The last 4.5 feet of the digestive tract includes the colon and rectum. These two words are often combined as "colorectal." This region of the digestive tract is highly prone to noncancerous growths called polyps, as well as colon cancer and rectal cancer.
Fortunately, colorectal cancer is often curable — and sometimes preventable — using the screening test known as colonoscopy. Any polyps or other growths that are found can be removed during colonoscopy to be analyzed.
Physicians at the Center for Advanced Digestive Care at NewYork-Presbyterian/Weill Cornell Medical Center treat patients with all stages of colon cancer and rectal cancer. They are highly skilled in designing optimal colon cancer therapies, particularly for patients with stage 2, stage 3, and stage 4 colon cancer. Our surgeons use a range of surgical approaches depending on the diagnosis, including laparoscopic, robotic, and new endoscopic surgical techniques. Minimally invasive surgical approaches are prioritized whenever possible, as well as new targeted drugs and combination drug therapies based on the latest medical evidence. Our goal is to improve safety, speed each patient's recovery, and achieve high colon and rectal cancer survival rates.
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Colorectal polyps are small, usually slow-growing growths of tissue that protrude from the lining (wall) of the colon or rectum. They can be flat, round, or stalk-like. Polyps can develop anywhere in the colon or rectum and can be detected using colonoscopy and some imaging tests.
Most colorectal polyps are benign (non-cancerous), but some may become cancerous. Removing polyps during colonoscopy, before they have a chance to become cancerous, is a way to prevent colorectal cancer from developing. Whenever possible, polyps are removed through minimally invasive techniques, such as laparoscopic or robotic surgeries, or endoscopic submucosal dissection. These techniques and the technology that supports them allow us to intervene with less impact to the overall well-being of a patient.
The Center for Advanced Digestive Care currently has multiple options for removing polyps, including combined endo-laparoscopic surgery (CELS) for large polyps or ones that are hard to reach by normal methods. Pioneered at the CADC, the CELS procedure uses both endoscopic and laparoscopic techniques at the same time. This provides another option to patients who have been told that they must have a portion of their colon removed because the polyp or polyps are not easily removed. Combined endo-laparoscopic surgery can improve recovery time as well, because only small incisions are made.
Colorectal (large intestinal) cancer, which begins on the lining of the colon or rectum, is one of the most common cancers in the Western world. In the United States, cancer of the colon and rectum is the third most common cancer, and also the third most common cause of cancer death.
Colorectal cancer risk factors include age (over 50) obesity, inactivity, a Western diet (high in fat and red or processed meat and low in fruits and vegetables), alcohol intake, long-term smoking, genetics (family history of colorectal polyps, colon cancer, rectal cancer, or certain genetic syndromes), and personal medical history (such as inflammatory bowel disease or polyps).
Stages of Colon Cancer
More than 95 percent of colorectal cancers are adenocarcinoma, a cancer type that starts in cells that line the colon and rectum. Colorectal cancer stage is determined by analyzing the extent of cancer growth.
- Stage 1 colon or rectal cancer just begins to invade the muscle layer of the colon or rectum.
- Stage 2 colon or rectal cancer has grown through the muscle layer of the colon or rectum.
- Stage 3 colon or rectal cancer has spread to nearby lymph nodes.
- Stage 4 colon or rectal cancer has spread to other parts of the body, most often the liver. This is also called metastatic colorectal cancer.
Screening for Colorectal Cancer
Colorectal cancer screening is important, because most patients with early-stage cancer do not have any symptoms. Colon and rectal cancers surgically removed at an early stage have a greater chance of being cured than those detected at a later stage.
For patients at average risk for colon cancer, men and women who are healthy and have no family members with a history of colon cancer, The American Cancer Society and other cancer prevention authorities recommend that colon cancer screening should begin at age 50. If a screening test (such as a stool blood test) shows anything suspicious for a polyp or cancer, a complete colonoscopy is recommended. Colonoscopy involves the examination of the inside of the rectum and colon using a flexible lighted tube with a camera at its tip.
Men and women with certain colon cancer or rectal cancer risk factors should speak with their doctors about starting screening at a younger age and possibly being screened more often than people at average risk. Patients who have a history of ulcerative colitis or Crohn's disease, or a family history of intestinal conditions or other cancers?particularly breast, ovarian, or uterine cancers?must also be screened at a younger age.
Diagnosis of Colorectal Cancer
Tests used to help diagnose colon and rectal cancers include:
- Blood tests (including complete blood count and carcinoembryonic antigen)
- Endoscopic tests, such as sigmoidoscopy and colonoscopy with biopsy
- Imaging tests, such as a barium enema ("lower GI series") and computed tomography (CT) scanning
Confirmation of the diagnosis can only be made by taking a sample (biopsy) of the potentially cancerous tissue for examination by a pathologist. In addition, a complete examination of the colon and rectum is essential (not just flexible sigmoidoscopy), since 5 percent to 8 percent of patients with a primary cancer will have a second cancer at the same time, and 30 percent to 40 percent will have additional polyps.
Colorectal Cancer Treatment
Once a diagnosis of colorectal cancer is made, patients typically require surgery to remove cancerous tissue and determine the cancer stage. Minimally invasive (laparoscopic, endoscopic, robotic) procedures are used when possible, and when not possible, bowel-sparing surgical techniques are utilized to remove the least amount of colon possible.
Chemotherapy may be used to treat patients with certain stages of colon cancers (particularly stage 3 and stage 4 colon cancer), while radiation therapy and chemotherapy are used for locally advanced rectal cancers. Even when multiple treatments are needed, many patients can be cured of their disease, especially when the cancer is diagnosed in its earlier stages. Colorectal cancers are among the most curable of the most common cancers.
All of the major treatments for colorectal cancer are available through the Center for Advanced Digestive Care. Patients may also have opportunities to participate in clinical trials of innovative treatments, especially for metastatic colorectal cancer.
Surgery for Colorectal Cancer
The most commonly performed colon surgery is a "segmental resection" (removal of a section of the large intestine), which is performed laparoscopically at NewYork-Presbyterian/Weill Cornell more than 80 percent of the time. During this procedure (which is guided by a small camera inserted into the abdomen) surgeons remove the cancer, with some surrounding normal colon tissue and nearby lymph nodes, through several small incisions. Other techniques, including robotic colon resections, also aim to save as much bowel as possible. Surgery may also be used to prevent and treat the spread of cancer from the colon to other organs, such as the liver and ovaries.
Many patients ask if they will need a colostomy after colorectal cancer surgery (a bag worn outside the abdomen to collect intestinal material). At the Center for Advanced Digestive Care, fewer than 5 percent of patients undergoing colorectal cancer will need a permanent colostomy.
The CADC has a team of wound, ostomy and continence nurses specializing in care for these types of outcomes, and also runs a free ostomy support group for patients who wish to participate. Some patients with complex rectal conditions may need a "temporary" stoma to safely permit healing. Our center features a team of specialist nurses (called "enterostomal therapists") to help treat and counsel patients who require this care.
Chemotherapy, Radiation Therapy, and "Targeted Therapy"
Chemotherapy, radiation therapy, and "targeted therapies" may be used on their own or in combination before or after surgery to treat colorectal cancer. Brachytherapy, a type of radiation therapy that uses small pellets of radioactive material placed in or near a cancer, is sometimes used to treat rectal cancer.
Before surgery,chemotherapy and radiation therapy may be used to shrink the size of a tumor and reduce the risk associated with removing the tumor. This is especially important if the tumor has grown outside of the wall of the colon or rectum or is near a critical area, such as an artery.
Chemotherapy, radiation therapy, and increasingly targeted therapy may be used after surgery to destroy any remaining cancer cells. Targeted therapies are drugs that destroy cancerous cells by targeting specific proteins, leaving healthy cells unharmed; examples include cetuximab, bevacizumab, and panitumumab. These therapies also may be used for patients with advanced cancer or when surgery is not possible, to minimize the effects and symptoms of the cancer that patients may experience.
Physicians in the Center for Advanced Digestive Care are participating in clinical trials evaluating new chemotherapy drugs and drug combinations for patients with locally advanced and metastatic colon and rectal cancers. The goal of these studies is to improve the colorectal cancer survival rate.
Heated Intraperitoneal Chemotherapy (HIPEC)
In colorectal cancer cases where the malignancy has spread from the colon to the surrounding abdominal cavity, a new innovative procedure combines surgical techniques with chemotherapy to reduce as much cancerous tissue as possible. Heated intraperitoneal chemotherapy, or HIPEC , first removes any visible tumors with surgery, known as the cytoreduction stage. Then, the surgical team adds heated chemotherapy to the surgical site in a process known as chemoperfusion, with the intent of killing any remaining, unseen cancer cells. Heating the chemotherapy to a specific temperature increases its cancer-fighting ability and applying it to the site of surgery rather than intravenously can reduce some common chemo side effects. HIPEC is an option for a select group of patients, and carries a unique set of risks and side effects. Nevertheless, HIPEC gives a new option to some patients where other treatment options may not be as effective.