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Colorectal Cancer
According to the American Cancer Society an estimated 104,950 colon and 40,340 rectal cancer cases are expected to occur in 2005. Colorectal cancer is the third most common cancer both in men and in women. An estimated 56,290 deaths are expected to occur in 2005, accounting for about 10% of cancer deaths. Mortality rates continue to decline in both men and women, reflecting decreasing incidence rates and improvements in survival. Early diagnosis of this disease is one of the key elements to its cure. Colorectal cancers probably develop slowly over a period of several years. Before a true cancer develops, there are often earlier changes in the lining of the colon or rectum. If found early, before colorectal cancer has spread, the disease is considered curable. However, as the tumor spreads to the lymph nodes, a patient's chance of living at least five years drops to 40 - 60%. If the cancer has already spread to distant organs, the long-term survival rate decreases substantially. Top of this Page | Back to Cancer Information DiagnosisOver 95% of colon and rectal cancers are adenocarcinomas, a type of cancer of the cells that are on the inside lining of the colon and rectum. Colon cancer can be prevented if the polyps that form on these linings that lead to the cancer are detected and removed. Recently, screening methods have been recommended for people without symptoms to try to find either the polyps or cancer early. In many cases, these tests can find colorectal cancers at an early stage and greatly improve the chances of successful treatment. Screening tests include:
Many colon cancers have no symptoms. Hidden blood in the stool is often the only warning sign of colon cancer. However, you should talk to a doctor if you have any of the following symptoms, as they also can be associated with colon and rectal cancer.
If colon cancer is detected in its early stages, it is up to 90% curable. When colon cancer is found - PET Scanning can help. If your doctor suspects that you have colon cancer, you will need to have further tests to find out if the disease is really present and to see if it has spread. To find out if the cancer is present, you will need to have a biopsy procedure, which may be done as a part of a colonoscopy. Your doctor may order a series of blood tests to look for substances (like CEA and CA-19-9) that are made by colon and rectal cancer cells and released into the blood stream. In cases of suspected or known colon cancer, your doctor may also order a CT scan to show the structure of the organs and tissues in the abdomen. While these tests can provide information regarding the size and location of the primary tumor and may be able to detect other abnormalities that may represent the spread of the disease, they cannot tell if the abnormalities are benign or cancerous. Top of this Page | Back to Cancer Information 
TreatmentThe doctors diagnose the cancer and determine what kind it is by looking at a sample of the tumor under a microscope. This alone does not determine what treatment you can have. Before treatment, your doctors must determine if or how much the colon or rectum cancer has spread. This is called staging the cancer. In colon cancer, staging reflects how far into the colon the tumor has grown and whether or not it has spread beyond it, either to the lymph nodes or to distant organs. Earlier stage may be curable; however, in most cases cancer that has spread to other organs is incurable, once again highlighting the importance of early detection. The outlook for your recovery and your treatment options, which may include surgery, radiation therapy or chemotherapy, depend upon the stage of the cancer. For early cancer, surgery may be all that is needed. For cancer that is more advanced, chemical or radiation therapy may be needed as well to increase the chance of a cure or delay the cancer's progression. PET is the most useful test that you can have when doctors are staging or re-staging colon or rectal cancer because it is more accurate than CT or any other test. How PET works: In cancer, cells begin to grow at a much faster rate, feeding on sugars like glucose. PET works by using a small amount of a radioactive drug called a tracer in combination with a compound such as glucose. Once you are injected with the tracer and glucose, the tracer travels through your body. It emits signals as it travels and eventually collects in the organs targeted for examination. If an area in an organ is cancerous, the signals will be stronger since more glucose will be absorbed in those areas. In colon cancer, if the lymph nodes near the tumor or if a distant organ such as the liver has become involved by the cancer, they will take up more of the radioactive glucose. Whether or not distant organs are involved is a critical factor in deciding what your surgical and medical treatment will be. Some studies have shown that even if the cancer is spread in a limited way outside the colon, surgery can be done to remove these other tumors and improve your chance of recovery. CT scans may over or under-estimate the number of tumors in the liver, making it an unreliable test to identify patients that might benefit from aggressive surgical intervention. In the same whole-body picture, the PET scan can look throughout your whole body to see if there are any clumps of the cancer cells that have spread. The PET scan can make the difference in determining whether surgery should be done as well as chemotherapy or radiation therapy. After first showing the doctors where the cancer cells are, PET can also see if the chemotherapy and/or radiation therapy has been effective in killing them. Top of this Page | Back to Cancer Information Follow-UpFor several years after treatment, it is important to have regular follow-ups to determine if any active cancer cells have returned. Physical and rectal exams by a physician, regular colonoscopy, and blood tests are important to help tell if the cancer has come back. Blood markers like CEA are present in some patients with active colon cancer, so a rise in these blood values is used as an early warning sign that the cancer has returned. However, some people without cancer also have CEA in their blood, so it cannot be a specific test for cancer. Imaging with PET is also critical in order to look for the return of the cancer. Before PET, it was extremely difficult to monitor patients to see if the cancer had come back. Earlier imaging tests might not see the cancer as sensitively as PET, which could result in a delay of further treatment. In many patients with colorectal cancer, a mass may develop in the pelvis. This can be seen on a CT scan, but CT cannot determine if it is the result of surgical or radiation scarring, or is a recurrent cancer that must be treated. If the mass is cancerous, it will pick up the radioactive glucose and be seen on the PET scan. If, however, the mass is scarring caused by the radiation treatments, no glucose uptake will be seen in the area of the mass. PET can be used to image tumor response to therapy and to detect recurrence in successfully treated lesions. For post surgery and other treatments, PET is extremely important for monitoring to see if the cancer cells have returned and if treatment should be re-started. Colorectal cancer rarely recurs after 5 years, thus most patients who live 5 years without recurrence are considered cured. In the interim, make sure that PET is a part of your regular testing. Top of this Page | Back to Cancer Information Case Study
Top of this Page | Back to Cancer Information More InformationFind the support you need:The stress of illness can often be helped by joining a support group where members share common experiences and problems. Support programs exist in a variety of formats, including counseling, support groups, and self-help programs. For those who cannot attend meetings, there are also on-line mechanisms that may allow a patient to "chat" with other people facing similar situations. These types of programs can provide a way for you to relate your experience firsthand with others and may provide treatment-related tips about drug side-effects that will be helpful to you. Online Resources: |
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