Colon cancer, which affects men and women, it is one of the most common cancer globally. It is approximated that 49,190 colorectal deaths occur in Nigeria in 2016. Colorectal cancer is the third most common cancer in Nigerian men (after prostate and liver cancer) and the fourth most common cancer in Nigerian women (after breast, cervical and liver cancer).
What is colon or rectum cancer?
Cancer can start any place in the body. Cancer that starts in the colon or rectum is often called colorectal cancer. It starts when cells in the colon or rectum grow out of control and crowd out normal cells. This makes it hard for the body to work the way it should.
Cancer cells can spread to other parts of the body. Cancer cells in the colon or rectum can sometimes travel to the liver and grow there. When cancer cells do this, it’s called metastasis (pronounced meh-TAS-tuh-sis). To doctors, the cancer cells in the new place look just like the ones from the colon or rectum.
Cancer is always named for the place where it starts. So when colorectal cancer spreads to the liver (or any other place), it’s still called colorectal cancer. It’s not called liver cancer unless it starts from cells in the liver.
The colon and rectum
Ask your doctor to show you on this picture where your cancer is found.
The colon and rectum
Colon cancer starts in the colon, and rectal cancer starts in the rectum. These are both part of the digestive system. This is where food is broken down to make energy and where the body gets rid of solid waste (poop or stool). In the picture above you can see where the colon and rectum are inside the body.
In most cases, colon and rectal cancers grow slowly over many years. We now know that most of those cancers begin as a growth called a polyp (PAH-lip). Taking out the polyp early may keep it from turning into cancer.
Are there different kinds of colon and rectum cancers?
There are a few kinds of colon and rectum cancers.
The most common kind is called adenocarcinoma (AD-uh-no-KAR-sin-O-muh). This kind starts in the cells that make mucus to cover the inside surfaces of the colon and rectum.
How does the doctor know I have colorectal cancer?
Some signs of colorectal cancer are changes in your poop, bleeding, and belly pain. If signs are pointing to cancer, more tests will be done.
Here are some of the tests you may need:
Blood tests: Certain blood tests can tell the doctor more about your overall health.
Biopsy (BY-op-see): For this test, the doctor takes out a small piece of tissue where the cancer seems to be. The tissue is checked for cancer cells. This is the best way to know for sure if you have cancer.
CT or CAT scan: Uses x-rays to make detailed pictures of your body. CT scans can be used to help do a biopsy and can show if the cancer has spread.
Ultrasound: For this test, a small wand is moved around on your skin. It gives off sound waves and picks up the echoes as they bounce off tissues. The echoes are made into a picture on a computer screen. It’s used to help find cancer and see if it has spread.
MRI scan: Uses radio waves and strong magnets instead of x-rays to make detailed pictures. MRI scans are helpful in looking at the liver and the brain and spinal cord.
Chest x-rays: X-rays may be done to see if the cancer has spread to your lungs.
PET scan: PET scans use a kind of sugar that can be seen inside your body with a special camera. If there is cancer, this sugar shows up as “hot spots” where the cancer is found. This test looks at the whole body. It can help if the doctor thinks the cancer has spread, but doesn’t know where.
How serious is my cancer?
If you have colon or rectal cancer, the doctor will want to find out how far it has spread. This is called staging. You may have heard other people say that their cancer was “stage 1” or “stage 2.” Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.
The stage describes the growth or spread of the cancer through the layers of the wall of the colon or rectum. It also tells if the cancer has spread to nearby organs or to organs farther away.
Your stage can be stage 0, 1, 2, 3, or 4. Stage 0 is also called carcinoma in situ (KAR-sin-O-ma in SY-too). The lower the number, the less the cancer has spread. A higher number, such as stage 4, means a more serious cancer that has spread. For most people, the stage is not known until after surgery, so your doctor may wait until then to tell you about your stage and what it means for you.
Grading colorectal cancer
The cancer cells in the biopsy sample will be given a grade. This helps doctors predict how fast the cancer is likely to grow and spread. The grade is based on how much the cancer cells look like normal cells. Grades 1, 2, 3, and 4 are used. Cells that look very different from normal cells are given a higher grade (4) and tend to grow faster. Ask the doctor to explain the grade of your cancer. The grade helps the doctor decide which treatment is best for you.
What kind of treatment will I need?
There are many ways to treat colon and rectal cancers, but the main types of treatment are surgery, radiation, chemotherapy, and targeted therapy.
Two or more types of treatment may be used at the same time, or they may be given one after the other. The treatment plan that’s best for you will depend on:
- The stage and grade of the cancer
- The chance that a type of treatment will cure the cancer or help in some way
- Your age
- Other health problems you have
- Your feelings about the treatment and the side effects that come with it
Surgery for colon cancer
Most people with colon cancer have some type of surgery (SUR-jur-ee). The cancer, a small part of normal colon on either side of the cancer, and nearby lymph (limf) nodes are often removed. The 2 ends of the colon are then put back together.
For most colon cancers, an opening on the belly to get rid of body waste (poop) is not needed, but sometimes one is used for a short time. This opening is called a colostomy (kuh-LAHS-tuh-me). If you need a colostomy for a short time, your doctor or nurse can tell you more about how to take care of it and when it can come out.
Surgery for rectal cancer
Most people with rectal cancer need surgery (SUR-jur-ee). Radiation and chemo might be given before surgery. Sometimes the cancer can be removed through the anus, without cutting through the skin. This might be done to remove some stage 1 cancers that are small and close to the anus.
If the rectal cancer is more advanced and close to the anus, surgery will be done to take out the cancer and make an opening on your belly to get rid of body waste (poop). This is called a colostomy (kuh-LAHS-tuh-me). You will need it for the rest of your life.
If the rectal cancer has spread into nearby organs, more surgery is needed. The doctor may take out the rectum and nearby organs, like the bladder, prostate, or uterus, if the cancer has spread to those organs. You will need a colostomy after that surgery. If the bladder is removed, an opening to collect urine or pee (called a urostomy [yur-AHS-tuh-me]) is needed, too.
If you have a colostomy or a urostomy, you will need to learn how to take care of it. Nurses with special training will see you before and after surgery to teach you what to do.
Ask your doctor what type of surgery you will need. Ask what your body will look like and how it will work after surgery.
Side effects of surgery
Any type of surgery can have risks and side effects. Ask the doctor what you can expect. If you have problems, let your doctors know. Doctors who treat people with colon and rectal cancer should be able to help you with any problems that come up.
Radiation treatment
Radiation (RAY-dee-A-shun) uses high-energy rays (like x-rays) to kill cancer cells. After surgery, radiation can kill small spots of cancer that may not be seen during surgery. If the size or place of the cancer makes surgery hard to do, radiation may be used before the surgery to shrink the tumor. Radiation can also be used to ease some problems caused by the cancer.
For rectal cancer, radiation is given to help keep the cancer from coming back in the place where it started. It’s also used to treat cancer that has come back and is causing problems, like pain. Sometimes the radiation is aimed through the anus to reach the rectum, or small radioactive pellets or seeds might be used. They can be put around or right into the cancer. This is called brachytherapy (BRAKE-ee-THER-uh-pee).
Sometimes, both types of radiation are used.
Side effects of radiation treatments
If your doctor suggests radiation treatment, talk about what side effects might happen. The most common side effects of radiation are:
- Skin changes where the radiation is given
- Feeling sick to your stomach
- Diarrhea, pain when pooping, or blood in the poop
- Having to pee a lot, burning when you pee, or blood in the pee
- Feeling very tired (fatigue, which is pronounced fuh-TEEG)
Most side effects get better after treatment ends. Some might last longer. Talk to your cancer care team about what you can expect during and after treatment.
Chemo
Chemo (KEY-mo) is the short word for chemotherapy (pronounced KEY-mo-THER-uh-pee) — the use of drugs to fight cancer. The drugs may be given through a needle into a vein or taken as pills. The drugs go into the blood and spread through the body.
Chemo is given in cycles or rounds. Each round of treatment is followed by a break. Most of the time, 2 or more chemo drugs are given. Treatment often lasts for many months.
Chemo after surgery can help some people live longer. It can also help ease symptoms caused by the cancer.
Side effects of chemo
Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out. But these problems go away after treatment ends.
There are ways to treat most chemo side effects. If you have side effects, talk to your cancer care team so they can help.
Targeted drugs
Targeted drugs attack the changes in cells that cause cancer. These drugs affect mainly cancer cells and not normal cells in the body. They may work even if other treatment doesn’t. These drugs have different side effects than chemo, and they are often not as bad.
Side effects of targeted drugs
Side effects of targeted therapy depend on which drug is used. These drugs might cause high blood pressure, low blood counts, heart problems, and liver problems.
There are ways to treat most of the side effects caused by targeted drugs. If you have side effects, talk to your cancer care team so they can help.
What about other treatments that I hear about?
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, diets, and other things. You may wonder about these treatments.
Some of these treatments are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.
Questions to ask the doctor
- Why do you think I have cancer?
- Do you know the stage and grade of the cancer?
- What will happen next?
What will happen after treatment?
You’ll be glad when treatment is over. But it’s hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. At first, your visits may be every few months. Then, the longer you’re cancer-free, the less often the visits are needed.
Be sure to go to all of those follow-up visits. You will have exams, blood tests, and maybe other tests to see if the cancer has come back. Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health.
You can’t change the fact that you have cancer. What you can change is how you live the rest of your life – making healthy choices and feeling as well as you can.
REFERENCES
American Cancer Society (2015) http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf
Nzelu Abia (2015) http://guardian.ng/opinion/colon-cancer-prevention-is-achievable/
American Cancer Society (2015) Colorectal Cancer. Access: March 17th 2017, Source: