Colon Tumor / Cancer

What is a colon tumor?

It is a disease that manifests itself as a mass formation in any part of the large intestine. It is one of the most common tumors worldwide. The masses in the large intestine can be mainly of 3 types.

  1. Some are benign (polyps, lipomas, mesenchymal tumors),
  2. Some are low malignant potential tumors which can be considered as the lesser of two evils (stromal tumors, neuroendocrine tumors).
  3. Some are malignant (colon cancer)

What are the symptoms of colon tumors?

Unfortunately, since it is an insidious disease, many patients may have no symptoms. Therefore, screening is essential to catch the disease at an early stage when there is no symptom. As for the symptoms:

  1. Change in defecation habits: Sudden disruption of defecation habit that has been regular for many years, diarrhea or constipation attacks may mean a danger signal.
  2. Iron deficiency anemia: The tumor present in the patient may cause the patient to lose blood with minor hemorrhages. This anemia may manifest itself with malaise, palpitation, excess chills. Small amounts of bleeding do not cause discolored stool and may not be noted for a long time
  3. Rectal bleeding: Especially masses located close to the area where stool leaves the body, called anus, manifest themselves with light red bleeding. The majority of patients do not care about these bleedings, assuming that they are caused by hemorrhoid or crack. Unfortunately, we witness that some doctors also do not care about this condition, sliding it over with hemorrhoid creams. This shows up as a situation delaying the diagnosis of the disease.
  4. Abdominal pain and cramps: Especially in periods when the mass starts to obstruct the intestine, agonizing severe abdominal pain and subsequent development of diarrhea attacks are an important indication.
  5. Weight loss: Weight loss that develops unintentionally without dieting and exercise may be an important symptom not only for colon cancer but also for many types of cancer.

What are the risk factors?

  1. 50 years of age and older
  2. Family history of colon cancer
  3. Presence of polyps in the colon
  4. Presence of a chronic inflammatory bowel disease such as ulcerative colitis or Crohn’s disease
  5. Frequent consumption of animal fat and red meat
  6. Diet poor in fiber
  7. Obesity

What should be done for early diagnosis?

It is very important to catch colon cancer at early stages. Therefore, we can say that we are almost 100% successful in the treatment of tumors caught in patients with no complaint before the symptoms come up.For this, beginning from the age of 50 years, both men and women should have;

  • Annual fecal occult blood test (T.R. Ministry of Health launched a free screening program)
  • Rectal examination and total colonoscopy every 10 years or
  • Screening tests should be started at an earlier age in individuals with a family history of colon cancer.

What is the treatment?

Although the treatment varies depending on the stage of the disease, removal of the mass is the most important step. It is possible to remove small masses with colonoscopy or local intervention. Larger masses can be removed using a method in which the abdomen is entered through small ports, called laparoscopy. Larger, multiple masses or masses spread other organs or surrounding tissues should be removed with open surgery. In some cases, it may be necessary to add radiation or medical therapy to the treatment in the pre- or post-operative period.

Is stoma (colostomy or ileostomy) required?

There are two factors that determine this:

  1. Location of tumor: The main goal of this surgery is to remove the tumor thoroughly with the surrounding lymph nodes. In the meantime, if the muscles that help us keep in control of our bowel movements and stool are involved by the tumor, stoma may be required. This may be temporary or permanent for life.
  2. Surgeon’s training and experience: It is not recommended that surgeons, who do not have extensive experience in the treatment of tumors especially located close to the anus, called the rectum, to perform this surgery on their own. Assoc. Prof. Samet Yardimci, MD had special training for both open and laparoscopic surgeries of the tumors of this region when he worked abroad at the MD Anderson Cancer Center, as well as during subspecialty training of gastrointestinal surgery, thereafter he worked for years at a center like Marmara University where about 600 colorectal surgeries are performed per year and trained his young colleagues in this respect.

Is non-surgical treatment possible?

The last 15 cm length of the large intestine is called rectum. Radiotherapy (irradiation) has been used for the first-line treatment of tumors in this rectum part for many years. In some patients, the tumor completely disappears after radiotherapy. We are able to follow up some of these patients whose tumors completely disappeared without surgery. However, I have to underline that this is a very new treatment modality and that such a tumor is likely to recur in the long-term or short-term, and requires close follow-up.

Which one is better, robotic/laparoscopic/open surgery?

Two factors measure the success of this treatment. The first is the removal of the tumor, the second is stoma. Neither laparoscopic nor robotic technique has a superiority to open surgery in these two factors. However, laparoscopy has some advantages over open surgery. In brief, these are:

  • less postoperative pain
  • very small, hardly visible scar on the abdomen
  • easier return to daily routine
  • minimization of the risk of hernia that may occur after the surgery

These advantages are the same in robotic and laparoscopic surgeries. Robotic surgeries are very expensive and have no superiority to laparoscopy. For this reason, laparoscopy is the most commonly used surgery type in colon and rectal tumors worldwide.

What to expect after the surgery?

After colon and rectal surgery, the portion removed is sent to the pathology unit and it is understood whether the tumor is benign or malignant, and if it is malignant, its stage is determined. Too many drugs have been discovered recently for colon tumor. We should say that we are very successful in its treatment compared to the past. Even in tumors that have spread to the liver, we can achieve long-term survival. I have to specify that we have many patients who had been operated 8-10 years ago and whom we follow up alive and well. The correct approach is not to underestimate the disease, at this point, it is very important to show the required effort and patience and to adapt to your treatment. Even though it is called cancer, it does not mean that it is invincible. Please note that

You are not defeated when you lose. You are defeated when you quit.
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