Colorectal cancers are cancers affecting the large intestine (colon) and rectum (the last part of the large intestine). Early diagnosis and correct treatment method are of great importance in the course of the disease and the patient's lifespan.
Colorectal cancer is the 2nd most common type of cancer in women and the 3rd most common type of cancer in men. While the risk of occurrence in the general population 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 ( In those with FAP), this risk is 100%.
These risks increase with sedentary life, alcohol, cigarette use and age.
Fiber consumption, vegetable and fruit consumption, calcium, D. Risks are reduced with vitamin A, folic acid supplements, exercise and screening.
What are the symptoms of colorectal cancer?
It is not very obvious in the beginning.
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Continuous diarrhea and constipation,
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Thinning of stool of normal thickness,
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Anus and defecation bleeding,
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Egg white-like secretion during defecation,
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The feeling of not emptying the intestines sufficiently,
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Painful defecation,
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Weakness,
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Anemia,
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Anorexia,
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Abdominal pain,
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Iron deficiency anemia,
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Weight loss,
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Feeling of a mass in the abdomen
Those who have such complaints should consult a doctor before the disease progresses. Early diagnosis greatly increases the chance of survival.
How is colorectal cancer diagnosed?
Patients with the above complaints should be examined in the rectum and large intestine. An examination called colonoscopy is performed. If there is a mass or suspicious area in the large intestine or rectum, a biopsy is taken.
How is colorectal cancer treated?
After diagnosis, staging is done to determine the extent of the disease. For this purpose, the following tests are used;
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Computed tomography of the chest and abdomen ( CT)
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Abdominal magnetic resonance imaging (MRI)
In Stage I, the disease is limited to the intestinal wall and extends to the lymph nodes. While it has not spread, in stage IV there is spread to distant organs.
Treatment depends on the stage of the disease.
Treatment of colon and rectum cancer varies.
Colon cancer treatment
The treatment of colon cancer is surgery. Depending on the stage of the disease, chemotherapy may also be required. Radiotherapy is rarely required.
Surgical Treatment:
The part of the intestine where the cancer is located is removed together with the feeding vessels and the fatty tissue and lymph nodes accompanying them. After the diseased area is removed, the two remaining intestine ends are often brought together and joined together with stitches or special tools called staplers. This means that the patient will continue to defecate naturally (anus).
However, in special cases (emergency situations such as obstruction, poor general condition of the patient, etc.), the two ends of the remaining intestine cannot be joined. In this case, the intestine is mouthed to the abdominal wall. 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.
Rectal cancer treatment
Depending on the stage of the disease, surgery, radiotherapy, and chemotherapy are often performed together.
Surgery is sufficient in Stage I.
In Stages II and III, chemotherapy and radiotherapy are generally recommended before surgery. This is called neoadjuvant chemo-radiotherapy. Sometimes chemotherapy is continued after surgery.
In Stage IV, treatment is mostly chemotherapy. Sometimes surgery and radiotherapy may be required.
In some cases, only short-term radiotherapy (5 days) is recommended instead of chemoradiotherapy before surgery.
Surgical treatment:
The fatty tissue called mesorectum, which contains the rectum and the vessels feeding it, and the lymph nodes along the vessels, are removed as a block. If the tumor extends to the anus, the anus is also removed. The remaining intestine is attached to the abdominal wall and a stoma is opened.
What methods are available in colorectal cancer surgery?
Today, colorectal cancers are treated with open, laparoscopic and robotic methods.
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.
Robotic surgery systems have begun to take part in colorectal cancer treatment in recent years.
How is screening done for colorectal cancer?
Screening should start after the age of 50 in individuals without complaints. 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.
In individuals with a history of colorectal cancer or adenomatous polyps in their first-degree relatives, the same procedures as the normal population begin at the age of 40. 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.
In families with familial polyposis syndromes, genetic tests should be performed after the age of 10-12 and screening should be performed with annual sigmoidoscopy and colonoscopies.
Genetic mutations should be investigated in those with a family history of familial non-polyposis colorectal cancer. Colonoscopy every 2 years from the age of 20-25 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 annually from the age of 25-30 in women, urinalysis and cervical smear follow-up from the age of 5. Skin examination should be performed once a year, and upper digestive system endoscopy should be performed every 1-3 years.
What is the role of the robot in colorectal surgery?
Robotic systems in colorectal surgery. It can be used in cancers, diverticulitis, inflammatory bowel diseases (Crohn's disease, ulcerative colitis) and rectal prolapse.
In robotic surgical systems, surgeries are performed through small holes created in the abdominal wall, as in laparoscopy. This system consists of the console where the surgeon performs the surgery, the unit where the robot's arms are placed next to the patient, and a 3D view where the operating field is projected on the screen. It consists of a printing unit. Surgical instruments used in the robotic system can rotate 540 degrees thanks to the feature called 'endowrist'. It provides mobility in narrow and restricted areas. The 2-dimensional image in laparoscopy is replaced by a 3-dimensional image in the robotic system. In laparoscopic surgery, the human hand shakes slightly. This tremor is eliminated with the precise movement ability of the robotic system.
Negative environmental surgical margins in rectal cancer surgery increase 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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