Colon Cancer and Colorectal treatment at City of Hope cancer research hospital, located near Los Angeles, California

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Colorectal Cancer

Why Choose City of Hope

City of Hope’s approach to treating colon and rectal cancers is highly aggressive, comprehensive and collaborative, combining the newest therapies and technologies with the skills of renowned specialists to give patients the best possible outcomes.

Because City of Hope develops some of the newest and most promising treatments for cancer, our clinical trials program is among the most extensive anywhere. This allows us to often provide patients access to promising new anticancer drugs and technologies not available elsewhere.

About

About Colorectal Cancer and FAQs

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).

If I have a polyp, does that mean I'm going to get colorectal cancer?

Most polyps are benign, or non-cancerous, growths on the inner wall of the colon and rectum. They are fairly common in people over 50. Some types of polyps can become cancerous if not removed. Not all polyps become cancerous, but nearly all colon cancers start as polyps. A colonoscopy can find and remove polyps before they become cancerous. Early detection is the best weapon against most forms of cancer.

Does diet play a role in colorectal cancer?

Diet may be associated with the risk of developing colorectal cancer. Colorectal cancer occurs more frequently in populations that consume a diet high in fat, protein, calories, alcohol, and red and white meat, and low in calcium and folate, when compared to populations that consume a low-fat, high-fiber diet.

Am I at high risk of developing colorectal cancer if there is a history of it in my family?

Parents, children or siblings of a person who has had colorectal cancer are somewhat more likely to develop colorectal cancer themselves. This is especially true if the relative has the cancer at a young age. If more than one family member has had colorectal cancer, the chances increase even more.

Is there anything I can do to prevent colorectal cancer?

You can help prevent colorectal cancer by getting tested. Early detection is the best weapon in preventing and fighting this kind of cancer. Colon cancer almost always starts with a polyp, a small growth on the lining of the colon and/or rectum. Finding and removing polyps before they become cancerous can stop colorectal cancer before it begins.

How can the risk for developing colorectal cancer be lowered?

Follow the testing guidelines set by the American Cancer Society. Testing can find precancerous polyps, and removing these polyps can prevent most colon cancers. Testing also can help detect colon cancer early, when the chances for successful treatment are greatest. Also:

Know your family history. If colon cancer runs in your family, you may need to be tested earlier and more often.
Avoid cigarettes and other tobacco products.
Maintain a healthy body weight. Obesity is associated with an increased risk of colon cancer.
Get plenty of exercise. Even small amounts of exercise on a regular basis can be helpful.
Eat plenty of fruits, vegetables, and whole grain foods, and limit the intake of high-fat foods.

What should I remember to ask my doctor about colorectal cancer?

If you are 50 years or older, talk with your doctor about colorectal cancer screening even if you don't have symptoms and don't have a family history of the disease. You should feel free to ask any question on your mind, no matter how small it might seem. Here are some questions you might want to ask ( feel free to add your own to this list):

I'm over 50-should I get tested for colon cancer?
I've read that there's more than one way to be tested for colon cancer. Which one do you think is right for me?
How is the test done?
Will it be done in your office?
Who will be in the room?
How do I prepare for it?
What will happen to me, and how will it feel?
Now that I'm 50, what other tests should I have?

What is the statistical incidence of colorectal cancer?

Colorectal cancer is the third most-common type of non-skin cancer in men (after prostate cancer and lung cancer) and in women (after breast cancer and lung cancer). It is the second-leading cause of cancer death in the United States after lung cancer. The rate of new cases and deaths resulting from this disease is decreasing. Still, each year, more than 147,000 new cases are diagnosed, and more than 57,000 people die from the disease.

What are the different types of clinical trials?

Clinical trial research is designed for a variety of clinical objectives, ranging from disease prevention to quality of life, in both adults and children.

Disease prevention: test new approaches to prevent diseases in people who have never had the disease or to prevent it from coming back in people who have already had the disease.

Disease screening and detection: test new approaches to find a disease in its earliest stage, optimizing the potential success of the treatment.

Disease treatment: test new treatments such as a new drug, new approaches to surgery or radiation therapy, new combinations of treatments or a new treatment method.

Symptom management: test new treatment approaches to reduce the side effects from primary treatments such as chemotherapy, radiation therapy or surgery.

Quality of life: explore ways to define and measure the patient's experiences during and after treatment, such as psychosocial problems, daily functioning and pain management.

What is a protocol?

All clinical trials are based upon a study plan called a protocol. Designed with great care, the plan helps to ensure the safety of the participants and answer specific research questions. A protocol details the specifics of the study: who can participate, different procedures, test schedules, medications and dosages, and the length of the study.

Why should I get a colorectal cancer screening?

Colorectal cancer screening is used to detect cancer, precancerous polyps and other abnormal conditions. Screening can find polyps that may eventually become cancerous (precancerous polyps), as well as some cancers in an early stage, before they spread to other parts of the body.

If screening detects an abnormality, diagnosis and treatment can occur promptly. Finding and treating polyps may be one of the most effective ways to prevent the development of cancer altogether. Colorectal cancer is generally more treatable when it is found early.

Several major organizations, including the U.S. Preventive Services Task Force (a group of experts convened by the U.S. Public Health Service), the American Cancer Society, and professional societies, have developed guidelines for colorectal cancer screening. Although some details of their recommendations vary regarding which screening tests to use and how often people should be screened, all of these organizations support screening for colorectal cancer.

Talk with your health care provider about when to begin screening for colorectal cancer, what tests to have, the benefits and risks of each test, and how often to schedule appointments.

How do I know what colorectal test to take?

The decision to have a certain test will take into account several factors:

A person's age, medical history, family history and general health
Accuracy of the test
Risks associated with the test
Preparation required before the test
Sedation necessary during the test
Follow-up care after the test
Convenience of the test
Cost and insurance coverage of the test

What are the advantages of a fecal occult blood test (FOBT)?

No preparation of the colon is necessary. Samples can be collected at home. Cost is low compared to other colorectal cancer screening tests. FOBT does not cause tears or bleeding in the colon.

What are the disadvantages of a fecal occult blood test (FOBT)?

This test fails to detect most polyps and some cancers. False positive results are possible. Dietary limitations and other restrictions, such as increasing fiber intake and avoiding meat, certain vegetables, vitamin C, iron and aspirin are often recommended for several days before the test. Additional procedures, such as a colonoscopy, may be necessary if the test indicates an abnormality. The test is generally not considered adequate screening when used alone.

What are the advantages of a sigmoidoscopy?

The test is usually quick, with few complications. Discomfort is minimal. In some cases, the doctor may be able to perform a biopsy (the removal of tissue for examination under a microscope by a pathologist) and remove polyps during the test, if necessary. Less extensive preparation of the colon is necessary with this test than for a colonoscopy.

What are the disadvantages of a sigmoidoscopy?

This test allows the doctor to view only the rectum and the lower part of the colon. Any polyps in the upper part of the colon will be missed. There is a very small risk of bleeding or tears in the lining of the colon. Additional procedures, such as colonoscopy, may be necessary if the test indicates an abnormality.

What are the advantages of a colonoscopy?

This test allows the doctor to view the rectum and the entire colon. The doctor can perform a biopsy and remove polyps during the test, if necessary. Patient is sedated and should feel minimal, if any, discomfort during the procedure

What are the disadvantages of a colonoscopy?

The test may not detect all small polyps and cancers, but it is the most sensitive test currently available. Thorough preparation of the colon is necessary before the test. Although uncommon, complications such as bleeding and/or tears in the lining of the colon can occur.

What are the advantages of a double contrast barium enema (DCBE)?

This test usually allows the doctor to view the rectum and the entire colon. Complications are rare. No sedation is necessary.

What are the disadvantages of a double contrast barium enema (DCBE)?

The test may not detect some small polyps and cancers. Thorough preparation of the colon is necessary before the test. False positive results are possible. The doctor cannot perform a biopsy or remove polyps during the test. Additional procedures are necessary if the test indicates an abnormality.

What are the advantages of a digital rectal exam (DRE)?

This test usually allows the doctor to view the rectum and the entire colon. Complications are rare. No sedation is necessary.

What are the disadvantages of a digital rectal exam (DRE)?

The test can detect abnormalities only in the lower part of the rectum. Additional procedures are necessary if the test indicates an abnormality. Generally not considered adequate screening when used alone

Risk Factors/Symptoms

Colorectal Cancer Risk Factors and Symptoms

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

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

Screening/Diagnosis

Colorectal Cancer Screening and Diagnosis

Prevention

Some people have a higher risk for colorectal cancer due to genetics, family history, age or environmental/lifestyle factors. City of Hope’sCancer Screening & Prevention ProgramSMcombines 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.

Screening

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.

Diagnosing

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.

Treatments

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
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
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
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.

Resources

Colorectal Cancer Resources

All of our 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
703-548-1225
C3 pushes for research to improve screening, diagnosis and treatment of colorectal cancer and encourages legislation for policy decisions.

Colon Cancer Alliance
877-422-2030
The Colon Cancer Alliance is a national patient advocacy organization that provides patient support, education and research information across North America.

American Cancer Society
800-ACS-2345
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)
800-4-CANCER
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)
301-496-4000
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.

Research/Clinical Trials

Colorectal Cancer Research and 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.

To learn more about our clinical trials program and specifically about trials for colorectal cancer, click here.

Colorectal Cancer Team

People

TeamMembers

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Clinics, Treatments and Services

City of Hope Events

About Colorectal Cancer

Detailed information on colon and colorectal cancers.

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Clinics/Treatments/Services

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

How to Become a Patient

City of Hope is committed to making the process of becoming a patient here as easy as possible. Call 800-826-HOPE (4673) or complete the online appointment form.

Supportive Care

Led by multidisciplinary teams of volunteers and professionals, the Sheri & Les Biller Patient and Family Resource Center offers an integrated array of support services.

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. Last year, City of Hope conducted more than 300 studies enrolling almost 5,000 patients. Find out more about City of Hope's Clinical Trials.

Visiting City of Hope

Our treatment facilities are located throughout our 100+ acre grounds in Duarte, California as well as in Antelope Valley, Santa Clarita, South Pasadena and Palm Springs.

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