Colon Cancer Treatment

Colon cancer is a type of cancer that begins in the colon or large intestine.

The colon is the last part of the digestive system. It is a 5- to 6-foot-long tube connecting the small intestine to the rectum. The colon along with the rectum is known as the large intestine. The colon helps in moving and processing the digested food across the body down towards the rectum, where the food exits the body as stool.

The different types of colon cancers include:
1. Adenocarcinomas: This is the most common type of colon cancer. Adenocarcinomas form within the mucus-making cells in the colon.
2. Lymphomas: This type of cancer can develop in the lymph nodes or colon.
3. Carcinoids: This type of cancer starts in the hormone-making cells present within the intestines.
4. Sarcomas: This type of cancer starts in the soft tissues like muscles in the colon.
5. Gastrointestinal stromal tumors: These types of tumors start off as being benign (non-cancerous) and then turn malignant (cancerous).

The exact cause of colon cancer is uncertain. Colon cancer usually begins when the healthy cells in the colon develop mutations or changes in their DNA. When the DNA of a cell is damaged, it continues to grow and multiply. As the cells continue to multiply rapidly, they tend to accumulate and form a tumor. These cancer cells can further grow to invade and destroy the normal tissues nearby.
The cancerous cells can travel and affect the other parts of the body, known as metastasis.

Certain factors may increase the risk of developing colon cancer and may include:

• Increase in age
• African-American race
• History of colon cancer
• History of colon polyps (a small clump of cells that form on the colon lining)
• Chronic (long-term) inflammatory conditions of the intestines, like:
• Ulcerative colitis: It is an inflammatory bowel disease causing irritation and ulcers in the large intestine
• Crohn’s disease: It is an inflammatory bowel disease leading to the swelling and irritation of the digestive tract
• Family history of colon cancer
• Inherited syndromes, like:
• Familial adenomatous polyposis: It is a rare, hereditary condition in which an individual develops several precancerous polyps known as adenomas.
• Lynch syndrome or hereditary nonpolyposis colorectal cancer: It is an inherited condition that increases the chances of a person getting certain cancers.
• A high-fat and low-fiber diet
• Inactive lifestyle
• Diabetes
• Smoking
• Heavy alcohol consumption
• Obesity
• Radiation therapy (treatment for cancer)

The symptoms of colon cancer are:

• Change in bowel habits
• Constipation or diarrhea
• Change in the consistency of stools
• Blood in stools or rectal bleeding
• Fatigue or weakness
• Abdominal (stomach-related) discomfort, like pain, gas, or cramps
• A feeling that the bowel does not empty completely
• Weight loss

Colon cancer can be diagnosed by:

1. Physical examination: The doctor will examine the patient physically. The patient’s symptoms are noted, along with the family history and medical history of the patient.
2. Blood tests: The doctor may recommend some blood tests to get an idea of what could be the cause of the various symptoms. Complete blood count (CBC) and liver function tests help in ruling out other diseases.
3. Imaging tests: Tests like X-rays, CT scans, MRI scans, PET scans, Ultrasound, and Angiography help in obtaining clear images of the internal organs of the body.
4. Biopsy: The doctor removes a small sample of the suspected tissue growth and sends it to the laboratory to check for the presence of cancer cells in case of a biopsy.
5. Diagnostic colonoscopy: A thin, long, flexible tube with a camera on one end, known as a colonoscope, is used to view tE entire colon and rectum. This procedure can also be used to remove polyps, and so a biopsy.
6. Proctoscopy or rigid sigmoidoscopy: A straight, hollow plastic or metal tube, known as a proctoscope, is used to examine the inside of the anus and rectum. It is done to check for the presence of polyps, tumors, bleeding, inflammation, or hemorrhoids.

The stages of colon cancer range from Roman numerals 0 to IV. The lowest stages indicate that the cancer is confined to the lining inside the colon. Stage IV cancer is considered to be advanced and has spread or metastasized to the other parts of the body.

Doctors recommend people having an average risk of developing colon cancer begin screening for colon cancer at around 50 years of age. But people having a family history of colon cancer or an African-American heritage should start screening earlier.
The common colon cancer screening tests recommended include:

• Colonoscopy: A long, flexible tube known as a colonoscope is used for viewing the rectum and the entire colon. This helps in checking for the presence of any polyps or colorectal cancer.
• Flexible sigmoidoscopy: A flexible tube known as a sigmoidoscope is inserted into the anus, up through the rectum and lower part of the colon to view the inside of the rectum and lower colon.
• Fecal immunochemical test (FIT): This test is done to check for the presence of blood in stools.
• Guaiac-based fecal occult blood test: A chemical reaction is used in this test to check for the presence of blood in stools.
• Fecal DNA test: This test works by checking for the blood products and genetic mutations in the stools.
• Double-contrast barium enema: In this test, barium is given as an enema (insertion of liquid or gas into the rectum). Air is then blown into the rectum for expanding the colon, to obtain an outline of the colon on an x-ray.
• CT colonography or virtual colonoscopy: This procedure involves taking a CT scan to obtain clear images of the abdomen and pelvis (region below the stomach) after drinking a contrast dye, and inflating air and contrast into the rectum.

The treatment of colon cancer depends on the stage and location of cancer, and the overall health of the patient. The various treatment modalities include:
Surgery for colon cancer in the early stage: The doctor may recommend minimally invasive procedures in case of early-stage cancer, which may include:
1. Polypectomy: The removal of polyps during a colonoscopy is known as polypectomy. This is done in cases of small, localized cancer which is completely contained within a polyp.
2. Endoscopic mucosal resection: The larger polyps can be removed along with a small amount of the inner lining of the colon in this procedure.
3. Laparoscopic surgery: Several small incisions (cuts) are made by the surgeon in the abdominal wall and a lighted tube with a camera on one end, known as a laparoscope, is inserted inside along with other surgical tools. Polyps can be removed using this method. Lymph node samples may also be collected by the surgeon by this technique.

Surgery for colon cancer in the advanced stage: In case of cancer that has grown into or through the colon, the surgeon may recommend the following types of surgeries:
1. Partial colectomy: This procedure involves removal of that part of the colon that contains cancer, along with a margin of the normal tissue present on either side of cancer. This procedure is usually done using a laparoscope.
2. Ostomy: An opening is created in the wall of the abdomen from a part of the remaining bowel to eliminate the stool into a bag that fits over the opening.
3. Removal of the lymph nodes: The nearby lymph nodes are normally removed during the surgery for colon cancer treatment, and tested for cancer.

Chemotherapy:
Chemotherapy is a method of using certain drugs to kill cancer cells.
Chemotherapy can be used before surgery to shrink the cancer cells so that they can easily be removed.
Chemotherapy can also be used after surgery to kill any cancer cells that may still be remaining.

Radiation therapy:
This therapy involves using powerful energy beams, like x-rays and protons, to kill the cancer cells.
Radiation therapy can sometimes be used in combination with chemotherapy.

Targeted drug therapy:
This therapy involves using drugs that target specific abnormalities that may be present within the cancer cells.
This causes the cancer cells to die.

Immunotherapy:
This is a drug therapy that boosts the body’s immune (disease-fighting) system to kill the cancer cells.

The side effects of colon cancer treatment depending on the type of treatment done include:
1. Surgery:

• Swelling
• Pain
• Bruising
• Infection
• Fatigue
• Stomach upset

2. Chemotherapy:

• Hair loss
• Fatigue
• Mouth ulcers or sores
• Nausea
• Vomiting
• Diarrhea
• Neuropathy (nerve damage)
• Bleeding
• Infection
• High blood pressure
• Anxiety
• Depression

3. Radiation therapy:

• Skin reactions
• Diarrhea 
• Loss of appetite

Colon cancer can be prevented by:

• Screening tests starting around the age of 50, or earlier in cases of an increased risk 
• Eat a well-balanced diet including fruits, vegetables, and whole grains
• Quit smoking
• Limit your intake of alcohol
• Exercise regularly
• Maintain a healthy weight
• Preventive medications like aspirin (should be taken only after consulting your doctor)

The cost of Colon Cancer Treatment varies across different cities and hospitals in India.