A National Cancer Institute-designated Comprehensive Cancer Center

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Colorectal Cancer

Colorectal Cancer
At City of Hope, a multidisciplinary team of nationally recognized experts in the research, diagnosis and treatment of gastrointestinal cancer provides outstanding medical care to patients with colon and rectal cancers. We are experts in treating patients with early to advanced colon and rectal cancers, including:
  • Adenocarcinoma
  • Leiomyosarcoma
  • Lymphoma
  • Melanoma
  • Neuroendocrine tumors
City of Hope researchers and physicians have pioneered new methods of treating colon and rectal cancers. Our approach to treating colon and rectal cancers combines aggressive therapies, minimally invasive and robotic-assisted surgery, and state-of-the-art technologies with highly compassionate care to give patients the best possible outcomes. Treatment for colon and rectal cancers may involve:
  • Surgery
  • Radiation therapy, including helical TomoTherapy
  • Chemotherapy
  • Chemoradiation
  • Heated intraperitoneal chemotherapy (HIPEC)
Through our clinical trials research program — among the most extensive in the nation — we can often provide patients with access to promising new anticancer drugs and technologies not available elsewhere.
About Colorectal Cancer
  • The colon and rectum are parts of the body’s gastrointestinal system, also called the digestive tract.  After food is digested in the stomach and nutrients are absorbed in the small intestine, the remaining material moves down into the lower large intestine (colon) where water and nutrients are absorbed.  The lower parts of the digestive tract include the rectum and anus, through which stool (solid waste) travels as it passes from the body.
  • Colorectal cancer (cancer of the colon or rectum) occurs when abnormal cells in the colon or rectum start to divide uncontrollably, forming a malignant (cancerous) tumor.
  • Cancer cells may invade the healthy tissues around them and spread (metastasize) to other parts of the body such as the liver and lung.  After treatment, some cancers may come back (recur).
Colorectal Risk Factors
Certain factors increase your risk of developing colon cancer. These include:
  • Age older than 50
  • Personal history of colorectal disorders:
    • Previous diagnosis of colorectal cancer
    • History of precancerous polyps
    • History of inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
  • Family history of colorectal cancer, especially before age 60
  • Hereditary syndromes
    • HNPCC (hereditary non-polyposis colorectal cancer)
    • FAP (familial adenomatous polyposis)
  • Diabetes
  • Ethnicity
    • Eastern European Jewish heritage
    • African-American heritage
  • Lifestyle factors
    • High-fat diet from animal sources, especially red meats and processed meats
    • Lack of exercise
    • Obesity
    • Cigarette smoking
    • Heavy consumption of alcohol

Colorectal Symptoms

Possible signs of cancer of the colon and/or rectum include a change in bowel habits or blood in the stool. These and other symptoms may be caused by colon and/or rectum cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
  • A change in bowel habits
  • Blood (either bright red or very dark) in the stool
  • Diarrhea, constipation, or feeling that the bowel does not empty completely
  • Stools that are narrower than usual
  • Frequent gas pains, bloating, fullness, or cramps•Weight loss for no known reason
  • Feeling very tired
  • Vomiting

How We Screen and Diagnose Colorectal Cancer

Some people have a higher risk for colorectal cancer due to genetics, family history, age or environmental/lifestyle factors. City of Hope’s Cancer Screening & Prevention Program combines clinical, research and educational initiatives to identify people who may be at increased risk for developing colorectal cancer.Because of these factors, reduce risk factors in this population wherever possible, and utilize the latest technologies for prevention and early detection of colorectal cancer.

Colorectal screening allows doctors to find and remove polyps (small areas of tissue that can become cancerous), as well as discover colorectal tumors at an early stage, rather than waiting for symptoms to occur.

General guidelines for colorectal screening are as follows:
  • Colonoscopy every 10 years, beginning at age 50
  • Annual fecal occult blood test (described below), preferably combined with sigmoidoscopy every five years.

City of Hope recommends patients talk with their physician about when to begin screening for colorectal cancer. A colonoscopy may be advisable more frequently for individuals with polyps, inflammatory bowel disease, previous colorectal cancer and family members with colon cancer.

Several different types of tests are used to examine the colon, rectum and stool for evidence of colon cancer, including:

  • Physical exam and history
  • Fecal occult blood test
    Small samples of stool are placed on chemically treated cards and examined for the microscopic presence of blood.
  • Digital rectal exam
    A doctor inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
  • Barium enema (also known as a lower GI series)
    For this examination, a liquid containing barium is placed into the rectum, which makes the colon and rectum easier to see in an X-ray.
  • Sigmoidoscopy
    In this test, a sigmoidoscope (a thin, lighted tube) is inserted through the rectum into the sigmoid colon. During the procedure, polyps or tissue samples may be removed for biopsy.
  • Colonoscopy
    A colonoscopy allows doctors to examine the entire colon and rectum for polyps, abnormal areas or cancer. In this test, a colonoscope (a thin, lighted tube) is inserted through the rectum into the colon and polyps or tissue samples may be taken for biopsy. Some colon polyps can be removed entirely during this procedure, which is performed under sedation.
  • Biopsy
    Tissue samples are examined under the microscope to determine what types of cells are present.
  • Virtual colonoscopy
    Also called colonography or CT colonography, this procedure uses a series of X-rays to create detailed pictures of the colon. The images are combined by computer in a process called computed tomography, or CT, to create detailed two- and three-dimensional images that can reveal polyps and other abnormalities inside the colon.

Colorectal Cancer Treatment Approaches

City of Hope brings together the most advanced resources to manage the treatment of patients with early and advanced colorectal cancers. Our team includes gastroenterologists, medical oncologists, radiation oncologists and surgical oncologists working cooperatively to create the most effective treatment plan.

In addition to conventional therapies, our clinical research programs offer patients access to promising new treatments.

Surgery to remove cancerous tissue is a primary treatment at all stages of colorectal cancer. City of Hope surgeons are among the most experienced in the U.S. at treating colon cancer, and have excellent success rates using a range of advanced technologies.

Minimally Invasive and Laparoscopic Surgery
Surgery is the primary treatment used for localized tumors. When applicable, our specialists utilize minimally invasive surgery with advanced technologies such as laparoscopy and the new da Vinci S Surgical System with robotic capabilities that allows for greater precision. These surgeries feature small incisions and potentially:
  • Less blood loss, pain and visible incisions
  • Shorter hospital stays and recovery time
  • Fewer complications and quicker return to normal activities

One of the following surgical procedures may be used:
  • Local excision
    This surgery (sometimes called a polypectomy) is used to remove precancerous polyps and very small colon cancers.
  • Resection
    If a cancer is larger, a partial colectomy (removing the cancer and a margin of healthy tissue around it) may be performed. Lymph nodes near the colon may also be taken out and examined for signs of cancer. Usually, the surgeon will reattach the healthy parts of the colon back together.
  • Resection and colostomy
    In rare cases, the remaining parts of the colon cannot be reattached. Instead, an opening (stoma) is created on the outside of the body for waste to pass through. This procedure, called a colostomy, may be required only for a few months until the lower colon has healed, after which it can be reversed. However, if the entire lower colon needs to be removed, the colostomy may be permanent.
  • Radiofrequency ablation
    This procedure uses a special probe that kills cancer cells with electrical current. The probe may be inserted directly through the skin, or through an incision in the abdomen. Radiofrequency ablation is sometimes used to treat liver metastases from colon and rectal cancers.

Radiation and chemotherapy
Even if the surgeon can remove all signs of cancer that can be seen during an operation, patients may be given additional treatments. These may include chemotherapy or radiation therapy following surgery to kill any residual cancer cells.

Treatment given after surgery is called adjuvant therapy. In some patients with rectal cancer, chemotherapy and radiation therapy may be given before their operation to reduce the size of the tumor. This is called neoadjuvant therapy.

Radiation Therapy
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. Our Department of Radiation Oncology was the first in the western United States to offer the Helical TomoTherapy Hi-Art System , one of the first radiation therapy systems of its kind to incorporate not only radiation therapy, but also tumor imaging capabilities comparable to a diagnostic computed tomography (CT) scan.

The helical TomoTherapy Hi-Art system integrates two types of technology – spiral CT scanning and intensity modulated radiation therapy, or IMRT – thus producing hundreds of pencil beams of radiation (each varying in intensity) that rotate spirally around a tumor. The high-dose region of radiation can be shaped or sculpted to fit the exact shape of each patient’s tumor, resulting in more effective and potentially curative doses to the cancer. This also reduces damage to normal tissues and results in fewer complications.

Chemotherapy drugs destroy cancer cells by interfering with their growth and multiplication. There are several methods by which these cancer-fighting medicines are delivered. In particular, City of Hope has been a pioneer in furthering the use of infusion chemotherapy to treat liver metastases arising from colorectal cancer.

Patients with liver metastases are evaluated for either resection or radiofrequency ablation. During surgery, a continuous infusion pump is placed under the skin to deliver anticancer medicine directly to the liver, in addition to chemotherapy given through a vein. This approach, called regional chemotherapy, has made major advances in controlling the spread of colorectal cancer.

Chemoradiation combines chemotherapy with radiation therapy to increase the effects of both. This strategy is often used for rectal cancers.

Heated Intraperitoneal Chemotherapy (HIPEC)
In the HIPEC procedure, the surgeon uses a special machine to pump high doses of heated chemotherapy drugs into the peritoneal cavity (the inner lining of the abdomen) while still in the operating room. The machine circulates the solution through the patient for up to two hours to reliably attack and eliminate any residual cancer cells that may remain after surgery. By bathing the abdomen with heated chemotherapy immediately following surgery, a higher dose of medication can be used than would normally be tolerated by a patient if given intravenously -- the traditional way chemotherapy is administered.

This type of chemotherapy is best at destroying cancer cells that are too small to be seen with the naked eye and prevents these cells from being left behind to form new cancerous tumors in the abdomen. The procedure also improves drug absorption and effect with minimal exposure to the rest of the body. In this way, the normal side effects of chemotherapy can be avoided.

Colorectal Cancer Resources

All of our colorectal cancer patients have access to the Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
Additional Resources
C3-Colorectal Cancer Coalition
C3 pushes for research to improve screening, diagnosis and treatment of colorectal cancer and encourages legislation for policy decisions.
Colon Cancer Alliance
The Colon Cancer Alliance is a national patient advocacy organization that provides patient support, education and research information across North America.
American Cancer Society
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
National Comprehensive Cancer Network (NCCN)
888-909-NCCN (6226)
The National Comprehensive Cancer Network, an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.
National Cancer Institute (NCI)
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
U.S. Dept. of Health & Human Services National Institutes of Health (NIH)
301-402-9612 for TYY
The National Institutes of Health (NIH) is one of the world's foremost medical research centers, and the federal focal point for medical research in the United States. The NIH, comprising 27 separate institutes and centers, is one of eight health agencies of the Public Health Service, which, in turn, is part of the U.S. Department of Health & Human Services.

Colorectal Cancer Research/Clinical Trials

City of Hope has long been a leader in cancer research, including colorectal cancers. We are currently conducting multiple clinical trials of new chemotherapy drugs and other agents that may improve outcomes for patients with regionally metastatic and advanced disease, and prevent recurrence after treatment of early colorectal cancer.
Through our research program, patients gain access to promising new anticancer drugs and technologies that are not available to the general public. As a patient at City of Hope, you may qualify to participate in a test of these new investigational therapies.
Learn more about our clinical trials program and specifically about trials for colorectal cancer.

Colorectal Cancer Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Joe Komsky
Senior Director
Phone: 213-241-7293
Email: jkomsky@coh.org

Colon Cancer Treatment and Colonoscopies
Watch Dr. Stephen Sentovich talk about advances in colon cancer treatment and the importance of colonoscopies.
Our Programs and Treatments

City of Hope is a national leader in cancer treatment and prevention. Read more...

Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials.
Our treatment facilities are located throughout our 100+ acre grounds in Duarte, California as well as in  Antelope Valley, South Pasadena, Santa Clarita and Palm Springs.
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