Colon cancer

Why do I have cancer?

Most cancers of the colon develop at the cell level lining the inner wall of the colon that come into contact with food (mucosa). Due to a change (mutation) in the cell’s genetic code (DNA), these cells can begin to multiply uncontrollably in the intestinal lumen (the cavity in the intestine). We then speak of an intestinal polyp.

During the uncontrolled multiplication of the cells, new changes (mutations) in the genetic code can occur, allowing these cells (polyps) to invade the intestinal wall and to metastasize in other organs.

Doctors judge that in most cases it takes 5 to 10 years for a polyp to degenerate into cancer.

This can happen faster in hereditary forms and in patients with inflammatory bowel disease.

Every tumor is different and in some patients the time frame may be shorter.

There are mutations that are passed on to children. These mutations actually account for only a small proportion of intestinal tumors. Hereditary mutations do not make the development of colon cancer inevitable, but they do increase the risk. Not every person who carries these mutations will necessarily develop colon cancer.

When a hereditary mutation is suspected, increased vigilance and detection is required.

The most frequent hereditary syndromes:

→ HNPCC – Hereditary non polyposis colorectal cancer (Lynch’s syndrome)
→ FAP – Familial adenomatous polyposis

It is important to ask biological relatives about the presence of colon cancers and other types of cancers (gastroenterology, gynecology, urology…).

Do family members have cancer or had cancer? Then you should find out at what age the disease was diagnosed and which cancer developed.

The presence of colon cancer in family members increases the risk of developing cancer, aside from the known hereditary factors. This risk increases with the number of cases within the family,  and according to the degree of kinship (brother, sister, parents).

When in doubt or if you have any questions, it is best to talk to your doctor.

• Age: most colon cancers are diagnosed after 50 years of age
• Smoking
• Alcohol
• Obesity
• Sedentary lifestyle: sport reduces cancer risk
• Diabetes
• Low-fibre and high-fat diet: a diet rich in fruits and vegetables reduces cancer risk
• Chronic inflammatory bowel disease: Crohn’s disease, ulcerative colitis
• History of adenomatous colon polyps
• History of colorectal cancer in the family
• Hereditary syndrome with increased risk of colorectal cancer

A consultation with the gastroenterological oncologist is scheduled postoperatively. She will give you more information about chemotherapy.

In this section, we tried to answer the most frequently asked questions.

The decision to administer chemotherapy after surgery (adjuvant chemotherapy) is taken during the multidisciplinary oncology meeting, taking into account the recognized international guidelines.

Adjuvant chemotherapy depends on several factors: The result of the pathological-anatomical examination, the symptoms at diagnosis, the general health condition and the patient’s age.

Pathology

• If one or more lymph nodes in the surrounding fatty tissue of the colon contain tumor cells, adjuvant chemotherapy is recommended.
• Also, if the cancer penetrates the entire wall of the colon or affects an adjacent organ, chemotherapy is recommended.

Symptoms at diagnosis

• Patients presenting at the emergency department with an occlusion, perforation or hemorrhage may benefit from chemotherapy.

General condition

• The patient’s general health must be reasonably good to tolerate the effects of chemotherapy.

Age

• The younger the patient, the more he or she will benefit from chemotherapy. At an older age, the undesirable effects are more pronounced and reduce the potential benefit of chemotherapy.

A weekly meeting where patients’ treatment is discussed in the presence of an:

– Oncologist

– Radiotherapist

– Radiologist

– Anatomopathologist

– Surgeon

Chemotherapy starts 5 to 6 weeks after surgery at the earliest.

Before starting chemotherapy, the surgical scars must have healed and the patient must have recovered sufficiently from surgery.

A small box (Port-a-cath or port catheter) is implanted subcutaneously under the clavicula. This is done in day hospitalization in an operating theatre, under local anesthesia and sedation.

The port catheter is punctured to administer chemotherapy on an outpatient basis and can also be used for monitoring with blood samples.

Chemotherapy is administered at a frequency of 1 day every 14 days for 6 months.

The patient comes to the day hospital in the morning. Depending on the results of the drawn blood and the patient’s general condition, the doctor will decide whether chemotherapy may be administered.

After puncturing the port catheter, the administration of chemotherapy is started and the patient can return home.

Chemotherapy is administered on an outpatient basis for 48 hours via a pump worn by the patient on a shoulder strap. After two days, the patient returns to the hospital. The pump is disconnected from the port catheter and the patient returns home. Two weeks later, he or she returns. This cycle is repeated during 6 months

The side effects vary from one patient to another. Adjuvant chemotherapy for colon cancer is usually well tolerated.

If side effects occur, they are mostly limited to the 3 days of chemotherapy administration and the following two days.

Frequent adverse effects:

– Fatigue

– Stomach pain, nausea

– Increased risk of infection

– Redness, tingling and sensitivity of palms and soles of feet (can persist long term)

– Sensitivity to cold drinks

Hair loss is extremely rare after chemotherapy for colorectal cancer

The catheter tip from the port catheter is placed into a large hollow vein (vena cava), just above the heart.

Thus, chemotherapy is administered directly into the large vena cava.

If the chemotherapy was administered into a small peripheral vein of the arm, the very irritating chemotherapy would cause a painful inflammation of the vein and phlebitis, which would clog the vein at each administration of chemotherapy.

The aim of chemotherapy after colon cancer surgery, is to reduce the risk of relapse (recurrence) or distant metastasis (metastasis).

The administration of chemotherapy cannot guarantee that metastases will not occur in the future.

La seule manière de savoir si un traitement est efficace, est d’effectuer des examens médicaux (prise de sang, imagerie médicale…). 

Sachez qu’il n’y a habituellement aucun rapport entre la présence ou non d‘effets secondaires et l’efficacité du traitement. 

Neither the radiation from radiotherapy nor the cytostatics from chemotherapy are spread to people around the patient. Your children and grandchildren may therefore visit you without any danger during your radiotherapy or chemotherapy.

Every patient has the right to decide whether or not to follow a proposed treatment. To do so, however, he or she must be fully informed of the possible consequences of his or her decision. Cancer treatments are often stressful and are sometimes accompanied by unwanted side effects, such as fatigue, diarrhea, nausea and vomiting.

Certain side effects, such as tingling of the palms of the hands or soles of the feet, can be permanent.

A patient who declines a proposed treatment, will be counseled to find an alternative treatment or an acceptable follow-up of the condition.

If chemotherapy is indicated, follow-up is done alternately by the oncologist and the surgeon.

If chemotherapy is not required, follow-up is done by the surgeon.

1st year → every 3 months alternating follow-up: abdominal ultrasound + lab / abdominal CT scan + lab

2nd year → every 3 months alternating follow-up: abdominal ultrasound + lab / abdominal CT scan + lab

3rd year → every 6 months alternating follow-up: abdominal ultrasound + lab / abdominal CT scan + lab

4th year → every 6 months alternating follow-up: abdominal ultrasound + lab / abdominal CT scan + lab

5th year → annually alternating follow-up: abdominal ultrasound + lab / abdominal CT scan + lab

Year 5, monitoring is done annually.

The frequency of follow-up may vary. The intensity of follow-up depends on the patient’s general condition, the risk of relapse inherent to the stage of the cancer and the patient’s age.

Depending on the patient’s general condition, age and request of the patient, a decision not to intervene may be made after discussion with the patient and his or her immediate family.

Curative treatment of colon cancer is performed in most cases through surgical removal of part of the colon

Surgical treatment

• Right hemicolectomy : Removal of the right part of the colon (first part of the colon) up to the transverse colon (second part of the colon), connecting the small intestine to the transverse colon under general anesthesia.

See surgical procedure: Right hemicolectomy

• Left hemicolectomy – Sigmoidectomy: Removal of part of the left half of the colon up to the rectum, connecting the remaining colon to the rectum, under general anesthesia.

See surgical procedure: Left hemicolectomy – Sigmoidectomy