Colon Cancer

A particular focus of the Visceral Centre is the treatment of colon and rectal cancer.

Colon cancer

Colon cancer is one of the most common cancers in developed countries. In Germany, 70,000 people are diagnosed with colorectal cancer each year. Earliest-possible diagnosis combined with professional and competent treatment are the best prerequisites for successful treatment of colon cancer.

To this end, the Visceral Centre works in close cooperation with specialists from all relevant departments (gastroenterologists, oncologists, surgeons, radiologists, pathologists, radiotherapists and psycho-oncologists) to devise an individualised treatment concept with clear guidelines on diagnostics and therapy for each patient with colon cancer.

What is colon cancer?

Colon or bowel cancer refers to a disorder of the colon or rectum. It occurs when cells of the intestinal mucosa divide uncontrollably, and when initially benign polyps of the mucosa in the course of time become tumours that grow into the surrounding tissue (invasive carcinoma) or release cells that spread to other organs and establish themselves there. These subsidiary growths are referred to as metastases. The transformation of a benign intestinal polyp into a carcinoma generally takes years.

Therefore, colon cancer can easily be detected early on.

With a preventive medical check-up/colonoscopy, the condition can be diagnosed at an early stage or even prevented by removal of the polyps. For this reason, it is recommended that a colonoscopy be carried out from the age of 50 and repeated every 10 years, even in the absence of symptoms. It is furthermore advisable to undergo a yearly examination of the stool for occult blood.

Symptoms of colon cancer

Symptoms of colon cancer often do not appear until the condition has reached an advanced stage, and the tumour has reached a certain size. In the initial phase, a growing tumour will not result in symptoms for some time. Close attention should therefore be paid to new symptoms. The following symptoms may indicate the presence of colon cancer:

• blood in the stool (hence the medical check-up to screen for occult blood)
• anaemia coupled with fatigue and exhaustion
• abdominal pain
• varying types of bowel movements (alternating between diarrhoea and constipation), when the tumour is already partly blocking the intestine or
• a bowel obstruction in advanced colon cancer with complete blockage of intestinal passage

Course of treatment

If your family physician or resident specialist physician suspects or has already diagnosed colon cancer, you may schedule an appointment at short notice for further treatment in our Visceral Centre at short notice. (Contact)

Generally, further check-ups are carried out in the first 1-2 days of a hospital stay as long as these have not already been performed during outpatient treatment.

The following tests are required prior to surgery:

• blood analysis to determine the CEA tumour marker
• ultrasound of the abdomen
• computed tomography (CT) of the abdomen
• chest x-ray of the lungs
• colonoscopy with biopsy (if this has not already been done during outpatient care)
• additional examination in the case of rectal cancer: endoscopic ultrasound exam of the rectum, to determine
• the size of the tumour and lymph nodes) 

Over the past few years, numerous studies on the treatment of rectal cancer have demonstrated that, once a specific tumour size has been reached and the lymph nodes have increased in size, a combination of chemotherapy and radiotherapy before an operation can improve the prognosis. All test results from patients with rectal cancer are therefore presented at the tumour conference, and a treatment procedure is recommended.

The test results and recommendation of the tumour conference are discussed with you in detail. The treatment plan to follow is then determined in consultation with you.

Surgery

Colonic irrigation will be required on the day before surgery -  this means that you will need to drink 2-3 litres of a laxative solution.

If creation of an artificial anus (stoma) is necessary, a stoma therapist will inform you of care options, counsel you, and be available for further consultation following the operation.

Different portions of the colon or rectum are removed depending on the location of the colorectal cancer. The objective of the operation is complete removal of the tumour as well as the lymphatic drainage area.

The operation can be carried out using either the conventional technique with an abdominal incision, or by employing a minimally invasive technique (“keyhole surgery”).

Conventional, open surgical procedure

The open surgical procedure with a large abdominal incision is utilised particularly with large tumours or advanced colon cancer with involvement of neighbouring organs.

Following an open surgical procedure, more time is usually needed for mobilisation and reintroduction of solid food, somewhat increasing the length of a hospital stay. The risk of wound infection or scar rupture is higher than with the minimally invasive method.

Minimally invasive surgery (MIS)

In contrast to the open method, the minimally invasive surgical procedure generally results in less post-operative pain, fewer scar ruptures and wound infections, allows for speedier mobilisation and reintroduction of a normal diet, and usually reduces the length of a hospital stay.

However, the minimally invasive technique cannot be used with large tumours or involvement of neighbouring organs that must also be removed.

In order to let our patients benefit from the advantages of minimally invasive surgery, we use this method with operations for colon cancer whenever possible.

In operations for colon cancer, the appropriate section of the colon is removed depending on the tumour’s location, together with the supplying blood vessels and attached lymph nodes. If adjacent organs are also involved, these will be partly or completely removed as far as possible to achieve \ complete removal (resection) of all cancerous tissue.

An artificial anus is generally not created during these procedures. A colostomy is only needed in exceptional cases.

In operations for rectal cancer, the scope of the operation depends on the tumour’s location in the rectum. The rectum is divided into an upper, middle and lower portion, with the sphincter located in the lower third.

If the tumour is positioned in the upper or middle portion of the rectum, the corresponding segment can be removed. The colon is then attached to the remaining portion of the rectum. In order to protect this ‘intestinal suture’, some cases may require provision of a temporary artificial anus. Once the intestinal suture has completely healed, after approx. 2-3 months, the anal opening can be returned to its original position.

Tumours found in the lower third of the rectum (0-4cm) are usually so close to the sphincter that the sphincter cannot be retained, since an adequate safety margin needs to be kept to achieve complete removal of the tumour. As a result, a permanent, artificial stoma needs to be created.

This permanent stoma is created in the left middle abdomen, i.e. the end of the intestine is sewn into the abdominal skin. The stool is then emptied through the stoma and collected in a pouch. Following the operation, our stoma therapist will work with you to practise affixing and changing the pouch.

If desired, we will connect you with the self-help group ILCO, which is a self-help group for people living with a stoma.

After the operation, you will quickly be able to eat again and, with the support of physiotherapists, stand up and move around (fast track rehabilitation). The aim is to remove all probes, catheters and drainages as quickly as possible.

Depending on the histological examination of the tumour, further post-operative care and treatment (chemotherapy, radiotherapy) are determined in the tumour conference. In consultation with you, our oncologists will explain the process in detail and discuss each required step.

In uncomplicated cases, an inpatient hospital stay of 10-14 days should be expected.