Colon cancer is one of the most common cancers. It’s largely preventable, provided you have regular check-ups/screening.
All colon cancers originate in colon polyps. A polyp is a small growth (tumour) in the lining of the colon and is usually completely asymptomatic, which is why screening is so important. Undergoing a routine screening colonoscopy allows your surgeon to identify polyps and remove them before they progress into cancer.
How can I know if I have a colon polyp or early cancer?
Frankly, the only way you’ll know for sure is to have a colonoscopy. Colon polyps and early cancers are largely asymptomatic. Only when tumours grow big do they begin to cause subtle symptoms like a change in bowel habit, rectal bleeding, mucous discharge or a feeling of an incomplete emptying of the rectum.
But can’t blood tests be done to see if I have colon cancer?
No, this is a common misconception. The role of tumour markers in colon cancer is to monitor disease progression in an established case of cancer. Many patients with colon cancers have ‘normal’ tumour marker levels when they’re first diagnosed, making it unreliable as a screening test.
So should everyone undergo a routine colonoscopy at a stage?
Yes. Current guidelines recommend you have your first colonoscopy at age 50. Thereafter, every 10 years. If you have an immediate family member (like your mother, father, brother or sister) who had either colon cancer or a colon polyp, then your risk goes up. If this is the case, you should have your first screening scope at age 40 or at an age that’s 10 years younger than the age of your family member when they were first diagnosed, whichever comes first. So as an example, if your father had colon cancer at age 60, you need to be screened at age 40. If he had colon cancer at age 45 you need to be screened at 35.
How is colon cancer diagnosis confirmed?
Usually a tumour is discovered when your surgeon or gastroenterologist does a colonoscopy. A biopsy (small tissue sample taken with a special forceps) will be taken and sent to a pathologist. The pathologist examines the tissue under a microscope and confirms whether it’s cancerous or not.
What happens after I am diagnosed with colon cancer?
A staging work-up needs to be done. ‘Staging’ means to see how far the cancer has spread, if at all. This usually entails a CT-scan of your lungs, liver and abdomen, as well as some blood tests. Final staging can usually only be done once the cancer has been removed.
Will I need chemotherapy if I have colon cancer?
It’s likely that you will, but some patients with early-stage colon cancer don’t need chemotherapy. They only need the cancer removed and have their recovery closely monitored.
What surgery needs to be done?
The cancer and adjacent lymph nodes need to be surgically removed. This involves removing a section of your large bowel (colon) containing the cancer and then reconnecting the two ends. If the cancer is very close to the anus, the anus needs to be removed and a permanent colostomy created.
What are the major risks of this type of surgery?
Your biggest risk is the development of a small leak at the join-line (anastomosis). This is a serious complication that requires revision surgery and often a temporary colostomy is needed to allow everything to settle.
But shouldn’t a good surgeon prevent a complication like this?
Yes, your surgeon has some control over the situation. He needs to make sure that the bowel ends have a good supply of blood and are under no tension before joining them up. Impeccable surgical technique is vital in doing the actual ‘join’, but unfortunately, even while adhering to all of the above, leaks still occur in 2 to 7% of cases. It’s important that your surgeon identifies any complications timeously and deals with them decisively, before they lead to severe illness.
Can this surgery be performed by keyhole (laparoscopic) surgery?
Often it can, but this depends on numerous factors like the size and position of the tumour, your physical attributes and your surgical history.
How long will I be in hospital after a colon cancer operation and how long will I be off work?
The postoperative stay is usually between 5 and 7 days. Afterwards, you’ll recover at home for another 2 weeks, making it a total of 3 weeks before you can go back to work.
Are any follow-up colonoscopies needed after my cancer?
Yes. As far as you’re concerned your first follow-up colonoscopy will be a year after your initial diagnosis and tumour removal. Thereafter, you’ll have colonoscopies every 3 to 5 years.
It’s also important for your immediate family members to undergo a screening colonoscopy. Please read point 3 above.