Management of Colon Cancer

Management of colon cancer includes investigations or tests (to have some tests aid the diagnosis) and treatment options which may be surgical or radiotherapy or some home remedies.

Investigations:

The following investigations or tests may be performed to diagnose colon cancer^1,2:

• Barium enema- a special x-ray of the large intestine
  
• Colonoscopy- a procedure to see inside the colon
  
• Biopsy- a test to see cancer cells in the specimen taken
  
• CT Colonoscopy- a special test which uses x-rays and computers to produce high quality images of colon
  
• Ultrasonography- sees the deep structures of the body using ultrasonic waves
  
• Carcinoembryonic antigen (CEA)- a cancer marker for colon cancer
  
• FNAC (Fine needle aspiration cytology)- a test to see cancer cells in the specimen taken from the patient
  
• Complete blood count
  
• Haematocrit
  
• ESR
  
• Liver function tests
  

Management of colon cancer sometimes includes advanced techniques like laproscopic surgery. Laproscopic procedure is given below³:

Laproscopic Procedure

Colonoscopy examines the whole large bowel; the demonstrated image is shown below⁴:

Colon Cancer

Barium enema shows irregular filling defect and apple core lesion in left sided colon cancer. Colonoscopy and biopsy confirms the diagnosis of colon cancer. CT Colonoscopy is also useful to visualize the entire colon. Ultrasonography should be done to see the secondaries in liver, peritoneum, and lymph node status and rectovesical pouch.

Carcinoembryonic antigen (CEA) is a cell surface glycoprotein that is normally produced by colonic epithelium. Its normal value is less than 2.5ng/ml. Level of CEA above 5ng/ml is significant for the diagnosis of colorectal cancer. Even though it is widely used tumor marker but it has got low sensitivity.

Left supraclavicular lymph node if palpable, its FNAC may clinch the histological diagnosis of colon cancer. Other baseline investigation like complete blood count, haematocrit, ESR, hemoglobin level and liver function tests must be carried out. CT scan abdomen and pelvis can be done to see local spread, invasion, size and extent of tumor, nodal status and liver secondaries².

Treatment options

Surgical:

Treatment of colon cancer is mainly surgical. The following surgical procedures can be done:

• Right radical hemicolectomy- an operation where right half of the large bowel is removed.
  
• Ileo-transverse anastomosis- a surgical procedure where a part of small bowel (the ileum) is joined with the portion of large bowel (the transverse colon).
  
• Left radical hemicolectomy- an operation where left half of the large bowel is removed
  
• Colostomy- a procedure where one end of colon is brought out through the abdominal wall.
  
• Hemihepatectomy- a surgical procedure where half or a lobe of liver is removed
  
• Laparoscopic evaluation and resection
  

In right sided early growth, right radical hemicolectomy with ileo-transverse anastomosis is done. In inoperable right sided growth ileo-transverse anastomosis is done as bypass procedure. In left sided early growth left radical hemicolectomy is done.

Left sided stenosing type of growth can present with acute intestinal obstruction, in which case initially colostomy is done. Later, after 3-6 weeks, following proper preparation required normal procedure is done, followed by colostomy closure after 8 weeks (3-stage operation).

In solitary liver secondary, segmental hepatic resection is useful. In case of multiple secondaries confined to one lobe of liver, hemihepatectomy can be done. Laparoscopic evaluation and resection is becoming popular now days.

Adjuvant therapy:

It includes chemotherapy and radiotherapy.

Chemotherapy:

Indications for chemotherapy include lymph node involvement, involvement of adjacent organs, venous spread, signet cell type carcinoma, poorly differentiated tumor and changes in CEA level. Postoperative chemotherapy is used commonly. 5-Fluorouracil with folinic acid is the most commonly used regime for six months as monthly cycles. Other drugs being used are irinotecan, oxaliplatin, capecitabine and cetuximab.

Radiotherapy:

Usually there is no role of radiotherapy as tumor is radio-resistant. It is often used in locally advanced tumor, infiltrating the psoas major muscle or lateral abdominal wall. It is also used in inoperable recurrent tumor.

Colon Cancer Pain and its Management

Colon cancer can cause pain by obstructing the intestinal lumen, by pressing against the nerves or bones and by spreading to the nearby or distant organs. Option for pain management includes:

• Medicines
  
• Alternative treatments
  
• Surgery
  
• Radiation
  
• Nerve block
  

The medicines that can relieve pain may be oral or intravenous opoids or some type of NSAIDS⁵.

Alternative management of colon cancer includes the treatment with massage, acupuncture and acupressure. Pain can also be relieved by learning relaxation techniques like listening to slow music or breathing slowly and comfortably.

Radiations can relieve the cancer pain by shrinking the tumor; it can be applied externally or internally. Radiation therapy can be used with or without chemotherapy or surgery. Surgery is the main treatment for early colon cancer and it is especially useful to relieve the pain when tumor is obstructing intestine.

Alcohol can be injected around the nerves of colon, involved in causation of cancer pain- a nerve block.

Home remedies for Colon Cancer

Home remedies also play an important role in the management of colon cancer. Establishing a healthy nutrition via dietary modifications is one of the most efficient home remedies for colon cancer. The following home remedies can be taken in account if you are suffering from colon cancer pain:

• Eat healthy food
  
• Add dietary fiber to your food
  
• Use grains
  
• Eat fruits and vegetables
  
• Use olive oil and omega-3 oils
  
• Decrease the use of red meat
  
• Add turmeric spice to your food
  

The patient should eat well to get the much required nutrients and calories to establish or improve physical strength and increase the capability of the immune system. The diet of patient must include dietary fiber, grains and foods like fruits and vegetables must be an important part of daily intake.

Also, the patient must use foods with good fats like olive oil and omega-3 oils. It is also necessary to decrease the intake of red meat.

Turmeric is a curry spice and it is used in Indian traditional medicine. Its active ingredient is curcumin, which is protective against colon cancer. One teaspoon of fresh turmeric powder mixed in boiled water can be used as a home remedy to cure colon cancer. It can be used three times a day for six months⁶.

References

1. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, editors. Harrison’s principles of internal medicine. 18^th ed. New Delhi: Mc Graw Hill Medical; 2012.
   
2. Bhat S. SRB’s manual of surgery. 3^rd ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2209.
   
3. Ideas for surgery [Internet]. 2008 [cited 2013 July 21]. Available from: https://www.ideasforsurgery.com/.
   
4. Colon caner [Internet]. 2012 [updated 2012 Nov 17; cited 2013 July 21]. Available from: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001308/.
   
5. Colon cancer pain [Internet]. 2010 [updated 2010 May 16; cited 2013 July 17]. Available from: https://colon-cancer.emedtv.com/colon-cancer/colon-cancer-pain.html.
   
6. Colon cancer [Internet]. 2006 [updated 2006; cited 2013 July 17]. Available from: https://www.homeremedycentral.com/en/natural-cures/home-remedy/colon-cancer.html.