Colorectal Cancers

At St. Clair Health, we understand the uncertainty that comes with colorectal conditions and diagnosis. One of the most advanced colorectal surgical teams in western Pennsylvania is here for you, close to home. Our team of experts are highly trained and experienced in their field to provide our patients with exceptional and compassionate care. With state-of-the-art technology, treatments and procedures are less severe and bring peace of mind to our community. St. Clair’s Colorectal Surgery team works closely with medical oncologists and radiation oncologists affiliated with UPMC Hillman Cancer Center, gastroenterologists, radiologists, pathologists, and nurse navigators. Frequent collaborative discussions occur with this team of experts to help guide patient care and treatment through every step.

Two of the most common types of adult GI cancers include:

Colon cancer usually begins as small, noncancerous (benign) clumps of cells called polyps that form on the inside of the colon. Over time some of these polyps can become cancerous.  

Rectal cancer is very similar to colon cancer and the same processes occur in the rectum which is the last portion of the colon.  Malignant (cancer) cells form in the tissues of the rectum and can grow at a rapid pace.

Types of Adult Colorectal Cancers

• Colorectal cancer involves both colon and rectal cancers.
• Rectal cancer starts in the rectum — the last few inches of the large intestine.
• Anal cancer affects the anus, where the digestive tract ends and expels waste.
• Small intestine cancer forms in the small intestine, the part of the bowel between the stomach and the colon.
• GI carcinoid tumors are slow-growing cancers that affect the neuroendocrine cells of the GI tract.

Diagnostic Tools

• Colonoscopy is an exam used to detect changes or abnormalities in the large intestine (colon) and rectum. During a colonoscopy, a long, flexible tube (colonoscope) is inserted into the rectum. A tiny video camera at the tip of the tube allows the doctor to view the inside of the entire colon.
• CT Scans are special X-rays that are analyzed by a computer, giving cross-sectional images of the body. The abdomen and pelvis are usually checked by these computerized scans when colon or rectal cancer has been diagnosed. These are used to evaluate the extent of other organ involvement, especially the liver, which helps stage the cancer and guide therapy.
• MRI (Magnetic resonance imaging) scans show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. A contrast material called gadolinium may be injected into a vein before the scan to get clear pictures. MRI can be used to look at abnormal areas in the liver or the brain and spinal cord that could be cancer spread. 
• PET (Positron emission tomography) scanning and PET combined with computed tomography (PET-CT) is used for colorectal cancer. Whole-body PET imaging will show any areas of increased metabolism (cells soaking up the sugar radiotracer) throughout your body.
• ERUS is a method of staging rectal cancer which is human dependent. ERUS is less accurate for T staging of stenotic tumors, but the accuracy may still be within acceptable limits. Surgeons use ERUS to adopt a treatment protocol, knowing the risk of under-staging and over-staging of this method.

Treatment Options

Surgical Oncology

• Polypectomy (removing polyps during a colonoscopy) occurs if the cancer is small, localized, completely contained within a polyp and in a very early stage, your doctor may be able to remove it completely during a colonoscopy.
• Endoscopic Mucosal Resection happens when larger polyps might be removed during colonoscopy using special tools to remove the polyp and a small amount of the inner lining of the colon.
• Minimally Invasive Surgery (laparoscopic surgery) is a type of surgery where your surgeon performs the operation through several small incisions in your abdominal wall, inserting instruments with attached cameras that display your colon on a video monitor. 
• Partial Colectomy is a procedure where the surgeon removes the part of your colon that contains the cancer, along with a margin of normal tissue on either side of the cancer. Your surgeon is often able to reconnect the healthy portions of your colon or rectum. This procedure can commonly be done by a minimally invasive approach (laparoscopy). The surgeon may also take samples from lymph nodes in the area where the cancer is located.
  • Lymph node removal are typically removed during colon cancer surgery and tested for cancer.

• Ostomy is a procedure that makes a temporary/permanent opening in the skin called a stoma. A stoma is a pathway from an internal organ to the outside of your abdomen.

Medical Oncology

Medical Oncology uses chemotherapy, immunotherapy, and targeted drug therapy to focus on specific mutations and to eliminate cancer cells. These therapeutics for colorectal cancers are usually given after surgery if the cancer is larger, has spread to the lymph nodes, or has other concerning pathologic features. These therapies might also be used before an operation to shrink a large cancer so that it’s easier to remove with surgery, reduce the bulk of tumor burden for symptom relief, or treat micrometastatic disease.

Radiation Oncology

Radiation therapy uses powerful energy sources, such as X-rays and protons, to eliminate cancer cells. It might be used to shrink a large cancer before an operation so that it can be removed more easily. When surgery isn’t an option, radiation therapy might be used to relieve symptoms, such as pain. Sometimes radiation is combined with chemotherapy.

Survivorship Resources/Education

Although cancer doesn’t have to define you, the disease changes your life in a number of ways. You’ll have to deal with the immediate and long-term physical effects of treatment, ongoing screening and monitoring, new concerns about staying healthy and a wide range of emotions.

This post-treatment period is called survivorship. While survivorship varies from patient to patient, there are some common concerns that often affect cancer survivors. We encourage you to follow up with your specialist and team for local recommendations regarding survivorship resources and support programs.