Cure Cancer Mesothelioma

How Is Colorectal Cancer Treated

2009-02-21T03:52:00.000-08:00

This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

The 4 main types of treatment for colorectal cancer are
surgery
radiation therapy
chemotherapy (often called just "chemo")
targeted therapies (called monoclonal antibodies)

Depending on the stage of your cancer, 2 or more types of treatment may be used at the same time, or used one after the other.

Take your time and think about all of your treatment choices. You may want to get a second opinion. This can give you more information and help you feel better about the treatment plan you choose. Your chances of having a good outcome are highest in the hands of a medical team that has experience in treating colorectal cancer.

Surgery

The types of surgery used to treat colon and rectal cancers are slightly different and are described separately.

Colon surgery

Surgery is often the main treatment for earlier stage colon cancer. The surgery is called a colectomy or a segmental resection. Usually the cancer and a length of normal colon on either side of the cancer (as well as nearby lymph nodes) are removed. The 2 ends of the colon are then sewn back together. For colon cancer, a colostomy (an opening in the abdomen for getting rid of body wastes) is not usually needed, although sometimes a short-term colostomy may be done to allow the colon to heal.

Most often, surgery is done through an incision in the abdomen, but for some earlier stage cancers a different approach might be an option. In laparoscopic-assisted colectomy, instead of 1 long incision in the abdomen, the surgeon makes several small ones. Special long instruments are put into these small openings and used to remove part of the colon and lymph nodes. This method appears to be about as likely to cure the cancer as the standard approach for earlier stage cancers and patients usually recover faster than they do after the usual operations. But the surgery calls for special skill. If you are thinking about this approach, be sure to look for a skilled surgeon who has done a lot of these operations.

Some very early colon cancers (stage 0 and some early stage I tumors) or polyps can be removed using a colonoscope. When this is done, the surgeon does not have to cut into the abdomen. Early stage cancers that are only on the surface of the colon lining can be removed along with a small amount of nearby tissue. For a polypectomy, the cancer is cut out across the base of the polyp's stalk, the area that looks like the stem of a mushroom.

Rectal surgery

Surgery is usually the main treatment for rectal cancer, too, although radiation and chemotherapy will often be given before surgery. There are several types of surgery for rectal cancer.

Some operations (such as polypectomy, local excision, and local transanal resection) can be done with instruments placed into the anus, without having to cut through the skin. One of these methods might be used to remove some stage I cancers that are fairly small and not too far from the anus.

For some stage I, and most stage II or III rectal cancers, other types of surgery may be done. These are described here:

Low anterior resection: This approach is used for cancers near the upper part of the rectum, close to where it connects with the colon. The surgeon makes the incision only in the abdomen. Then he removes the cancer and a small amount of normal tissue on either side of the cancer, along with nearby lymph nodes and a large amount of fatty and fibrous tissue around the rectum. The anus is not affected. After the surgery, the colon is reattached to the anus and waste leaves the body in the usual way.

Abdominoperineal (AP) resection: For cancers in the lower part of the rectum, close to its outer connection to the anus, an abdominoperineal (AP) resection is done. For this the surgeon makes 1 incision in the abdomen, and another in the area around the anus. Because the anus is removed, a colostomy is needed. A colostomy is an opening of the colon in the front of the abdomen. It is used for the body to get rid of solid body waste (feces or stool).

Pelvic exenteration: If the rectal cancer is growing into nearby organs, more extensive surgery is needed. In a pelvic exenteration the surgeon removes the rectum as well as nearby organs such as the bladder, prostate, or uterus if the cancer has spread to these organs. A colostomy is needed after this operation. If the bladder is removed, a urostomy (an opening to collect urine) is also needed.

Side effects of colorectal surgery

Side effects of surgery depend on several things, such as the extent of the operation and a person's general health before surgery. Most people will have at least some pain after the operation, but this can usually be controlled with medicines if needed. Eating problems usually inprove within a few days of surgery.

Possible side effects of surgery include bleeding from the surgery, blood clots in the legs, and damage to nearby organs during the operation. Rarely, the connections between the ends of the intestine may not hold together completely and leak. If an infection occurs, it is possible that the incision might open up, causing an open wound. Later, after the surgery, you might develop scar tissue in your abdomen (called adhesions) that could cause the bowel to become blocked.

If you have a colostomy or a urostomy, you will need help in learning how to manage it. This can be done by specially trained nurses. They will usually see you before your operation and again afterwards for more training.

Colorectal surgery and sex

If you are a man, an AP resection can cause you to have "dry" orgasms. That is, the feeling of pleasure will most likely still be there, but no semen comes out. In some cases an AP resection may make you unable to have erections or reach orgasm. In other cases your pleasure at orgasm may become less intense. Normal aging may cause some of these changes, but surgery can increase them.

For some men, the surgery causes the semen to go backward into the bladder. This is not harmful. But if you still want to father a child, you should talk to your doctor about how the surgery will affect you and what might be done to achieve a pregnancy.

If you are a woman having colorectal surgery, you should not normally find any loss of sexual function. Scar tissue may sometimes cause pain or discomfort during intercourse. And if the uterus is removed, pregnancy will not be possible.

For men and women, a colostomy can affect your body image and your sexual comfort level. While you may need to make some adjustments, it should not keep you from having an enjoyable sex life.

The American Cancer Society has more information for both men and women about sexuality and cancer. Please see the list of booklets at the end of this article.

Surgery for colorectal cancer that has spread

Sometimes, surgery for cancer that has spread to other organs can help you to live longer or, depending on the extent of the disease, may even cure you. If the colorectal cancer has spread to a few areas in liver or lungs (and nowhere else), the cancer can sometimes be removed by surgery.

For spread to the liver, there are other methods besides surgery which might be used to destroy the cancer. These include methods to block the blood supply to the tumor or to destroy the cancer through freezing or by heating with microwaves. These methods are not meant to cure the cancer.

Radiation therapy for colon and rectal cancer

Radiation therapy is treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in the tumor (brachytherapy or internal or implant radiation).

After surgery, radiation can kill small areas of cancer that may not be removed during surgery. If the size or location of a tumor makes surgery hard, radiation may be used before the surgery to shrink the tumor. Radiation can also be used to ease symptoms of advanced cancer such as intestinal blockage, bleeding, or pain.

The main use for radiation therapy in people with colon cancer is when the cancer has attached to an internal organ or the lining of the abdomen. If this happens, the doctor can't be sure that all the cancer has been removed, and radiation therapy is used to kill the cancer cells left behind after surgery. For rectal cancer, radiation is also given to prevent the cancer from coming back in the place where it started and to treat local recurrences that are causing symptoms such as pain. Radiation is seldom used to treat metastatic colon cancer.

External-beam radiation therapy: In this method, radiation is focused on the cancer from a machine outside the body. This approach is most often used for people with colon or rectal cancer. Treatments are given 5 days a week for several weeks. Each treatment lasts only a few minutes although the setup time -- getting you into place for treatment -- usually takes longer.

A different approach may be used for some cases of rectal cancer with small tumors. The radiation can be aimed through the anus and reaches the rectum without passing through the skin of the abdomen. This means it is less likely to damage nearby tissues and cause side effects.

Brachytherapy (internal radiation therapy): In this method, small pellets or seeds of radioactive material are placed next to or directly into the cancer. The radiation travels only a short distance, limiting the effects on nearby healthy tissues. This method is sometimes used in treating people with rectal cancer, particularly sick or older people who would not be able to withstand surgery.

Side effects of radiation therapy

Side effects of radiation therapy for colon or rectal cancer include mild skin irritation, nausea, diarrhea, trouble controlling your bowel, rectal or bladder irritation, or tiredness. Sexual problems may also occur. Side effects often go away after treatment is over. If you have these or other side effects, talk to your doctor. There are often ways to reduce or relieve many of these problems.

Chemotherapy

Chemotherapy (often called simply "chemo") is the use of drugs to fight cancer. The drugs may be injected into a vein or given by mouth. These drugs enter the bloodstream and spread throughout the body, making the treatment useful for cancers that have spread to distant organs.

Chemo after surgery can increase the survival rate for patients with some stages of colorectal cancer. Chemo can also help relieve symptoms of advanced cancer.

In some cases, chemo drugs can be injected into an artery leading to the part of the body with the tumor. This approach is called regional chemotherapy. Since the drugs go straight to the cancer cells, there may be fewer side effects.

Side effects of chemotherapy

While chemo kills cancer cells, it also damages some normal cells and this can cause side effects. These side effects will depend on the type of drugs given, the amount given, and how long treatment lasts. Side effects could include the following:
diarrhea
nausea and vomiting
loss of appetite
hair loss
hand and foot rashes and swelling
mouth sores
increased chance of infection
easy bleeding or bruising after minor cuts or injuries
severe tiredness (fatigue)

Most of the side effects go away when treatment is over. For example, hair will grow back after treatment ends, though it may look different. Anyone who has problems with side effects should talk with their doctor or nurse, as there are often ways to help.

Targeted therapies

Targeted therapies are drugs that attack a part of cancer cells that makes them different from normal cells. Because these drugs affect only cancer cells, they often cause fewer side effects than chemo. Man-made proteins called monoclonal antibodies have been approved for use, along with chemo, against colorectal cancer.

Colorectal cancer survival rates

The 5-year survival rate is the percentage of patients who are alive 5 years after their cancer is found (leaving out those who die of other causes). Many of these patients live much longer than 5 years. While the numbers below are among the most current we have, they are from people who were first treated many years ago. Because cancer treatment continues to improve, the survival rates for people now may be higher.

Survival rates for colon cancer by stage
Stage I 93%
Stage IIA 72%
Stage IIB 72%
Stage IIIA 83%*
Stage IIIB 64%
Stage IIIC 44%
Stage IV 8%

*In this study, survival was better for stage IIIA than for stage IIB. The reasons for this are not clear, and it is not known if this is still the case.

Relative survival rates for rectal cancer by stage
Stage Relative 5-year Survival Rate
Stage I 92%
Stage II 73%
Stage III 56%
Stage IV 8%

These numbers provide an overall picture, but keep in mind that every person is unique and statistics can’t predict exactly what will happen in your case. Talk with your cancer care team if you have questions about your own chances of a cure, or how long you might survive your cancer. They know your situation best.

Symptoms & Types of Colorectal Cancer

2009-02-21T03:46:00.000-08:00

Understanding Colorectal Cancer - Symptoms
What Are the Symptoms of Colorectal Cancer?

In its early stage, colorectal cancer usually produces no symptoms. The most likely warning signs include:
Changes in bowel movements, including persistent constipation or diarrhea, a feeling of not being able to empty the bowel completely, or rectal bleeding
Dark patches of blood in or on stool; or long, thin, "pencil stools"
Abdominal discomfort or bloating
Unexplained fatigue, or loss of appetite or weight

Call Your Doctor About Colorectal Cancer If:
You notice a change in your bowel movements, experience bleeding from the rectum, or notice blood in or on your stool. Don't assume you have hemorrhoids; your doctor will most likely perform a rectal examination and possibly a sigmoidoscopy or schedule a colonoscopy -- an examination that involves a long flexible tube inserted in your rectum.
You experience persistent abdominal pain, unusual weight loss, or fatigue. These symptoms may be due to other causes, but they could also be linked to cancer.
You are diagnosed with anemia. In determining its cause, your doctor should check for bleeding from the digestive tract because of colorectal cancer.

Often times, colon cancer has no symptoms, but this quick, handy guide to the main symptoms of colon cancer can help you know what to look for.

Types:

Staging Colon and Rectal Cancer

After undergoing many tests, you have finally been given your diagnosis. But, what does it mean when your doctor says you have stage I colon cancer or stage III rectal cancer? The following information will help you understand your diagnosis better.
Stages of Colorectal Cancer

Colon and rectal cancer are staged according to how far they have spread through the walls of the colon and rectum and whether they have spread to other parts of the body. This staging process allows doctors to determine the best treatments for the particular cancer. It also allows them to determine if the cancer is getting better with treatment or not responding.
Staging Colon Cancer
Stage 0
Stage 0 cancer of the colon is very early cancer. The cancer is found only in the innermost lining of the colon.

Learn more about treatments for stage 0 colon cancer.

Stage I
Also called Dukes A colon cancer, the cancer has spread beyond the innermost lining of the colon to the second and third layers and involves the inside wall of the colon. The cancer has not spread to the outer wall of the colon or outside the colon.

Learn more about treatments for stage I colon cancer.

Stage II
Also called Dukes B colon cancer, the tumor extends through the muscular wall of the colon, but there is no cancer in the lymph nodes (small structures that are found throughout the body that produce and store cells that fight infection).

Learn more about treatments for stage II colon cancer.

Stage III
Also called Dukes C colon cancer, the cancer has spread outside the colon to one or more lymph nodes (small structures that are found throughout the body that produce and store cells that fight infection).

Learn more about treatments for stage III colon cancer.

Stage IV
Also called Dukes D colon cancer, the cancer has spread outside the colon to other parts of the body, such as the liver or the lungs. The tumor can be any size and may or may not include affected lymph nodes (small structures that are found throughout the body that produce and store cells that fight infection).

What Is Colorectal Cancer?

2009-02-21T03:25:00.000-08:00

In order to understand colon and rectal cancer, collectively known as colorectal cancer, it might first help to understand what parts of the body are affected and how they work.
The Colon

The colon is a 6-foot long muscular tube connecting the small intestine to the rectum. The colon, which along with the rectum is called the large intestine, is a highly specialized organ that is responsible for processing waste so that emptying the bowels is easy and convenient. The colon removes water from the stool, and stores the solid stool. Once or twice a day it empties its contents into the rectum to begin the process of elimination.
The Rectum

The rectum is an 8-inch chamber that connects the colon to the anus. It is the rectum's job to receive stool from the colon, to let you know that there is stool to be evacuated, and to hold the stool until evacuation happens.

What Is Colorectal Cancer?

Cancer that begins in the colon is called colon cancer, and cancer that begins in the rectum is called rectal cancer. Cancers affecting either of these organs also may be called colorectal cancer.

Colorectal cancer occurs when some of the cells that line the colon or the rectum become abnormal and grow out of control. The abnormal growing cells create a tumor, which is the cancer.

How mesothelioma is diagnosed

2009-02-20T09:46:00.000-08:00

Most people begin by seeing their GP when they have symptoms. Your GP will examine you and may arrange for you to have some tests or x-rays. You may be referred to hospital for these tests and for specialist advice and treatment. At the hospital, the doctor will take your medical history and occupational history before doing a physical examination.

Chest x-ray
CT scan
Pleural or peritoneal aspiration
Biopsy
Waiting for your test results
Chest x-ray

A chest x-ray will be taken to check for any abnormalities in your lungs, such as thickening of the pleura or fluid around the lungs. However, there can be other causes of thickening of the pleura and peritoneum (and fluid around the lungs or in the abdomen) apart from mesothelioma.

The following tests may also be needed to diagnose mesothelioma, and your doctor may arrange for you to have one or more of them at the hospital.

CT scan

A CT scan (computerised tomography scan) takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan is painless but takes from 10 to 30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

CT scans of the chest and of the abdomen will show the size and position of the mesothelioma and whether it has spread to other parts of the body.

You may be given a drink or injection of a dye that allows particular areas of your body to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine, or have asthma, you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.

You will probably be able to go home as soon as the scan is over.

Pleural or peritoneal aspiration

If there is fluid in your chest or abdomen, the doctor can take a sample by using a local anaesthetic and passing a needle through the skin into the fluid. Some of the fluid is then drawn off into a syringe and can be analysed in the laboratory to look for mesothelioma cells.

Taking fluid from between the pleura is known as a pleural aspiration and taking fluid from the abdomen is known as drainage of ascites (or peritoneal aspiration).

Biopsy

If you need a biopsy, your doctor will take a sample of tissue from the thickened pleura or peritoneum. A local anaesthetic is used to numb the area and a special type of needle is passed through the skin into the tumour. The needle has a tip that can cut out a sample of the tumour. The doctor may use ultrasound or a CT scanner to position the needle accurately. An ultrasound uses sound waves to build up a picture of the organs in a part of the body. A small device is passed over the skin to show the doctor where the tumour is and guide the needle into the right place.

Sometimes the doctor will want to look at the area of the pleura or the peritoneum directly to get a sample of tissue from the right area. This is done by using a thin flexible tube with a light and camera at the end. The tube (endoscope) can be passed through the skin of the chest, where it is called thoracoscopy, or the abdomen, where it is called laparoscopy. The procedure is done under a general anaesthetic by a surgeon. You will usually be able to go home the same day.

Your doctors may want to check for any signs of spread of the cancer to the nearby lymph glands in the centre of the chest. This central area, around the lower part of the windpipe, is called the mediastinum and the lymph glands which are found there are the mediastinal lymph nodes. This test is called a mediastinoscopy. The test is done under a general anaesthetic and will mean a short stay in hospital. A small cut is made through the skin at the base of the neck. A tube, like a small telescope, is passed into the chest through the hole created by the cut. The doctor can use this tube to examine the area. Samples can be taken for examination under a microscope.

Analysing the biopsy in the laboratory is the only way your doctors can make the diagnosis of mesothelioma. Sometimes, even after taking a biopsy, the doctors may not be sure of the diagnosis, because mesothelioma can be very difficult to distinguish from other illnesses. In this situation, the biopsy samples may be sent to other laboratories to confirm the diagnosis, some of your tests may need to be repeated or you may be referred to another hospital for a second opinion.

Waiting for your test results

It will probably take several days for the results of your tests to be ready and a follow-up appointment will be arranged for you before you go home. This waiting period is likely to be an anxious time for you and it may help to talk things over with a close friend or relative. You may want to ring our cancer support service to ask any questions you may have.

Symptoms of mesothelioma

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Mesothelioma often starts as a lot of tiny lumps (nodules) in the pleura, which may not show up on scans or x-rays until they are quite large. The main symptoms of pleural mesothelioma are breathlessness and chest pain. Some people find that their voice becomes hoarse and they have a cough that does not go away.

Peritoneal mesothelioma often causes swelling and pain in the abdomen.

General symptoms

Both types of mesothelioma can cause other general symptoms, such as loss of appetite, sweating (especially at night), weight loss and tiredness. As many of these symptoms can also be caused by other illnesses, your doctor will need to do a series of tests before a diagnosis can be made.

Causes of mesothelioma

2009-02-20T09:13:00.001-08:00

Asbestos is the most common cause of mesothelioma. Up to nine out of ten cases of mesothelioma are caused by exposure to asbestos. Asbestos is a natural mineral, mined from rock found in many countries. It is made up of tiny fibres that are as strong as steel but can be woven like cotton and are highly resistant to heat and chemicals.

During the 1960s the first definite link between mesothelioma and asbestos was made. In the past asbestos was imported to the UK in large quantities. It was used in construction, ship-building and in household appliances. Asbestos was very widely used in insulation materials, such as amosite insulation board, and building materials, including asbestos cement.

When asbestos is disturbed or damaged, it releases tiny fibres that can be breathed into the lungs. Asbestos fibres are very fine and, when breathed in, they can make their way into the smallest airways of the lung, so they cannot be breathed or coughed out. Once the fibres are in the lungs, the body's defence mechanism tries to break them down and remove them, which leads to inflammation in the lung tissue.

The asbestos fibres can also penetrate through the lung tissue to settle in the pleura (the membrane around the lung). Over many years they can cause mesothelioma or other lung diseases to develop.

Asbestos fibres can also be swallowed, and some of the fibres can stick in the digestive system. They can then move into the membrane that lines the abdomen (the peritoneum), where they cause inflammation.

The people most likely to have been exposed to asbestos include:
construction workers
plumbers
electricians
boilermakers
shipbuilders
demolition workers
people who worked in other places where asbestos was present and
people who lived near to asbestos factories.

Family members of people who worked with asbestos and brought the dust home on their clothes have also sometimes developed mesothelioma.

There are three types of asbestos: blue, brown and white. Blue and brown asbestos are the types most commonly linked with mesothelioma. They are now very rarely used and cannot be imported into the UK. Originally, white asbestos was thought not to be dangerous but recent studies have now shown that it is also harmful.

In the 1980s, imports of blue and brown asbestos into the UK were stopped, and in 1999 the importation and use of all asbestos was banned. However, as mesothelioma develops so slowly, it is estimated that by 2015 approximately 3000 people will be diagnosed with mesothelioma each year. The number of people who develop mesothelioma will then start to reduce each year.

Mesothelioma does not usually develop until many years after exposure to asbestos. It can take any time from 10 to 60 years, although the average is about 30 to 40 years after exposure to asbestos.

Occasionally, mesothelioma develops in people who have never been exposed to asbestos. The other causes of the disease are not fully understood, but in rare cases the development of mesothelioma has been linked to exposure to radiation.

Research has not found any evidence that smoking increases a person's risk of developing mesothelioma. It is also thought that exposure to other building materials such as fibreglass does not increase the risk.

Mesothelioma is not contagious and cannot be passed on to other people. It is not caused by inherited faulty genes and so family members do not have an increased risk of developing it, unless they have been in contact with asbestos.