rectal cancer, depending on where they start. Colon cancer and rectal cancer are often grouped together because they have many features in common.

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body

Types of Colon Cancer

Adenocarcinoma is the most common type of colorectal cancer. Other colorectal cancers include gastrointestinal carcinoid tumors, gastrointestinal stromal tumors, primary colorectal lymphoma, leiomyosarcoma, melanoma and squamous cell carcinoma.

There are two main subtypes of adenocarcinoma:

  • Mucinous adenocarcinoma is made up of approximately 60 percent mucus. The mucus can cause cancer cells to spread faster and become more aggressive than typical adenocarcinomas. Mucinous adenocarcinomas account for 10 to 15 percent of all colon and rectal adenocarcinomas.
  • Signet ring cell adenocarcinoma accounts for less than one percent of adenocarcinomas. Named for its appearance under a microscope, signet ring cell adenocarcinoma is typically aggressive and may be more difficult to treat.
  • Gastrointestinal carcinoid tumors: This slow-growing cancer forms in the neuroendocrine cell (a nerve cell that also creates hormones) in the lining of the gastrointestinal tract. These tumors account for just 1 percent of all colorectal cancers, but half of all of the cancers found in the small intestine.
  • Primary colorectal lymphomas: A type of non-Hodgkin lymphoma (NHL), lymphomas are cancers that develop in the lymphatic system from cells called lymphocytes. Lymphocytes are a type of white blood cell that helps the body fight infections. NHL can develop in many parts of the body, including the lymph nodes, bone marrow, spleen, thymus and the digestive tract..
  • Gastrointestinal stromal tumors: Also known as GISTs, this is a rare type of colorectal cancer that starts in a special cell found in the lining of the gastrointestinal (GI) tract called interstitial cells of Cajal (ICCs).
  • Leiomyosarcomas: Another form of sarcoma, leiomyosarcomas essentially means “cancer of smooth muscle.” The colon and rectum have three layers of the type of muscle that can be affected, which all work together to guide waste through the digestive tract. This rare type of colorectal cancer accounts for about 0.1 percent of all colorectal cases.
  • Melanomas: Though most commonly associated with the skin, melanomas can occur anywhere, including the colon or rectum.
  • Squamous cell carcinomas: Some parts of the GI tract, like the upper part of the esophagus and the end of the anus, are lined with flat cells called squamous cells. These are the same type of cells that are found on the surface of the skin. Cancers starting in these cells are called squamous cell carcinoma

Causes of Colon Cancer

  • The risk of colorectal cancer increases as people get older. Colorectal cancer can occur in young adults and teenagers,
  • Men have a slightly higher risk of developing colorectal cancer than women.
  • Family history of colorectal cancer. Colorectal cancer may run in the family if first-degree relatives (parents, brothers, sisters, children) or many other family members (grandparents, aunts, uncles, nieces, nephews, grandchildren, cousins) have had colorectal cancer.
  • Physical inactivity and obesity. People who lead an inactive lifestyle, meaning no regular exercise and a lot of sitting, and people who are overweight and obese may have an increased risk of colorectal cancer.
  • While various dietary factors have been looked at as possibly affecting the risk of developing colorectal cancer, the current research most consistently links eating more red and processed meat to a higher risk of the disease.
  • Recent studies have shown that smokers are more likely to die from colorectal cancer than nonsmokers.

Symptoms of Colon Cancer

  • A change in bowel habits
  • Diarrhea, constipation, or feeling that the bowel does not empty completely
  • Bright red or very dark blood in the stool
  • Stools that look narrower or thinner than normal
  • Discomfort in the abdomen, including frequent gas pains, bloating, fullness, and cramps
  • Weight loss with no known explanation
  • Constant tiredness or fatigue
  • Unexplained iron-deficiency anemia, which is a low number of red blood cells

Sometimes bleeding happens when the colon cancer progresses. Gradually, there will be not enough red blood cells in the body that is called as anemia. Following are some of the symptoms of anemia –

  • Breathlessness
  • Fatigue

Also obstruction is caused by the colon cancer that include following symptoms –

  • Vomiting
  • A feeling of bloating, especially near the belly button
  • Constipation
  • Abdominal pain

Stages of Colon Cancer

Stage 0: This is called cancer in situ. The cancer cells are only in the mucosa, or the inner lining, of the colon or rectum.

Stage I: The cancer has grown through the mucosa and has invaded the muscular layer of the colon or rectum. It has not spread into nearby tissue or lymph nodes (T1 or T2, N0, M0)

Stage IIA: The cancer has grown through the wall of the colon or rectum and has not spread to nearby tissue or to the nearby lymph nodes (T3, N0, M0).

Stage IIB: The cancer has grown through the layers of the muscle to the lining of the abdomen, called the visceral peritoneum. It has not spread to the nearby lymph nodes or elsewhere (T4a, N0, M0

Stage IIC: The tumor has spread through the wall of the colon or rectum and has grown into nearby structures. It has not spread to the nearby lymph nodes or elsewhere (T4b, N0, M0).

Stage IIIA: The cancer has grown through the inner lining or into the muscle layers of the intestine and spread to one to three lymph nodes, or to a nodule of tumor in tissues around the colon or rectum that do not appear to be lymph nodes but has not spread to other parts of the body (T1 or T2; N1 or N1c, M0 or T1, N2a, M0).

Stage IIIB: The cancer has grown through the bowel wall or to surrounding organs and into one to three lymph nodes or to a nodule of tumor in tissues around the colon or rectum that do not appear to be lymph nodes, but it has not spread to other parts of the body (T3 or T4a, N1 or N1c, M0; T2 or T3, N2a, M0; or T1 or T2, N2b, M0).

Stage IIIC: The cancer of the colon, regardless of how deep it has grown, has spread to four or more lymph nodes but not to other distant parts of the body (T4a, N2a, M0; T3 or T4a, N2b, M0; or T4b, N1 or N2, M0)

Stage IVA: The cancer has spread to a single distant part of the body, such as the liver or lungs (any T, any N, M1a).

Stage IVB: The cancer has spread to more than one part of the body (any T, any N, M1b).

Recurrent: Recurrent cancer is cancer that has come back after treatment. The disease may be found in the colon, rectum, or in another part of the body

Diagnosis of Colon Cancer

In addition to a physical examination, the following tests may be used to diagnose colorectal cancer. The doctor will also ask about your medical and family history.

  • As described in Screening, a colonoscopy allows the doctor to look inside the entire rectum and colon while a patient is sedated. If colorectal cancer is found, a complete diagnosis that accurately describes the location and spread of the cancer may not be possible until the tumor is surgically removed.
  • A biopsy is the removal of a small amount of tissue for examination under a microscope. A biopsy may be performed during a colonoscopy, or it may be done on any tissue that is removed during surgery. Sometimes, a CT scan or ultrasound is used to help perform a needle biopsy. A needle biopsy removes tissue through the skin with a needle that is guided into the tumor.
  • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy).
  • Blood tests. Because colorectal cancer often bleeds into the large intestine or rectum, people with the disease may become anemic. A test of the number of red cells in the blood, which is part of a complete blood count (CBC), can indicate that bleeding may be occurring.
  • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow. In a person with colon cancer, a CT scan can check for the spread of cancer in the lungs, liver, and other organs. It is often done before surgery.
  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow. MRI is the best imaging test to find where the colorectal cancer has grown.
  • Ultrasound is a procedure that uses sound waves to create a picture of the internal organs to find out if cancer has spread. Endorectal ultrasound is commonly used to find out how deeply rectal cancer has grown and can be used to help plan treatment; however, this test cannot accurately detect cancer that has spread to nearby lymph nodes or beyond the pelvis. Ultrasound can also be used to view the liver, although CT scans or MRIs are preferred because they are better for finding tumors in the liver.
  • Chest x-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. An x-ray of the chest can help doctors find out if the cancer has spread to the lungs.
  • Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.
  • Carcinoembryonic Antigen (CEA) Assay : CEA levels in the blood are measured in this test. The normal as well as cancer cells release CEA in the bloodstream. When these CEA is found in large amounts then it indicates colon cancer.
  • Proctoscopy: A proctoscope (a thin and tube-like instrument having light and lens for viewing) is inserted into the rectum in this rectum test. Sometimes removal of the tissue is also done by using a tool in order to check the presence of a disease by examining under a microscope.
  • Reverse-Transcription Polymerase Chain Reaction (RT-PCR) Test : Function of genes or the changes in the structure in a tissue sample are examined by using certain types of chemicals

 Treatment of Colon Cancer

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. This is the most common treatment for colorectal cancer and is often called surgical resection. Part of the healthy colon or rectum and nearby lymph nodes will also be removed. In addition to surgical resection, surgical options for colorectal cancer include

Laparoscopic surgery. Some patients may be able to have laparoscopic colorectal cancer surgery. With this technique, several viewing scopes are passed into the abdomen while a patient is under anesthesia. The incisions are smaller and the recovery time is often shorter than with standard colon surgery.

Colostomy for rectal cancer. Less often, a person with rectal cancer may need to have a colostomy. This is a surgical opening, or stoma, through which the colon is connected to the abdominal surface to provide a pathway for waste to exit the body; such waste is collected in a pouch worn by the patient

Radiofrequency ablation. Some patients may be able to have surgery on the liver or lungs to remove tumors that have spread to those organs. Another way is to use energy in the form of radiofrequency waves to heat the tumors, called radiofrequency ablation or RFA.

Radiation therapy

Radiation therapy is the use of high-energy x-rays to destroy cancer cells. It is commonly used for treating rectal cancer because this tumor tends to recur near where it originally started

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is usually given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.