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Colon and Rectal Cancer

Overview

At City of Hope, our approach to treating colon and rectal cancers starts with personalized care — not just for your cancer, but the kind that makes you feel supported throughout your treatment. Our world-class colorectal team combines a multidisciplinary team approach with the newest, leading-edge colorectal genetic screening to provide you with the most accurate diagnosis and treatment path.

City of Hope is one of only a few cancer centers in the country that provides comprehensive treatment. That means you have a team that is working together to combine innovative, genetically targeted therapies with leading-edge surgical techniques — all with the goal of making you whole again.

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City of Hope’s world renowned colorectal care team use the latest technology and innovation to treat colon and rectal cancer while providing compassionate care. Call 800-826-HOPE or request an appointment online.

 

"New drugs and combinations of drugs are more effective, surgical treatments have been refined and improved, and most patients are candidates for minimally invasive surgical techniques that have less pain and faster recovery."  Stephen Sentovich, M.D., M.B.A., Chief, Colon and Rectal Surgery Section

City of Hope is internationally-recognized for its research and breakthrough treatments, has been named one of America’s top cancer hospitals by U.S. News & World Report for more than 10 years running and is a National Cancer Institute-designated comprehensive cancer center.

Our commitment to providing the best care for you includes:

  • Surgeons expert in minimally-invasive techniques, including robotic and laparoscopic surgeries, for smaller incisions, less pain and faster recovery.       
  • Surgeons who know how to do everything possible to avoid a colostomy.
  • Colorectal surgeons specializing in complicated, late-stage cancers using combined colon and liver operations performed with our world-renowned liver surgery team.
  • Ultra-precise radiation and chemotherapy to target tumors and preserve healthy tissue.
  • Hyperthermic intraperitoneal chemotherapy, a complex treatment that involves removing widespread cancer then delivering heated chemotherapy directly to the abdomen.
  • Expertise in hereditary cancer syndromes, including use of next-generation DNA sequencing methods.
  • Genetic targeting used to figure out a tumor’s specific biology and to design treatments to stop it from growing.
  • Supportive care that continues long after treatment ends, including helping you and your family adjust to post-treatment diet and lifestyle changes.

At City of Hope we see complicated colon and rectal cancer cases every day, so we are experts at treating advanced and recurrent disease. That treatment happens just steps away from groundbreaking research and clinical trials — happening right on City of Hope’s campus — that could directly impact how we treat your cancer.  

When we care for you at City of Hope, we are not just focused on leading-edge care and innovation — we are working to make you whole again.

NEWS & BREAKTHROUGHS

We have made great advancements in the field and the majority of colon cancers are curable," Kurt Melstrom, M.D., colorectal surgeon

  • Colon and rectal cancers combined are the fourth most diagnosed cancer in the United States, behind breast, lung and prostate.
  • Since they are so similar the two often are lumped into one category and called colorectal cancer.
  • More than 134,000 people will get colorectal cancer in the United States this year.
  • That means about one in 20 people will get the disease during their lifetimes.
  • Although colorectal cancer is the third leading cause of cancer death, that rate has been dropping steadily, most likely because of better screening and treatment.

Types of colon cancer

There are several types of colon cancer, but most are what is called adenocarcinoma:                  

  • Adenocarcinoma is the most common type of colorectal cancer; it starts in the cells that make the mucus lining on the inside of the colon and rectum. Ninety-five percent of colorectal cancers are adenocarcinomas.

Other types of cancer that can start in the colon and rectum are much less common:

  • Gastrointestinal stromal tumors (GISTs) start in special cells found in the wall of the GI tract, called the interstitial cells of Cajal. It is unusual to find GISTs in the colon.
  • Lymphomas are a types of cancer that typically start in immune system cells, but can also start in the colon, rectum or other organs.
  • Carcinoid tumors start in hormone-making cells in the intestine.
  • Sarcomas are rare cancers that can start in blood vessels, muscle or connective tissue in the wall of the colon and rectum.

How colon cancer develops

The colon is a five-foot-long tube, shaped like a giant question mark, stretching from the small intestine to the rectum. It is part of the large intestine. When you eat food, it travels from the stomach and through the small intestine — where it is digested and absorbed — then it goes through the colon, where any leftover water and salt are absorbed.

The last six inches of the large intestine includes the rectum, a receptacle for the waste that is left before it leaves your body — and the anus. Cancers of the colon tend to be grouped with rectal cancer, and called colorectal cancer, because they are so similar.

Getting colon cancer

Getting colorectal cancer means abnormal cells in your colon or rectum are growing and dividing at a rapid pace — so fast that cells in your immune system that fight disease cannot keep up.

Layers of tissue inside the colon and rectum form what is called the wall. The innermost layer of that wall, called the mucosa, is where colorectal cancer usually starts. When cells in the mucosa grow uncontrollably, they join together to form a small, bulb-like growth called a polyp. Most polyps are benign, which means they do not cause cancer, but some can turn into cancer over time.

There are three main types of polyps:

  • Adenomatous polyps: The most common type of polyp, also called an adenoma. The cells that form these polyps grow and divide abnormally compared with normal colon cells, but only sometimes become cancer.
  • Hyperplastic polyps: Cells in this type of polyp grow fast but rarely become cancer. This is a common type of polyp and usually is found in the lower part of the colon or rectum.
  • Inflammatory polyps: These often appear after a bout with inflammatory bowel disease. They rarely become cancer.

If it is caught early through routine screening, colorectal cancer is very treatable. In more advanced cases, cancer cells will have grown through the colon wall and eventually spread to other parts of the body — a process called metastasis. Colorectal cancer that has metastasized tends to travel through the blood or lymph system, to the liver, lung and peritoneum.

What increases your risk of colon cancer?

Things that put you at higher risk for getting colorectal cancer are called risk factors. The links between diet, weight and exercise and colorectal cancer are some of the strongest for any type of cancer. Your risk of getting colorectal cancer depends on a complex interaction between those lifestyle factors and your inherited risks — in other words, the ones you’re born with.

Lifestyle-related risk factors for colon cancer include:

  • being older
  • being overweight or obese
  • not exercising enough
  • having type 2 diabetes
  • smoking
  • drinking alcohol excessively
  • eating a diet high in red, processed and charred meats
  • having a history of inflammatory bowel disease, ulcerative colitis or Crohn’s disease

Inherited risks for colon cancer include:

  • a family history of colorectal cancer or adenomatous polyps
  • being of African-American or Ashkenazi Jewish descent
  • having an inherited syndrome such as familial adenomatous polyposis or Lynch syndrome

Colon cancer prevention

More than most other cancers, colorectal cancer is affected by things you can control, like what you eat and how much you exercise. Eating a diet that includes plenty of vegetables, fruits, and whole grains — and that is low in animal fat — has been linked with a lower risk of colorectal cancer. Other lifestyle changes like quitting smoking, drinking less and exercising regularly may help lower your risk.

And getting screened for colorectal cancer starting at age 50 (or younger if you have a family history) may help doctors to find and remove polyps before they turn into cancer.

Colon cancer symptoms

Most of the time during the early stages, colorectal cancer does not cause symptoms. Polyps can grow in the colon wall for months or years without causing bleeding or pain. It is usually during the later stages — once the cancer has grown or spread — that symptoms may appear:

Typical colorectal cancer symptoms include:

  • a change in bowel habits that lasts more than a few days
  • pain in the abdomen (belly), cramping, bloating or gas pain
  • diarrhea, constipation or nagging feeling that bowel will not empty all the way
  • bleeding of the rectum
  • dark or bright red blood in the stool                   
  • weakness and fatigue
  • unintended weight loss
  • vomiting

These symptoms could also be a result of other conditions like hemorrhoids, irritable bowel syndrome, inflammatory bowel disease or infection. Still, if you have any of these problems for more than two weeks, it’s important to see your doctor right away to pinpoint and treat the cause.

 

Colon cancer screening

Screening involves looking for cancer before you have symptoms and increases your chances of catching colorectal cancer at an early stage, when it is more likely to be cured. Colorectal cancer screening is important because polyps containing cancer cells can stay lodged in the colon wall for months or years without causing bleeding, pain or any other symptoms.

At City of Hope we are dedicated to increasing the number of lifesaving screenings, and to support that effort we offer state-of-the-art diagnostic tools including colonoscopy and stool DNA testing. And our genetic screening and counseling program for colorectal cancer allows for the most accurate diagnosis and a clearly defined treatment path.

Many people do not get screened

Colorectal cancer is one of the most curable cancers, yet research shows tens of millions of people are skipping out on potentially lifesaving screening. The biggest reason: fear.

Fear of bowel preparation. Fear of the test. Fear of the results.

But most of those concerns are unfounded — especially fear of the test. The gold standard for colorectal cancer screening — colonoscopy — is a painless exam that happens while a patient is sedated (sleeping), and usually is over in less than 30 minutes.

If people who are avoiding them got colon cancer screenings, it could prevent 60 percent of colorectal cancer deaths.

When should you be screened?

You should start routine colorectal cancer screening at age 50 if you:

  • have no symptoms
  • have no personal or family history of benign or precancerous polyps
  • have no personal or family history of colorectal cancer

Your screening should begin before age 50, with more frequent follow-up, if you:

  • have developed polyps or colorectal cancer in the past
  • have a history of inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis
  • have first-degree relatives (parents, siblings) who developed colorectal cancer before age 50
  • have family history of inherited conditions associated with colorectal cancer, such as Lynch syndrome or familial adenomatous polyposis

Hereditary causes of colorectal cancer

Having close relatives with colorectal cancer increases the risk of developing the disease — and being diagnosed earlier in life — and could direct or change the treatment for some patients. Up to 10 percent of people with colorectal cancer have an inherited genetic abnormality that associated with developing the disease. Two of the most common inherited conditions that influence your risk of disease include:

  • Lynch syndrome is a condition that increases the risk of colorectal and other cancers — including stomach, liver, ovarian, endometrial, brain, skin and small intestine cancers. The syndrome is also referred to as hereditary nonpolyposis colorectal cancer.
  • Familial adenomatous polyposis involves developing multiple noncancerous polyps in the colon early in life that may later progress to colorectal cancer. This condition appears and is diagnosed at a much earlier age than normally developing colorectal cancers.

Although hereditary factors account for less than 5 percent of colorectal cancers, your chances of having one of these conditions is higher if several of your close family members have been diagnosed.

If your family history suggests an increased risk of colorectal cancer, City of Hope’s Division of Clinical Cancer Genetics offers genetic counseling and screening that can identify whether inherited conditions influence your risk — and guide you to the best treatments.

Diagnosing colon cancer

At City of Hope, we have several ways to screen for colorectal cancer including:

  • Colonoscopy: This test uses a long, lighted tube with a video camera on the end to examine your colon and rectum. While you are sedated (made to sleep), the tube is inserted into your rectum and through your colon, to look for and remove polyps or other abnormal growths, then send them to a lab for testing.
  • Flexible sigmoidoscopy: This test involves using a thin, lighted tube with a small video camera on the end to look at your rectum and the lower part of your colon. It looks for polyps or other abnormal areas, which are removed and sent to a lab for testing.
  • Double-contrast barium enema: A chalky white liquid called barium is put into the rectum, making it easier to see abnormal areas on an X-ray.
  • Virtual colonoscopy (CT colonography): This test is a special type of CT scan of the colon and rectum. Once the CT images are taken, a computer combines them to create a 3-D picture. This lets the provider look for polyps or cancer.  

Other screening tests look for signs of cancer in your stool or feces, but are less sensitive than tests like colonoscopy:

  • Fecal occult blood test or fecal immunochemical test: This is a test you do at home that looks for blood in the stool. This test must be repeated yearly to be effective.
  • Stool DNA test: This test looks for DNA changes in cells in the stool that might be signs of cancer. The stool sample is sent to a lab for testing.

A colonoscopy is the only test that lets the provider see your entire colon and rectum, and remove polyps at the same time. If you have any of the other tests and something uncertain is found, you will likely need a colonoscopy.

The most important thing about being an oncologist is to be there for your patient all along — to have an honest and ongoing discussion of what’s going on." Marwan Fakih, M.D., medical oncologist

City of Hope’s approach to treating colorectal cancer is focused on precision medicine. That means we apply precise and minimally invasive surgical techniques — and test individual cancer cells to find drug combinations that would work best for your specific cancer.

We are a leader in targeting therapy to individual patients and have many options for treating complex colorectal cancers including:

  • Sphincter-saving surgery that drastically reduces the need for permanent colostomy
  • Expertise in cancer that has spread to the liver, including combination surgeries with our world-renowned hepatobiliary surgery team
  • Expertise in HIPEC, or hyperthermic intraperitoneal chemotherapy, a treatment that involves removing tumors, then delivering heated chemotherapy directly to the abdomen
  • Clinical studies that are regularly finding new drug therapies and combinations to treat advanced cases

City of Hope is one of the few centers in the country that treats colorectal cancer using a comprehensive, team-based approach, by a team whose only focus is treating this type of cancer.

Your care includes regular interaction and input from a team of colorectal surgeons, oncologists, gastroenterologists, radiologists and pathologists — along with nurses, genetic counselors, nutritionists and specially trained support staff.

That comprehensive approach to your care means better care and a strong potential for you to live longer.

I find great satisfaction in identifying a tumor, removing it and restoring the body to normal functioning. My inspiration comes from the individual challenge that each patient brings and finding the best way to treat them." Kurt Melstrom, M.D., colorectal surgeon

Surgery

City of Hope’s surgeons are world leaders in robotically assisted and minimally invasive colorectal surgery that is focused on avoiding colostomy. Our surgeons work on a team to determine the best way to treat your cancer and preserve your bowel function and quality of life.

Surgeries for colon cancer

  • Polypectomy involves removing a polyp, often during a colonoscopy. It does not require an incision.
  • Local excision/Transanal excision involves removing the cancer and a small area of the tissue around it. It is typically done during a colonoscopy to remove very shallow tumors, or may be done in the operating room.
  • Colectomy/Hemicolectomy is when colon cancer has grown beyond the colon wall, the surgeon removes the part of the colon that has cancer, as well as a small amount of normal colon on either side, and nearby lymph nodes. The lymph nodes are then looked at under a microscope.
  • Lymphadenectomy is a surgery that involves removing and testing lymph nodes for cancer.

Surgeries for rectal cancer

  • LAR, or lower anterior resection, removes the part of the rectum that has cancer.
  • Proctectomy with coloanal anastomosis removes the whole rectum. The colon is then joined to the anus.
  • APR, or abdominoperineal resection, removes the anus and the tissues surrounding it, including the sphincter muscle.
  • Pelvic exenteration removes the rectum, as well as nearby organs if the cancer has spread there. These include the bladder, and the prostate in men or the uterus in women.

Chemotherapy or radiation may be given before surgery to shrink the tumor; and after surgery to try and wipe out any remaining cancer cells.

Chemotherapy

Chemotherapy is a treatment that uses drugs to either kill cancer cells or stop them from growing.

  • Exciting advances in chemotherapy at City of Hope are allowing patients with advanced disease to get combinations of drugs to shrink tumors, making it easier to take them out later with surgery — or melt them away and avoid surgery altogether.
  • If you have failed all standard chemotherapy, City of Hope has several experimental approaches — including immunotherapy and targeted therapy — designed to target your specific tumor and extend your life.
  • And for cancer that has spread to the liver, we offer leading-edge therapies like hepatic arterial infusion: a small disc implanted under the skin that sends chemotherapy drugs directly into the artery that feeds the liver.

Targeted therapies

City of Hope uses the latest technology to spot genetic vulnerabilities in cancer cells and use medications — or combinations of medications — to stop them from growing. This allows us to create targeted therapies: drugs or drug combinations tailored to treat specific cancers.

Radiation therapy

Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors. City of Hope offers advanced radiation treatments that are highly targeted to cancer cells including:

  • Intensity modulated radiation therapy and image-guided radiation therapy are ways of directing radiation directly at a tumor while protecting normal tissue around it.
  • Four-dimensional computed tomography (CT) scanning is a way to more accurately target cancer cells to reduce side effects.
  • Stereotactic Body Radiation is a new technology that delivers a very high dose of focused radiation treatment to tumors.
  • Advanced positron emission tomography (PET)/CT scanning is high-resolution imaging that helps to positively and clearly define tumors that, using other scanning techniques, might otherwise be missed.
  • Embolization involves having substances injected to try to block or reduce the blood supply to cancer cells.

City of Hope’s renowned physicians and researchers use the latest in technology and innovation to treat colon and rectal cancer, coupled with an enduring belief in providing unparalleled compassionate care.

Surgery

Kurt A. Melstrom, M.D., F.A.C.S., F.A.S.C.R.S.

Clinical Specialties

  • Colon and Rectal Surgery
I. Benjamin Paz, M.D., F.A.C.S.

Clinical Specialties

  • Surgical Oncology
Stephen M. Sentovich, M.D., MBA

Clinical Specialties

  • Colon and Rectal Surgery
Lily Lau Lai, M.D., F.A.C.S.

Clinical Specialties

  • Surgical Oncology

Medical Oncology

Joseph Chao, M.D.

Clinical Specialties

  • Medical Oncology
Vincent Chung, M.D., F.A.C.P.

Clinical Specialties

  • Medical Oncology
Marwan G. Fakih, M.D.

Clinical Specialties

  • Medical Oncology
Dean W. Lim, M.D.

Clinical Specialties

  • Medical Oncology

Radiation Oncology

Yi-Jen Chen, M.D., Ph.D.

Clinical Specialties

  • Radiation Oncology

Gastroenterology

Donald S. David, M.D., F.A.C.G.

Clinical Specialties

  • Gastroenterology
James L. Lin, M.D.

Clinical Specialties

  • Gastroenterology

Diagnostic Radiology

Jonathan Kessler, M.D.

Clinical Specialties

  • Diagnostic Radiology
  • Interventional Radiology

Colon Cancer Research at City of Hope

Getting treated for colorectal cancer at City of Hope means you are steps away from labs where new treatments are being developed every day. That proximity means you will benefit from something unique in cancer care — bench to bedside treatment. "Bench to bedside" means exciting new research we are conducting in our labs is moved quickly to the bedside to treat our patients.

Colorectal cancer is an extremely complex disease that can act many different ways in the body. Clinical trials at City of Hope are focused on those differences — and designing therapies that affect how colorectal cancer develops, progresses and spreads:

  • A City of Hope study is looking at a new combination of chemotherapy drugs that target a mutation (a problem with a cell) called BRAF that causes tumors. This mutation is found in 5 to 10 percent of patients with colorectal cancer and tends to resist chemotherapy and lead to poor overall survival. This study is testing whether adding a new combination of chemotherapy drugs will shrink tumors and improve survival for patients.
  • Some patients have metastatic colorectal cancer — cancer that has spread to other parts of the body — that stops responding to chemotherapy drugs. A new study involves giving patients high doses of new, experimental drugs called nintedanib and capecitabine. This drug combination will be studied to see how well it works in patients whose cancer has not responded well to multiple other treatments.
  • A study at City of Hope is testing two new chemotherapy drugs, MEDI4736 and tremelimumab, for colorectal cancer patients whose tumors have figured out how to outsmart the immune system.
  • Patients who have a malignant bowel obstructions, or a blockage in the bowels because of cancer or treatment for cancer, may be treated either with surgery or nonsurgical treatment. Both strategies are considered standard of care. This study will compare two groups of patients with this condition and compare the quality of life of those who are treated with surgery and those who receive the best medical management and no surgery.
  • Tissue from patients who have had their colon and/or rectum removed in a surgery gives researchers valuable clues about how to treat the many different types of colorectal cancer. In a study at City of Hope, tissue left over after colorectal surgery will be studied to see how certain types of cancer behave and how best to treat them.
  • City of Hope has a study looking at the psychological and social impact on patients who were cancer-free for a long time, then had their colorectal cancer come back in an advanced stage.

In addition to these clinical trials, City of Hope has several others that will open soon that look at new therapies for patients with specific mutations called RAS, and will explore new immunotherapy approaches, which is a way of helping the patient’s own immune system fight cancer.

Living with Colon Cancer

When you come to City of Hope, you have access to a strong network of support services and staff to help you and your family along your colon cancer journey. That support includes everything from talk therapy to meditation to being paired up with a patient navigator. Learn more about the resources listed below at our Living with Cancer or Supportive Care Medicine sites.

  • Managing pain, fatigue and nausea
  • Adjusting to new diet and lifestyle habits
  • Your emotional, social and spiritual well-being
  • Staying healthy and active
  • Healthy cooking and eating
  • Healing arts
  • Caregiver skills
  • Dealing with family stress
  • Controlling cancer risk with exercise
  • Navigating the health care system
  • Occupational and rehabilitation services

Once treatment is complete, City of Hope’s support services include education and training from ostomy nurses who provide specialty care for patients with wounds resulting from colorectal surgery.

Anne Bourque Success Story Image
Anne, colon cancer survivor

Anne Bourque is not only a colon cancer survivor, she is also a longtime City of Hope employee who began as a registered nurse in 1980 and is now the clinical director of the Hematopoetic Cell Transplantation Program.

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