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All you need to know about
COLON & RECTAL CANCER

Colon and Rectal Cancer
1. What is Rectal Cancer?

Rectal Cancer is a cancer, which involves the last 6 inches of the large intestine - called the rectum.

2. What are the symptoms in a person with Rectal Cancer?

Rectal Cancers usually present with bright red blood in the stool. It is often mistaken for 'piles' as this condition also presents with blood in the stool. Change of bowel habits [e.g. constipation in a person who was not having any problems with passing stool] is also common. Rectal pain may occur in advanced cases.

3. What causes Rectal Cancer?

Dietary and Environmental factors play a role. A diet high in fat and red meat [beef, mutton, pork and liver] predisposes to this cancer, as does the consumption of large amounts of alcohol and smoking.

Obesity is also a risk factor. Around 10% of persons develop this cancer due to a change in the genes [called a mutation], some of these mutations may be inherited from the parents. Read More...
4. Can Rectal Cancer be prevented?

The only intervention, which can prevent Rectal Cancer, is to have regular colonoscopies from the age of 50. This would detect and treat small growths called polyps, which eventually turn malignant.

5. What are the treatments available for Rectal Cancer?

Surgery is the main treatment for this disease, which consists of removal of the portion of the rectum with the tumour and rejoining the intestine above and below.

In some patients, the tumour may be large and extend beyond the bowel wall, in this situation, radiotherapy is needed to shrink the tumour, so that surgery can be performed. The gap between radiation and surgery is usually 8 - 10 weeks to allow the radiation reaction to disappear. Read More...
6. What types of surgery are available for Rectal Cancer?

There are 2 types of operations. If the tumour is involving the muscles in the anus, then complete removal is needed, which requires a permanent bag to collect stool from the intestine stitched to the abdominal wall [Abdomino-perineal resection].

If the muscles are free, then only a portion of the rectum is removed and the two ends are joined back. A permanent bag is not needed. This is called an anterior resection of the rectum. Read More...
7. What are the latest advances in the treatment of Rectal Cancer?

Robotic Surgery is the latest and most sophisticated treatment for Rectal Cancer. It is a form of keyhole surgery using tiny [8mm] incisions to introduce special instruments connected to a robot, which is a computerized device, which is completely under the surgeon's control.

It offers several advantages including:
  • More precise surgery
  • Shorter length of stay
  • Less blood loss
  • Earlier return to normal work
  • Cure rates similar to open and laparoscopic surgery
Read More...
7. What happens after I have my surgery?

Typically you will stay in the hospital for just 3 - 4 days after surgery especially if you had Robotic Surgery.

Once the detailed report of the tumour, which was removed, is available [in about 7 days], your doctor will discuss with you regarding the need for chemotherapy to further improve your chances of cure. You will usually be able to go back to work 3 - 4 weeks after your surgery. Sometimes a temporary bag is needed after the intestine is joined back, to protect the area which has been joined and to keep stool away from it. This is called an 'ileostomy'. This will require a small second operation to close it approximately 3 - 4 months after the first surgery. Read More...
8. Do I need to have check ups after my treatment is complete?

Yes, regular follow up is recommended. This is done 3 monthly for the first 2 years and 6 monthly for the next 3 years after surgery.

Once you cross 5 years, it is very unlikely your cancer will come back, and you are considered 'cured'. At each visit, simple blood tests, an examination by your doctor and scans if needed are required. These tests can be performed at your hometown and the reports can be mailed to your doctor. Read More...
1. What is Colon Cancer?

Colon Cancer is a cancer, which involves the large intestine, which is the portion of the gut measuring around 5 feet from the small intestine to the end of the gut called the rectum.

2. What are the symptoms in a person with Colon Cancer?

Colon cancer is usually present with either altered blood [brown or black color] or bright red blood in the stool.

It is often mistaken for 'piles' as this condition also presents with blood in the stool. Anemia which is low hemoglobin on a routine check-up and fatigue can be the only presenting feature of colon cancer as well. Change of bowel habits [e.g. constipation in a person who was not having any problems with passing stool] is also common. Abdominal pain, bloating, and vomiting might also occur in advanced cases. Read More...
3. What are the causes of Colon Cancer?

Dietary and Environmental factors play a role. A diet high in fat and red meat [beef, mutton, pork, and liver] predisposes to this cancer, as does the consumption of large amounts of alcohol and smoking.

Obesity is also a risk factor. Around 10% of persons develop this cancer due to a change in the genes [called a mutation], some of these mutations may be inherited from the parents. These mutations may lead to cancers in other organs such as the ovaries and uterus as well. Read More...
4. Can Colon Cancer be prevented?

The only intervention, which can prevent Colon cancer, is to have regular colonoscopies from the age of 50. This would detect and treat small growths called polyps, which eventually turn malignant.

5. What are the treatments available for Colon Cancer?

Surgery is the main treatment for this disease, which consists of removal of the portion of the rectum with the tumour and rejoining the intestine above and below.

In some patients, the tumour may be large and extend beyond the bowel wall, in this situation, radiotherapy is needed to shrink the tumour so that surgery can be performed. The gap between radiation and surgery is usually 8 - 10 weeks to allow the radiation reaction to disappear. Read More...
6. What types of surgery are available for Colon Cancer?

The operation to remove a cancer in the colon is called a colectomy.

It involves removal of the affected segment of intestine with a margin of normal colon on either side, all the lymph glands draining the cancer, and any additional organs which might be stuck to the cancer. Depending on the site of the cancer, your doctor will use terminologies such as a right hemicolectomy, transverse colectomy, left hemicolectomy, or a sigmoid colectomy. Sometimes the entire colon has to be removed- a total colectomy; typically when there are two cancers at the same time in different parts of the colon [Synchronous cancers]. If you have inflammatory bowel disease with cancer, a total proctocolectomy, removing the entire large intestine and rectum is perfumed-a Total Proctocolectomy. A permanent bag is usually not needed after surgery for colon cancer, except when the entire colon is removed with part or whole of the rectum. This is called an anterior resection of the rectum. Read More...
7. What are the latest advances in the treatment of Colon Cancer?

Traditionally, Colon cancers are removed by open surgery, using a long 15-20 cm incision.

With advances in technology, laparoscopic surgery which involves passing a lighted camera into the belly and special instruments through small 5mm to 10mm cuts has been used successfully to remove these cancers with less pain and shorter stay. Robotic Surgery is the latest and most sophisticated treatment for rectal cancer. It is a form of keyhole surgery using tiny [8mm] incisions to introduce special instruments connected to a robot, which is a computerized device, which is completely under the surgeon’s control. It offers several advantages including:
  • More precise surgery
  • Shorter length of stay
  • Less blood loss
  • Earlier return to normal work
  • Cure rates similar to open and laparoscopic surgery
Read More...
8. What happens after I have my surgery?

Typically you will stay in the hospital for just 3 - 4 days after surgery especially if you had robotic surgery.

You will walk the day after surgery and start liquids within 6 hours of surgery. A normal diet can be started once you have had a bowel movement. You will be prescribed a low residue diet, which has a low fiber content for 6 weeks after surgery, to prevent any block of the intestine at the site where it has been joined. Once the detailed report of the tumour, which was removed, is available [in a week], your doctor will discuss with you regarding the need for chemotherapy to further improve your chances of cure. You will usually be able to go back to work 3 - 4 weeks after your surgery. Sometimes a temporary bag is needed after the intestine is joined back, to protect the area which has been joined and to keep stool away from it. This is called an 'ileostomy'. This will require a small second operation to close it approximately 3 - 4 months after the first surgery. Read More...
9. What happens to my bowel function after Colon surgery?

Typically removal of the colon, leads to increased frequency of stool, due to the shortening of the gut. However, in time, the body adapts and stool frequency and consistency become near normal; typically this takes 3-6 months after surgery.

10. Do I need to have checkups after my treatment is complete?

Yes, regular follow up is recommended. This is done 3 monthly for the first 2 years and 6 monthly for the next 3 years after surgery.

Once you cross 5 years, it is very unlikely your cancer will come back, and you are considered 'cured'. At each visit, simple blood tests, tumour markers [CEA assay], and examination by your doctor and scans if needed are required. A yearly CT scan of the chest, abdomen, and pelvis is mandatory for 5 years. A colonoscopy is performed to look for any small polyps which might have grown after surgery and thereafter every year or every other year based on the findings. Read More...