Facts on File Encyclopedia of Health and Medicine

Sigmoidoscopy (for the lower colon) and
colonoscopy (for the full length of the colon)
allow the gastroenterologist to detect and remove
intestinal polyps and to biopsy suspicious growths.
The gastroenterologist may use colonoscopy to
explore suspicious findings from other screening
procedures. Further diagnostic procedures may
include transrectal or abdominal ULTRASOUND, COM-
PUTED TOMOGRAPHY(CT) SCAN, and MAGNETIC RESO-
NANCE IMAGING(MRI).
Pathology examination of the suspect tissue
confirms the diagnosis and establishes the extent
of the cancer, a clinical classification process called
STAGING OF CANCER. Staging identifies how far the
cancer has spread, determines treatment recom-
mendations and protocols, and establishes expec-
tations about how the cancer will respond to
treatment (prognosis). The higher the stage num-
ber, the more advanced the cancer.

Treatment Options and Outlook
Surgery is the first course of treatment for nearly
all colorectal cancers. In cancers detected early,
surgery often cures the cancer. Depending on the
location and extent of the cancer, the surgeon can

usually remove the cancerous tissue (called a

bowel resection) and reconnect the healthy ends

of the colon so the colon continues to function

normally. Sometimes the colon needs first to heal

from the resection, in which case the surgeon per-

forms a temporary COLOSTOMY that allows the

colon to pass fecal matter through an opening cre-

ated in the abdomen. When the colon heals, the

surgeon reconnects the ends and closes the

colostomy. Extensive cancer may make necessary

a permanent colostomy.

The oncologist may recommend RADIATION THER-

APYto shrink large tumors before surgery or to kill

any cancerous cells remaining after surgery, pri-

marily for cancer located in the rectum.

CHEMOTHERAPY kills cancer cells that may have

spread beyond the local tumor, and is the follow-

up treatment of choice for cancers that involve

LYMPH NODES. Often the oncologist will recommend

a combination of therapies. Oncologists also typi-

cally offer people who have stage 2 through stage

4 colorectal cancer the opportunity to participate

in clinical research studies of new treatments. It is

important to fully understand the benefits and

risks of the investigational treatment.

colorectal cancer 29

BASIC STAGING OF COLORECTAL CANCER

Stage Meaning Treatment Protocol
stage 0 cancer is in its earliest stages, completely surgery to remove the cancerous polyp (polypectomy), typically
confined to the polyp; also called CARCINOMA via COLONOSCOPY
in situ or intramucosal carcinoma

stage 1 cancer involves but remains confined to the surgery to remove the tumor and the involved segment of colon
inner layers of the intestinal mucosa (local excision)

stage 2 cancer extends beyond the wall of the COLON surgery to remove the tumor and involved segment of colon;
but not into the LYMPH NODES occasionally RADIATION THERAPYor CHEMOTHERAPY

stage 3 cancer extends beyond the wall of the colon surgery to remove the tumor, the involved segment of colon, the
and into nearby lymph nodes surrounding tissue into which the cancer has spread, and the
involved lymph nodes; radiation therapy or chemotherapy

stage 4 cancer has spread to other organs surgery to remove tumors and involved tissues when possible;
radiation therapy and/or chemotherapy

recurrent a return of the cancer to the colon surgery to remove the tumor and involved segment of colon;
radiation therapy and/or chemotherapy