Colon cancer is one of the most frequently diagnosed malignancies in men and women in developed countries. This disease rarely occurs before age 40, and the risk of colon cancer is highest at age 70. Seventy-five per cent of colon tumours occur in patients aged 65 and over.
The incidence of colon cancer has increased over the last few decades. As the general population ages in industrialized countries, the number of adult patients with this disease will increase in the coming decades. Unfortunately, most elderly patients with colorectal cancer have other significant comorbidities, such as cardiovascular and pulmonary disease, which increases the risk of surgery and the risk of postoperative morbidity and mortality. Other factors that contribute to poor surgical outcomes in the elderly include delayed performance and advanced disease.
Therefore, Early Diagnosis and laparoscopic surgery-is feasible for colorectal cancer in the elderly, especially in many elderly patients with limited chances of survival. This article aims to provide the outcome of colon surgery in the elderly in our hospital to determine the best treatment strategy for this category of patients.
An overview of Colon cancer
Colon cancer is a type of cancer that starts in the colon in the intestine. It begins at the small intestine and ends at the rectum. Colon cancer usually affects the elderly, although it can occur at any age. It usually starts as a collection of small, non-cancerous (benign) cells called polyps in the large intestine. Over the years, some of those polyps can develop into colon cancer.
Polyps may be small and cause a few signs and symptoms. For this reason, doctors recommend regular screening exams to save you from colon cancers using identifying and removing polyps before they turn cancerous.
If colon cancers develop, many treatments are available, including surgical treatment, radiation therapy, drugs, chemotherapy, and immunotherapy. Rectal cancer is sometimes referred to as colon cancer. This term combines colon cancer and rectal cancer that starts in the rectum.
Colon cancer signs and symptoms include:
- Constant changes in your bowel habits, including diarrhoea or constipation or changes in stool consistency
- Rectal bleeding or blood in your stool
- Persistent stomach discomforts such as cramping, gas, or pain
- The feeling that your stomach is not empty
- Weakness or fatigue
- Unexplained weight loss
Many humans with colon cancers experience no signs in the early stages of cancer. If symptoms do occur, they most likely vary depending on colon cancer’s size and location.
When to see a doctor
If you have persistent symptoms that bother you, make an appointment with your doctor. Talk to the doctor about when to start colon cancer screening. Guidelines generally recommend that colon cancer screening be started around 50. Your doctor may recommend a more frequent or earlier screening procedure if you have other risk factors, such as a family history of the disease.
Reason for colon cancer
Doctors aren’t sure what causes most types of colon cancer.
In general, colon cancer begins when healthy cells in the significant intestine change (mutations) in their DNA. The cell’s DNA carries a sequence of commands that inform the cell what to do.
Healthy cells grow and divide for your body to function normally. However, when a cell’s DNA breaks down and becomes cancerous, the cells continue to divide – even when new cells are not needed. When cells accumulate, they form tumours.
Over time, cancer cells can grow to attack and destroy the surrounding normal tissue. And cancer cells can migrate to other parts of the body to form deposits (metastasis).
Screening for Colon Cancer
Doctors recommend screening tests for healthy people for detecting any signs of colon cancer or non-cancerous colon polyps. Early detection of colon cancer offers the most excellent chance of cure. Screening has been shown to reduce the risk of dying from colon cancer.
Doctors usually recommend people with a moderate risk of colon cancer start screening around age 50. However, individuals with a family history of colon cancer should consider early screening.
There are a variety of filtering options – each with its advantages and disadvantages. Talk to your doctor about your options and together decide which test is proper for you. If a colonoscopy is used for screening, polyps can be removed during the procedure before they become cancerous.
if your signs and symptoms endorse that you may have colon cancers, your doctor can also recommend one or more assessments, including:
- Using an area to examine the inside of the large intestine (colonoscopy): A colonoscopy uses a long, flexible, thin tube attached to a video camera and monitor to view your entire colon and rectum. If any suspicious areas are found, your doctor may insert surgical instruments through a tube to take a tissue sample (biopsy) for analysis and remove polyps.
- Blood test: No blood test can tell you if you have colon cancer. However, your doctor may do blood tests for signs of your general health, such as: About kidney and liver function tests.
- Your doctor may also test your blood for chemicals sometimes caused by colon cancer (carcinoembryonic antigen, or CEA). Over time, the CEA level in your blood can help your doctor understand your prognosis and determine if your cancer responds to treatment.
Determination of the extent of cancer
Colon cancer stages
In case you’re diagnosed with colon cancers, your physician might also propose assessments to decide the extent (stage) of your cancers. Staging will help determine which treatment is best for you.
Performance tests may include imaging tests such as CT scans of the abdomen, pelvis, and chest. In many cases, your cancer stage cannot be entirely determined at the end of colon cancer surgery.
Colon cancer stages are indicated by Roman numerals ranging from 0 to IV, with the lowest stage indicating cancer confined to the colon’s inner lining. In stage IV, cancer is considered advanced and has spread (metastasized) to other areas of the body.
The treatments that will help you depend on your individual state of the situation, such as the location of your cancer, its degree, and different health troubles. Treatment for colon cancer in the elderly usually involves surgery to remove cancer. Other treatments, such as radiation therapy and chemotherapy, may also be recommended.
Surgery for early-stage colon cancer
If colon cancer is minimal, your doctor may recommend a minimally invasive surgical approach such as:
- Removal of polyps during colonoscopy (polypectomy): If your cancer is small, localized, wholly contained in a polyp, and in its earliest stages, your doctor may be able to remove it altogether during a colonoscopy.
- Endoscopic resection of the mucosa: Larger polyps can be removed with special instruments during a colonoscopy to remove the polyp. A small amount of the colon’s inner lining is a procedure called endoscopic lining resection.
When is Laparoscopic MIS surgery an option?
Most traditional abdominal and rectal procedures can be performed using a minimally invasive approach. Numerous studies have shown that minimally invasive surgery is an effective option for colon cancer when done correctly. There is less research comparing minimally invasive surgery with traditional open surgery for rectal cancer. The consensus is that minimally invasive surgery for rectal cancer in a trained surgeon’s hands, based on recognized surgical oncological principles, is appropriate.
The following factors will help determine whether a minimally invasive procedure can be performed safely and effectively.
- Operation history.
- Medical history.
- Description of the disease (such as inflammation, tumour size).
Colorectal tumours can be removed through open surgery, where the surgeon makes a large incision in the abdomen (10-25 cm) to reach the large intestine. There are now new and less invasive surgical procedures that increase safety and recovery time.
Laparoscopic surgery is a minimally invasive surgery. The surgeon uses several small incisions in the abdomen (0.5 to 1 cm) to insert surgical instruments, including a long, thin tube with a light and a camera that functions as a laparoscope. About 3 to 5 cm wide, a larger incision is made to remove the colon or rectum’s cancerous part. The laparoscope displays the image on a video monitor in the operating room. During surgery, the surgeon moves the instruments and supervises the monitor.
Laparoscopic surgery is an effective and safe alternative to conventional surgery for treating early-stage colon cancer in the elderly. However, the surgeon must be qualified in the laparoscopic technique to get the best results. Early-stage colon cancer patients who need surgery may want to talk to their doctor about the risks and benefits of laparoscopic surgery and inquire about the surgeon’s experience.
Surgery for advanced cancer
If your cancer is very severe or your general health is feeble, your surgeon may recommend surgery to relieve colon obstruction or other conditions to improve your symptoms. This surgery is not done to treat cancer but to relieve signs and symptoms such as blockage, bleeding, or pain.
In some instances, when cancer has only spread to the liver or lungs, but your overall health is good, your doctor may recommend surgery or other topical treatments to remove cancer. Chemotherapy can be used before or after this type of procedure. This approach allows you to get rid of cancer in the long run.
Benefits of laparoscopic surgery
The incisions are much smaller than traditional surgery. Possible benefits are:
- Reduces postoperative discomfort
- Length of stay in hospital
- Reducing the need for prescription pain relievers
- Return to normal activities sooner
- The scars are less visible
It is important to note that the long-term results between open and minimally invasive procedures are similar. However, minimally invasive surgery offers potential benefits in the initial recovery period after surgery.
Laparoscopic surgery is suitable for older patients because of the shorter postoperative stay period, similar long-term outcomes in open surgery, and an acceptable low conversion rate. For general and long-term oncology outcomes, laparoscopic surgery results are similar to open surgery at all stages.
Elderly patients who underwent laparoscopic colectomy had fewer localized postoperative complications than those who underwent open colectomy. However, in the first postoperative month, these patients had a worse global quality of life than younger patients who underwent the same operation. But overall, the health of the elder patient will be excellent and laparoscopic surgery is feasible.
For more information on Early Diagnosis and laparoscopic surgery in the elderly, contact Dr Venu Gopal Pareek. If you’re a candidate for surgery, meet Dr Venu Gopal Pareek call at 91777 77715.