SPECIAL FIELD BOWEL CANCER
Bowel cancer refers to malignant tumours of the rectum, large intestine and small intestine. In this context, tumours of the rectum (rectal carcinoma) and the large intestine (colon carcinoma) are significantly more frequent than carcinomas of the small intestine (jejunum and ileum carcinoma). The sooner the disease can be detected and removed completely, the better the chances of a cure.
Most colorectal carcinomas develop over several years from benign preliminary stages of so-called neoplastic polyps in an “adenoma to carcinoma sequence" (adenoma – benign, carcinoma – malignant). This is why a precautionary colonoscopy for the early detection and removal of such polyps represents an important measure to prevent the development of colorectal carcinomas.
The main risk factors for developing bowel cancer are old age and the presence of polyps in the large intestine.
Less frequent risk factors are genetic disposition, specific genetic syndromes and chronic inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease. There is an increased risk of developing colorectal carcinomas in the case of constant excessive caloric intake, a diet that is rich in fats and meat as well as a low intake of dietary fibre.
Early detection of colorectal cancer
There are, however, also good reasons to recommend an early detection screening for colorectal cancer to healthy persons. The sooner preliminary stages of cancer (colorectal polyps) are diagnosed and removed, the greater the likelihood of a permanent cure.
The following examinations for the early detection of cancer of the large intestine have been included in the colon cancer prevention programme:
- Test for (unseen) blood in stools (Fecal Occult Blood Testing; FOBT): annually from the age of 40
- Colonoscopy: every five to seven years from the age of 50
CT colonography (virtual colonoscopy) as an alternative?
A virtual colonoscopy is a procedure where the large intestine is examined by using computed tomography and double-contrast enema; it produces three-dimensional images of the colon without an endoscope actually being inside the intestines. Although this method is gentler than regular colonoscopy, polyps can only be seen but not removed. This is why a CT colonography cannot fully replace regular colonoscopy.
Colorectal cancer and rectal cancer
If colorectal cancer or rectal cancer is diagnosed during a preventive check-up or due to symptoms, immediate treatment is necessary. The tumour has to be removed by surgery. Some situations require chemotherapy and/or radiation therapy before or after surgery.
I will advise you as to the full clarification of the diagnosis of disease and the necessary treatment methods and will perform the operation in a professional and competent way.
Keyhole surgery (laparoscopic operation) has also found its way into the surgical treatment of cancer of the large intestine and might be applicable in your situation. At present, the majority of operations on the large intestine and rectum are, however, still performed using conventional open surgery.
Together we can plan the surgical procedure best suited to you for the safe and radical removal of the diseased parts of the bowel.
The part of the colon affected by the tumour and the surrounding tissue including the lymph nodes are removed and the healthy ends of the colon are reattached (anastomosis).
In some situations, until the complete healing of the anastomosis, it may be necessary to build a temporary enterostomy (colostomy, ileostomy). In most cases this is a temporary measure and can be reversed in another operation, restoring the intestinal tract back to normal.
Follow-up of bowel cancer
In order to detect a recurrence of the disease in time or discover concomitant diseases follow-up examination is necessary and useful.
Regular examinations give you the assurance that everything is alright.
The follow-up of patients with colorectal cancer depends on the extent of the primary disease from (tumor stage).
During the first two years after surgery, the intervals between follow-up visits are short, usually every three months. The intervals are extended thereafter to six months, and finally to once a year. After five years, you can change the regular follow-up on a symptom-oriented follow-up.
The tests usually include:
- Physical examination, body weight and size
- Talking about the current condition and current complaints
- Blood laboratory: values for kidney, liver and bile degradation products
- Tumor markers in the blood: CEA and CA 19-9
- Contrast-enhanced computed tomography (CT) of the lungs and abdomen
- If necessary: Magnetic resonance imaging of the liver
- Colonoscopy: Twelve months after primary tumor surgery. Colonoscopy should be repeated every two to three years in unaffected mucosa, but annually after removal of polyps.
- After rectal cancer a sigmoidoscopy should be performed twice a year during the first and second year, if no colonoscopy was already performed
- Sometimes additional tests are required.
I am happy to organize the follow-up for you and discuss the obtained findings with you.
After five years, the general follow-up program has ended. I suggest continuing the annual aftercare visits with a medical interview, physical examination, blood tests and CEA determination and computed tomography.