Colon cancer

Dr. José Luis Hernández Lizoáin, especialista en cirugía general de la Clínica Universidad de Navarra

diagnosis and treatment of colon cancer

Colon cancer is the third most common type of cancer. However, it is curable in 90% of cases if it is diagnosed early on.

For the early diagnosis of colon cancer, there are different tests. The Clínica has the latest technology to detect it, including a non-invasive endoscopic capsule for frailer patients.

To successfully treat Colon cancer it is not only important to quickly diagnose it, but also to establish the correct treatment. As a result, the doctors work in multidisciplinary teams, looking for a quick and efficient solution for each patient.

We have a large experience and excellent results in the treatment of colorectal cancer. In the Clínica, the disease is controlled in 98% of patients, with an overall survival rate of 90%.

The Clínica has a Prevention and Consultation of High Risk Digestive Tumours Unit whose objective is to determine the possibility of contracting the tumorous disease in the patient's relatives through genetic testing and, in cases where it is detected, to ensure they receive the correct follow-up care to avoid suffering from this disease in the future.

Colon cancer is the most common type of cancer in Spain. However, if detected early, can be cured in 90% of cases. [Video only available in Spanish]

The multidisciplinary treatment of colon cancer has many benefits for the patient, in that we can offer them the best and fastest treatment possible for their situation.”

To diagnose colorectal cancer, it's necessary to directly visualise the colon to evaluate if there are lesions and, if there are, to take a sample for analysis:

Other tests that can be carried out in order to if the disease has spread are:

Surgical treatment: removal of the tumour conventionally or laparoscopically

Surgery aims to remove:

  • The tumour and sufficient surrounding tissue
  • The main arterial and venous vessels that sustain the section of the intestine containing the tumour 
  • Nearby lymph nodes 

The removal can be carried out conventionally or laparoscopically, with a smaller incision and a smaller post operation recovery period.

Types of Surgery

  • Right hemicolectomy (Tumour in the caecum or ascending colon)
  • Left hemicolectomy (Tumour in the descending colon or sigmoid)
  • Segmental colectomy (Tumours in the transverse colon or splenic flexure)

Once the tumour has been extracted, it is analysed by the Department of Anatomic Pathology. Depending on the characteristics of the tumour, it may be necessary to administer chemotherapy and/or radiotherapy treatment in addition to the surgery. 

Metastatic Tumours

When Colon cancer has spread, one of the zones where metastasis most commonly occurs is in the liver. The aim is to surgically remove the hepatic metastases and primary tumour, as to increase the patient's chance of survival.

If the metastases cannot be operated on, other treatments can be carried out to control the disease:

  • Chemotherapy combined with new biological therapies, depending on the molecular composition of the tumour.
  • Intra-arterial chemotherapy to specifically reach the area affected by the metastatic disease. The drugs are more concentrated on the area without increasing the toxicity and this therefore improves the response to the treatment.
  • Radioembolization of the hepatic metastases with Yttrium spheres. This consolidates the hepatic lesions which are not to suitable for removal in surgery through chemotherapy.

The objective is to administer a combination of drugs that achieve a better balance between tolerance and control of the disease, according to each patient's.

Conservative surgery tends to be used whenever possible. 

Treating rectal cancer without distant metastasis consists in extracting the affected rectum. 

Occasionally, depending on the stage at which the tumour is discovered, it is necessary to administer radiotherapy and chemotherapy before the operation.

There are 3 types of surgery for this disease:

  1. Anterior resection of the rectum: in higher rectal tumours, the last part of the rectum can be conserved. If the tumour is lower, they will remove the whole rectum and will stitch the colon to the anus (coloanal anastomosis).
  2. Abdominoperineal Amputation: when the tumour is very close to the anus or spreads to the anal sphincter, the whole rectum and anal canal are removed. The colon is externalised through the abdominal wall via a permanent colostomy.
  3. Transanal Surgery and TEM (Transanal Endoscopic Surgery): if the rectal tumour is in a very early stage, local surgery can be carried out through the anus to extract the tumour and a sufficient amount of surrounding tissue. More aggressive surgery can be avoided through rectum extraction or abdominoperineal amputation. This surgery can be carried out directly through the anus or using TEM (Transanal Endoscopic Surgery) equipment.

Chemotherapy and radiotherapy in non-metastatic rectal cancer before surgery:

This consists in administering Intensity Modulated Radiation Therapy (IMRT) and chemotherapy before surgical intervention.

This seeks to increase the control of the disease locally and improve the outcome of the surgery to preserve the function of the anal sphincter. The tumour ́s response to the treatment correlates to the survival rate.

IMRT allows a precise dose of radiation to be administered to the areas needing treatment and significantly reduces the irradiation of healthy tissue; this reduces the treatment time and combines more active chemotherapeutic agents working against the tumour without increasing the toxicity.

In patients with distal rectum tumours that require rectum amputation (permanent colostomy), a chemo-radiotherapy treatment can be used as a further treatment following conservative sphincter surgery, like Transanal Endoscopic Surgery (TEM).

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