Diagnosis
If a conspicuous mucosal finding is discovered in a colonoscopy and the histopathological examination confirms that it is colon cancer, several further examinations follow. These include an ultrasound examination of the abdomen, an X-ray examination of the lungs, possibly a CT or MRI examination of the abdomen and breast area, and a determination of tumour markers. Depending on the location of the tumour, an endosonographic examination may also be used.
In this case, an ultrasound device is inserted into the anus to better assess the spread of the tumour. All the above mentioned examinations are called tumor staging. The exact stage of the tumour can only be determined when all the results of the examination are available.
The therapy strategy is then also based on the stage of the tumour. In stages I to III, the tumour is surgically removed, if the patient’s general condition permits this. From stage II onwards, chemotherapy is usually administered after the operation.
In stage IV, the treatment strategy depends on whether the scattered foci (metastases) can be surgically removed or not. Once the colon cancer therapy has been successfully completed, follow-up care follows. This involves examinations at certain intervals over a period of 5 years, which are designed to detect a recurrence of colorectal cancer in good time. These include physical examination, determination of tumour markers, ultrasound examination of the abdomen, CT examination of the abdomen or chest and a new colonoscopy.
Cure of colon cancer
Depending on the stage of the tumour, healing can be achieved by surgical removal of the tumour alone or by a combination of surgical tumour resection and chemotherapy. In tumour stage IV, surgical resection of metastases may also be necessary. It is not always possible to predict whether or not a cure can be achieved with the above-mentioned therapy options.
The earlier the tumour is discovered, i.e. the smaller it is, the better the chances of recovery. It also plays an important role whether and how many lymph nodes are affected by tumour cells and whether the tumour has already spread. If the tumour has been completely removed, a 5-year aftercare follows, as the risk of recurrence is highest within the first 5 years.
Course of an inoperable colorectal cancer
The inoperability of colorectal cancer can have various reasons. For example, it may already have grown so large and infiltrated important structures that complete removal is not possible. In the case of colorectal cancer, however, this is usually not the decisive point.
In the vast majority of cases, the tumour can – at least theoretically – be radically removed. However, this may mean that larger parts of the colon or rectum have to be removed as well. In many cases, this can also mean the creation of an artificial bowel outlet.
However, a tumour can also be inoperable if it has spread so much that a complete surgical removal of all tumour cells is not possible. Tumours in lower tumour stages can also be inoperable. Namely, if the patient is in poor general condition so that the risks of anaesthesia and surgery are too high.
In all these cases the so-called palliative therapy is used. Palliative means that the aim of the therapy is not the healing but the alleviation of symptoms and prolongation of life. Examples of palliative therapy for colorectal cancer are partial removal of the tumor or metastases if they are a burden.
This can be the case, for example, if the tumour moves the intestinal lumen, causing food to accumulate (intestinal obstruction). In this case, palliative therapy can attempt to remove the tumour to such an extent that the intestinal passage can be restored, at least temporarily. Chemotherapy without surgery is also palliative, as it cannot cure the tumour but can alleviate symptoms and/or prolong life. Furthermore, pain therapy plays an important role in palliative treatment.
