Colon Cancer more common than you think!

Brent Wogahn, MD
General & Vascular Surgery
Evergreen Surgical
Eau Claire

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Colon cancer is the second most common cancer for women and third for men. One out of every 20 people in the United States will have to deal with this type of cancer. It is also commonly known as “bowel cancer” and can also be called colorectal cancer if it involves the rectum.

Risk Factors
The typical American diet of high fat, low-fiber (meat and potatoes) has long been associated with increased risk of developing colon cancer. A more fiber rich, lower fat diet such as you would find in Asia has a lower risk.

Colon cancer development is usually a very random event. While it is common, only 15% of colon cancers are genetically associated. Familial adenomatous polyposis and Gardner’s Syndrome are two examples of genetically transmitted precancerous polyps or growths in the colon. In both of these syndromes the colon is full of many polyps instead of the scattered few that most people with polyps develop. Consequently, they are at higher risk of colon cancer.

Symptoms
The spectrum of symptoms for colon cancer can vary widely. Many individuals do not have symptoms or only have microscopic/trace amounts of blood in their stool. Others may have nonspecific complaints of bloating or trouble passing their stool. Frank blood in the stool or obstruction of the bowel tends to occur later in the disease process. Abdominal pain and/or rectal pain usually indicate more advanced disease.

Diagnosis
The first step in diagnosis is often your Medical Internist or Family Practitioner. A physical exam and likely a rectal exam can lead them to be suspicious of cancer. I have felt many new cancers on rectal exam in people who have had minimal complaints.

A special test card called “Stool Guaiac Card” can be used by your doctor to screen for occult blood (trace amounts) in the stool. Be aware that this test has many false negatives (you have cancer and the test says “no”) or false positives (no cancer, but the test says “yes”). The problem lays in the fact that many of the things that we eat or drink may mislead the test. Eating a special diet or rather not consuming particular items for three days prior to the test may help improve the accuracy of the results.

 

The mainstay of screening or diagnosis for colon cancer is a colonoscopy. That is a test done by Gastroenterologists and Surgeons using a lighted long flexible scope to look up into the rectum and colon directly. A bowel cleasing preparation must be done the day prior to the exam and sedation is used during the exam to make it more comfortable. The colonoscopy is very good at identifying small tumors or growths called polyps.

A barium enema can also be used to screen for colon cancer. It can detect tumors and polyps greater the 1/2 cm in diameter, but does not allow for the suspicious item to be biopsied. Typically, I reserve this test for times when a colonoscopy was unable to be done or unable to be completed.

Treatment
Surgical removal is the primary treatment for colon cancer. Fortunately, this disease does typically grow and spread in a predictable pattern. The goal of surgery is to completely remove all cancer, if possible. The surgical treatment has remained essentially unchanged for several decades. However, the way we get to the operative site can vary from surgeon to surgeon. The traditional open surgery is still the most common method of removing a section of colon. However, we do have the option locally of doing laparoscopic and even robotically assisted laparoscopic surgery. Regardless of the mode of entering the abdomen, the surgery on the inside is the same. Personally, I prefer a hybrid approach using both laparoscopic and open surgery because it allows for more efficiency, smaller incisions and shorter operating times. In older individuals, less anesthetic time is important for a quicker recovery.

Chemotherapy for colon cancer has been improving over the years with better survival statistics. Furthermore, we are treating more advanced non-obstructive cancers with chemotherapy and/or radiation prior to surgical resection. Thus hopefully causing the tumor to shrink and allow a better resection. However, chemotherapy is more typically employed after surgical treatment. Radiation therapy is used for low colon or colorectal cancers because of the adverse effects of the radiation on the small bowel.

Colon cancer spreads via three modalities: direct extension, the lymphatic channels/lymph nodes and the blood stream. Tumor cells that get into the blood stream travel through the portal vein to the liver. This is why metastatic disease (spread of cancer) to the liver is common. Depending on the area in the liver, the number of metastatic nodules and the overall health of the individual, liver disease is more easily treated today. The nodules of cancer can be treated using microwave probes or cold freezing through the skin or during surgery. The nodules themselves may also be removed by surgery employing a new surgical device available locally that cooks the liver as we cut through it. This instrument essentially can make the surgery almost bloodless. I have even removed some tumor nodules laparoscopically using this device.

Survival
The success of treatment for colon cancer is dependant on how deep the cancer eats into the colon wall and whether there is any spread of disease beyond where the cancer started. Complete resection of the cancer, any lymph nodes or liver nodules if possible is crucial. The addition of chemo/radiation therapy improves your odds of survival further or can delay cancer growth and extend life.

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Dr. Brent Wogahn – Evergreen Surgical
For information or to schedule an appointment:
715-832-1044 | www.evergreensurgical.com
Dr. Wogahn sees patients in Eau Claire and Durand.