Brief information, risk factors and symptoms
Colon cancer, that is also known as colorectal, is a type of cancer that starts from rectum or colon. As any other type of cancer, colon cancer is characterized by uncontrolled growing cells of the body. This type of cancer usually starts with a polyp – a kind of growth on the inner lining of the rectum or colon. However, it is important to know that not all polyps change into cancer, though some of them might do it after several years. The chances that a polyp will become cancer after some, depends on the type of polyps. There are two of them: hyperplastic or inflammatory polyps that are more common and rarely change into cancer, and adenomatous polyps that have higer chances to become cancer, thus they are also called pre-cancerous condition. There is a number of risk factors that increase a chance to get colon cancer that need to be taken into consideration. The first factor is weight, which means that if a person has an excessive weight, his chances to have this disease in the future are higher. Another factor is the lack of physical activity. According to the statistic, majority of people, who get colon cancer, are not physically active. Therefore, it is important to do regular physical exercises in order to prevent this disease. Diet is the next important factor, because many studies showed that high amount or red or processed meat increases the chances of colon cancer. Therefore, those people, who prefer fast food to fresh vegetables and fruits, are in risk group. The last important factor is smoking. Smoking is harmful for health in general and it does not only increase chances in getting colon cancer, but also many other types of cancer and serious diseases. It is also important to know that the older person is, the higher his chances to have colon cancer. Moreover, it is more common among men than women.
In terms of symptoms, colon cancer often unfortunately do not have any symptoms, therefore many people live with this cancer even without knowing about it. However, if the symptoms appear, the combination of them helps easily to identify this type of cancer. The most common symptoms are: a change in bowel habits including diarrhea, narrowing of the stool or constipation that might last for several days; rectal bleeding; abdominal and cramping belly pain; fatigue and weakness; unintended and uncontrolled weight loss; blood in the stool and some others. Very often patients with colon cancer have anemia – a low amount of red blood cells that is caused by a constant bleeding. Therefore, often it is the first symptoms that many patients have. However, it is also necessary to note that very often some of the symptoms mentioned above are the signs of other not lethal diseases; therefore it is always necessary to consult a doctor immediately once the symptoms have appeared in order to eliminate a possible cancer. (Colorectal cancer)
Though colon cancer is a serious disease that might lead to death, there are several existing treatment methods that might be effective and can cure the cancer. However everything depends on the stage of the disease, the age of patients, coexisting diseases and etc. All the possible treatment methods will be discovered and analyzed further in the essay in more detail.
Treatment of colon cancer
Though colorectal cancer often becomes a reason of deaths, especially among older population, there are several various treatment methods that might be helpful in curing of colon cancer. The earlier the cancer is diagnosed, the higher is success that it will be cured and a patient will be able to return to a normal life.
The first widely used treatment method is called colectomy. It is defined as a surgical procedure, during which a surgeon removes a part of the colon. Depending on the extent of the disease, different parts and the length of the colon can be removed. For example, in serious cases the surgeon removes the whole colon that is called a total colectomy. If only one part is cut off, it is a partial colectomy. Hemicolectomy is a surgery, during which removal is applied either to the left or to the right portions of the colon. The fourth type of colectomy called proctoclectomy is the most serious because during this operation a patient loses both the colon and the rectum. (Mayo Clinic Staff) Regarding the method, how the colectomy is conducted, it might be divided into two types: open and laparoscopic. In the open colectomy a surgeon make a long incision in the wall of the abdomen, which allows to the see the colon. Laparoscopic colectomy does not require to make a long incision. Instead, the surgeon makes several small incisions and a thin tube with a light and a camera is inserted inside, with the help of which the surgeon is able to see the colon. The whole surgery is also made only with the help of small incisions, through which all the required and necessary surgical instruments are inserted with the purpose of performing colectomy. When the whole colon or a part of it is removed, the surgeon reconnects the digestive system of a patient in order to allow his or her body to expel waste, which offers several possible options. The first option is to rejoin the remaining parts of the colon. In order to do this, the surgeon attaches the portions of the colon to each other by creating anastomosis. This procedure does not impact the stool. Another option is to connect the intestine to an opening in the abdomen. After this procedure the waste will the body of a patient through the opening called stoma. In this case a patient has to wear a special bag for collection the stool. This option might be either temporary or permanent. The last third option is connection the small intestine to the anus. This option is used usually after proctoclectomy, when both the colon and the rectum are removed. In this case the surgeon uses a part of the small intestine in order to make a puch that is attached to the anus. This option does not impact the stool, and the waste leaves the body a natural way as it had been before colectomy. (Mayo Clinic Staff)
As any other surgery, colectomy might have different side effects and negative complications that are necessary to be considered. They include bleeding; infection; injuries of small intestines; bladder or any nearby organ; thrombosis of deep veins; bowel obstruction as a result of the surgery; pulmonary embolism that is also known as the presence of blood clots in the lungs; tears in sutures that reconnected before parts of the digestive system and some others. (Colectomy) After colectomy is done, a patient has to stay in a hospital for a whole in order to let his or her digestive system to heal.
Depending on the situation and the condition, a patient might spend in a medical institution from one day to a week. Moreover, after staying in a hospital, a patient also needs a long recovery at home – a period that involved weakness, fatigue and inability to eat normally for a while. Often, it is also needed to prepare for this surgery, and usually preparation involves some steps that are taken by a patient several days before colectomy. The first step is to stop taking certain medication that might increase the risk of above mentioned complications. The second step is fasting before the operation. Though it is not an obligatory requirement, some patients are asked by their doctor to stop drinking and eating several hours and sometimes even days before colectomy. In order to empty the colon it might be also prescribed by a doctor to drink a laxative solution that causes diarrhea and, as a result, cleans up the colon. In some cases patients also need to start taking antibiotics before this surgery because they help to prevent infection that might appear after the operation. However, it is also important to note that preparation for colectomy is not always required and even possible. For example, if there is a bowel perforation or obstruction, an emergency colectomy is needed, due to which there is simply no time for preparation. (Mayo Clinic Staff)
Another treatment method that has proved its effectiveness is radiation therapy. Radiation therapy is defined as the use of ionizing radiation with the purpose of destroying cancer cells. In terms of the treatment of colon cancer, this treatment method is believed to be an important modality, especially for the cancer treatment in the rectal area. Radiation therapy is applied either alone or in combination with other methods including surgery and chemotherapy. The main purpose of radiation therapy is to deliver to a patient a therapeutic dose of ionizing radiation to the tumor while minimizing injury to surrounding healthy tissues. (Berg 153) During radiation therapy high-energy rays are used in order to kill cancer cells. This kind of therapy might be used in the treatment of colon cancer in three different ways. First way is to use radiation therapy after the surgery. If the cancer was attached to the lining of the abdomen, the surgeon cannot be sure that the cancer had been totally removed after surgery. Therefore, in such cases radiation therapy is used to order to destroy all the possible cancer cells left behind. Also, radiation therapy might be used for those patients who cannot have surgery because of the health issues. Thus, radiation therapy is used instead as an alternative. Radiation therapy is also administered if the stage of the cancer is too serious and the cancer cells spread to other parts of the body, including the brain and bones, which makes other treatment methods not effective.
There are several types of radiation therapy used nowadays: external-beam radiation therapy, internal radiation therapy or brachytherapy, and radioembolization. External-beam radiation therapy is the most common type of radiation therapy applied to most patients with colon cancer. During this procedure a patient receives radiation from a special machine outside of the body, which makes it similar to getting X-ray, though the radiation level is more intense. Usually, patients receive this type of radiation therapy five days per week for several weeks. Internal radiation therapy is not so common, however it might be used for treatment some forms of colon cancer. Since it is an internal radiation, the source of radiation is places to the colon directly next to the tumor or even into it. This approach has one significant advantage: since the radiation reaches the tumor without passing through the abdomen’s tissues and the skin, there is a lower risk of possible side effects. Internal radiation therapy is divided into two subtypes: endocavitary and interstitial brachytherapy. During endocavitary radiation therapy a small device is placed into the colon through the anus in order to deliver the radiation to the tumor for several minutes. Typically there are 4 treatments for most of the cases of colon cancer, and the duration of endocavitary radiation therapy is approximately 2 weeks. This type of radiation therapy is good for older patients because it allows to escape a serious surgery and, as a result, possible severe side effects. Interstitial brachytherapy is conducted with the help of a special tube that is placed inside the rectum. When the tube is placed, small pellets of radiation are put through this tube for several minutes. This type of radiation therapy is used in many, but not all cases, and is more preferable for patients, who are not healthy enough for conducting the surgery. Usually interstitial brachytherapy is conducted for 2-3 weeks several times per week, though it also can be one-time procedure if necessary. Radioembolization is the third type of radiation therapy. In contrast to others, this type is usually used for those patients, who metastatic colon cancer with liver metastases.
Despite the fact that radiation therapy has proved to be an effective treatment, there is a number of possible side effects that every patient should be informed about before the treatment. The most common side effects include stool leakage, blood in the stool, diarrhea, painful bowel movements, tiredness and fatigue and even sexual problems including vaginal irritation for women and erection issues for men. Though most side effects disappear after the treatment, some of them might stay longer. If side effects are too intense and long, a patient should immediately to consult his or her doctor in order to find out the reason and possible solution. (Radiation therapy for colorectal cancer)
The third effective treatment method of colon cancer is chemotherapy. It is a treatment based on the use of special anti-cancer medicaments. The drugs provided to a patient during chemotherapy can be given in different ways: though injections, with a pump or in a form of pills that are taken by mouth. Chemotherapy can be divided into several types in accordance with every individual situation. For example, palliative chemotherapy is good for advanced forms of colon cancer when metastases have already spread to different organs of the body. Since in such cases it is impossible to remove the tumor, the best way is to use chemotherapy that leads to shrinkage of the tumor, alleviate symptoms and extends the life of a patient. Adjuvant chemotherapy is good for those patient, who have already gone through the surgery and the tumor was removed. In such case adjuvant chemotherapy is used in order to kill the cancer cells that might have been left and missed, especially those that have already spread to the liver for example. Neoadjuvant chemotherapy is opposite to adjuvant because it is conducted before the surgery. Usually, such therapy is applied in order to shrink the tumor, which will make the surgery easier and will allow a surgeon to remove the tumor completely. (Chemotherapy for colorectal cancer). Chemotherapy is given to patients in three different ways: systemic, regional or hepatic artery. In terms of systemic approach, the medicaments are injected or taken by mouth in order to enter the bloodstream of a patient’s body and approach all its parts. Systemic chemotherapy is especially good and effective for the cancer that has already metastasized. Regarding regional approach, it is a method when the drug is injected directly into the artery that leads to the colon or the organ with the tumor. This approach reduces the chances of side effects because other parts of the body are not affected by the drugs. The third is when the medicament is injected to the hepatic artery, which makes this method similar to the regional chemotherapy. This approached is preferable and especially effective for patients with metastases in the liver. Regardless the methods and type of chemotherapy, it is always given in cycles, which means that after one period of chemotherapy there is a rest period that is provided in order to give the body time for recovery. An average duration of one cycle of chemotherapy is 2-4 weeks and usually there several cycles.
Unfortunately chemotherapy also has some side effects. Since the drugs injected in the body attack directly and very fast the tumor by killing cancer cells, other cells including those in the bone marrow, hair follicles, the lining of intestines and the mouth are affected and destroyed as well, which is the main reason of side effects of chemotherapy. Therefore, the most common side effects include: the loss of hair, loss of appetite and as a result the loss of weight, diarrhea, mouth sores, high chance of various infections because of having few white blood cells, fatigue, easy bruising and bleeding and some others. Moreover, there are some side effects that are related only to specific drugs. However, regardless the side effects and their intensity, most of them disappear quiet fast once chemotherapy is finished. If the side effects are too intense and cause much discomfort to a patient, there are also drugs that might reduce some of them and improve the quality of a patient’s life during the treatment. It is also very important for patients to tell about the side effects to their doctors because in some cases it is better to reduce the volume of the drugs for chemotherapy or even to stop the therapy for a while (Chemotherapy for colorectal cancer)
There are different drugs that are used for chemotherapy. The first choice chemotherapy drug in treatment of colorectal cancer is 5-Fluorouracil that has been used already for many years. It is used in the combination a vitamin called leucovorin, which makes 5-FU much more effective. There is also a pill form of 5-Fluorouracil known as Xeloda. It is usually used for those patients, whose colon cancer has already spread throughout the whole body. There are also two other drugs – Eloxatin and Camptosar – that are used in combination with Xeloda and 5-FU after the surgery for better effect and faster recovery. All these mentioned medicaments are considered to be traditional because they are the first that started being used for treatment of colorectal cancer. However, new drugs also appear. Among the newest are Erbitux, Avastin, Vectibix and Aflibercept that are also usually given not alone but in combination with 5-FU. Sometimes also Eloxatin and Camtosar are also given, especially if there are already metastases in the body. There is also one new drug that is given alone orally in case, if other medicaments do not help anymore or have stopped working – Regorafenib.
There is also one more new treatment method – immunotherapy. Immunotherapy, that is also known as biological treatment, is a type of therapy that is based on the usage of a person’s own immune system in order to fight with cancer cells. The main principle of immunotherapy is to stimulate the immune system in order to make it work more effectively.
There are several different types of immunotherapy available nowadays for treatment of colon cancer. The first one is biological response modifiers. These modifiers are specific substances, the purpose of which not to destroy cancer cells directly, but rather to strengthen the immune system in order to increase its productivity to affect tumors indirectly. These modifiers include cytokines – special chemicals that are produced by body cells in order to instruct other cells. The cytokines are divided into interleukins and interferons. These substances are given to patients in a form of infusion or injection with the purpose of stimulating the immune system and help it work in a more affective way. Another type of immunotherapy is colony-stimulating factors. They are special substances that are used in order stimulate the production of sponge-like, soft material inside the bones called bone marrow cells and that are divided in both red and white cells. The role of white blood cells is to fight with infection, while red blood cells are responsible for carrying carbon dioxide and oxygen between tissues and organs. Since very often other treatment methods lead to decrease of these important cells in the body of a patient, colony-stimulating factors support the immune system during the treatment of colon cancer and help it to remain strong enough.
The third type of immunotherapy that is believed to be very promising is a tumor vaccine. These vaccines are still being developed by doctors and researchers, and their purpose is to help the immune system to recognize cancer cells better and faster. In theory, it is expected that tumor vaccines will be similar in the functions to the vaccines against mumps, measles and other well known infections. It is expected that these vaccines will be provided to patients who have had already cancer in order to protect the body and prevent colon cancer from returning, which unfortunately happens quiet often. However, the effect of tumor vaccines has not been scientifically proved yet, therefore they are still being studied in clinical trials.
One more type of immunotherapy is called monoclonal antibodies. They are also special antibodies that are produced now in the laboratories and used for treatment not only of colon cancer, but also other forms of cancer. These antibodies work in two directions: they might either the detect cancer and the exact location of the tumor, or to deliver radioactive material, drugs and toxins directly to a tumor in order to kill it as quick as possible. In February 2004 the first monoclonal antibody Erbitux was officially proved for treatment of colorectal cancer with metastases. Three years later another drug called Vectibix, similar to Erbitux, appeared.
Though immunotherapy is quiet safe method of treatment of colon cancer, it still might cause different side effects that are quiet individual and can vary from patient to patient. Usually immunotherapy causes side effects similar to flu symptoms, including nausea, chills, fever and the lack of appetite. As a result of treatment, the blood pressure might also drop. Many patients also have rashes, especially those, who take Vectibix and Erbitux. However, rashes are not bad because they indicate that these medicaments are working and treatment is successful. Sometimes, if side effects are too intense, it might be a sign that immunotherapy is not the best choice for a patient and then alternative methods of treatment should be chosen. (Immunotherapy for Colorectal Cancer)
Conclusion
Summarizing all the written about colon cancer and different methods of treatment, it is possible to say that fortunately patients with colorectal cancer have quiet high chances for recovery, especially if it is diagnosed at the early stage. Moreover, there are many various methods of treatment for all stages of the cancer, therefore even patients with metastases still have a chance for a recovery or at least for a prolonged life.
In terms of effectiveness of different methods of treatment, it is possible to say that the most effective way to treat colon cancer is a surgery – colectomy. However, it is not always helpful, especially if the cancer is diagnosed too late, and if a patient has serious health problems that do not allow surgery. Furthermore, it is also possible to say that usually it is much better and more effective to combine several treatments together in order to achieve the best results – like colectomy and chemotherapy or colectomy and radiation therapy for example.
Works Cited
Berg, Deborah. Pocket Guide to Colorectal Cancer. Sudbury: Jones and Barlett Publishers. 2003. Print
“Chemotherapy for colorectal cancer”. WebMd. WebMd, LLC. 20 Jan 2016. Web. 17 Apr 2016.
“Colectomy”. Depatment of Surgery: colorectal surgery. The Regents of the University of California. 2015. Web. 16 Apr 2016.
“Colorectal Cancer” American Cancer Society. American Cancer Society, Inc. n.d. Web. 16 Apr 2016
“Immunotherapy for Colorectal Cancer”. WebMd. WebMd, LLC. 27 July 2014. Web. 18 Apr 2016.
“Radiation therapy for colorectal cancer”. American Cancer Society. American Cancer Society, Inc., n.d. Web. 17 Apr 2016.
Mayo Clinic Staff. “Colectomy” Mayo Clinic. Mayo Foundation for Medical Education and Research. 17 Nov 2015. Web. 16 Apr 2016.
