Colon Cancer: Surgery as only treatment modality- Part 2

Dr. Femi Olaleye, medical director of Optimal Cancer Care Foundation, in this concluding part, told GERALDINE AKUTU how colon cancer could be managed.

How is it diagnosed?

Physical examination by a doctor can point to a diagnosis. Complaints such as fatigue, weight loss and blood in the stool with associated palpable abdominal or rectal mass, with evidence of rectal bleeding (occult or frank) usually need to be further investigated with

Blood tests – complete blood cell counts and Kidney and Liver Function Tests (to assess the patient’s organ function). Tumor markers such as CEA help to establish baseline and assess the extent of the disease as it carries a prognostic value.

Imaging tests – Ultrasound scans of the abdomen and the pelvic region. Chest and Abdominal X-rays with contrast studies (Barium swallow and Barium enema). CT scans and MRI are also very important to help stage the extent of the disease. PET scan (if available) is emerging as a very useful tool for staging the disease.

Colonoscopy/Sigmoidoscopy and Biopsy for Histology – Direct visualisation of the tumour with a camera and taking of small tissue samples for confirmation of the diagnosis by a pathologist is essential before commencing treatments.

Molecular Testing – The treatment of colon cancers is increasingly guided by molecular testing of the tumor. There are now published evidence-based guidelines and guidance for specialists managing colon cancers in order to improve clinical care.

What are treatment options?

Surgery – remains the only curative treatment modality. Surgical resection of a cancer with portion of the affected bowel provides good prognosis for patients with limited disease without metastasis (Stage I – III).

Adjuvant Chemotherapy – standard for patients with Stage III but its use in Stage II is controversial.
Radiation therapy – limited to palliative care for selected metastatic sites such as the brain and bone metastases.

Chemotherapy only – reserved for patients with metastatic colorectal cancer.

What lifestyles changes can be made to avoid or manage the disease?

Invasive colorectal cancer is a multi-factorial disease process. Genetic factors, environmental exposures (including diet) and inflammatory conditions of the digestive tract are all involved in the development of the disease.

The use of aspirin has been shown to be effective in both primary prevention of colorectal cancer.

The goal of colorectal cancer screening in high-risk environments and in patients with evidence of precancerous lesions (colon polyps) is to decrease the mortality and improve prognosis due to early detection of the tumour.