STAGING

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Investigations for Staging

Once a colon or rectal cancer has been detected, preoperative staging, assessment of resectability, and assessment of the patient’s operative risks are indicated. The entire colon and rectum should be evaluated, usually with colonoscopy. Preoperative staging is done with CT scan abdomen and pelvis and chest Xrays or CT scan of lungs. Preoperative CEA, a cancer marker that can be detected in the blood,  will provide an effective marker to monitor post- treatment disease recurrence in CEA-elevated patients.

ADVANCES IN TREATMENT

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The management of colorectal cancers involves a multidisciplinary approach. This includes surgery, chemotherapy and radiotherapy. However, recent advances in surgical techniques and chemo-radiotherapy have resulted in lower morbidity and better clinical outcomes.

Surgery

Early stages of colorectal cancers are amenable to curative resections. Minimally invasive colorectal surgery for both benign and malignant conditions is available at Nobel Surgery Centre. Laparoscopic cancer surgery is safe, even for the elderly, and that the rates for tumour recurrence and patient survival are similar to open surgery. Laparoscopic colorectal surgery is advantageous over open surgery because it allows for smaller surgical wounds; leading to reduced post-operative pain, faster post-surgical recovery and earlier hospital discharge. Better surgical techniques, advanced surgical instrumentation and the availability of effective chemotherapy nowadays enable surgeons to resect low lying rectal tumours (1 – 2 cm above anal sphincter) without compromising anal function, thereby minimising the need for permanent stoma.

Chemo-radiation Therapy

Post-operative chemotherapy, with or without radiation therapy, is generally reserved for late stage colorectal cancer patients after surgical resection. However, a new concept of using ‘neo-adjuvant’ chemoradiation therapy, that is delivering combined radiotherapy and chemotherapy before surgery, is particularly useful for bulky, mid- to low-lying rectal cancers as a means of shrinking the tumour prior to surgical resection. This way, resection can be less radical and provides a better chance for preserving anal function and reducing recurrence rate.

PROGNOSIS

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The 5 year survival rate for  stage I is 90 percent and for stage II it is 75 percent. By the time rectal bleeding or change in bowel habits occur, the disease is likely to be at least stage III, which has a survival rate of around 70 percent. However, in stage IV disease, the 5 year survival significantly reduced to less than 30 percent.

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Expert Author:

Dr Chen Chung Ming, Nobel Surgery Centre

The article above is meant to provide general information and does not replace a doctor's consultation. 
Please see your doctor for professional advice.