Cancers involving the large intestine (colon) and rectum (the last part of the large intestine) are called Colorectal cancers. Early diagnosis and correct treatment methodare of great importance in the course of the disease and the survival and even recovery of the patient.
Colorectal cancer is the 4th most common in women and the 3rd most common in men. It is a type of cancer. The role of heredity in this cancer has been determined. While the normal risk of occurrence in society is 5%, this rate is 15-20% in those with a family history of colorectal cancer, 15-40% in those with inflammatory bowel disease, 70-80% in those with familial non-polyposis colorectal cancer (HNPCC) gene mutation, and familial adenomatous polyposis ( This risk is 100% in patients who can involve the entire colon, known as FAP.
These risks increase with excessive fatty food consumption, sedentary life, alcohol and cigarette use, and advancing age.
Diet has a very important place in protecting against Colon Cancer and Rectum Cancer. Risks are reduced, especially with fiber consumption, consumption of vegetables and fruits, foods such as yoghurt, milk and kefir containing calcium, vitamin D, folic acid supplements, exercise and colonoscopy screenings using endoscopy.
Colorectal cancer. What are the symptoms?
It is not very obvious in the beginning.
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Change in normal defecation habits, diarrhea or constipation that was previously normal
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Stools of normal thickness begin to become thinner after a while,
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Blood coming from the anus with or after defecation and at the beginning,
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Whitish, gel-like, sticky egg white-like secretion while defecating,
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The feeling of not emptying the intestines sufficiently after defecation,
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Feeling of pain during defecation,
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Weight loss,
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Feeling of fatigue,
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Anemia,
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Loss of appetite,
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Abdominal pain,
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Iron deficiency anemia,
Those with such complaints should consult a doctor and the diagnosis of colorectal cancer will greatly increase the chance of survival if diagnosed early before the disease progresses.
How is colorectal cancer diagnosed?
Patients with the above complaints undergo an examination called colonoscopy, which allows looking at the large intestine and rectum. . If there is a suspicious area during colonoscopy, a biopsy is taken.
How is colorectal cancer treated?
After the diagnosis is made and the cancer diagnosis is confirmed, staging is done to determine the extent of the disease according to staging. For this purpose, the following tests are used;
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Computed tomography (CT) of the chest cavity and the organs in it and the organs of the abdominal region
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Abdomen or magnetic resonance imaging (MRI) covering the bottom of the groin area
In stage I, the disease is limited to the intestinal wall and has not spread to the lymph nodes, while in stage IV, there is spread to distant organs. is the subject.
Treatment depends on the stage of the disease.
Treatment of colon and rectum cancer varies.
Colon cancer treatment
Colon cancer is treated with surgery. Depending on the stage of the disease, chemotherapy may also be required. Radiotherapy may be required before surgery if the disease is in the rectum.
Colon Cancer Surgery
The part of the intestine where the cancer is located is removed. After the diseased area is removed, the two remaining intestines are often brought together and joined together. This means that the patient will continue to defecate naturally.
However, in some emergency cases (special situations such as obstruction, poor general condition of the patient, etc.), the intestine can be attached to the abdominal wall after the diseased part of the intestine is removed. This is called a stoma. The stool is removed with a collecting bag covering the stoma. Mostly these stomas are temporary. At the end of the treatment, the intestines are joined together again. In some cases, this situation may be permanent.
Rectum cancer treatment
Treatment varies depending on the stage of the disease. Treatment begins with surgery in the early stages. In stages II and III, chemotherapy and radiotherapy are usually recommended before surgery. This is called neoadjuvant chemo-radiotherapy. r. Sometimes chemotherapy is continued after surgery.
In Stage IV, treatment is mostly chemotherapy. If there is a response to chemotherapy or if it spreads to the abdominal membrane, surgery and radiation may be required.
In some patients, short-term radiotherapy, such as 5 days, is recommended before surgery.
Treatment with surgery
The rectum and the vessels that feed it, the veins and the fatty tissue surrounding the rectum are removed together. If the tumor extends to the anus, the anus can be closed. The remaining intestine is given to the abdominal wall by opening a stoma.
What methods are available in colorectal cancer surgery?
Studies have shown that there is no significant oncological difference between laparoscopic and open methods. Laparoscopy allows the patient to recover in a shorter time and with less scarring.
Robots, as in all fields, have begun to take part in colorectal cancer treatment.
How is screening done for colorectal cancer?
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Screening should start after the age of 40 in individuals without complaints.
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For this purpose, fecal occult blood should be checked once a year, sigmoidoscopy should be performed every 5 years, and colonoscopy should be performed every 10 years. The frequency of colonoscopy may be increased depending on the high risk situation.
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In individuals with a history of colorectal cancer or adenomatous polyps in their first-degree relatives, the same procedures as the normal population start from the age of 35. For individuals whose first-degree relatives develop colorectal cancer at an early age, the screening procedure should begin 10 years before the relative's age of cancer onset.
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In families with familial polyposis syndromes, genetic tests should be performed after the age of 10-12 and screening should be performed with annual colonoscopies.
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Genetic mutations should be investigated in those with a family history of familial non-polyposis colorectal cancer. Colonoscopy every 2 years starting from the age of 20 or 5 years before the age of the family member who developed early cancer, annual screening from the age of 40-45, examination of the uterus and ovaries and breast examination in women every year from the age of 25-30, urinalysis and cervical smear from the age of 5. follow-up once a year, skin examination annually Upper digestive system endoscopy should be performed every 1-3 years.
What is the role of Hot Chemotherapy in colorectal surgery?
Approximately 25% of Colon Cancer and Rectum Cancer patients have spread to the abdominal membrane during the first surgery, but this spread is not visible or detectable during surgery. After surgery is performed and treatments are completed over time, symptoms usually occur within 18-24 months after the surgery. Symptoms caused by tumors spreading into the abdomen may need to reach sizes larger than 1cm in order to be detected on tomography and to cause symptoms. For this reason, it may be necessary to obtain consent for the addition of Hot Chemotherapy treatment before surgery in patients who need to undergo surgery.
In robotic systems, surgeries are performed through small holes created in the abdominal wall, as in laparoscopy. It provides mobility in narrow and restricted areas.
Negative circumferential surgical margins in rectal cancer surgery increases the patient's long-term survival. In addition, in rectal cancer surgery, protecting the nerves that stimulate the genital and urinary systems is important for the continuation of the functions of these organs after surgery. With robotic systems, the risk of damage to these nerves is less, especially in men and patients with narrow pelvises.
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