Screening, Diagnosis and Treatment Options
Screening and Diagnosis: Get Checked
Generally speaking, doctors recommend that people age 50 and older should be screened for colorectal cancer. So if you are in that category, take time to schedule tests. If you are experiencing worrisome symptoms, your doctor may recommend testing, no matter what your age. Here is what to expect:
- Barium enema: In this test, a doctor will insert an enema containing a colored dye, called barium, into your bowel. Then the doctor will take an x-ray, which will give him a good picture of your colon and rectum.
- Colonoscopy: The idea of getting a colonoscopy may seem daunting to you, but in most cases, you will not feel any pain. It is considered the best diagnostic tool for detecting colorectal cancer.
- Before the test, it's important that your colon be cleaned out, so your doctor will give you specific instructions. Your diet may be limited in the days leading up to the exam and you will probably not be allowed to eat solid food on the day before. To completely empty your colon, you may be advised to take a laxative or an enema the night before the test. Be sure you talk to your doctor about any medications you're taking, as they might have to be adjusted.
- During the test, you'll probably wear a medical gown. You will be given a mild sedative, perhaps in conjunction with a painkiller, so you should be fairly comfortable. You'll lie on your side and pull your knees up to your chest. Next, a doctor will insert a long tube, called a colonoscope, into your rectum. The tube has a light and a tiny camera, and it reaches the entire length. As the tube moves, you may feel cramping, but the feeling should pass.
- The camera provides images of the inside of your colon. Based on what the doctor sees, he may use other instruments to take tissue samples or he may remove polyps that are present. The test usually takes 20 to 60 minutes.
- After the exam, you will still be need someone to take you home, since it may be several hours before the sedative completely wears off. You may experience cramps or bloating, and it is advised that you relax for the rest of the day.
- Virtual colonoscopy: This is an alternative to a regular colonoscopy and it involves using a number of computerized tomography (CT) images to get a good look at your colon.
If your colonoscopy is negative, congratulate yourself for being proactive and looking out for yourself. Then check with your doctor about a schedule for future tests. During this screening process, if any of these tests indicate that you have cancer, your doctor will run further tests to determine what stage the cancer is in. These tests may include stomach and chest CTs, other X-rays and blood tests.
These are the basic stages:
- Stage 0: This is the earliest stage, and your cancer is has not grown beyond the inner layer of the colon.
- Stage I: Your cancer has grown beyond the inner layer but has not spread outside the colon.
- Stage II: Your cancer has spread through the wall of the colon but not to the adjacent lymph nodes.
- Stage III: The cancer has spread to the lymph nodes but not to other parts of the body.
- Stage IV: Your cancer has spread to other organs, such as your lungs or liver.
Treatment: Get Better
If you get the news that you have cancer, you may wonder, What do I do next? It's important to talk to your doctor about what stage the cancer is in and what your treatment options are.
- Surgery: If your doctor suggests surgery, the type will depend on the stage of your cancer. If you're in an early stage, the doctor may have already removed the cancerous polyps during your colonoscopy. Other polyps can be removed during another colonoscopy or with laparoscopic surgery. This operation is done with a local anesthetic and is not as invasive as other types of surgery.
- If your cancer is more advanced, you may require a colectomy. This operation involves removing part of your colon and some of the tissue around it. In many cases, the healthy parts of your colon will then be reconnected and you will have bowel movements like you did before surgery. However, if this is not possible, you will need a colostomy. This means you'll have an opening on your abdomen where your bowel empties waste to a bag. In some cases, you may need the colostomy only until your colon heals. Or you may need it permanently.
- In the event that your cancer is very advanced, a doctor may perform what is called palliative surgery. This means that blockages will be removed from your colon to make you more comfortable and to alleviate symptoms, but the cancer will not fully be removed or cured. In this case, talk to your doctor about ways to improve your quality of life.
- Chemotherapy: If you get chemotherapy, you will be given drugs-in IV or pill form-that will kill cancer cells. This treatment is often used after surgery or to control the growth of the cancerous tumors. It is usually given in cycles, so you have time to recuperate for a few days between treatments. Side effects often include nausea and fatigue, and some patients lose their hair. Your oncologist will discuss the specific side effects for you based on the chemotherapy drugs you receive, and how these side effects will be managed.
- Radiation: This therapy is often used in conjunction with chemotherapy. It involves using high-energy x-rays to pinpoint and destroy cancerous cells. It is commonly used in treating all stages of rectal cancer. If you undergo radiation therapy, you will probably feel somewhat weak and nauseated.
Follow-up: Keep Watch
After you have had cancer treatment, pay close attention to your body. You will probably have concerns about the cancer coming back, so educate yourself about your condition and the symptoms to look out for. These include:
- Changes in bowel movements
- Bleeding from the rectum or blood in your stools
- Unexplained weight loss
Be sure to talk to your doctor about follow-up tests. He will probably recommend that you have a colonoscopy approximately six months after surgery. If that is normal, then you will likely need a colonoscopy every 1-3 years after that. In addition, make sure you have a general physical each year to monitor your health. Blood tests that check for carcinoembryonic antigens (CEAs) may help determine if the cancer has returned. If your doctor feels that you remain at high risk, he may recommend CT scans of your chest and abdomen every few months.
As you recover, accept the help that is offered to you. If friends and family can assist you with everyday chores, be grateful. Join a support group so you can share your experiences and worries with others who are in a similar situation. Remember that you are never alone in this journey.
For more information on colorectal cancer care and screenings at The Cancer Center at St. Anthony’s Hospital, please call (727) 825-1253.
St. Anthony's Cancer Center
1201 5th Ave. N., Suite 130
St. Petersburg, FL 33705
Phone: (727) 825-1253
Fax: (727) 825-1332