• Colorectal (Large Intestinal)
  Polyps & Cancer
• Anorectal Disorders
• Inflammatory Bowel Disease (IBD)
• Irritable Bowel Syndrome (IBS)

The last 4.5 feet of our gastrointestinal (GI) tract is known as the colon and rectum. These two words are often combined—colorectal—and this is the region of our GI tract that is highly prone to polyps (non-cancerous growths) and cancers.

Colorectal Polyps

Colorectal polyps are small growths of tissue that protrude from the lining (wall) of the colon or rectum into the channel of the intestines. Polyps can be flat, round, or stalk like. They can develop anywhere in the colon or rectum and can be detected by colonoscopy and some imaging tests. Some polyps may become malignant, but most colorectal polyps are benign (non-cancerous). If left untreated for months or years, polyps may transform into cancers.

For more information on polyps and colorectal cancer, visit our Health Library.

Colorectal Cancer

Colorectal (large intestinal) cancer, which begins on the lining of the colon or rectum, is one of the most common cancers of the Western world. Unfortunately, the incidence of colorectal cancer is also rising rapidly in developing countries and has a strong association with a Western-style diet. Cancer found in the colon or rectum also may spread to other parts of the body. More than 95 percent of colorectal cancers are adenocarcinoma, a cancer type that starts in cells that line the colon and rectum.

For more information on colorectal cancer, including risk factors and symptoms, visit our Health Library.

Screening

For patients at average risk for colon cancer, men and women who are healthy and have no family members with a history of colon cancer, The American Cancer Society and other cancer prevention authorities recommend that screening should begin at age 50.

If screening tests show anything suspicious for a polyp or cancer, a complete colonoscopy is recommended.

Men and women with certain risk factors—such as a personal or family history of colorectal polyps or cancer—need to speak with their doctor about getting screened at a younger age. Patients who have a history of ulcerative colitis or Crohn's disease, or a family history of intestinal conditions or other cancers, particularly, breast, ovarian or uterine cancer, must also be screened at a younger age. Screening is important because the majority of patients with early, curable cancer display no symptoms at all.

Diagnosis

Several diagnostic tests are available to help in diagnosing colorectal cancer. Some of these tests include:

• Blood tests (complete blood count or CBC, carcino antigen (CEA) and certain other nonspecific studies)
• Endoscopic tests, such as sigmoidoscopy, flexible sigmoidoscopy and colonoscopy with biopsy
• Imaging tests such as a barium enema (lower GI series) and CT or CAT scan

Confirmation of the diagnosis can only be made if a biopsy sample taken directly from a potential cancer site and examined by pathologists. A complete study of the colon and rectum is essential (not just flexible sigmoidoscopy) since 5% to 8% of patients with a primary cancer will have a second synchronous cancer and 30% to 40% of patients will have additional polyps.

Treatment

Once a diagnosis of colorectal conacer is made, usually all patients will require some type of surgery to treat the cancer. Chemotherapy may be suggested for certain types of colon cancers, and radiation and chemotherapy for locally advanced rectal cancers. Even when multiple treatments are needed, most patients can be cured of their disease. Colorectal cancers are among the most curable of the major cancers.

Physicians at the Center for Advanced Digestive Care are highly skilled in designing optimal colon cancer therapies. Our specialists are constantly developing and using new, targeted drugs (chemotherapies) and new, minimally invasive surgical devices and techniques to improve safety, hasten recovery time and achieve higher cure rates.

Surgery

The most commonly performed colon surgery is a segmental resection (removal of a section), which is performed laparoscopically at our institution more than 80% of the time. In this procedure, specialist surgeons remove the cancer, with some surrounding normal colon tissue, and nearby lymph nodes. Surgery may also be used to prevent and treat the spread of cancer from the colon to other organs (e.g., liver, ovaries), and often this too can be highly successful.

At the Center for Advanced Digestive Care, less than 5% of patients undergoing colorectal cancer will need a permanent colostomy on the skin to drain intestinal material. Some patients with complex rectal conditions may need a "temporary" stoma to safely permit healing. We have a team of specialist nurses (enterostomal therapists) to help treat and counsel our patients who require this care.

The Roles of Radiation, Chemotherapy & “Targeted Therapy”

Brachytherapy, a type of radiation therapy that uses small pellets of radioactive material placed in or near a cancer, is sometimes used to treat rectal cancer.

Chemotherapy, radiation, and targeted therapy may be used on their own or in combination before or after surgery to treat colorectal cancer.

Prior to surgery, chemotherapy and radiation may be used to shrink the size of a tumor and reduce the risk associated with removing the tumor. This is especially important if the tumor has grown outside of the wall of the colon or rectum or is near a critical area, such as an artery.

Following surgery, chemotherapy, radiation, and increasingly targeted therapy (an emerging class of drugs that destroys cancerous cells leaving healthy cells unharmed) may be used to destroy any remaining cancer cells. These therapies also may be used for patients with advanced cancer or when surgery is not possible, to minimize the effects and symptoms of the cancer that patients may experience.

Brachytherapy

a type of radiation therapy, which uses small pellets of radioactive material placed in or near the cancer, is sometimes used to treat rectal cancer.