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Colon and Rectal Cancer



The Section of Colon and Rectal Surgery, within the Division of General Surgery at Washington University School of Medicine, provides comprehensive care for patients with diseases of the colon, rectum and anus.

The focus of our seven surgeons is to provide up-to-the-minute care in all aspects of colon and rectal surgery, with particular interests in colon and rectal cancer, inflammatory bowel disease and benign anorectal disorders. Washington University colorectal surgeons have special expertise in laparoscopic colon surgery, offering this treatment for colon and rectal cancer, diverticulitis, ulcerative colitis, Crohn's disease, colon polyps, rectal prolapse and chronic constipation. Working as part of a leading academic medical center, an integrated team of colon and rectal surgeons, gastroenterologists, oncologists and radiologists works together to provide the best possible care for patients in the St. Louis region and beyond.

Colorectal Specialists

Elisa Birnbaum, MD

Sekhar Dharmarajan, MD

Sean Glasgow, MD

Steven Hunt, MD

Matthew Mutch, MD

Matthew Silviera, MD

Paul Wise  MD

Shanna Shucart, PA


What is cancer of the colon and rectum? How common is it?

Colorectal cancer is cancer of the colon or rectum -- the colon and rectum are the large intestine and external opening of the gastrointestinal tract. Colorectal cancer  is the third most common cancer in both men and women in the United States. Approximately one out of every 20 people in the United States will develop colorectal cancer in his or her lifetime.

According to the American Society of Colon and Rectal Surgeons, if colorectal cancer is found and treated at an early stage, before symptoms develop, the opportunity to cure is 80 percent or better. Washington University surgeons and genetic cancer risk specialists are available to help assess individual patient risks.

How do I know I have colon or rectal cancer?

Colorectal cancer usually has no symptoms in its early stages. It begins in a benign polyp that has existed in the colon for many years in its harmless state before changing to a cancer.

The best way to identify colorectal cancer is to actively look for signs of the problem. The signs and symptoms of colorectal cancer include abdominal pain or swelling, change in bowel habits -- such as frequent diarrhea or constipation, blood in the stool or losing weight without trying. These signs do not mean you have colorectal cancer, but you should contact your doctor to have a check-up.

What are the types of colorectal cancer screening?

Colonoscopy is used to look at the entire colon. The surgeon uses a flexible, lighted tube with video capabilities which is inserted into the colon through the rectum to locate and remove the polyps (if any are found).

Fecal occult blood testing screens for blood in your stool. See your doctor if this occurs.

Digital rectal exam is when the doctor inserts a lubricated, gloved finger into the rectum and feels the wall of the rectum. The lower part of the rectum is then checked for polyps or other changes.

Sigmoidoscopy is used to check the rectum and lower part of the colon (known as the sigmoid colon). If polyps are seen, they can be removed during this test.

Barium enema is an x-ray of the colon taken after barium liquid is put into the rectum and colon. It is used to check for polyps.

At what age should screening for colorectal cancer begin?

People at average risk (defined as someone without symptoms, with no family or personal history of colorectal polyps or cancer) should undergo a total colon examination consisting of a full colonoscopy or a flexible sigmoidoscopy plus a barium enema at age 50 years. If those studies are negative then screening should occur every seven to ten years.

However, people who have had previous cancer or polyps, a genetic abnormality or family history or symptoms of colorectal cancer should have the entire colon examined by colonoscopy between age 40 and 50 and every three to five years thereafter. If polyps are found during a colonoscopy, the colonoscope can remove them immediately and prevent the development of cancer.

Who is at high risk for colorectal cancer?

You may be at high risk if you have a family history of colorectal cancer, familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC). Your risk also increases if you have a personal history of polyps in the colon or rectum, inflammatory bowel disease or Crohn's disease, or if you have a parent or sibling with colorectal cancer. You can have inherited colorectal cancer, even though no one else in your family has had colorectal cancer.. You may be interested in learning more about the registry for high risk patients

What are hereditary types of colon cancer?

Hereditary non-polyposis colon cancer (HNPCC) is a type of hereditary colorectal cancer in which affected individuals have a high risk to develop colorectal cancer and other types of cancer such as uterine, ovarian and stomach cancer. HNPCC most often strikes young patients, under the age of 50, and accounts for approximately 10% of all colorectal cancers.

Familial adenomatous polyposis (FAP) is a type of hereditary colorectal cancer in which affected individuals typically develop hundreds to thousands of adenomatous polyps in the colon or rectum. People with FAP have a very high risk to develop colorectal cancer. FAP accounts for approximately 5%of all colorectal cancers.

When investigating the genetics of colon and rectal cancer, or how the condition is inherited and passed from generation to generation, the Washington University physicians at Barnes-Jewish Hospital work closely with medical geneticists and basic science researchers.

Patients who may have an inherited form of colon and rectal cancer -- such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC) -- have access to the latest techniques for diagnosis and treatment.

Families can participate in genetic counseling and genetic testing for these diseases, as well as  endoscopic screening.

What are treatment options?

An integrated team of colorectal cancer specialists at Barnes-Jewish Hospital and Washington University School of Medicine work with each patient to determine the optimal treatment based on the disease stage, patient age and other illnesses the patient may have.

Surgery  is usually the best method to eradicate colorectal cancer and is curative if all of the cancer, surrounding tissues, and involved large intestine (colon or rectum) can be removed as one large piece.

Our colon and rectal surgical specialists are leaders in laparoscopic surgery. This type of minmally invasive surgery results in smaller incisions and a faster, more comfortable recovery.

Radiation therapy  is used to shrink rectal tumors and make sphincter sparing possible, as well as reduce recurrence and improve long-term survival. In some cases, radiation may be given to shrink tumors before surgery.

Radiation oncologists can also treat some small rectal cancers with radiation alone. This can prevent the need for a colostomy (an opening for the colon after the rectum or part of the colon is removed or cut).

Our doctors have treated one of the largest patient groups in the world using endocavity radiation. In this type of treatment, the tumor is irradiated through a large scope placed in the rectum.

Other techniques used include 3-D conformal external beam radiation therapy, which enables the radiation oncologists to give higher doses of radiation to a tumor while sparing normal surrounding tissue.

Chemotherapy after surgery improves long-term survival of colorectal cancer by about 30%. Our specialists are conducting studies to find out what combinations of these drugs have the best results for patients with colorectal cancer.

What if the cancer returns?

Recurrent colon or rectal cancer can be very difficult to treat. Obviously, the best treatment is to avoid recurrence, and our results have been outstanding in that regard. When patients are referred to our colorectal surgeons, the following questions are considered: Can the tumor be removed for cure? If not, what is the best method of controlling symptoms to give a good quality of life?

The use of new imaging techniques such as positron emission tomography (PET) has allowed aggressive surgical procedures to be applied to selected patients with excellent cure rates. Patients with localized, curable disease are identified on PET scan and undergo wide resection to achieve clear margins and a cure. This usually is accomplished after preoperative radiation and chemotherapy. Input from other disciplines -- such as urology, gynecology, hepatobiliary surgery and neurosurgery -- is essential for success.

Controlling symptoms for pain, obstruction (food blockage) and wide tumor growth is best performed in a multidisciplinary setting to include medical oncology, radiation oncology, colorectal surgery, gastroenterology and anesthesiology. Minimally invasive (laparoscopic) techniques are used to select the easiest method for the patient to overcome the acute problem and start on a systemic (whole body) treatment of their disease.

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Copyright 2015 Washington University School of Medicine
Copyright 2015 Washington University School of Medicine