Question:My 40 year-old daughter has just been diagnosed with a colon cancer in her right colon. What should we do now?
Answer: Colon cancer is the third most common cancer in adults and is usually curable when caught early. Today, we treat more young people (under 50) with this disease than ever before. This is because we now can identify a subset of people with colon cancer caused by a familial genetic predisposition. Those younger patients require quite a different treatment approach than that of the more common sporadic colon cancer.
The first step your daughter should take is to get a thorough family history to determine if she fits in a high-risk familial cancer group. This usually involves a session with a genetic counselor or registry coordinator at a familial cancer registry. There is such a program at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University Medical School. This identifies all family members who could be affected by the genetic change that may be causing your daughter’s cancer.
Several cancers which, in combination with colon cancer, are found in familial cancer syndromes. These include uterine, duodenal, bladder or transitional cell cancer of the urinary tract, breast, ovarian or rectal cancers. If any of these cancers are or were present in other close family members, then their risk is elevated. We would then urge all adult family members to be screened with colonoscopy before the age of 35 and schedule other screening procedures for the tumors mentioned above.
The next step for your daughter would be to have a CT scan to check for any disease that may have spread to other areas of the body, such as the liver or lungs. If this is clear, then a straightforward laparoscopic right colectomy should be able to provide complete removal of the local cancer. The laparoscopic approach requires a smaller incision, results in less pain and requires a shorter in-hospital and at home recovery.
The pathology review of the tissue removed at operation will tell us if there is a need for additional treatment with chemotherapy after recovering from surgery. Special testing of the tumor for the genetic mutation may be possible and would help identify your daughter’s risk for other tumors and the risk of your other family members for colon cancer.
Your daughter should contact a specialist in colorectal cancer as soon as possible to begin her treatment and get on with her life.