Colon and Rectal Cancer Care in Northwest Indiana

Colorectal cancer is a collective term used to describe cancer that begins in the colon or in the rectum. Depending on where they start, these cancers can also be named colon cancer or rectal cancer. In the United States, colorectal cancer is the third most common cancer diagnosed in both men and women. Because of this, the American Cancer Society recommends that people at average risk of colorectal cancer start regular screening at age 45.

Learn more about how colon and rectal cancer, including understanding your cancer type and treatment options.

Diagnosing Colorectal Cancer

If you have screening test results that suggest colorectal cancer or you have symptoms of colorectal cancer, your doctor must find out whether they are due to cancer or some other cause. There are many tests used for diagnosing colorectal cancer. In addition to a physical examination, the following tests might be used to diagnose colorectal cancer.

• Colonoscopy. A procedure using a tube-like instrument called a colonoscope looks inside the rectum and colon for polyps, abnormal areas, or cancer. The colonoscope has a light and a lens for easier viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.
• Virtual colonoscopy. Also called computed tomography colonography (CTC), this procedure 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.
• Sigmoidoscopy. A procedure to look inside the rectum and sigmoid (lower) colon for polyps, abnormal areas, or cancer. A sigmoidoscope is a tool very similar to a colonoscope used for a colonoscopy.
• Biopsy. This step is required to determine if cancer is present in the cells removed during a colonoscopy or other procedure. This might be done after a routine colonoscopy where polyps are found, and it’s performed after a diagnostic colonoscopy. Other tests can suggest that cancer is present, but only a biopsy can diagnose colorectal cancer.
• DNA stool test. This test checks DNA in stool cells for genetic changes that may be a sign of colorectal cancer.

• CT Scan. This type of imaging inside the body is often used with contrast to make it easier to see any other areas where cancer may be developing. If cancer has spread beyond the second layer of the colon wall, the CT may also be used to check the chest, abdomen, and pelvis for cancer.
• PET Scan. A small amount of radioactive glucose (sugar) is injected into a vein. Cancer cells metabolize sugar quicker than healthy cells. If there are cancer cells in areas of the body that aren’t visible in a CT Scan, the PET scan will show bright spots where the cancer cells are starting to focus in the body.
• Tumor Marker Genetic Testing. This type of test evaluates the cancerous cells to see if one of several known gene mutations is present. If so, this can change the type of treatment that is likely to work best.

Determining the Extent of Colorectal Cancer

If the biopsy shows that colorectal cancer is present, your doctor needs to know the extent (stage) of the disease to recommend the best treatment plan for you. This is also referred to as staging.

One common tool used to describe the stage of cancer is the TNM system: 

• Tumor (T): Has the tumor grown into the wall of the colon or rectum? How many layers?
• Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?
• Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Tumor (T)

The "T" plus a letter or number (0 to 4) is used to describe how deeply the primary tumor has grown into the bowel lining.

TX: The primary tumor cannot be evaluated.

T0 (T zero): There is no evidence of cancer in the colon or rectum.

Tis: Refers to carcinoma in situ (also called cancer in situ). Cancer cells are found only in the epithelium or lamina propria, which are the top layers lining the inside of the colon or rectum.

T1: The tumor has grown into the submucosa, which is the layer of tissue underneath the mucosa or lining of the colon.

T2: The tumor has grown into the muscularis propria, a deeper, thick layer of muscle that contracts to force along the contents of the intestines.

T3: The tumor has grown through the muscularis propria and into the subserosa, which is a thin layer of connective tissue beneath the outer layer of some parts of the large intestine, or it has grown into tissues surrounding the colon or rectum.

T4a: The tumor has grown into the surface of the visceral peritoneum, which means it has grown through all layers of the colon.

T4b: The tumor has grown into or has attached to other organs or structures.

Node (N)

The "N" stands for lymph nodes. Lymph nodes near the colon and rectum are called regional lymph nodes. All others are distant lymph nodes that are found in other parts of the body.

NX: The regional lymph nodes cannot be evaluated.

N0 (N zero): There is no spread to regional lymph nodes.

N1a: There are tumor cells found in 1 regional lymph node.

N1b: There are tumor cells found in 2 or 3 regional lymph nodes.

N1c: There are nodules made up of tumor cells found in the structures near the colon that do not appear to be lymph nodes.

N2a: There are tumor cells found in 4 to 6 regional lymph nodes.

N2b: There are tumor cells found in 7 or more regional lymph nodes.

Metastasis (M)

The "M" stands for metastasis, which describes cancer that has spread to other parts of the body, such as the liver or lungs.

M0 (M zero): The disease has not spread to a distant part of the body.

M1a: The cancer has spread to 1 other part of the body beyond the colon or rectum.

M1b: The cancer has spread to more than 1 part of the body other than the colon or rectum.

M1c: The cancer has spread to the peritoneal surface.

Stages of Colorectal Cancer

Colorectal Cancer Grades (G)

If the cancer looks similar to healthy tissue, it is called "differentiated" or a "low-grade tumor." If the cancerous tissue looks very different from healthy tissue, it is called "poorly differentiated" or a "high-grade tumor." The cancer’s grade may help the doctor predict how quickly it will spread. In general, the lower the tumor’s grade, the slower it’s likely to grow and the better the prognosis.

GX: The tumor grade cannot be identified
G1: The cells are more like healthy cells (well-differentiated)
G2: The cells are somewhat like healthy cells (moderately differentiated)
G3: The cells look less like healthy cells (poorly differentiated)
G4: The cells barely look like healthy cells (undifferentiated)

Colorectal Cancer Treatment Options

Treatment for colorectal cancer usually depends on the location of the tumor in the colon or rectum and the stage of the disease. The type of treatment recommended for colorectal cancer may include surgery, chemotherapy, biological therapy, radiation therapy, or a combination of methods.

Surgery to Remove Colorectal Cancer

Surgery is commonly used when colorectal cancer is found before Stage 3. There are several different types of procedures that can be used, but the most common is surgical resection, also called colectomy. This means removing the area of the colon where cancer was found along with some of the healthy colon nearby (in case cancer cells have already started growing there) and some of the nearby lymph nodes. The colon is then reconnected so that the patient can have regular bowel movements after healing.

Early-stage colorectal cancer might be able to be removed through procedures used during a colonoscopy. These include:

• Polypectomy: If the cancer is found in a polyp (a small bulging area of tissue), the operation is called a polypectomy. The procedure usually involves passing a wire loop through the colonoscope to cut the polyp from the wall of the rectum with an electric current.
• Local excision: This procedure involves using tools through the colonoscope to remove small cancers on the inside lining of the colon or rectum along with a small amount of surrounding healthy tissue.

If the cancer has spread to the lungs or liver, radiofrequency ablation (RFA) or cryoablation may be useful to kill cancer cells in those areas without requiring an open surgery. Not all liver or lung tumors can be treated with these approaches, but this type of surgery is typically less invasive and used when it’s likely to kill all the cells in the area. RFA can be done through the skin or during surgery.

Will You Need a Colostomy or Ileostomy?

Some patients will need to have the fecal matter removed from their body through an opening that’s surgically created rather than through its normal pathway. This can be done in a couple of ways:

• Colostomy: Often used for patients with rectal cancer or who’ve had a section of their colon removed. By making a surgical opening in the bowel, called a stoma, fecal matter can exit the body. It’s collected in a flat bag that fits over the stoma. A special adhesive holds it in place on your skin. The end of the colon is attached to the stoma.
• Ileostomy: The ileum is located at the lowest point of the small intestine. If you have an ileostomy, the stoma is attached to the end of the small intestine. An ileostomy is commonly used when a person’s ileum isn’t working properly or, in the case of colorectal cancer, when the disease has spread to the ileum.

Keep in mind that these are not always permanent conditions. Your oncologist and surgeon will discuss what’s necessary and why.

Radiation Therapy for Colorectal Cancer

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area and is often used for colorectal cancer patients because the cancer tends to recur in the same place it was previously found.

Doctors use different types of radiation therapy to treat cancer. Sometimes people receive two types of radiation therapy to treat colorectal cancer, including:

Radiation therapy may be given before surgery, after surgery, or both depending on whether the cancer spread and what was found during surgery.

Medical Oncology Therapies for Colon and Rectal Cancers

Your colorectal cancer treatment plan may include medications to destroy cancer cells. Some therapies are systemic, meaning the medications are given through the bloodstream to reach cancer cells throughout the body. Others are considered local therapies because the medication is applied directly to the cancer or kept in a single part of the body. This can be given before and/or after surgery.

The types of medications used for colorectal cancer include: