Around one million people in the world are diagnosed with colon (large intestine) and rectum cancer and colorectal cancer every year. Mostly, polyps in these areas arise from adenomas.

It is more common in males than females. Early diagnosis and treatment is very important because it is one of the cancer types that cause the most loss of life.

These benign tumors originating from the colon or rectal mucosa often go undetected because they remain silent for many years. The incidence of adenomas increases with age.

Although the process of cancer development from adenoma has been largely clarified, the external factors affecting this process are still a matter of debate.

What is Colon Cancer?

Cancers that occur on the inner surface of the large intestine, which is about 1.5 meters long, are called colon cancer.

This type of cancer occurs with the uncontrolled growth of cells and cell communities in the layer that covers the inner surface of the large intestine.

The last 15-20 cm of the large intestine is called the rectum, and cancers that develop here are called rectal cancer. “Colorectal cancers” is also a very common term to describe two types of cancer.

According to the data of the Ministry of Health, colorectal cancers are among the top 5 most common cancers in our country.

What are the Ways to Prevent Colon and Rectum Cancer?

The main condition for protection from colon and rectum cancers is not to neglect the necessary screening tests.

Having occult blood in the stool, colonoscopy or sigmoidoscopy examinations at intervals and as recommended by your physician who evaluated your family history and medical history is the primary way to prevent colon cancer.

On the other hand, avoiding cigarettes, tobacco products, and alcohol, adopting an active lifestyle in terms of sports and exercise, not overconsumption of fat and red meat, and adopting a diet rich in whole grains and fiber foods are also protective against colon cancer.

What Are the Risk Factors for Colorectal Cancer?

Colon cancer can occur at any age. The average age of onset is 63. However, according to studies, one-third of patients diagnosed with colorectal cancer are younger than 55 years of age.

Especially in recent years, there has been an increase in its incidence in the younger age group.

Although the exact cause of colorectal cancer is not known, the risk factors that increase the development of colorectal cancer are as follows:

• Advanced age,
• Presence of polyps in the intestine (especially those with adenomatous pathology),
• Presence of colorectal cancer patients in the family,
• Presence of certain genetic disorders (patients with non-hereditary polyposis colon cancer) and/or familial polyposis syndromes characterized by hereditary polyps in the colon and rectum, which have caused significant changes in genes,
• Having inflammatory bowel disease (Ulcerative colitis or Crohn’s disease) that may cause cancer by disrupting the intestinal cell type within a certain period of time,
• Having a history of ovarian, breast and uterine cancer in women,
• Excessive consumption of processed and animal foods, less consumption of fruits and vegetables and smoking

People with these risk factors should be screened for bowel cancer from an earlier age.

What are Colon Cancer Symptoms?

The onset of colon cancers is cell growths, namely polyps, in the intestine. Polyps usually do not cause any complaints at first.

As polyps begin to become cancerous, grow in size or increase in number, they cause the following changes in a person’s bowel habits:

• New onset constipation or vice versa, change in stool consistency (in favor of diarrhea) or odor,
• Anemia caused by iron deficiency
• Thinning of the thickness of the stool, blood mixed with the stool or bleeding from the anus after going to the toilet,
• Abdominal pain, loss of appetite and involuntary weight loss.

The above findings alone do not indicate colorectal cancer. However, if you have these complaints, you should definitely consult your doctor for the necessary controls.

In addition, if you have a family history of bowel cancer, breast, ovarian or cervical cancer along with one of these symptoms, do not neglect to consult your doctor.

Bleeding from the anus can also be seen due to hemorrhoid disease or anal fissures rather than colorectal cancer symptoms, especially in young people, those with chronic constipation, those who do not have alarm complaints (such as weight loss, loss of appetite, anemia).

It is often not possible to tell the true cause of these complaints without further investigations.

The Relationship between Ulcerative Colitis and Crohn’s Disease and Colorectal Cancer

Ulcerative colitis or Crohn’s disease is a chronic inflammation of the tissues lining the large intestine. Both are risk factors for developing colorectal cancer disease.

Especially in people who have had ulcerative colitis for more than 10 years (even if they have responded to treatment), the probability of developing colorectal cancer is considerably increased. For this reason, routine screening colonoscopies should be performed in these patients whether or not they have complaints related to their disease.

In Crohn’s disease, the probability of developing colorectal cancer increases in areas with intestinal strictures due to this disease.

Continuing to smoke increases the risk of developing colorectal cancer in the presence of these two diseases.

Colon Cancer Diagnosis

Tests for early screening of colon cancer include:

• Colonoscopy,
• Checking for occult blood in the stool,
• Computed tomography (CT) colonography,
• Flexible sigmoidoscopy,
• DNA tests in stool.

When Should a Colonoscopy Be Done?

Colonoscopy screening is started at the age of 50 in people who do not have a family history of bowel cancer and have no bowel complaints, and should be repeated every 10 years if no polyps are seen.

The age of screening with colonoscopy is 40 years in the first degree relatives of people with advanced bowel cancer before the age of 65 or breast, uterine and ovarian cancers. If it is 10 years before the age of the person’s first degree relative with cancer, and before the age of 40, screening should be done at an early age.

In patients with ulcerative colitis, colonoscopy control is required every year when the disease age exceeds 10 years.

In people with genetically inherited polypoisis syndromes in the family, screening should begin at the age of 15-18 years.

According to the number and pathological types of polyps detected in screening colonoscopy, control colonoscopy is performed at intervals of 1-3-5 or 10 years.

If screening is aimed only for left colon tumors, flexible sigmoidoscopy every 2-3 years can be used for screening between long colonoscopic examinations.

Unless there are necessary conditions, the statements that “colonoscopy should be done every year” are not true. Annual follow-up should be done only in special circumstances.

In cases where the patient does not prefer colonoscopy, CT colonographies can be performed every 5 years. However, only diagnosis can be made in CT colonographs, when any polyp or mass is seen, colonoscopy will be required to take biopsy from those lesions.

In addition, it should not be forgotten that CT has limitations in the diagnosis of early stage colon and rectal cancer.

Testing for occult blood in the stool should be done once a year until the first colonoscopy screening. DNA tests in the stool are also among the screening tests performed every 2-3 years.

Where does colon cancer spread first?

Colon cancer, which is known to be a dangerous type of cancer that tends to spread, usually first spreads to the patient’s liver, lungs and the peritoneum, also known as the peritoneum. Among these organs, the most common organ that colon cancer will spread will be the liver. Liver metastases are relatively common in colon cancers.

At what stage is colon cancer surgery?

Colon cancer is considered a dangerous type of cancer, and in the first stage of cancer, the patient is usually treated with surgery alone. The technique or method to be used for this surgery may vary according to the health status of the patient and the specific characteristics of the cancer. In addition, from time to time, surgical intervention may be recommended to remove the cancerous parts in the second stage of the disease.

What are the Treatment Methods in Colon Cancer?

In the treatment of colon and rectum cancers, Surgery, chemotherapy (drug therapy) and radiotherapy (radiation therapy) are the most commonly used methods.

Before making a treatment plan for colon and rectal cancer, it is important to obtain information about the general condition of the patient and the prevalence of the disease. For this reason, it is necessary to know the stage of the cancer in the treatment planning.

Is colon cancer surgery risky?

Colon cancer surgeries can be relatively risky surgeries. This risk may vary to a certain extent depending on the health status of the patient and the specific characteristics of the cancer. The most risky situation in colon cancer surgeries is bleeding.

Despite this situation, it is known that the success rate in colon cancer surgeries is quite high. Especially for patients diagnosed and treated in the first stage, the 5-year survival rate is ninety percent.

What happens after the large intestine is removed?

Patients who have had their large intestine removed for the treatment of diseases such as colon cancer need to be more careful at some points after surgery. There may be some changes in the toilet habits of patients who have had the entire large intestine removed. On the other hand, with the right diet planned by a specialist physician, the patient can continue his life normally without decreasing his living standards.

What are Colon and Rectum Cancer Stages?

• Stage I: It is the earliest disease stage. Cancer cells occupy the inner and middle layers of the intestine. There is no involvement in lymph nodes and distant organs.
• Stage II: Cancer cells occupy all layers of the intestine, reach the outermost layer, and can spread to neighboring organs or organs. There is no involvement in lymph nodes and distant organs.
• Stage III: Regardless of the level of involvement in the intestinal wall, there is tumor spread in the lymph nodes adjacent to the intestine.
• Stage IV: It constitutes the most advanced stage of the disease. Regardless of the tumor spread in the intestinal wall or lymph nodes, there are metastases in organs such as liver, lung, peritoneum, bone, brain.

What should be done in colon cancer stage 1?

In the first stage, where the cancer has not yet spread to the organ walls, the cancerous area is surgically removed from the patient’s body along with the surrounding tissues. Meanwhile, lymph nodes, one of the surrounding tissues removed from the patient’s body, are examined by a pathologist after the operation. As a result of this examination, it will be understood whether the cancer has spread to the large intestine. In this stage, that is, in the first stage, patients are generally not treated with chemotherapy.

Major Treatment of Colon and Rectum Cancer in All Stages; It is surgery.

However, the type of surgical treatment may vary depending on the location, size, stage of the tumor in the colon and rectum, and whether the patient presents with tumor complications (such as obstruction, perforation, bleeding) in emergency conditions.

Today, laparoscopy applications in the surgical treatment of colon and rectum cancer have become increasingly widespread. The main techniques used are:

In some small rectal tumors, cutting and removing only the tumor part through the anus is called local excision.

Depending on the location of the tumor, cutting and removing a part (or all) of the large intestine and a part (or all) of the rectum is called resection.

In this surgical technique, the adjacent lymph nodes are removed together with the intestine. If the tumor has spread to neighboring organs, these organs may also need to be removed during radical surgery.

The healthy intestinal ends remaining from the removed intestine are brought together and joined.

After colon or rectal resections, in some cases, an artificial anus (ileostomy or colostomy) can be created by suturing the small intestine or colon to the abdominal wall for various reasons.

The intestinal contents are emptied from this artificial anus into the plastic bag attached to the abdominal wall. While this may be permanent in some patients, it may be a temporary process in some patients.

The appropriate number and size of liver and lung metastases can be removed by surgical technique (metastasectomy). In particular, surgical removal of liver metastases provides significant gains in long-term survival for patients.

For this reason, with our advanced liver surgery experience, we are at your service to offer you up-to-date and accurate treatment with our specialist physicians in our center for surgical treatment of liver metastases.

In advanced stage colon and rectum cancers that cannot benefit from radical surgical treatment, palliative surgical interventions that will increase the patient’s comfort of life can be applied (such as opening a colostomy).

III. and IV. Chemotherapy and/or radiotherapy can be added to the treatment before and/or after the surgery of the patients in the second stage.

References: ÜYETÜRK, Ü., Öksüzoğlu, B., ARSLAN, Ü. Y., & Alkiş, N. (2011). Metastatik kolon kanseri tedavisinde bevacizumab kullanımına bağlı ince barsak perforasyonu gelişen bir olgu ve literatürün gözden geçirilmesi. Turkish Journal of Oncology, 26(4), 178-81.