Colon cancer

It is the second most deadly cancer. It is the 3rd most common cancer in France.
It is 90% non-hereditary. Only familial adenomatous polyposis and HNPCC (Lynch syndrome) have a higher risk of colorectal cancer. It often appears from the age of 50 and doubles every decade.
Its diagnosis is often made around the age of 70.
60 to 80% of cancers develop from an adenoma. The risk of an adenoma becoming cancerous depends on its size, location and degree of dysplasia.
Symptoms:

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Total colonoscopy:
Key examination under general anesthesia. It is a long flexible tube composed of an endoscope (camera) and pliers that are inserted by the anal route. At the same time, biopsy samples are taken and sent to pathology to confirm the diagnosis and type of cancer. The exam lasts about 20 minutes, then you stay in the recovery room between 1 and 2 hours.
A preparation based on laxatives and a strict residue-free diet is essential within 5 days of this examination.
Biology:
A standard biological assessment and specific tumour markers: ACE (carcinoembryonic antigen). Other markers can be made: alpha foeto-protein CA19-9.
Imaging:

1. The thoraco-abdomino-pelvic CT with contrast injection is essential to assess the existence of metastases.
2. Abdominal-pelvic ultrasound can be performed
3. Liver MRI with contrast injection is useful for looking at the liver
4. The PET Scan: Positron Emission Omography is an imaging examination based on the injection into the blood of a low-level radioactive tracer.
5. This tracer of labelled glucose, once injected, binds to different organs and allows its function to be analysed.
6. Since tumor cells are more active than normal cells, they consume and therefore bind glucose more.
7. PET thus makes it possible to obtain precise images of the distribution of radioactive glucose in the body and therefore of cancer cells. A computer reconstructs a three-dimensional and color image of the observed organ.
8. This examination is not systematic in the diagnosis of colorectal cancer. It can be used to look for possible invisible metastases on images obtained by other imaging techniques or more often to check for recurrence after treatment.
9. An echoendoscopy or rectal MRI

SURGERY:
Colon cancer without metastasis:
Surgery is the essential treatment. Before the operation you will meet the surgeon, the anaesthetist and an enterostomatologist nurse specialising in cancer and the placement of ostomy bags. Everything will be clearly explained to you and you will be able to ask all your questions.
It is carried out by laparotomy or laparoscopy. The surgeon removes the segment of the colon where the tumor is located as well as the part of the mesocolon, the fatty tissue that contains the blood vessels and lymph nodes, connected to this segment. He sends everything to anatomopathology to certify the degree of cancer. The procedure is performed under general anesthesia. Once the affected portion of the colon has been removed, the surgeon performs an anastomosis, i. e. he stitches the two ends of the remaining colon together, using wires (called manual anastomosis) or mechanical forceps (called mechanical anastomosis).
STOMIE or artificial anus:
When the intestine is too inflamed or the healing too fragile, the surgeon may not want to perform the suture immediately. In these cases, he/she creates a suture between the colon and the skin: the intestine empties of its stool in an external pocket called the STOMIE.
It is in 70% of cases temporary. 6 to 8 weeks after the operation, a second operation is scheduled for final intestinal suture.
Colon cancer with metastases:
Surgery of primary colon cancer is only indicated after multidisciplinary consultation. If possible, it is performed by laparotomy or laparoscopy under general anaesthesia. An ostomy pouch is placed temporarily.
Surgery for liver or lung (damaged) metastases is only performed if they are completely resectable.

You stay in the recovery room for about 2 hours before returning to the room. Treatment for pain is initiated by the anaesthetist through the vein.
Transit disorders are frequent, especially loose stools, during the following year. A precise diet is established by the nutritionist (no fruit juices, no cereals, no frying) and antidiarrheal treatments will be prescribed.
The main complication is anastomotic fistula. This is the defect in the healing of the anastomosis, i. e. the suture between the 2 remaining parts of the colon. It is diagnosed with abdominal pain, transit and fever. Its diagnosis is confirmed by an abdominal scan. This complication requires urgent surgical resumption.
Hospitalization lasts 6 days on average.
A check-up with the surgeon will be scheduled after 8 days.

About Colon cancer

CHEMOTHERAPY:
It will be well explained to you by your oncologist and a schedule of sessions will be organized in advance. Chemotherapy consists of administering drugs most often by the venous route or by the oral route. It is most often done on an outpatient basis at the hospital, where you will be brought and escorted during the day. Sometimes it is possible to stay at home. In these cases, a caregiver will come to your home to infuse you. It may also be possible to place you in a catheter run (central line) that will provide a pre-programmed pump or diffuser that will send you the drugs when you need them.
Before each session, a clinical and biological examination will be carried out.
Chemotherapy is carried out by cure: either daily for a certain period of time followed by a rest period, or by cycle, for example 3 days every 15 days.
Side effects are numerous and vary from one treatment to another, from one patient to another. You will be regularly monitored by the oncologist and the pain doctor to better manage these effects.
**Non-metastatic cancers: **
Only stage 3 cancers (with lymph nodes affected by cancer cells) require adjuvant chemotherapy composed of several molecules including: 5-fluorouracil, oxaliplatin, capecitabine. 5-fluorouracil, oxaliplatin, ketuximab, irinotecan, bevacizumab, capecitabine, raltitrexed.
Cancers with metastases:
Chemotherapy is essential. The oncologist will discuss the risk/benefit ratio with you in advance.
It can be either:

As a treatment prior to any surgery or as an exclusive treatment.
The protocols are based on the following molecules: 5-fluorouracil, oxaliplatin, ketuximab, irinotecan, bevacizumab, capecitabine, raltitrexed.
Clinical and imaging evaluation is done after 2 months of treatment:

• If there is a regression of metastases, the surgery is discussed again.
• If there is stagnation or regression without the metastases being resectable: either it is decided to continue the treatment or it is decided to take a break and review at 2 months. Decisions are discussed with the patient.
• If there is progression of metastases: discontinuation of chemotherapy and change of protocol
  FOLLOW-UP:
  It is essential to avoid any risk of recurrence. It lasts for minimum 5 years.
  Follow-up is based on consultations with the surgeon, blood tests and imaging.
  On average, the follow-up is as follows:
  Abdominal-pelvic scan or abdominal ultrasound and possibly hepatic MRI every 3 months for 1 year then every 6 months for 3 years.
• Appointment with the surgeon and complete biological check-up with marker control every 3 months for 1 year then every 6 months for 3 years.
  A control colonoscopy is performed every year for 5 years.

Follow-up is adapted on a case-by-case basis.
Some complex diseases such as cancer can lead some patients to seek a second medical opinion. Almost 50% of patients using the second medical opinion have seen their treatment options evolve. Seeking a second medical opinion is perfectly legitimate when faced with a serious illness.
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MEDICAIM takes care of the follow-up on a case-by-case basis. www.medicaim.com
MEDICAIM is looking for the best specialists for you and we will offer you several renowned doctors.
MEDICAIM organizes your entire stay for you: post-operative nursing care, biological follow-up, therapeutic, nutritional and psychological support.
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