Colon and Rectal Cancer Care in the Greater Philadelphia Area

Patients have access to the most advanced colorectal cancer therapies through Consultants in Medical Oncology and Hematology. A personalized treatment plan is created for each person based on the cancer's stage, the patient's age, and any genetic changes that give the oncologist information about which treatments will work best. Our team is here to guide you through every step of the way.

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In the United States, colorectal cancer is the third most common cancer diagnosed in both men and women. Because of this, and because there are rarely any early symptoms of colorectal cancer, the American Cancer Society recommends that people at average risk for colorectal cancer begin regular screening at age 45. Talk to your doctor about whether you’re at a higher risk for developing colorectal cancer.

There are several steps used to diagnose colorectal cancers such as:

Colonoscopy

This procedure uses a tube-like instrument called a colonoscope to look inside the rectum and colon for polyps, abnormal areas, or cancer. The colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.

This procedure is often used as part of a screening test, but can also be used for diagnostic purposes. If you have polyps removed during a screening colonoscopy, they will be evaluated by a pathologist to determine if the cells inside are normal, precancerous or cancerous.

Sigmoidoscopy

A procedure to look inside the rectum and sigmoid (lower) colon for polyps, abnormal areas, or cancer. A sigmoidoscope is a tool very similar to a colonoscope used for a colonoscopy.

Biopsy

If a mass has been identified during imaging tests and/or a colonoscopy, samples of the tumor cells will be removed so they can be viewed under a microscope by a pathologist to check for signs of cancer. This might be done after a routine colonoscopy where polyps are found and it’s performed after a diagnostic colonoscopy. A biopsy is the only test that can make a definite diagnosis of colorectal cancer.

Some patients have surgery to remove a larger tumor which is then tested for cancer along with nearby lymph nodes to determine if cancer cells have spread outside of the colon.

If cancer is found, additional tests are performed to see if cancer has spread to nearby lymph nodes or other areas of the body. These can include one or more of the following:

Computed Tomography (CT) Scan

A type of imaging procedure that makes a series of detailed pictures of areas inside the body. A contrast may be given to make it easier to see any other areas where cancer may be developing. If cancer has spread beyond the second layer of the colon wall, the CT may also be used to check the chest, abdomen and pelvis for cancer.

Positron Emission Tomography (PET) Scan

A small amount of radioactive glucose (sugar) is injected into a vein. Cancer cells metabolize sugar more quicker than healthy cells. If there are cancer cells in areas of the body that aren’t visible in a CT Scan, the PET scan will show bright spots where the cancer cells are starting to focus in the body.

Tumor Marker Genetic Testing

A test used to evaluate the cancerous cells to see if one of several known gene mutations is present. If so, this can change the type of treatment that is likely to work best.

Determining the Extent of Colorectal Cancer

If the biopsy shows that colorectal cancer is present, your doctor needs to know the extent, or stage, of the disease. It is important to know the stage in order to plan treatment.

One common tool used to describe the stage of cancer is the TNM system:

Tumor (T):
Has the tumor grown into the wall of the colon or rectum? How many layers?
Node (N):
Has the tumor spread to the lymph nodes? If so, where and how many?
Metastasis (M):
Has the cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person.

There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Tumor (T)

The "T" plus a letter or number (0 to 4) is used to describe how deeply the primary tumor has grown into the bowel lining.

TX: The primary tumor cannot be evaluated.

T0 (T zero): There is no evidence of cancer in the colon or rectum.

Tis: Refers to carcinoma in situ (also called cancer in situ). Cancer cells are found only in the epithelium or lamina propria, which are the top layers lining the inside of the colon or rectum.

T1: The tumor has grown into the submucosa, which is the layer of tissue underneath the mucosa or lining of the colon.

T2: The tumor has grown into the muscularis propria, a deeper, thick layer of muscle that contracts to force along the contents of the intestines.

T3: The tumor has grown through the muscularis propria and into the subserosa, which is a thin layer of connective tissue beneath the outer layer of some parts of the large intestine, or it has grown into tissues surrounding the colon or rectum.

T4a: The tumor has grown into the surface of the visceral peritoneum, which means it has grown through all layers of the colon.

T4b: The tumor has grown into or has attached to other organs or structures.

Node (N)

The "N" stands for lymph nodes. Lymph nodes near the colon and rectum are called regional lymph nodes. All others are distant lymph nodes that are found in other parts of the body.

NX: The regional lymph nodes cannot be evaluated.

N0 (N zero): There is no spread to regional lymph nodes.

N1a: There are tumor cells found in 1 regional lymph node.

N1b: There are tumor cells found in 2 or 3 regional lymph nodes.

N1c: There are nodules made up of tumor cells found in the structures near the colon that do not appear to be lymph nodes.

N2a: There are tumor cells found in 4 to 6 regional lymph nodes.

N2b: There are tumor cells found in 7 or more regional lymph nodes.

Metastasis (M)

The "M" stands for metastasis, which describes cancer that has spread to other parts of the body, such as the liver or lungs.

M0 (M zero): The disease has not spread to a distant part of the body.

M1a: The cancer has spread to 1 other part of the body beyond the colon or rectum.

M1b: The cancer has spread to more than 1 part of the body other than the colon or rectum.

M1c: The cancer has spread to the peritoneal surface.

Stages of Colorectal Cancer

The doctor will combine the T, N, and M information to say what stage the cancer is:

Stage 0

This is called cancer in situ. The cancer cells are only in the colon or rectum's mucosa, or the inner lining.

Stage I

The cancer has grown through the mucosa and has invaded the muscular layer of the colon or rectum. It has not spread into nearby tissue or lymph nodes (T1 or T2, N0, M0).

Stage II

Stage IIA:
The cancer has grown through the wall of the colon or rectum but has not spread to nearby tissue or to the nearby lymph nodes (T3, N0, M0).

Stage IIB:
The cancer has grown through the layers of the muscle to the lining of the abdomen, called the visceral peritoneum. It has not spread to the nearby lymph nodes or elsewhere (T4a, N0, M0).

Stage IIC:
The tumor has spread through the wall of the colon or rectum and has grown into nearby structures. It has not spread to the nearby lymph nodes or elsewhere (T4b, N0, M0).

Stage III

Stage IIIA:
The cancer has grown through the inner lining or into the muscle layers of the intestine. It has spread to 1 to 3 lymph nodes or to a nodule of tumor cells in tissues around the colon or rectum that do not appear to be lymph nodes but has not spread to other parts of the body (T1 or T2, N1 or N1c, M0; or T1, N2a, M0).

Stage IIIB:
The cancer has grown through the bowel wall or to surrounding organs and into 1 to 3 lymph nodes or to a nodule of tumor in tissues around the colon or rectum that do not appear to be lymph nodes. It has not spread to other parts of the body (T3 or T4a, N1 or N1c, M0; T2 or T3, N2a, M0; or T1 or T2, N2b, M0).

Stage IIIC:
The cancer of the colon, regardless of how deep it has grown, has spread to 4 or more lymph nodes but not to other distant parts of the body (T4a, N2a, M0; T3 or T4a, N2b, M0; or T4b, N1 or N2, M0).

Stage IV

Stage IVA:
The cancer has spread to a single distant part of the body, such as the liver or lungs (any T, any N, M1a).

Stage IVB:
The cancer has spread to more than 1 part of the body (any T, any N, M1b).

Stage IVC:
The cancer has spread to the peritoneum. It may also have spread to other sites or organs (any T, any N, M1c).

Recurrent

Recurrent cancer is cancer that has come back after treatment. The disease may be found in the colon, rectum, or in another part of the body. If the cancer does return, there will be another round of tests, similar to the ones at the time of diagnosis, to learn about the extent of the recurrence.

Colorectal Cancer Grades (G)

If the cancer looks similar to healthy tissue, it is called "differentiated" or a "low-grade tumor." If the cancerous tissue looks very different from healthy tissue, it is called "poorly differentiated" or a "high-grade tumor." The cancer’s grade may help the doctor predict how quickly it will spread. In general, the lower the tumor’s grade, the slower it’s likely to grow and the better the prognosis.

GX: The tumor grade cannot be identified

G1: The cells are more like healthy cells (well-differentiated)

G2: The cells are somewhat like healthy cells (moderately differentiated)

G3: The cells look less like healthy cells (poorly differentiated)

G4: The cells barely look like healthy cells (undifferentiated)

Colorectal Cancer Treatment Options

Treatment for colorectal cancer usually depends on the location of the tumor in the colon or rectum and the stage of the disease. The type of treatment recommended for colorectal cancer may include surgery, chemotherapy, biological therapy, or radiation therapy. Some people have a combination of treatments. These treatments are described below.

Surgery to Remove Colorectal Cancer

Surgery is most commonly used when colorectal cancer is found before stage 3. Several types of surgery are used to remove colorectal cancer. The most common, however, is surgical resection (also called colectomy). This means removing the area of the colon where cancer was found along with some of the healthy colon nearby (in case cancer cells had already started growing there) and some of nearby lymph nodes. The colon is then reconnected so that the patient can have regular bowel movements after healing.

Early-stage colorectal cancer might be able to be removed through procedures used during a colonoscopy. These include:

Radiofrequency ablation (RFA) or cryoablation may be used in cases where the cancer has spread to the liver or lungs. This involves using energy in the form of radiofrequency waves to heat the tumors ( RFA), or to freeze the tumor (cryoablation) without requiring an open surgery. Not all liver or lung tumors can be treated with these approaches, but this type of surgery is typically less invasive and used when it’s likely to kill all the cells in the area. RFA can be done through the skin or during surgery.

Will You Need a Colostomy or Ileostomy?

Especially for rectal cancer patients, there may be a period of time when the colon and rectum can’t be used to expel waste. An opening can be made in the lower abdomen that allows fecal matter to be removed. This is not necessary for many colorectal cancer patients. And for those who need it, the opening is often temporary.

There are two different types of surgeries:

Colostomy

A surgical opening, or stoma, through which the colon is connected to the abdominal surface. It provides a new path for waste material to leave the body. The waste is collected in a flat bag that fits over the stoma. Colostomy is often used for patients with rectal cancer or who’ve had a section of their colon removed.

Ileostomy

The ileum is located at the lowest point of the small intestine. If you have an ileostomy, the stoma is attached to the end of the small intestine. An ileostomy is commonly used when a person’s ileum isn’t working properly or, in the case of colorectal cancer, when the disease has spread to the ileum.

Radiation Therapy for Colorectal Cancer

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area. It is a common treatment for colorectal cancer since the cancer tends to recur in the same place it was previously found.

Doctors use different types of radiation therapy to treat cancer. Sometimes people receive two types:

External Radiation

A machine delivers x-rays to where the cancer is located. Radiation treatment is usually given 5 days a week for several weeks. It may be given in the doctor's office or at the hospital.

Intraoperative Radiation Therapy (IORT)

In some cases, radiation is given during surgery.

Radiation therapy may be given before surgery, after surgery, or both depending on whether the cancer spread and what was found during surgery.

Colorectal Cancer Medical Oncology Therapies

Your colorectal cancer treatment plan may include medications to destroy cancer cells. These therapies are systemic, meaning the medications are given through the bloodstream to reach cancer cells throughout the body. These can be given before and/or after surgery.

The types of medications used for colorectal cancer include:

Chemotherapy
Targeted therapy
Immunotherapy

Chemotherapy for Colorectal Cancer

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Anticancer drugs are usually given intravenously, but some may be given orally.

Targeted Therapy for Colorectal Cancer

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. The oncologist can better determine if there is a particular drug available to target the specific genetic mutation found in the cancer cells based upon the results of the tumor marker testing performed at the time of diagnosis. By using a targeted therapy, the genetic mutation that allows the cancer cells to grow will be attacked, slowing the growth of cancer while causing less damage to healthy cells than chemotherapy or radiation therapy.

Immunotherapy for Colorectal Cancer

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells.

Checkpoint inhibitors are an important type of immunotherapy used to treat colorectal cancer. Immune checkpoint inhibitors block proteins called checkpoints that are made by some types of immune system cells, such as T cells, and some cancer cells. These checkpoints help keep immune responses from being too strong and sometimes can keep T cells from killing cancer cells. When these checkpoints are blocked, T cells can kill cancer cells better. They are used to treat some patients with metastatic colorectal cancer.

Find Colorectal Cancer Care in the Greater Philadelphia Area

The specialists at Consultants in Medical Oncology and Hematology work with you to ensure you have the most effective treatment plan. We have convenient locations serving the Broomall, Glen Mills, and Exton, Pennsylvania areas. We also offer second opinions on diagnosis and treatment plans for colon and rectal cancers. Take the time to evaluate your options and choose the cancer care team that meets all your needs.