Colorectal cancer is the second and third most common cancer after breast cancer in women and prostate and lung cancer in men, respectively, accounting for 13% of patients with a new cancer diagnosis. In Germany, about 60.000 patients are newly diagnosed with colorectal cancer per year of whom approximately 1.000 are living in the area of Munich.
The older we get, the higher is the risk to develop colorectal cancer. The good news is: Medicine has made big progress in the last few decades. If colorectal cancer is diagnosed early, e.g. during screening colonoscopy, the chance to heal the patient is very good. In fact, very few cancer entities have a prognosis as good as colorectal cancer when detected early enough. The bad news: Many people do not undergo screening programs for colorectal cancer and therefore jeopardize the chance for early diagnosis and healing of the disease.
If you have colorectal cancer, the Klinik Josephinum is the prime address for the treatment of your disease. Prof. Dr. Michael Kasparek and Dr. Irmgard Weindl have been working in two big colorectal cancer centers in Munich and are therefore specialized on state-of-the-art surgery for colorectal cancer.
If we summarize all cases of colorectal cancer in women and men, colorectal cancer is the most common cancer entity overall. In Germany and the U.S., colorectal cancer is far more common than in other countries such as Greece or Spain. It appears that the Mediterranean diet, e.g. tomatoes, olive oil, etc., might prevent the development of colorectal cancer. In contrast, red meat and fatty food can increase to risk to develop colorectal cancer.
However, not only our diet affects the cancer risk. Genetic factors can also be important. If one of your first-degree relatives developed colorectal cancer before the age of 50, your risk for colorectal cancer is increased by the factor four. Another risk factor are precursor lesions such as adenomas and polyps that might eventually progress into colorectal cancer and that should therefore be removed during screening colonoscopy before this happens.
During the development of colorectal cancer, an increased cell proliferation occurs, that causes an initial “hump” of the mucosa into the bowel lumen, that is also known as polyp or adenoma. If the control over the proliferation gets lost completely over time, these precursor lesions can progress into an invasive colorectal cancer in the so-called “Adenoma-Carcinoma-Sequence”, that accounts for the development of about 90% of all colorectal cancers.
Risk factors that we can be control by yourself:
In about 10% of colorectal cancer cases a genetic mechanism is assumed to underlay the development of the disease. You should keep this in mind when you have close relatives with colorectal polyps or cancer particularly early in their lives. In this case, you should contact your general practitioner, a gastroenterologist, or us, in order to figure out whether an early screening colonoscopy would be indicated.
Very frequently, colorectal cancer does not make symptoms for a long time, underlining the importance of early and consequent screening colonoscopies. The closer the cancer is located to the anus (e.g. rectal cancer), the more like patients observe blood or mucus from the tumor in the toilet or on the toilet paper. Although these symptoms can also result from harmless alterations like hemorrhoids, colorectal cancer should always be excluded if such symptoms occur.
In case of bigger tumors, the bowel can be obstructed leading to alterations of bowel movements. If persistent constipation or changes in the thickness of bowel movements occur, please make an appointment for a colonoscopy. We are glad to help you!
Colorectal cancer comprises the large bowel (colon) and its last part the so-called rectum. The cancer arises from the inner layer of the bowel wall, the mucosa that consists of glands and histologically colorectal cancer is therefore usually described as so-called “adenocarcinoma”. In contrast, cancer of other parts of the gastrointestinal tract, such as the esophagus, stomach, or small intestine, are relatively rare.
Symptoms can vary and also depend on the location of the tumor. If tumors are bleeding significantly, blood can be observed on the bowel movement, in the toilet or on the toilet paper. Very often tumors are bleeding only very little and special stool tests are necessary to diagnose blood in the feces. Anemia, weight loss, abdominal pain and alterations on bowel movements can also be signs of colorectal cancer. Relatively unspecific signs can be flatulence or constipation. Complete obstruction of the bowel with a subsequent ileus a perforation of the bowel, massive bleeding, or the invasion of other organs such as the vagina are severe complications of usually advanced colorectal cancer.
The primary aim of colorectal cancer treatment is the removal of the entire tumor tissue. This goal can usually be achieved when the cancer has not already spread to other organs like lymph nodes, liver, or lungs. In rare cases, very early tumor stages can be treated successfully by endoscopic removal of the tumor alone.
In most cases and particularly in the case of bigger tumors, the draining lymph nodes have to be removed together with the tumor, as they are frequently infiltrated by tumor cells, and tumor recurrence might originate from these cells later on when they are not removed properly. Therefore, oncologic resections usually require the removal of bowel segment carrying the tumor together with the draining lymph nodes with a re-connection of both bowel ends at the end of the operation. Very often, these procedures can nowadays be performed by minimal-invasive, laparoscopic surgery, enhancing the recovery of the patient.
Depending on the tumor stage that largely depends on the size of the tumor and on whether lymph nodes are infiltrated by the tumor, a so-called adjuvant chemotherapy might be recommended to minimize the risk of tumor recurrence from potentially remaining tumor cells later on.
In rectal cancer within the last 16cm above the anus, pre-treatment with radiochemotherapy or radiation alone can improve the oncologic outcome in patients with large tumors or tumor spread to the lymph nodes.
Should a spread to other organs such as the liver or lungs be detected during the preoperative work-up, an individual concept with a multidisciplinary approach might be necessary to achieve the best prognosis for the patient.
An ostomy, also known as stoma or “bag” is necessary if a rectal cancer infiltrates the anal sphincter and the sphincter subsequently has to be removed to achieve healing. Due to a better understanding of tumor biology, better surgical techniques, and efficient pre-treatment methods for these tumors with radiochemotherapy or radiation alone, this scenario is very rare nowadays.
However, particularly in patients with low rectal cancer and when patients underwent preoperative radiochemotherapy, it might be necessary to protect the newly generated re-connection of the bowel by a temporary stoma that can usually be closed a few weeks after the initial operation during a small surgical procedure.
We have a very close cooperation with our colleagues from the Departments of Gastroenterology, Oncology, and Radiology. This allows a stage-dependent treatment according to the most recent guidelines using state of the art surgical techniques. For our patients, this reflects an optimal prognosis.
Particularly in patients with higher tumor stages, a five-year follow up is recommended entailing consultations of a doctor, physical examination, blood tests, ultrasound, CT-scans, and colonoscopies on a regular basis following an established plan. The aim of this follow-up is to detect tumor recurrence as early as possible to allow subsequent treatment and healing.
The earlier colorectal cancer is diagnosed, the better is the prognosis. Very early cancers can be cured in most patients. The prognosis of so-called advanced tumor stages depends very much on the size of the tumor, infiltration of lymph nodes, and the presence of metastasis in distant organs such as the liver or lungs. The primary aim of the surgical treatment is the removal of the entire tumor cells. In order to eliminate remaining tumor cells after the operation, an additional chemotherapy might be recommended depending on the tumor stage, to improve the long-term outcome.
General health insurance in Germany usually covers examinations of the feces for blood that might come from lager polyps or tumors starting at the age of 50. Even more are the screening colonoscopy that are recommended from the age of 50 in male and from 55 in female individuals that should be repeated a few years later depending on whether polyps where seen and removed during the previous colonoscopy.
It is our utmost concern to encourage our patients to undergo screening colonoscopy early enough to either avoid the development of colorectal cancer by removal of polyps during colonoscopy or to identify colorectal cancer at very early stages to achieve the best possible prognosis for our patients.
In Germany screening colonoscopy is recommended in asymptomatic patients without risk factors (e.g. relatives with colorectal cancer early in their lives) at the age of 55. In case of risk factors or symptoms (see above) screening colonoscopy can be necessary much earlier. Please contact your general practitioner or us in case of any questions. Our colleagues from the Department of Gastroenterology are glad to help you to arrange an appointment for a colonoscopy.
What can I do to prevent development of colorectal cancer?
You can reduce your individual colorectal cancer risk by avoiding risk factors for colorectal cancer development. By the way: This also reduces your risk to develop other medical conditions such as obesity, hypertension, lung cancer, diverticular disease, or diabetes. Seek for frequent and sufficient exercise and avoid nicotine and alcohol. Look for a balanced, high-fiber diet and reduce the consumption of red meat. Us the offer of early and regular screening tests and colonoscopies.