Colon cancer diagnosis – now what?

In Switzerland, there are between 4,000 and 5,000 new cases of colon cancer each year. In this interview, Prof. Dr Christoph Maurer, accredited doctor at the Hirslanden Klinik Beau-Site in Bern and responsible for the Aare gastrointestinal center in Solothurn, explains to us the reasons why a surgical intervention is inevitable for patients suffering from colon cancer and in what extent we need our colon so that it can function without problems.

Teacher. Dr. Maurer, we often hear about “bowel cancer”: is it colon cancer or small bowel cancer?


Teacher. Dr. Christoph Maurer: When we talk about bowel cancer, it’s actually always colon cancer. Colon cancer is the third most common type of cancer in Switzerland (the most common types of cancer being breast cancer in women / prostate cancer, in men, followed by lung cancer) . Cancer of the small intestine, however, remains extremely rare.

What are the causes of colon cancer?


Teacher. Dr. Christoph Maurer: Colon cancer occurs in 97% of cases as a result of mild intestinal polyps. These are growths that develop on the mucosa. These growths, initially small, can over the years develop into large polyps and degenerate. In other words, almost all of them can develop into a malignant tumor. It takes between 5 to 7 years for a tiny polyp to turn into a clever polyp. This is called an adenoma-carcinoma sequence. Exceptionally, in only 3% of cases, colon cancer develops directly while the mucosa has a normal appearance.

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The adenoma-carcinoma sequence and the importance of screening tests

Scientists refer to the development of benign polyps (adenoma) into cancer (carcinoma) as the adenoma-carcinoma sequence. In order for adenomas not to develop into malignant tumors, they should be detected as far as possible by a colonoscopy and removed in time. In more than 90% of cases, colonoscopy performed early enough can prevent colon cancer. This is why colonoscopies as screening tests are essential.

What are the symptoms of colon cancer?

Teacher. Dr. Christoph Maurer: Changes in defecation habits are the most common symptom. For example, a person who usually has a bowel movement once in the morning, who suddenly no longer has a bowel movement, then has loose stools, and then has a bowel movement five times in a row the following day. In addition, blood in the stool and mucus can be signs of colon cancer. It is only later, when the cancer has progressed locally, that symptoms such as pain or cramps appear. Symptoms generally reflect the fact that the cancer has already developed and is no longer a benign polyp.

Colon cancer diagnosis

Who is the population most affected by colon cancer?


Teacher. Dr. Christoph Maurer: People aged 50 and over are the risk group. Genetic predisposition is the main risk factor here. People with a history of colon cancer or other types of cancer in the family should receive good care. Besides the genetic predisposition, smoking or being overweight can also promote colon cancer. In addition, people who eat red meat – especially grilled meat – regularly, ie several times a week, have a higher risk of colon cancer compared to people who eat less red meat or prefer to eat poultry or Fish.

My bowel movements changed or I noticed blood in my stool. What should I do?


Teacher. Dr. Christoph Maurer: It depends on the age: A person aged 50 or over who has never had a colonoscopy in his life must imperatively be examined quickly. Colonoscopy is the most effective diagnostic tool for colon cancer. It also allows you to do a biopsy, that is, to take tissue samples and screen for cancer. The presence of blood in the stool is not only a symptom of colon cancer, but can also be caused by hemorrhoids, small vascular abnormalities (angiodysplasias) or divercules. The first step for patients is to consult the family doctor to discuss the procedure to follow.

How is the diagnosis of colon cancer made? What tests are performed?


Teacher. Dr. Christoph Maurer: Colon cancer is diagnosed by a colonoscopy. In case of suspicious changes, tissue samples can be taken to determine the presence of cancer. Small colon polyps can be removed directly during the colonoscopy.

Many patients fear colonoscopy. Is it painful?


Teacher. Dr. Christoph Maurer: Typically, patients are given a fast-acting sleeping pill (Propofol) for colonoscopy. They are therefore relaxed and feel no pain. In addition, the removal of polyps does not cause any pain.

The patient was diagnosed with colon cancer. What is happening to him and what are his chances of recovery?

Teacher. Dr. Christoph Maurer: First, the stage of advancement of colon cancer has to be established. For this, a CT scan of the rib cage and the abdominal cavity is prescribed. Additional magnetic resonance imaging (MRI) is only necessary if the tumor is located in the rectum, the lowest part of the colon. Treatment for colon cancer varies depending on the location and stage of the tumor. The main method of treatment remains surgery, as the affected section of the colon must be removed, including the adjacent sections for safety. In addition, the potentially affected lymph nodes near colon cancer are also removed. Depending on the size of the tumor, the operation of the colon is done through an incision in the abdomen, with the technique of minimally invasive laparoscopy or using the Da Vinci surgical robot. In the latter two cases, it is possible to enter the abdomen through small skin incisions, which reduce convalescence.

If cancer is detected at an early stage, this maximizes the chances of being able to completely remove the tumor and promotes long-term healing. In such cases, surgery is usually sufficient. It does not require chemotherapy or in the case of radiotherapy rectal cancer (irradiation). But this is only the case if the cancer has not yet spread and has not yet progressed locally.

What is the treatment like if metastases have already formed in other organs?


Teacher. Dr. Christoph Maurer: Distant metastases (secondary tumors) that occur in the bloodstream in the liver or the lungs should also be completely eliminated as much as possible. If distant metastases cannot be removed initially, it is possible to do so by chemotherapy after reduction upstream. With current chemotherapy, it is possible to remove approximately 40% of initially inoperable liver metastases in the second place. This is a crucial step for the long term prognosis. This is why close and continuous collaboration between oncology, chemotherapy and surgery is essential.

When is a colostomy necessary after a colon operation?


Teacher. Dr. Christoph Maurer: If the tumor is located at the very bottom of the rectum, it may be necessary to remove the affected section of the colon with the anal sphincter during surgery. In this case, fecal continence cannot be maintained. It is necessary to perform a final colostomy. However, thanks to the highly specialized training and experience of the surgeon, it is possible to preserve the sphincter in 95% of cases of rectal cancer, without oncological compromises, which of course contributes greatly to the quality of life of the patient.

If the sphincter is retained during the rectum operation, the intestinal suture will be near the anus. This delicate suture requires a temporary colostomy. This helps relieve the suture and ensure better healing. After 6 to 12 weeks, the artificial anus can be removed, i.e. closed. Then the stool is eliminated again through the anus.

What complications can arise during the operation?


Teacher. Dr. Christoph Maurer: As with all operations, general complications can arise, such as hemorrhage or infection of a wound. If the suture between the two ends of the intestine to be joined is not tight, peritonitis can develop and usually requires a second operation. The average leak rate from the intestinal suture is 7% in Switzerland. In addition to reducing this rate to less than 1%, an experienced surgeon has learned how to preserve the nerves of the bladder and sexual organs of his patients with rectal cancer. Disorders of the bladder or sexual function after surgery should therefore be an exception today.

What happens to patients after the surgery?


Teacher. Dr. Christoph Maurer: As a rule, patients stay in hospital treatment for 4 to 8 days. The first days, they eat tea, soup, rusks and mash. Thereafter, light whole foods are allowed. After 3 weeks, patients can eat everything again without any restrictions. 3 to 4 weeks after the operation, patients can exercise again, especially if the laparoscopic technique has been used. Depending on the size of the abdominal incision, no heavy load should be lifted for a few weeks. Most patients return to work 3 to 4 weeks after surgery. The natural adaptation process to the shortened colon takes 3 to 12 months. After this period, the frequency and consistency of the stool is similar or identical to that before the operation. In principle, humans only need 20 to 30 cm from their colon for satisfactory functioning. The most important part is the rectum.

After microscopic analysis of the section removed from the colon and final determination of the stage of the tumor, the procedure to be followed in terms of treatment or follow-up is determined by the committee of cancer therapies in which various specialists participate, then is proposed to the patient.

What preventive measures reduce the risk of colon cancer?


Teacher. Dr. Christoph Maurer: Physical activity is very important because it stimulates bowel activity. People who exercise 3 times a week have better, more regular bowel movements. As a result, all harmful substances potentially present in the intestine act for a shorter time, thereby reducing the risk of colon cancer for these people. Avoiding overweight and abstaining from smoking also reduces the risk of colon cancer.

Good health begins in the gut


There is a close link between healthy intestinal flora and human health. On the Hirslanden Blog you will find tips for good gut health.


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