Now that I have been diagnosed to have colon cancer, how will I be treated?
Different types of treatment are available for patients with colon cancer. Three types of standard treatment are used.
- Targeted Therapy
Surgery is the most common treatment for all stages of colon cancer. Some patients may be given chemotherapy therapy after surgery to kill any cancer cells that are left. Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells either by killing the cells or stopping them from dividing. Targeted therapy uses drugs or substances to identify and attack specific cancer cells without harming normal cells.
Which kind of surgery is done for colon cancer?
The type of surgery depends on the location of the cancer and extent. There are curative and palliative colectomies.
Curative surgeries are done with an aim to remove the entire cancer with a margin of normal tissue around and all the lymph nodes involved (lymphadenectomy). These include:
Right hemicolectomy refers to the resection of the ascending colon.
Left hemicolectomy refers to the resection of the descending colon.
Extended hemicolectomy is when a part of the transverse colon is also resected.
Sigmoid colectomy refers to the resection of the sigmoid colon.
Total colectomy refers to the resection of the entire colon.
Subtotal colectomy refers to the resection of the part of the colon or a resection of the entire colon without complete resection of the rectum.
Palliative surgery is done for symptom control and not with intent for cure. This is because these surgeries are done in patients with advanced disease who have developed complications of the cancer (mentioned above). In an obstructing advanced cancer, only a bypass of the block (colostomy) may be possible. Sometimes, even if a patient is taken up for emergency surgery due to a complication of the cancer, no resection may be possible if the disease is very advanced and the colon will just have to be closed without any further surgical intervention.
In some patients with an obstruction who are not fit for surgery, endoscopic stenting of the tumour may be attempted.
Are there any alternatives besides surgery?
Till date, surgery is the only proven curative option for colon cancer.
How do I prepare myself for surgery?
The preparation is generally similar to any major surgery. If you are a smoker it is absolutely essential to stop smoking. Breathing exercises using the incentive spirometer and football bladder should be started. Follow the anesthetist’s advice regarding continuation of medications if you are on any. A high protein diet is preferred to improve nutrition.
How major is the surgery? What are the possible complications?
Colectomies with lymphadenectomy and other colon surgeries are deemed as major surgeries with a risk of complications and a very small risk of death (<2%). This means that if 100 people are operated, less than 2 of them have a chance of death.
The complications of Colectomies (removal of the colon and lymph nodes and
joining back (anastomosis) the healthy bowel / intestine) include:
- Leak of anastomosis
- Bleeding from the anastomosis
- Bladder and ureteric injuries
- Injury to the duodenum
- Wound infections
For how long do I stay in the hospital?
In an uncomplicated case, hospital stay after surgery is 7-10 days. This may be longer when there are complications.
Will I need any further treatment after surgery?
The decision about adjuvant treatment is based on the final histopathology report which will be available approximately 7-10 days following surgery. If any of the lymph nodes are positive and your general condition is good enough then you may be referred to the medical (GI) oncologist for consideration for chemotherapy.
What will be my survival after surgery? Are there any chances of the cancer coming back?
The survival depends on the stage of the disease. The average 5-year survival for all stages after curative surgery for colorectal cancer is between 40-75% depending on the stage of the cancer. As of date there is no foolproof way of predicting which patients will have recurrence and which patient will not.
Are there any special precautions I need to take to prevent cancer from coming back?
No there are no such proven precautions.
How frequently should I follow up after surgery?
After completion of treatment you will be advised to follow-up once in 3-4 months in the first 2 years. Then the frequency will be reduced to once in 6 months for the next 2-3 years. Subsequent follow up will be once a year. During each follow-up you will be asked to do certain blood tests, especially CEA. You may also be advised to get an ultrasound of the abdomen and colonoscopy done. Colonoscopy can show recurrence of polyps or cancer in the colon. In addition to checking for cancer recurrence, patients who have had colon cancer may have an increased risk of cancer of the prostate, breast and ovary. Therefore, follow-up examinations should include these areas.