Colorectal Cancer

Colorectal cancer is a disease in which malignant (cancer) cells form in the tissues of the colon.

Our physicians and surgeons are accustomed to treating the most advanced and challenging cases of colorectal cancer from throughout inland Northern California, and have built a reputation for innovative therapies and surgical techniques that minimize the need for temporary or permanent colostomies. Our specialists also have extensive experience and expertise with colorectal cancers that have spread to the liver or other areas of the abdomen.

A multidisciplinary team of top academic specialists evaluates every patient seen in our Colorectal Cancer Program. Depending on the type and stage of cancer, the treatment team may include surgical oncologists, radiation oncologists, medical oncologists, gastroenterologists, pathologists and radiologists. The team also includes oncology nurses, registered dietitians, clinical research associates, genetic counselors and social workers. Collaboratively, team members design an individualized course of treatment for each patient. In every case, the goal is to achieve the best chance for a cure, while maximizing quality of life.

Advanced techniques

Our specialists use a combination of advanced medical and surgical techniques, including staging with endorectal ultrasound, preoperative chemoradiation, external-beam radiation and colonic stents. Our surgeons are skilled at treating rectal cancers, using such advanced techniques as transanal tumor resection and nerve-sparing total mesorectal resection. We also offer multiple treatment options for patients whose cancer has spread to the liver, including radiofrequency ablation to destroy liver tumors and direct chemotherapy delivered to the liver via pumps.

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Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Fecal occult blood test: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.

Digital rectal exam: An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the rectum to feel for lumps or anything else that seems unusual.

Barium enema: A series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.

Sigmoidoscopy: A procedure to look inside the rectum and sigmoid (lower) colon for polyps (small pieces of bulging tissue), abnormal areas, or cancer. A sigmoidoscope is inserted through the rectum into the sigmoid colon. A sigmoidoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.

Colonoscopy: A procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope is inserted through the rectum into the colon. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.

Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.

Virtual colonoscopy: A procedure that uses a series of x-rays called computed tomography to make a series of pictures of the colon. A computer puts the pictures together to create detailed images that may show polyps and anything else that seems unusual on the inside surface of the colon. This test is also called colonography or CT colonography.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center

A change in bowel habits
Blood (either bright red or very dark) in the stool
Diarrhea, constipation, or feeling that the bowel does not empty completely
Stools that are narrower than usual
Frequent gas pains, bloating, fullness, or cramps
Weight loss for no known reason
Feeling very tired
Vomiting

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center

Age 50 or older
A family history of cancer of the colon or rectum
A personal history of cancer of the colon, rectum, ovary, endometrium, or breast
A history of polyps (small pieces of bulging tissue) in the colon
A history of ulcerative colitis (ulcers in the lining of the large intestine) or Crohn disease
Certain hereditary conditions, such as familial adenomatous polyposis and hereditary nonpolyposis colon cancer (HNPCC; Lynch Syndrome)

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center

Surgery

Surgery (removing the cancer in an operation) is the most common treatment for all stages of colon cancer. A doctor may remove the cancer using one of the following types of surgery:

Local excision: If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall. Instead, the doctor may put a tube through the rectum into the colon and cut the cancer out. This is called a local excision. If the cancer is found in a polyp (a small bulging piece of tissue), the operation is called a polypectomy.
Resection: If the cancer is larger, the doctor will perform a partial colectomy (removing the cancer and a small amount of healthy tissue around it). The doctor may then perform an anastomosis (sewing the healthy parts of the colon together). The doctor will also usually remove lymph nodes near the colon and examine them under a microscope to see whether they contain cancer.
Resection and colostomy: If the doctor is not able to sew the 2 ends of the colon back together, a stoma (an opening) is made on the outside of the body for waste to pass through. This procedure is called a colostomy. A bag is placed around the stoma to collect the waste. Sometimes the colostomy is needed only until the lower colon has healed, and then it can be reversed. If the doctor needs to remove the entire lower colon, however, the colostomy may be permanent.
Radiofrequency ablation: The use of a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in the hospital with general anesthesia.
Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy.

Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

More about surgical interventions for colon cancer

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

Chemoembolization of the hepatic artery may be used to treat cancer that has spread to the liver. This involves blocking the hepatic artery (the main artery that supplies blood to the liver) and injecting anticancer drugs between the blockage and the liver. The liver’s arteries then deliver the drugs throughout the liver. Only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on what is used to block the artery. The liver continues to receive some blood from the hepatic portal vein, which carries blood from the stomach and intestine. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy is a type of targeted therapy being studied in the treatment of colon cancer.

Monoclonal antibody therapy uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

New types of treatment are being tested in clinical trials.

UC Davis Cancer Center has a large clinical trials network, allowing our patients access to the newest drugs and therapies before they become widely available. During all stages of your treatment you should talk to your medical specialist about what clinical trials may be available for you.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center