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Colon and Rectal Cancer - Warning Signs, Diagnosis and Treatment


Amy Lynch for GBMC

March 6, 2020
Colon and rectal health probably isn’t something you’ll want to bring up at the dinner table or with a friend over coffee, but it is an important topic to discuss with your doctor.

“There’s no need to be embarrassed,” says Dr. Nina Ferraris, a colon and rectal surgeon with the Greater Baltimore Medical Center. “Surgeons and gastroenterologists talk about this stuff every single day. There’s nothing you can say that we haven’t heard before, and the sooner you can bring an issue to our attention, the easier it is to address.”

The last (and largest) section of the large intestine, the colon is a muscle that connects the small intestine and the anus. The rectum is the last portion of the colon that holds formed stool before elimination. The location of any cancer found in this area determines the most appropriate treatment protocol.

“We treat patients with rectal cancers differently than those with colon cancers,” Dr. Ferraris explains. “We’ve found that pre-surgical therapies like chemotherapy and radiation are helpful to improve outcomes for rectal cancer patients. Colon cancer is treated surgically first, and then followed up with chemotherapy afterward if it’s at an advanced stage.”

How Common are Colon and Rectal Cancers?

According to American Cancer Society statistics, colon cancer is the third most commonly diagnosed cancer in the U.S. and the third leading cause of cancer-related deaths in both men and women. If diagnosed while the cancer is still localized, the five-year survival rate for colon cancer is 90 percent and 89 percent for rectal cancer, supporting the ACS’s recent decision to move its baseline screening recommendation from age 50 to age 45.

“With appropriate therapies, early stage cancers have very good survival rates; as stages get higher, survival rates go down,” Dr. Ferraris says.

Who's At Risk?

The chances of developing colon and rectal cancers increase with age, and men, African Americans and people of Ashkenazi Jewish descent may be at slightly higher risk. Those with a family history of the disease or a history of polyps may also be at increased risk, as are patients with certain genetic conditions, those who are obese or inactive and those who smoke, drink alcohol on a regular basis, or eat a diet high in red or processed meat.

“Warning signs that should bring you in for an evaluation are changes in bowel habits —particularly narrowing of the stools or frequent constipation, blood during bowel movements and unexplained weight loss,” Dr. Ferraris adds. “It’s not one of the first indications of colon and rectal cancers, but if you are experiencing any kind of abdominal pain, you also should talk to your doctor.”

Diagnosis and Treatment

Colonoscopy remains the gold standard diagnostic procedure for detecting colon and rectal cancers, but depending on your general health, your doctor may recommend a flexible sigmoidoscopy, a virtual colonoscopy performed with a CT scanner or a Cologuard stool screening as an appropriate alternative.

“Colonoscopy remains the only test that allows doctors to simultaneously look for and remove polyps that we know based on data will eventually progress into colon cancers,” Dr. Ferraris says. “Everyone’s always nervous about the prep, but in the grand scheme of things, it’s really not that bad.”

If results don’t indicate any presence of polyps, colon or rectal cancer, patients should schedule a repeat colonoscopy every 10 years, or more frequently for those with a family history of cancer or a history of polyps.

GBMC offers a full scope of screening procedures, surgical interventions and treatment options for colon and rectal cancers including minimally invasive laparoscopic resections, assistive robotic technology, a number of oncology trials, integrative medicine for cancer patients and enhanced recovery pathways.
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