What We Treat

Here at the Colorectal Surgery Institute we Treat:

Method of screening for colorectal cancer

For individuals who do not have any symptoms or strong risk factors, screening methods for colorectal cancer include:

  • Digital rectal examination (DRE)
  • Fecal occult blood test
  • Fecal immunochemical test (FIT)
  • Sigmoidoscopy
  • Colonoscopy
  • CT colonography (virtual colonoscopy)
  • Stool DNA (sDNA)
  • Double contrast barium enema

These tests and procedures are described in the diagnostic procedures section of this site.

Screening guidelines for colorectal cancer

Those at an increased or high risk of colorectal cancer should begin colorectal cancer screening before age 50 and/or be screened more often. The following conditions are considered to be higher than average risk:

  • A personal history of colorectal cancer or adenomatous polyps
  • A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
  • A strong family history of colorectal cancer or polyps
  • A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC)

A full table of guidelines for people with increased risk, high risk and multiple risk factors is available online as part of the American Cancer Society recommendations for colorectal cancer early detection.

Diagnostic procedures for colorectal cancer

Exams, tests and diagnostic procedures are used to screen for and diagnose colorectal cancer
Exams
  • Digital rectal examination (DRE) — a physician or healthcare provider inserts a gloved and lubricated finger into the rectum to feel for anything unusual or abnormal. This test can detect cancers of the rectum, but not the colon.
Tests
  • Fecal occult blood test — checks for hidden (occult) blood in the stool. It involves placing a very small amount of stool on a special card, which is then tested in the physician’s office or sent to a laboratory.
  • Fecal immunochemical test (FIT) — A test that is similar to a fecal occult blood test, but does not require any restrictions on diet or medications prior to the test.
  • Stool DNA (sDNA) — a test used to check the stool or fecal matter for specific changes in DNA (the genetic blueprint of each cell) that indicate signs of colorectal cancer. The patient is required to save an entire bowel movement and the sample is sent to a laboratory.
  • Blood count — to check for anemia (a result of bleeding from a tumor).
Diagnostic Procedures
  • Sigmoidoscopy — a diagnostic procedure that allows the physician to examine the inside of a portion of the large intestine. A short, flexible, lighted tube, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.
  • Colonoscopy — a procedure that allows the physician to view the entire length of the large intestine. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the physician to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.
  • CT colonography (virtual colonoscopy) — a procedure that uses computerized tomography (CT) to examine the colon for polyps or masses using special technology. The images are processed by a computer to make a 3-dimensional (3-D) model of the colon. Virtual colonoscopy is non-invasive, although it requires a small tube to be inserted into the rectum to pump air into the colon.
  • Double contrast barium enema — a fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is inserted into the rectum via an enema to partially fill up the colon. An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages) and other problems.
  • Biopsy — a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.

Treatment plans for colorectal cancer

Specific treatment for colorectal cancer will be determined by your physician based on:

  • your age, overall health and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures or therapies
  • expectations for the course of this disease
  • your opinion or preference

After the colorectal cancer is diagnosed, your physician may recommend a treatment plan that involves a combination of surgery, radiation and/or chemotherapy.

Colon Surgery

The primary treatment for colorectal cancer is an operation called a colon resection. The cancer and a length of normal tissue on either side of the cancer are removed, as well as the nearby lymph nodes.

Treatment types—Radiation Therapy

External radiation

Also known as external beam therapy, this treatment precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area.

Internal radiation

Internal radiation is given inside the body as close to the cancer as possible. These treatments also are called brachytherapy or implant radiation.

  • Radioisotopes—substances that produce radiation—are swallowed, injected, or implanted directly into the tumor.
  • Some of the radioactive implants are called “seeds” or “capsules.”
  • Internal radiation involves giving a higher dose of radiation in a shorter time span than with external radiation.
  • Some internal radiation treatments stay in the body temporarily. Others stay in the body permanently, but the radioactive substance loses its radiation within a short period of time.

In some cases, both internal and external radiation therapies are used.

Treatment types—Chemotherapy

Chemotherapy uses anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. The oncologist will recommend a treatment plan for each individual.

Studies have shown that chemotherapy after surgery can increase the survival rate for patients with some stages of colon cancer.

Chemotherapy can also help relieve symptoms of advanced cancer.

Newer medications called targeted therapies may be used along with chemotherapy or sometimes by themselves. These medications have different—and often milder— side effects than standard chemotherapy medications.

Tests that find polyps and cancer

  • Flexible sigmoidoscopy every 5 years∗
  • Colonoscopy every 10 years
  • Double-contrast barium enema every 5 years∗
  • CT colonography (virtual colonoscopy) every 5 years∗

Tests that mainly find cancer

  • Fecal occult blood test (FOBT) every year∗,∗∗
  • Fecal immunochemical test (FIT) every year∗,∗∗
  • Stool DNA test (sDNA), interval uncertain∗

∗Colonoscopy should be done if test results are positive.
∗∗For FOBT or FIT used as a screening test, the take-home multiple sample method sho