Term Bowel Cancer

The term bowel cancer or colorectal carcinoma covers malignant diseases of the large intestine (colon) and the rectum. Two-thirds of carcinomas develop in the colon, and just under one-third in the rectum. In less than five per cent of cases, the small intestine is affected. Bowel cancer is one of the most common cancers in Germany. With increasing age (greater than 60 years), the risk of contracting the disease increases significantly. However, due to various risk factors or hereditary dispositions, the disease can also occur at a younger age. 

Since most carcinomas of the intestine develop from benign, very slow-growing intestinal polyps, regular colonoscopy is an important preventive measure. Health insurance companies cover the costs from the age of 55, for high-risk patients even earlier.

In the certified colorectal cancer centre at the Havelhöhe Community Hospital, gastroenterologists and surgeons work closely together on an interdisciplinary basis in the diagnosis and treatment of colorectal cancer. This has the advantage for patients that all specialists are on site and they do not have to be transferred for certain examinations or procedures. Diagnostics and therapy can be coordinated in an uncomplicated and timely manner; loss of information and unnecessary waiting times are avoided.

Causes and risk factors

There are various possible causes and risk factors for the development of bowel cancer:

  • A congenital genetic defect (approx. 5% -10% of sufferers).
  • A family history of colorectal cancer; first-degree relatives (mother / father) usually also have colorectal cancer at an early age
  • A chronic inflammatory bowel disease (IBD) that has been present for more than 10 years (ulcerative colitis or Crohn's disease with extensive colon involvement)
  • An unhealthy diet: low-fibre, high-fat and high-meat diet
  • Obesity
  • Little exercise
  • Smoking, frequent alcohol consumption
  • Type 2 diabetes mellitus
  • Presence of other diseases (HNPCC and FAP, Gardner syndrome, Peutz-Jeghers syndrome)

Symptoms

With bowel cancer, there are usually no symptoms in the early stages. Only in later stages do non-specific complaints become noticeable, such as cramp-like abdominal pain, changed bowel habits (occurrence of diarrhoea / constipation in alternation, pencil-thin stools), fatigue and weakness. Those affected often suffer from iron deficiency / anaemia and are pale. In the case of rectal cancer in particular, patients notice blood in the stool, plus a strong urge to defecate, often without emptying the bowels, and, in advanced stages, weight loss. Benign intestinal polyps, which can degenerate over time, rarely cause symptoms as a rule, so you should take advantage of the offer of a free colonoscopy even if you do not notice any symptoms.

Diagnosis

To confirm the suspicion of bowel cancer, a colonoscopy is necessary in any case. With the endoscope, the doctor also inserts a small instrument into the inside of the intestine with which he can take tissue samples. These are then examined histologically and provide reliable information about whether it is a tumour and about the degree of differentiation of the cells (grading). This is important, among other things, to be able to assess how aggressively the tumour will grow.

Polyps and tumours that can be removed endoscopically can be removed immediately during the examination.

In addition to the colonoscopy, ultrasound of the abdominal cavity and rectum (endosonography) as well as CT and X-ray images of the abdominal cavity and lungs are used to determine how far the tumour extends and whether it has already spread. On this basis, the tumour can be assigned to a specific stage and the corresponding therapy options can be planned. All patients with tumours are presented and discussed in the multi-disciplinary tumour meeting, in which gastroenterologists, surgeons, radiologists, nuclear medicine specialists, oncologists and, if necessary, other specialists take part. The end result is an individually tailored therapy concept that promises the best possible prospects of success.

Surgical therapy

The aim of surgical therapy is to completely remove the tumour tissue and thus provide a cure. The affected section of bowel is removed along with the associated blood vessels and surrounding lymph nodes. In the case of rectal cancer, sphincter-sparing procedures are used so that a permanent artificial bowel outlet (stoma) can be avoided in about 90% of all patients. Today, a cure for colorectal cancer is still possible in some cases even if the tumour has already metastasised to the liver and/or lungs. Here, the intestinal tumour is first removed in a first operation and the metastases are removed in further operations. Surgery can also be useful in advanced stages to avoid complications, such as bowel obstruction.

For inoperable metastases, radio frequency ablation is another established procedure available at the Havelhöhe Community Hospital. Here, the metastatic nodes are destroyed under local anaesthesia.

In some cases of rectal cancer, it is recommended to precede the operation with  radiotherapy/chemotherapy in order to improve the success of the treatment (neoadjuvant therapy).

In around 70% of all cases, it is possible to remove the tumours using minimally invasive surgery (laparoscopic keyhole surgery). Compared to open surgery, this is gentler on the patient and allows for a quicker recovery as a large abdominal incision can be avoided. Thanks to the minimally invasive surgery, a targeted, complete removal of the tumour is possible just as successfully as with a large abdominal incision.

Whenever possible, we work according to the fast-track concept in the context of colorectal cancer surgery. The aim is to minimise the consequences of the operation for the patients, to promote their recovery and to avoid complications. To this end, various modules were developed with measures that include improving pain control, early mobilisation of patients and an early change to the usual diet. Probes and drains are largely dispensed with. Convalescence sets in earlier. Close cooperation between doctors, nurses and patients is needed to implement the fast-track concept.

Drug therapies

Depending on the stage and cell structure of the tumour, additional medication is often administered after or, in some cases, before surgery. In order to reduce the risk of a relapse, patients receive individually tailored chemotherapy, in the case of rectal cancer also in combination with radiotherapy.

In advanced, metastatic colorectal cancer, antibody-based targeted therapies are used in addition to chemotherapy. These have a direct effect on the metabolic processes of the cancer cells. The drugs are based on different mechanisms of action, which are designed to prevent the growth of the tumour cells in different ways and to prevent the disease from progressing. We also offer PIPAC (pressurised intraperitoneal aerosol chemotherapy) and HIPEC (hyperthermic intraperitoneal chemotherapy).

Which drug holds the most promise can only be clarified individually, based on the histological characteristics of the tumour and other factors. In addition, there is the consideration of possible side effects that can also occur with these groups of medicines. In the multi-disciplinary tumour meeting, the specialists involved discuss the best possible approach in detail.

Unfortunately, a complete cure in advanced stages is not possible at present, even with this still quite new therapeutic approach. However, in many cases, the drugs lead to a longer-term containment of the disease and thus to a sustainable improvement in the quality of life.

Integrative Therapies

During an inpatient stay at Havelhöhe, we combine conventional medical therapies with integrative treatments that help you to strengthen your self-healing powers, activate the immune system and mobilise your strengths.

Mistletoe is also available as an accompanying naturopathic medicine that strengthens the immune system and can also reduce the side effects of cancer therapy, e.g. symptoms of exhaustion or fatigue syndrome that may occur.

Further integrative therapies can additionally significantly reduce the side effects of cancer therapy. These include movement and body therapies, e.g. eurythmy therapy and rhythmical massage therapy, as well as painting and music therapy. Additional support is provided by our anthroposophic care therapies, which promote regeneration.

You also have the option of taking advantage of psycho-oncological counselling. You can discuss possible fears there as well as the effects of the disease on your family situation or perspectives for the time after treatment.

Perspectives

Screening examinations play a central role in the fight against colorectal cancer - namely colonoscopy and, if necessary, testing for invisible blood in the stool. In this way, benign intestinal polyps can often be detected and removed at an early stage, and intestinal cancer does not develop in the first place. As with all cancers, the same applies here: the earlier a carcinoma is detected, the better the chances of a complete cure. However, even with more advanced disease, we now have good treatment options that can improve the quality of life for a longer period of time. At the Colorectal Cancer Centre in Havelhöhe, we work closely with our Department of Interdisciplinary Oncology and the Supportive Cancer and Palliative Care Unit in these cases. 

Aftercare

Regular follow-up is important in order to be able to respond to changes at an early stage and to treat any relapses that may occur in a targeted manner. The frequency of follow-up examinations for bowel cancer depends on the diagnosed stage of the disease, the fine tissue characteristics of the cancer cells and the type of surgery. Your attending physician at the Havelhöhe Community Hospital will discuss your individual aftercare plan with you and give you a copy of the agreed schedule.

In addition to physical and laboratory examinations, the attending physicians strive, if necessary, to further improve the patients' quality of life by arranging psychological or complementary medical services.

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Before discharge from the Havelhöhe Community Hospital, you will receive an aftercare passport from our Aftercare Documentation and Study Outpatient Department, in which all therapies and check-ups can be clearly noted. Medical aftercare is provided on an outpatient basis by your attending general practitioner or consultant, with whom we work closely.

We also ask you to report to our aftercare outpatient clinic at regular intervals so that we can document the progress of your treatment. As a certified oncology centre, we thus fulfil one of the quality criteria of the German Cancer Society.

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