MEDICAL SERVICES

Colorectal cancer: what is it?

Colon and Rectal cancer are a serious disease, but it can often be cured if it's caught early.

We've looked at the best and most up-to-date research to produce this information.

What is colorectal cancer?

The term 'colorectal' includes cancers of the colon and rectum, which make up the upper and lower part of your large bowel. Bowel cancer is sometimes called colorectal cancer.

Your large bowel turns food your body doesn't need into solid waste. The waste then leaves your body when you go to the toilet.

Bowel cancer starts when some of the cells in your large bowel begin to grow out of control. This can form a lump called a tumour. Cancer cells can then break off from the tumour and spread to other parts of your body and cause damage there.

What are the symptoms?

You might not get any symptoms in the early stages of bowel cancer. Some people only find out they have it when they go for a routine screening test.

But some people do get symptoms. These can include changes in your bowel habits that last for several weeks. For example, you may get diarrhoea or become constipated. Or your stools may be thinner than usual. This can happen if the cancer has partly blocked your bowel.

You may also get bleeding from your rectum or visible blood in your stools or get bad pain in your abdomen. If you have bleeding in your bowel, you may become anaemic. This can make you feel very tired and look pale.

If your doctor thinks you may have bowel cancer, you'll need tests. One of the main tests is called a colonoscopy. During a colonoscopy, a specialist doctor (a gastroenterologist) puts a tube with a camera on the end (a colonoscope) into your anus and passes it up into your rectum and colon. This allows the doctor to look for problems such as cancer.

Bowel cancer: what is it?

If the doctor sees anything unusual during the test, they can take a sample of tissue to look at more closely. This is called a biopsy. Other tests you may have include scans, x-rays, and blood tests.

Together, these tests can tell you for certain whether you have cancer. If you do have cancer, they can also help your doctor work out how advanced it is (its stage).

What will happen to me?

Bowel cancer is a serious illness. But many people are cured with treatment. Your doctor will be able to tell you about how many people recover, on average, from the stage and type of cancer you have. In general, the earlier you were diagnosed and the earlier the stage of your cancer, the better. But, remember, you are not a statistic. No one can say exactly what will happen to you.

You'll have regular check-ups after being treated for bowel cancer. There's good research to show that being checked on regularly can help you live longer. If your cancer does come back, regular check-ups mean that it will get picked up and treated sooner. However, if you get any symptoms that worry you, see your doctor straight away. Don't wait for your next check-up.

 

COLORECTAL CANCER – FAQ’s

If you've been diagnosed with bowel cancer (colon or rectal cancer), you may want to talk to your doctor to find out more.

Here are some questions that you might want to ask before surgery.

• Will I need surgery?

• If I need surgery, what will this involve? What will be removed?

• Will I need to have radiotherapy before the operation?

• Will my surgeon be someone with a lot of experience of this operation?

• Will I need to have a colostomy? If so, will it be permanent?

• Will I need any treatment after surgery?

• How long will it take me to recover after surgery?

• Is my family at risk of getting this type of cancer?

• Is there anything my family should be doing to protect themselves against this type of cancer?

• Will I need to have chemotherapy after surgery?

• Should I be taking any medicines to stop my cancer from coming back?

• Will my treatment cure my cancer? How will you know if I'm cured?

Here are some questions that you might want to ask after surgery.

• How far has the cancer spread? Has it reached other organs or is it just in the colon or rectum?

• What stage is the cancer?

• Do any of my lymph nodes have cancer cells in them? If so, how many nodes have cancer cells?

• Is my cancer likely to come back?

 

TREATMENT OF COLON CANCER

   The treatment of colorectal cancer depends on the stage in which it is detected. Whatever the stage if surgery is possible it is the best treatment for colorectal cancer. This may involve removing part of the large intestine or the rectum and metastatic tumours in the liver or local organs. Laparoscopy is often used to operate on the colon in colorectal cancer. In obese patient’s robotic surgery has an advantage for better removal of the cancer, faster patient recovery and less pain.

   Surgery is often followed up with chemotherapy unless in very early stage disease of the colon.

 

TREATMENT OF RECTAL CANCER

   The treatment of rectal cancer is more complex than colon cancer. This is because the rectum is

 situated in a narrow passage of the pelvis where spread can take place very early into the fat round

the rectum. That is why radiation is often given as the first treatment in rectal cancer unless it is very

early stage rectal cancer. If radiation is given, then surgery is advised six weeks after surgery.

Sometimes in early stages a shorter course radiation is given with earlier surgery. The challenge in

 rectal cancer is to remove the cancerous tumour and save the normal stools passage. There are

many complex decisions to achieve this end. This is well understood by a competent surgical

oncologist, colorectal surgeons or gastrointestinal surgeon. Please discuss the use of staplers,

laparoscopy and robotic surgery with your operating doctor.

 

LAPARASCOPY

   In good hands laparoscopy is as good as open surgery in removing the cancer completely. Laparoscopy means to make a few holes in the abdomen wall and inserting a camera and instruments and performing the whole surgery. It can result in less pain and faster recovery and return to work.  

Who should be doing laparoscopic surgery for colorectal cancer?

Only surgical oncologists, colorectal oncologists, gastrointestinal oncologists who have done adequate open surgeries and trained in laparoscopy should be doing laparoscopy for colon cancer.

 

ULCERATIVE COLITIS

Ulcerative colitis: what is it?

If you have ulcerative colitis your bowel becomes inflamed (swollen). This can cause unpleasant symptoms including pain and diarrhoea. But treatments can help control the condition.

What is ulcerative colitis?

Ulcerative colitis is a condition that can cause inflammation of the bowel. It is a long-term condition that can vary in its severity. A similar condition that you may have heard of is called Crohn’s disease. These conditions are sometimes grouped together under the name inflammatory bowel disease.

As well as swelling, ulcerative colitis can cause ulcers to form in the swollen part of the bowel. These can sometimes bleed or leak pus.

We don’t know for certain what causes the condition. But ulcerative colitis is probably what’s called an autoimmune condition. This means that the body’s immune system, which protects us against infection, goes wrong and starts to attack part of the body.

In the case of ulcerative colitis, it’s thought that the immune system attacks bacteria in your gut, even though these bacteria aren’t doing you any harm and may even be useful in helping you to digest food.

The cause of ulcerative colitis may also be partly genetic. This means that it might be more likely to happen to people who have family members who have inflammatory bowel disease.

What are the symptoms?

The most common symptoms of ulcerative colitis are:

• Diarrhoea that often contains blood

• Bleeding from the rectum

• Abdominal (tummy) pain.

Other symptoms that are less common include:

• Pain in your joints (arthritis)

Ulcerative colitis: what is it?

• Fever

• Weight loss

• Constipation, which can alternate with diarrhoea.

If your doctor thinks you might have ulcerative colitis he or she will suggest one or more tests that can help with a clear diagnosis. These might include:

• A stool test. A sample of your stool (faeces or ‘poo’) is tested for the presence of some substances. For example, if you have white blood cells or certain proteins in your stool, this suggests that you might have ulcerative colitis

• Blood tests

• A colonoscopy. A tiny camera is inserted into the rectum using a thin tube. This can show if you have ulcers and swelling in the bowel. If only the lower part of the bowel is looked at, it’s called a sigmoidoscopy

• A biopsy. This means that a sample of tissue is taken from the lining of the bowel for testing. This will be done at the same time as a colonoscopy or sigmoidoscopy.

What will happen?

Ulcerative colitis is very rarely life threatening, but it can be unpleasant, and if your symptoms are severe it can have a big impact on your life. Getting treatment to control the condition is important.

Having ulcerative colitis slightly increases your chance of getting colon cancer. So, you will need to have a colonoscopy every one to five years. How often you need them will depend on how severe your ulcerative colitis is.

If you need to take medications called corticosteroids regularly to control your symptoms, you have an increased chance of osteoporosis. This means that your bones are weaker than normal, and you may be more likely to get fractures.

Your doctor should discuss this with you, and how best to avoid fractures. He or she might suggest that you have regular tests to check if your bones are affected.

Your doctor should also warn you about medicines that can make your condition worse, such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.

There has been much discussion about how your diet might affect ulcerative colitis, but there isn’t much evidence about it. If you know that certain foods cause you to have symptoms, then you may want to stop eating them. But it is important to eat a healthy diet and make sure you are getting the nutrition you need.

Other things that will help keep you healthy include not smoking, not drinking too much alcohol, and taking plenty of exercise.

Your doctor may also advise you to take vitamin D and calcium supplements. But you should only take supplements of any kind after discussing them with your doctor, as some of them can interact with your medications.

 

TREATMENT FOR ULCERATIVE COLITIS

Ulcerative colitis: what treatments work?

If you have ulcerative colitis your bowel becomes inflamed (swollen). This can cause unpleasant symptoms including pain and diarrhoea. But treatments can help control the condition.

What treatments work?

Ulcerative colitis is a condition that can cause inflammation of the bowel. A similar condition that you may have heard of is called Crohn’s disease. These conditions are sometimes grouped together under the name inflammatory bowel disease.

We don’t know for certain what causes ulcerative colitis, but it is probably what’s called an autoimmune condition. This means that the body’s immune system, which protects us against infection, goes wrong and starts to attack part of the body.

The treatment that you need will depend on how severe your symptoms are, and on how much of your bowel is affected. But most people will need long-term drug treatment to control the disease, and some people will need surgery.

Vaccinations

The main medicines used to treat ulcerative colitis work by calming down your immune system so that it doesn’t attack your bowel. But it means that you are more at risk from certain infections. So your doctor will recommend that you have the following vaccinations:

• Influenza (flu)

• Pneumococcal polysaccharide. This protects against pneumonia, meningitis, and a type of blood poisoning called septicaemia

• Hepatitis B

• Human papillomavirus. This protects against genital warts and against cervical cancer in women

• Varicella zoster. You probably won’t need this vaccine if you have ever had chickenpox or shingles.

Ulcerative colitis: what treatments work?

Drug treatments

The main medicines used to treat ulcerative colitis are called 5-aminosalicylic acids, or 5ASA for short.

These medicines come as tablets. But if your symptoms are mild you may only need to take this medicine as suppositories. Suppositories are tablets that you insert into your rectum, and which then dissolve.

The advantage of suppositories over tablets that you swallow is that they are less likely to cause side effects. 5-ASA can cause side effects in some people, including headaches, nausea, abdominal pain, and vomiting.

If your symptoms are more severe you will need to take 5-ASA as tablets, and possibly as suppositories as well. You may also need to take medicines called steroids. These are drugs that reduce inflammation. Their full name is corticosteroids. They are different from the anabolic steroids that some athletes and bodybuilders use.

Your doctor will usually make sure that you only take steroids for a few weeks, as taking them for a long time can cause side effects, including osteoporosis (weaker bones), thinning of the skin, and diabetes.

If you need to take corticosteroids regularly to control your symptoms, you have an increased chance of osteoporosis. This means that your bones are weaker than normal, and you may be more likely to get fractures. Your doctor should discuss this with you, and how best to avoid fractures. He or she might suggest that you have regular tests to check if your bones are affected.

Some people have very severe symptoms, such as heavy or constant bleeding into their stools, passing stools more than 10 times a day, and severe pain.

If this happens to you, you will need urgent treatment in hospital. You may need to be given steroids through an intravenous (IV) drip to begin with. You may also need IV fluids if you have lost a lot of fluid through diarrhoea.

If 5-ASA and steroids don’t control your symptoms well enough there are other medications your doctor can prescribe. For example, your doctor may suggest:

• A drug called ciclosporin, which helps to calm down your immune system, or

• A type of drug called a monoclonal antibody, which helps stop inflammation in the bowel.

Surgery

Some people’s bowel is so badly damaged by ulcerative colitis that they need to have a part or all of it removed. This operation is called colectomy. You may sometimes hear it called a bowel resection.

Like all surgeries, this operation carries risks, such as blood clots in your legs (deep vein thrombosis or DVT) and infection. If your doctor thinks you might need this operation you can

Ulcerative colitis: what treatments work?

discuss it with him or her before deciding if it is the right treatment for you. But some people’s condition is so severe that this surgery may be the only option that is likely to help.

Treatment during pregnancy

Some ulcerative colitis medicines are fine to take during pregnancy, but others are not. If you become pregnant or are planning to become pregnant you should check with your doctor that your medicines are safe to take during pregnancy.

If you are planning to become pregnant your doctor might advise you to try to conceive at a time when you are not having a relapse of symptoms (this is called a period of remission). But this is not always practical. Talk to your doctor about how you can have the safest pregnancy. This will include eating a healthy diet and making sure you take the supplements your doctor prescribes.