Colorectal cancer
Colorectal cancer is a type of cancer that develops in the large intestine (large intestine) or deep in the large intestine that is connected to the anus (rectum). This cancer can be called colon cancer or rectal cancer, depending on the location of the cancerous growth.
Most colorectal cancers originate from polyps or intestinal tissue that develops in the inner lining of the large intestine or rectum. However, not all polyps develop into colorectal cancer. The possibility of polyps becoming cancer also depends on the type of polyp itself. There are 2 types of polyps in the large intestine, namely:
In addition to the type of polyp, several factors can influence the change in polyps in colorectal cancer, such as polyps larger than 1 cm.
Symptoms of colorectal cancer
Symptoms of colorectal cancer are often felt by patients when the cancer has progressed considerably. The type of symptom depends on the size and location of the cancerous growth. Some symptoms that may appear include:
Seek medical attention immediately if the symptoms appear above. Initially, the symptoms of colorectal cancer are often not felt. Therefore, routine checks must be carried out just in case.
Causes and risk factors for colorectal cancer
Abnormal cell growth is the cause of all cancers, including colorectal cancer. However, until now, it is not known for certain what causes the growth of these cells is not controlled.
Although the cause is unknown, several factors can trigger colorectal cancer, namely:
Diagnosis of colorectal cancer
Colorectal cancer can be detected early with a number of screening tests. People over the age of 50 are asked to undergo systematic screening according to doctor's instructions. Each filter has advantages and disadvantages. For this reason, it is important to consult a doctor before choosing the right screening for patients.
Various types of colorectal cancer screening, including:
Stool examination, including:
Colonoscopy. This procedure is identical to sigmoidoscopy, but uses a longer tube to examine the inside of the rectum and all parts of the large intestine. If the test shows polyps or cancer, the doctor will remove polyps or cancer. Colonoscopy is recommended every 10 years.
CT colonography (virtual colonoscopy). This examination uses a scanner to display the overall picture of the large intestine, for further analysis. This test is done every 5 years.
After confirmation of colorectal cancer in the patient, the doctor will conduct an examination to determine the stage of cancer development. The types of examination that can be chosen are X-rays, CT scans, PET scans, and MRI. Another examination procedure that can also be performed to determine the stage of colorectal cancer is lymph node biopsy, which involves taking lymph node samples for microscopic examination.
In addition to tests to determine the stage of cancer, other tests are performed on patients with colorectal cancer. One of them measures the level of CEA (carcioembryonic antigen) in the blood. High levels of CEA in the blood can be a sign of colorectal cancer. A complete blood count, ie the number of red blood cells, white blood cells, hemoglobin and platelets, is also needed to assess the patient's overall health.
Colorectal cancer stage
The development of colorectal cancer can be divided into several stages, namely:
Colorectal cancer treatment
Diagnosis and treatment of colorectal cancer as soon as possible will increase the chances of healing the patient. However, if the cancer has progressed at an advanced stage, treatment measures will be taken to prevent the spread while relieving the symptoms experienced by the patient.
Like other types of cancer, colorectal cancer treatments include surgery, chemotherapy and radiation therapy. The combination of the three stages of treatment depends on the patient's health condition and the extent of the spread of the cancer.
Mode of operation
Surgery is the main treatment for colorectal cancer. The doctor will do a resection, which involves cutting the colon or rectum which is attacked by cancer. The tissue and lymph nodes that surround the affected part of the cancer will also be removed. After this, resection will be accompanied by anastomosis, which is a combination of each end of the digestive tract that is cut by stitching.
Anastomosis will be very difficult in cases of cancer where there are only a few healthy parts. This condition is usually treated with a colostomy, which consists of a hole (stoma) in the abdominal wall. The stoma is connected to the end of the intestine that has been cut to remove impurities through the stomach wall. Outflow will be placed in a bag attached to the outside of the abdominal wall.
Colostomies can be temporary or permanent. Temporary colostomy is performed until recovery of the lower part of the large intestine. While permanent colostomy is performed on patients who have undergone rectal ablation as a whole.
Radio frequency ablation
This therapy uses radio waves to heat and destroy cancer cells. Radiofrequency ablation can be done by inserting electrodes into the skin preceded by local anesthesia. You can also insert electrodes through an incision in the abdomen, which is preceded by general anesthesia in the hospital.
cryosurgery
Cryosurgery is the procedure of freezing and destroying cancer cells with liquid nitrogen.
Chemotherapy and radiotherapy
Chemotherapy and radiotherapy are therapies that aim to destroy cancer cells and prevent them from multiplying. Chemotherapy can be given as tablets (eg, Capecitabine) or as an injectable form (5-fluorouracil, irinotecan, oxaliplatin). While radiotherapy is a therapy that uses high power radiation. Radiotherapy can be given externally using radiation or internally by inserting a catheter or wire containing radiation into an area of the body with cancer.
Both are also used in therapy before or after surgery. If this is done before surgery, the goal is to reduce the tumor to make it easier to remove. While chemotherapy or radiotherapy after surgery aims to kill the remnants of cancer cells that have spread from the main site of cancer.
The following will explain colorectal cancer treatments based on the stage of the patient's life:
Step 0
Treatment for stage 0 colorectal cancer depends on the size of the cancer. For small cancers, the surgeon-oncologist will excision, which involves removing the tumor and a small amount of surrounding tissue. Whereas in large cancers, the doctor will do resection of the large intestine, which cuts the large intestine and surrounding tissue affected by cancer. Lymph nodes around the large intestine will also be removed for microscopic examination, whether they have cancer or not. After the cancer section is removed, the doctor will perform an anastomosis, which is to reconnect a healthy large intestine by sewing.
Step 1
As in stage 0 colorectal cancer, treatment for stage 1 colorectal cancer consists of bowel resection with anastomosis. For cancer located in the rectum, the doctor can give radiotherapy or chemotherapy after resection.
Stage 2 and Stage 3
For cancers located in the large intestine, the doctor will undergo a bowel resection accompanied by anastomosis. In addition, doctors can also provide chemotherapy drugs. While in cancer located in the rectum, several treatment options can be used, including combining resection with chemotherapy and radiotherapy, accompanied by active monitoring of the patient's condition.
Step 4
In stage 4 colon cancer, or cancer that recurs after treatment, the following treatment options are:
If colorectal cancer has spread to the liver, lungs or ovaries, the doctor can perform surgical removal, depending on the patient's condition. In the case of cancer that has spread to the liver, surgery can be combined with chemotherapy before or after surgery.
Another therapeutic option is chemoembolization, which involves administering chemotherapy directly to the arteries, which leads to tumors to prevent blood supply to tumor cells. Whereas in patients with colon cancer who cannot undergo surgery, the doctor will undergo radiofrequency ablation or cryosurgery.
- Adenoma polyps. This type of polyp can turn into cancer, which is why adenomas are also called precancerous conditions.
- Hyperplastic polyps. This type of polyp is more common and usually does not become cancerous.
In addition to the type of polyp, several factors can influence the change in polyps in colorectal cancer, such as polyps larger than 1 cm.
Symptoms of colorectal cancer
Symptoms of colorectal cancer are often felt by patients when the cancer has progressed considerably. The type of symptom depends on the size and location of the cancerous growth. Some symptoms that may appear include:
- Diarrhea or constipation.
- Defecation that seems incomplete.
- Blood on the bench.
- nausea
- Gag.
- Stomach ache, cramps or bloating.
- The body gets tired easily.
- Weight loss for no apparent reason.
Seek medical attention immediately if the symptoms appear above. Initially, the symptoms of colorectal cancer are often not felt. Therefore, routine checks must be carried out just in case.
Causes and risk factors for colorectal cancer
Abnormal cell growth is the cause of all cancers, including colorectal cancer. However, until now, it is not known for certain what causes the growth of these cells is not controlled.
Although the cause is unknown, several factors can trigger colorectal cancer, namely:
- Age. The risk of colorectal cancer will increase with age. More than 90% of cases of colorectal cancer have been reported in people aged 50 or over.
- Disease history. Someone with a history of cancer or colorectal polyps is at higher risk for colorectal cancer. The same is true for family members who suffer from cancer or colorectal polyps.
- Genetic disease. Someone with a family disease, such as Lynch syndrome, is at high risk of colorectal cancer.
- Inflammatory bowel. Colorectal cancer is a high risk for people with ulcerative colitis or Crohn's disease.
- Lifestyle. Lack of exercise, inadequate consumption of fiber and fruit, consumption of alcoholic beverages, obesity or overweight, and smoking increase the risk of colorectal cancer.
- Radiotherapy. Exposure to radiation in the stomach area increases the risk of colorectal cancer.
- Diabetes
Diagnosis of colorectal cancer
Colorectal cancer can be detected early with a number of screening tests. People over the age of 50 are asked to undergo systematic screening according to doctor's instructions. Each filter has advantages and disadvantages. For this reason, it is important to consult a doctor before choosing the right screening for patients.
Various types of colorectal cancer screening, including:
Stool examination, including:
- Fecal occult blood test (FOBT). The purpose of this test is to determine whether there is blood that is not visible in the stool under a microscope. It is recommended to do FOBT once a year. This test includes 2 types, namely:
- Guaiac FOBT. Stool samples are placed on a special card and then chemicals are given. The card will change color if the positive stool contains blood.
- Fetal immunochemical testing (FIT). Stool samples are mixed with special fluids and placed in machines containing antibodies to control blood in the stool.
- The FIT-DNA test, which is an FIT test that is associated with tests to detect DNA changes in stool. This exam is done every 1 to 3 years.
Colonoscopy. This procedure is identical to sigmoidoscopy, but uses a longer tube to examine the inside of the rectum and all parts of the large intestine. If the test shows polyps or cancer, the doctor will remove polyps or cancer. Colonoscopy is recommended every 10 years.
CT colonography (virtual colonoscopy). This examination uses a scanner to display the overall picture of the large intestine, for further analysis. This test is done every 5 years.
After confirmation of colorectal cancer in the patient, the doctor will conduct an examination to determine the stage of cancer development. The types of examination that can be chosen are X-rays, CT scans, PET scans, and MRI. Another examination procedure that can also be performed to determine the stage of colorectal cancer is lymph node biopsy, which involves taking lymph node samples for microscopic examination.
In addition to tests to determine the stage of cancer, other tests are performed on patients with colorectal cancer. One of them measures the level of CEA (carcioembryonic antigen) in the blood. High levels of CEA in the blood can be a sign of colorectal cancer. A complete blood count, ie the number of red blood cells, white blood cells, hemoglobin and platelets, is also needed to assess the patient's overall health.
Colorectal cancer stage
The development of colorectal cancer can be divided into several stages, namely:
- Stage 0 - cancer appears in the deepest wall of the colonic wall.
- Stage 1 - cancer enters the second layer (mucosa) and spreads to the third layer (submucosa), but does not spread outside the colonic wall.
- Step 2 - The cancer spreads outside the walls of the large intestine and may have spread to nearby organs, but not to the lymph nodes.
- Stage 3 - The cancer has spread beyond the walls of the large intestine and to one or more lymph nodes.
- Stage 4 - Cancer has penetrated the walls of the large intestine and spread to distant organs of the large intestine, such as the liver or lungs. Tumor size can vary.
Colorectal cancer treatment
Diagnosis and treatment of colorectal cancer as soon as possible will increase the chances of healing the patient. However, if the cancer has progressed at an advanced stage, treatment measures will be taken to prevent the spread while relieving the symptoms experienced by the patient.
Like other types of cancer, colorectal cancer treatments include surgery, chemotherapy and radiation therapy. The combination of the three stages of treatment depends on the patient's health condition and the extent of the spread of the cancer.
Mode of operation
Surgery is the main treatment for colorectal cancer. The doctor will do a resection, which involves cutting the colon or rectum which is attacked by cancer. The tissue and lymph nodes that surround the affected part of the cancer will also be removed. After this, resection will be accompanied by anastomosis, which is a combination of each end of the digestive tract that is cut by stitching.
Anastomosis will be very difficult in cases of cancer where there are only a few healthy parts. This condition is usually treated with a colostomy, which consists of a hole (stoma) in the abdominal wall. The stoma is connected to the end of the intestine that has been cut to remove impurities through the stomach wall. Outflow will be placed in a bag attached to the outside of the abdominal wall.
Colostomies can be temporary or permanent. Temporary colostomy is performed until recovery of the lower part of the large intestine. While permanent colostomy is performed on patients who have undergone rectal ablation as a whole.
Radio frequency ablation
This therapy uses radio waves to heat and destroy cancer cells. Radiofrequency ablation can be done by inserting electrodes into the skin preceded by local anesthesia. You can also insert electrodes through an incision in the abdomen, which is preceded by general anesthesia in the hospital.
cryosurgery
Cryosurgery is the procedure of freezing and destroying cancer cells with liquid nitrogen.
Chemotherapy and radiotherapy
Chemotherapy and radiotherapy are therapies that aim to destroy cancer cells and prevent them from multiplying. Chemotherapy can be given as tablets (eg, Capecitabine) or as an injectable form (5-fluorouracil, irinotecan, oxaliplatin). While radiotherapy is a therapy that uses high power radiation. Radiotherapy can be given externally using radiation or internally by inserting a catheter or wire containing radiation into an area of the body with cancer.
Both are also used in therapy before or after surgery. If this is done before surgery, the goal is to reduce the tumor to make it easier to remove. While chemotherapy or radiotherapy after surgery aims to kill the remnants of cancer cells that have spread from the main site of cancer.
The following will explain colorectal cancer treatments based on the stage of the patient's life:
Step 0
Treatment for stage 0 colorectal cancer depends on the size of the cancer. For small cancers, the surgeon-oncologist will excision, which involves removing the tumor and a small amount of surrounding tissue. Whereas in large cancers, the doctor will do resection of the large intestine, which cuts the large intestine and surrounding tissue affected by cancer. Lymph nodes around the large intestine will also be removed for microscopic examination, whether they have cancer or not. After the cancer section is removed, the doctor will perform an anastomosis, which is to reconnect a healthy large intestine by sewing.
Step 1
As in stage 0 colorectal cancer, treatment for stage 1 colorectal cancer consists of bowel resection with anastomosis. For cancer located in the rectum, the doctor can give radiotherapy or chemotherapy after resection.
Stage 2 and Stage 3
For cancers located in the large intestine, the doctor will undergo a bowel resection accompanied by anastomosis. In addition, doctors can also provide chemotherapy drugs. While in cancer located in the rectum, several treatment options can be used, including combining resection with chemotherapy and radiotherapy, accompanied by active monitoring of the patient's condition.
Step 4
In stage 4 colon cancer, or cancer that recurs after treatment, the following treatment options are:
- Resection with or without anastomosis.
- Radiation therapy can be combined with chemotherapy to relieve symptoms experienced by patients.
- Chemotherapy to control tumor growth, with or without targeted therapy (angiogenesis inhibitors or monoclonal antibodies).
- In patients whose tumors are partially obstructed by the tumor, the doctor will place a stent to help the rectum remain open.
If colorectal cancer has spread to the liver, lungs or ovaries, the doctor can perform surgical removal, depending on the patient's condition. In the case of cancer that has spread to the liver, surgery can be combined with chemotherapy before or after surgery.
Another therapeutic option is chemoembolization, which involves administering chemotherapy directly to the arteries, which leads to tumors to prevent blood supply to tumor cells. Whereas in patients with colon cancer who cannot undergo surgery, the doctor will undergo radiofrequency ablation or cryosurgery.
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