The colon (large bowel) is the first part of the large intestine and is about five feet long. Together, the rectum and anal canal make up the last part of the large intestine and are about 6-8 inches long and end at the anus, the opening of the large intestine to the outside of the body. Colon or rectal cancer can occur anywhere along the length of the colon, rectum, and anus.

Colon cancer is unique because it is preventable with early detection. Other cancers may be caught early but are already cancers. Colon cancer is often preceded by precancerous lesions (polyps) that can be removed, preventing the cancer from ever happening. Even when caught as cancer, it can be curable in the early stages. However, it is still the second most common cause of cancer-related deaths in the U.S.

Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). They often begin as a growth called a polyp, which may form on the inner wall of the colon or rectum. Some polyps become cancer over time. Finding and removing polyps can prevent colon cancer.

Other types of cancer that occur far less often but can begin in the colon (or rectum) include:

• Carcinoid tumors: These tumors form from a certain type of neuroendocrine cell and the majority are found within the GI tract. Neuroendocrine cells produce hormones that aid in the control of digestive juices and muscles used in propelling food through both the stomach and the intestines. Likewise, a GI carcinoid tumor can also make hormones and release them into the body. Some are found inside the colon, but most occur in the small intestine, rectum, and appendix.
• Gastrointestinal stromal tumors (GIST): This type of tumor of the GI tract is uncommon. Most start in the small intestine, but GISTs can begin anywhere along the GI tract.
• Small cell carcinoma: Colorectal small cell carcinoma (SmCC) is a rare tumor with an aggressive course.
• Lymphoma: Intestinal lymphoma is very rare and is usually non-Hodgkin lymphoma originated in the B or T-cells. Patients are typically treated with standard lymphoma therapies.
• Peritoneal carcinomatosis (PC): This rare type of cancer occurs in the peritoneum, the thin layer of tissue that covers the abdominal organs and surrounds the abdominal cavity. The disease develops when cancers of the appendix, colon, ovaries or other organs spread to the peritoneum and grow tumors there. Almost 90 percent of cases of PC are metastases from colon cancer.

Tests

Early detection and an accurate diagnosis are essential to a successful colon or rectal cancer treatment. Along with reviewing your medical history and blood work, the following tests may be recommended to help us diagnose your cancer.

Colonoscopy
A small and flexible tube that has a camera at its end is utilized to check the full length of the inner colon. If polyps or other precancerous lesions are found, they can be removed during the test, preventing cancer from forming.

• A colonoscopy should be performed every 10 years in those who are over the age of 50 and who have a normal level of risk.
• However, for people with a strong family history of colorectal cancer or a genetic predisposition, they should be screened more often and screening should start at an earlier age.

Flexible sigmoidoscopy
This exam is similar to a colonoscopy. It utilizes a small and flexible tube to check just the lower part of the colon. The procedure is performed without sedation and should be done every five years. If polyps or cancer are found, you will need a colonoscopy.

Virtual colonoscopy (colonography)
Although the same bowel preparation is required for clear viewing of the colon, for some patients, virtual colonoscopy provides an alternative to traditional colonoscopy. Colonography is a type of CT scan that creates a 3-D image of the inside of the colon. While you are awake, a small tube is inserted into the rectum. It then gently inflates the colon with air to scan it. Because the procedure doesn't use any instruments, if a polyp or suspicious area is found, it cannot be removed or biopsied. You will still need a colonoscopy.

Biopsies
If your imaging exam or colonoscopy reveals a polyp or suspicious lesion, your doctor will remove the polyp or take a tissue sample to examine. This is the only definitive way to know if a growth is cancerous.

Multigene tests
Performed after a biopsy. Because no tumor has a single mutation, genomic profiling allows the pathologist to identify groups of mutations in your tumor tissue sample and create a tumor profile for you. This enables us to develop and deliver treatments that target those mutations. The profile can help us predict if your cancer is likely to spread to other parts of the body.

Treatments

Surgery
Surgery is the most typical course of treatment for the majority of early stages of colon cancer. With it, surgeons aim to remove the entire tumor and any cancer cells that may have spread to nearby tissue.

• Segmental Resection: During this surgery, the cancer and a length of normal tissue on either side of the cancer are removed, as well as the nearby lymph nodes. Much colon surgery is now done laparoscopically or robotically with several tiny incisions, rather than as an open surgical procedure. This approach lessens post-operative pain and shortens recovery time.

Radiation Therapy
Sylvester’s radiation oncologists use the most advanced technology to deliver radiation externally or internally to colorectal tumors.

• External Beam Radiation: Most colorectal radiation treatment at Sylvester is external beam from outside the body. Advanced technology tools working for you include RapidArc®, an advanced technology used to deliver intensity modulated external radiation therapy (IMRT). This shortens treatment times to one-half to one-eighth that of conventional radiation therapy, resulting in more precise tumor targeting and lessened damage to the nearby healthy tissue.

• Internal Radiation: Called brachytherapy, this type of radiation is good for smaller primary tumors, with clean, healthy skin around them, and no evidence of cancer in the lymph nodes. Brachytherapy involves temporarily implanting a radiation applicator into the tumor site and delivering doses of radiation locally, at certain intervals. It allows the radiation oncologist to keep the radiation dose away from sensitive organs.

Chemotherapy (Systemic Medical Therapy)
Chemotherapy can be administered intravenously or in the form of a pill and is typically a combination of various cancer-fighting drugs. If you require intravenous (infusion) chemotherapy, you can receive it at the Comprehensive Treatment Unit (CTU) at Sylvester's main location in Miami. It's a 12,000-square-foot unit that includes 33 recliners and 11 private rooms. If you prefer, you can also have your infusion treatments at the Kendall, Hollywood, Coral Springs, Coral Gables [MJ1] or Deerfield Beach locations.

Most chemotherapy is given after surgery, with combinations of drugs that have been shown to work well together for your type of cancer. Your specialist may also recommend using a standard therapy coupled with a clinical trial drug.

• HIPEC (Hyperthermic Intraperitoneal Chemoperfusion): Sylvester Comprehensive Cancer Center is the first in South Florida to deliver heated chemo to cancers that have spread through the abdominal cavity. The one-time treatment is performed in the operating room at UM Hospital, right after the cancer is removed. HIPEC allows a higher concentration of chemotherapy without the systemic side effects, increasing disease-free survival much better than systemic chemotherapy. For some patients, it is a total cure.

Targeted Therapy
Treatments designed to attack the molecular alterations that make the cancer cell grow and spread. They have the potential to be more effective and with fewer side effects than chemotherapy. Some of these medicines are given along with chemotherapy medicines, while others are used by themselves.

Clinical Trials
As a colorectal cancer patient at Sylvester, you have access to more novel or advanced treatments than anywhere else in South Florida. If your doctor thinks a clinical trial is right for you, he or she may recommend it.

Why Choose Sylvester Comprehensive Cancer Center?

Sylvester is an NCI-designated cancer center. The National Cancer Institute has recognized Sylvester for its outstanding work conducting research in its laboratories, treating patients in its clinics and hospitals, and reaching out to medically underserved communities with innovative prevention strategies.

Your team is composed of world-renowned experts who treat colorectal cancer. That specialization and depth of expertise can mean the difference between a correct comprehensive diagnosis and delivery of the most targeted treatments, and a cancer that is underdiagnosed or misdiagnosed, resulting in treatments that aren’t targeted and outcomes that aren’t the nation’s best.

Sylvester Comprehensive Cancer Center is the first in South Florida to deliver HIPEC (hyperthermic intraperitoneal chemoperfusion) or hot chemo to cancers that have spread through the abdominal cavity. The one-time treatment is done in the operating room at UM Hospital, right after the cancer is removed and gets the chemotherapy right to the site of the cancer.