Dickdarmkrebs Arzt, Dickdarmkrebs Chirurg
What is colon cancer?
This term refers to unregulated cell growth within the large bowel (intestine) . Based on the fact that the colon ends with the rectum, the illness is referred to as colorectal carcinoma. The colon is divided into the following parts: appendix, caecum, ascending colon (ascendens), transverse colon (transversum), descending colon, sigmoid colon(sigmoideum). The last 16 cm between anus and skin are the so called rectum. Most of the times, the tumor origins within the mucosa (the inside layer of the bowel wall), which is why it is referred to as cancer (latin: carcinoma). It is the second most common form of cancer among women and men. In Austria, about 5000 people sicken with colon cancer every year. 6 out of 10 000 people among the age of 45- 75 do have undiscovered colon cancer and 300 do have intestinal polyps.
How does a colorectal cancer emerge?
The colorectal carcinoma emerges from benign changes of the intestinal mucosa (polyps). Depending on the form and size of the polyps exists a varying inclination for a change into the malignant form. In 95% of the cases, the carcinoma emerges spontaneously, that means it origins from gene mutations. The occurrence of polyps, old age, high calorie nutrition, smoking and family history are counted as risk factors to the occurrence of colorectal cancer. Colitis ulcerosa ( a specific chronic inflammation of the colon) is also counted as of high risk of degeneracy. The risk of colorectal cancer is being lowered by eating fish, roughage nutrition and by taking acetylsalicylic acid medication.
In 5% of the colorectal carcinomas a hereditary cause can be detected.
How is the colorectal carcinoma discovered?
Colon cancer can remain undiscovered for a long time. The first perceptible hints are bleedings or constrictions of the colon, by a growing tumor. Complaints like constipation, abdominal cramping, fecal occult blood or anaemia, arise. In those cases the disease usually is highly advanced and can already lead to metastatic spread. The only early symptom is invisible bleeding, which can be detected by a test of the fecal occult blood.
Among people from the age of 50, even without any complaints, a colonoscopy is recommendable. A colonoscopy is a endoscopic examination with a flexible tube passed through the anus usually under general anesthesia. Changes of the mucosa can be detected, tissue samples for a histologic examination can be taken and a removal of the polyps can take place, in the context of a colonoscopy. If the colonoscopy reveals no suspicious changes, the procedure should be repeated after 10 years.
How is colon cancer being treated?
Only the removal of the tumor leads to possible healing. The sooner the cancer is being treated, the higher are the chances of healing. Depending on the state of the illness a preoperative chemotherapy is worth considering. Radiotherapy is also possible in case of a rectal carcinoma. The radiation should take place before the surgery, in cases of lager rectal carcinomas. The surgery aims to remove not only the tumor, but also the adjacent parts of the colon, as well as the associated lymphatic glands. In context of the surgery an artificial anus (colostomy) is only applied in cases of a tumor very close to the the anus. A bowel continuity reconstruction is possible in the other cases.
Minimal invasive colon surgery
Supplementary to the open (conventional) operation of the intestines, I have also been executing the minimal invasive technique for several years now. Only minimal harm of the abdominal wall is caused by the laparoscopically (keyhole) technique. Besides the cosmetic effect, the minimal inversive technique does have further advantages , such as: swifter mobility after the surgery, minor impairment of the respiratory function, swifter resumption of the intestinal activity, fewer formation of scar hernias. The regulation of the intestinal activity is also being optimized by the concept of “fast track surgery”.
Many studies have shown, that the oncologically quality of the minimal inversive surgery is equal to the one of the open procedure. Within the last years, the advantages of the minimal inversive technique are additionally supported by the so called SILS (singular incision laparoscopic surgery). In this case, the surgery takes place through a small (4 cm long) incision in the navel. This technique also allows oncological colon resections (removal) where applicable.
Autor: Dr. Andreas Franczak, Facharzt für Chirurgie, Gefässchirurgie und Visceralchirurgie