How to diagnose bowel cancer? Is intestinal cancer treatable?

Intestinal Cancer

Tumors in the colon are common. Although the majority are not malignant, cancers of the colon are the most frequent in the intestinal tract. If a tumor of the colon is suspected, the methods for diagnosing it are readily available and highly accurate. Unlike cancer of the stomach, cancers of the colon can usually be effectively removed and the long term outlook is much better. Because these are growths in the wall and passageway for stool, they cause blockage of the stool passage and they bleed.

Any change in bowel habit, cramps or bleeding in the stool requires investigation for the possibility of a colon tumor. Certain innocent tumors of the colon appear to have the potential for becoming cancerous. The surgical techniques and methods for managing these tumors are well established.

How can you know that there is a tumor in the colon? 

Sometimes the tumor can be felt by a digital examination of the rectum. At other times the physician can see the tumor through an instrument called a sigmoidoscope, which is inserted into the rectum for a distance of ten or more inches. Another procedure is to put barium into the rectum by an enema method and take X rays of the barium filled intestine. This is called a barium enema examination.

What does it mean to be "sigmoidoscoped" and how is the tumor seen through the rectum? 

This procedure can be done in the doctor's office. It is completely painless and does not require an anesthetic. You must take a laxative the night before and have a cleansing enema early on the morning of the examination. A hollow tube with a light attached is advanced to the colon through the rectum. This is easily done. If any abnormal growths are seen, a part of them can be removed (biopsied) for microscopic examination. All activities can be immediately resumed. Bleeding soon afterward is usualy insignificant and comes from the biopsy wound. This examination is a routine part of every adequate cancer detection study.

What is the barium enema X ray? 

The examination is done in the hospital or in the office of an X-ray specialist (a radiologist). As far as the patient is concerned, he will be getting an enema, but instead of water it contains a barium compound, which molds with the colon and can be photographed. The patient lies on a table during the examination and is moved about so that he can be photographed in various positions. Then the barium is passed just as if he were having a bowel movement. X-ray photographs are also taken in this evacuated state. The films are developed immediately and the diagnosis usually is readily made.

Where the study reveals a small tumor that can be confused with a piece of stool or where the findings are otherwise uncertain, the examination is repeated in a few days. The procedure is painless, with only a mild sense of abdominal pressure and a desire to move the bowels. A properly performed examination allows for an accurate diagnosis in most instances.

What surgery is done?

 Essentially the operation consists of removing the involved bowel containing the tumor and a generous segment on each side, together with its suspending membrane (mesentery). This membrane contains the vascular system of the colon and the lymph glands. The two remaining ends of the colon are sutured together so that the intestinal contents can pass. The creation of this new opening is called an anastomosis.

Will I move my bowels normally afterward? 

Yes, in surgery on these tumors the rectum is left intact.

Will I have an abdominal opening? 

Usually not. Sometimes we make a temporary abdominal opening, a colostomy, and close it before you leave the hospital. This often makes it possible to carry a patient through a difficult operation by avoiding serious complications.

What happens if nothing is done for this cancer? Is there such a thing as being too old for this operation? 

These cancers do not stay stationary; they continue to grow, and in so doing they cause bleeding and blockage of the bowel. In other words, they always cause trouble. Virtually all individuals with cancer of the colon should be operated on to avoid these problems. No patient is too old. One can adjust the kind of operation to the patient's condition.

What is the risk of this operation? 

Certain statistics for cancer have been likened to a bikini. What they reveal can be less interesting or vital than what they conceal. The risk of this operation lies not only in the fact that it is a cancer but also in the age and general condition of the patient. The entire past and present status of the patient's health is challenged by an operation. Thus a long term smoker runs the risk of pneumonia, a poorly nourished patient may not heal well, a cardiac may get an acute heart attack, an elderly man may have a stroke. Also a serious postoperative infection may occur. There is a wide range of risks; generally considered, 3 to 5 percent of the patients may not survive.

What does the operation accomplish? 

The aim is to remove the cancer so that it won't spread or recur. Even in a situation where cure cannot be achieved, it is usually possible to relieve the cramps and severe difficulty in moving the bowels and to eliminate the bleeding that causes anemic weakness and lethargy.

How often is it possible to get a real cure? 

In early colon tumors we can completely cure about 75 percent of those who survive the operation.

Is it possible to get another cancer in the part of the colon that is left behind? 

This happens in about 5 percent of the cases. It is a problem to which we have to be alert.

Why then isn't the entire colon removed? 

That can be done and is one of the standard operative techniques for this disease. Complete removal is a procedure of greater magnitude; it may be attended by significant postoperative diarrhea, but it may remove the cancer potential. When the colon has more than one tumor or when a second tumor appears, this is often the operation of choice.

If the operation is on Monday, why do I have to come to the hospital on the Tuesday before? 

It takes this amount of time to get the intestine cleaned out so that it is in the best condition for suturing. Certain blood tests and X rays have to be brought up to date. The time is also used to sterilize the bowel with various drugs and to get the patient stabilized. The time taken to get everything properly prepared and evaluated pays big dividends in terms of reducing postoperative problems.

Does this cancer come from hemorrhoids or the fact that I always delayed moving my bowels when I had the initial urge? I was always too busy. 

There is no connection as far as is known.

If the operation is successful, is there any specific advice for the future? 

Not really. After things are healed, the diet can be what you wish. Laxatives and even enemas are allowed, and there is no restriction of activity.

How can I know if it comes back that is, if the tumor regrows? 

That can be determined only by the patient's symptoms, the doctor's findings on abdominal and rectal examination, and subsequent X-ray studies.

Is there anything that my brothers or sisters or children should do to prevent this from happening to them? 

This disease of the colon is not inherited. The best precaution is early diagnosis for bleeding in the bowels or any change in bowel habits. There is value in having a sigmoidoscopy as part of a general annual checkup.


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