Screening and Early Evaluation 

Screening is testing for colorectal cancer when you do not have signs or symptoms. Your provider may look at your age, health history and family health history to help decide when you should start screening and which test may be right for you.

For people at average risk, colorectal cancer screening starts at age 45. There are several screening options, including colonoscopy, flexible sigmoidoscopy, CT colonography, stool-based tests and blood-based tests. Your health care provider can talk with you about the pros and cons of each option.

A colonoscopy lets a provider look at the large bowel and remove abnormal growths during the same procedure. Noninvasive screening tests can detect signs of colorectal cancer or polyps, but they cannot remove polyps. If a noninvasive test is positive, a colonoscopy is needed to complete the screening process.

Colon Cancer Care 

Colon cancer forms in the tissues of the colon. The colon is part of the large bowel, where digested food becomes a stool. Many colon cancers start as polyps, which are growths on the inner lining of the colon or rectum. Some polyps can become cancer over time. As such, finding them early with help of a colonoscopy may help prevent cancer before it starts. and if colon cancer is diagnosed continued treatment may be needed with a colorectal cancer doctor further management

Symptoms of Colon Cancer 

Colon cancer symptoms may overlap with other health problems, so it is important to talk with a colorectal cancer surgeon if something feels different or does not go away. Possible symptoms include:

• Blood in the stool, which may look bright red or very dark
• A change in bowel habits
• Diarrhea
• Constipation
• Feeling like the bowel does not empty completely
• Stools that are narrower or shaped differently than usual
• Frequent gas pains, bloating, fullness or cramps
• Weight loss for no known reason
• Fatigue
• Vomiting

How Colon Cancer Is Diagnosed 

Diagnosis focuses on finding out whether cancer is present and learning details that help guide the care plan. Possible diagnostic steps include:

• A personal and family health history
• A physical exam
• Colonoscopy to look inside the rectum and colon
• Biopsy, in which cells or tissue are checked under a microscope
• A pathology report that explains the diagnosis and other findings
• Blood tests, such as a complete blood count, chemistry profile and CEA test
• CT scans of the chest, abdomen and pelvis
• MRI, if needed
• PET scan
• Tumor testing, including mismatch repair or MSI testing
• Other testing, such as PIK3CA or DPYD testing, when it is relevant to care planning

Treatment Options for Colorectal Cancer

Treatment depends on the stage of the cancer, whether it has spread, tumor features and your overall health. Your care team may recommend one treatment or a combination of treatments. Colorectal cancer treatment types include:

• Surgery, such as polypectomy, local excision, colectomy or resection with anastomosis
• Colostomy in some cases, when an opening is made so stool can drain into a bag
• Chemotherapy, which uses medicines to stop cancer cells from growing
• Targeted therapy, which may be based on specific tumor features
• Immunotherapy, which may be used for cancers with certain biomarkers
• Radiation therapy for rectal cancer treatment
• Local treatment for metastatic colorectal cancer, such as thermal ablation, cryosurgery, chemoembolization, stereotactic body radiation therapy or surgery for cancer that has spread to areas such as the liver or lungs
• Clinical trials, which study new treatments or new ways of using current treatments

Recovery and Follow-up for Colorectal Cancer Treatment 

Follow-up care helps your care team check for changes, look for signs that cancer has come back and support you through side effects. Depending on the stage and treatment plan, follow-up may include:

• Follow up Colonoscopy
• Physical exams
• CEA blood tests
• CT scans
• Side effect support from the Cancer Center
• A written survivorship care plan
• Coordination between your oncologist and primary care provider

After colon surgery, bathroom habits may change. Some people have more bowel movements than usual and they may feel urgent. Support may include fiber, diet changes, anti-diarrhea medicines, pelvic floor strengthening, protective undergarments or help from a cancer nutritionist.

Rectal Cancer Care 

Rectal cancer forms in the rectum, which is the last part of the large intestine. The term colorectal cancer can refer to cancers that start in either the colon or the rectum, but rectal cancer treatment can be different from colon cancer treatment because of where the cancer starts.

Symptoms of Rectal Cancer 

Rectal cancer symptoms may also be caused by other conditions, so check with a health care provider if you notice changes such as:

• Blood in the stool, which may look bright red or very dark
• A change in bowel habits
• Diarrhea
• Constipation
• Feeling like the bowel does not empty completely
• Stools that are narrower or shaped differently than usual
• Frequent gas pains, bloating, fullness or cramps
• Change in appetite
• Weight loss for no known reason
• Fatigue

How Rectal Cancer is Diagnosed 

Diagnosis focuses on finding out whether cancer is present and learning enough about it to guide the care plan. Possible diagnostic steps include:

• A personal and family health history
• A physical exam
• Digital rectal exam
• Colonoscopy
• Biopsy
• Tumor testing to determine mismatch repair or MMR status
• Blood tests, including complete blood count, comprehensive metabolic panel and CEA
• MRI of the pelvis to see the extent of cancer in and near the rectum
• CT of the chest and abdomen to check for cancer spread beyond the pelvis
• Endorectal ultrasound, if MRI cannot be done
• Germline testing/ I3K pathway testing when relevant to care planning
• DPYD testing when treatment may include fluoropyrimidine chemotherapy

Treatment Options for Rectal Cancer

The treatment of rectal cancer has changed dramatically over the past decade. For carefully selected patients, modern treatment using chemotherapy and radiation can sometimes eliminate the cancer completely, allowing surgery to be avoided. This approach, known as non-operative management or "watch-and-wait," requires careful patient selection, expert interpretation of imaging, and an intensive surveillance program. As a fellowship-trained colorectal surgeon, Dr. Mohammed Ilyas offers comprehensive evaluation to determine whether surgery, organ preservation, or a combination of treatments provides the best chance for cure while maintaining quality of life.

Rectal cancer treatment depends on the stage, tumor features, whether the cancer has spread and your overall health. Care may include one treatment or a combination of treatments.

• Early rectal cancer: Surgery is recommended when possible. For some low-risk tumors that have not reached the muscle layer of the rectal wall, less invasive options may include endoscopic submucosal dissection or transanal local excision including robotic transanal surgery. Abdominal surgery may be recommended for tumors with higher-risk features or cancers that have grown into the muscle layer and these procedures are likely to be performed minimally invasive using advanced robotic technology,
• Locally advanced rectal cancer: Treatment often includes chemotherapy, radiation therapy or both. Chemoradiation combines chemotherapy and radiation therapy. For cancers with mismatch repair deficiency or microsatellite instability-high status, immunotherapy may be recommended. Surgery may follow if needed and possible.
• Stage 4 or recurrent rectal cancer: Treatment may include systemic therapy, targeted therapy, immunotherapy, surgery or local therapies when appropriate. For metastatic rectal cancer, biomarker testing helps guide treatment options. Local therapies may be used for tumors in areas such as the liver or lungs and systemic therapy is used when stage 4 cancer cannot be removed with surgery or local therapies.
• Active surveillance: In some situations, if no cancer can be detected after treatment, close monitoring may be an option instead of immediate surgery. Active surveillance may include tests such as digital rectal exam, MRI, endoscopy, sigmoidoscopy, CT scan, PET scan and CEA testing.

Clinical trials: Clinical trials study new treatments or new ways of using current treatments. For some people, joining a clinical trial may be an option.

Recovery and Follow-up After Rectal Cancer Treatment 

Follow-up care depends on the treatment received and the stage of the cancer. Surveillance may include:

• Physical exams
• CEA blood tests
• CT scans
• Colonoscopy
• Proctoscopy or flexible sigmoidoscopy in some situations
• MRI or endorectal ultrasound in some situations

Recovery may also include support for side effects. After surgery that removes all or part of the rectum, some people have bowel changes, such as more frequent bowel movements, urgent bowel movements, stool clustering, irregular bowel habits, fecal incontinence or more gas. Support may include anti-diarrheal medicine, pelvic floor exercises, diet changes, fiber supplements, protective undergarments or help from a cancer nutritionist.

Other recovery needs may include ostomy care, sexual health support and help with emotional, social or financial concerns. Survivorship care for rectal cancer focuses on physical, emotional and financial issues and supportive care can help manage symptoms, side effects and the concerns that come with cancer care.

Anal Cancer Care 

Anal cancer forms in the anus, the opening where stool leaves the body. Most anal cancers start in the anal canal, which connects the rectum and the anal opening. Less often, anal cancer starts in the perianal region, also called the anal margin, which includes the anal opening and the skin around it. Most anal cancers are squamous cell carcinomas. Human papillomavirus (HPV) is a major risk factor for anal cancer. About 9 out of 10 anal cancers are caused by HPV.

Symptoms of Anal Cancer 

Anal cancer symptoms may feel hard to talk about, but they should not be ignored. Possible symptoms include:

• Bleeding from the anus
• Blood in the stool, on toilet paper or in the toilet bowl
• Anal itching
• Pain in the anal area
• A lump or mass near the anus

These symptoms may be mistaken for hemorrhoids. Even if that seems possible, it is still important to be evaluated by a health care professional.

How Anal Cancer is Diagnosed 

Diagnosis focuses on finding out whether cancer is present and learning enough about it to plan care. Possible steps include:

• Digital rectal exam, where a provider checks the anus and rectum for abnormalities
• Anoscopy or high-resolution anoscopy, which allows the provider to look closely at the anal canal
• Biopsy of suspicious tissue to check for cancer
• Groin lymph node exam to check for swollen lymph nodes
• CT or MRI to see the extent of cancer in and near the anus
• CT of the chest and abdomen to look for cancer outside the pelvis
• PET/CT or PET/MRI in some cases
• HIV blood test
• DPYD testing if treatment with certain chemotherapy medicines is being considered
• Gynecologic exam, including cervical cancer screening, for people assigned female at birth
• Fertility preservation discussion if treatment may affect the ability to have children

Possible Treatment Options for Anal Cancer 

Treatment depends on where the cancer started, the stage, whether it has spread and the care plan you make with your treatment team.

• Non-metastatic anal canal cancer: Chemoradiation is recommended for stage 1, 2 and 3 squamous cell carcinomas in the anal canal. Chemoradiation means chemotherapy and radiation therapy are given during the same treatment period.
• Some stage 1 or 2A perianal cancers: Local excision may be an option for select perianal cancers that have not spread to nearby lymph nodes and have not invaded the sphincter muscle.
• Persistent or recurrent cancer: If anal cancer does not improve with recommended treatment or comes back, surgery may be needed. Surgery to remove the anus may require a permanent colostomy, which creates an opening for stool to leave the body into a bag.
• Metastatic anal cancer: If anal cancer has spread beyond the pelvis, systemic therapy may be recommended. A combination of platinum chemotherapy and immunotherapy may be recommended as first-line treatment in some cases.
• Clinical trials: A clinical trial may be an option for some people. Clinical trials study investigational treatments that may later be approved.

Recovery and Follow-up After Anal Cancer Treatment 

After chemoradiation, a physical exam with digital rectal exam and anoscopy is recommended 8 to 12 weeks later to check the results of treatment. Imaging may also be ordered. If no cancer is found, surveillance begins.

Surveillance may include:

• Digital rectal exams
• Inguinal or groin, lymph node exams
• Anoscopy when possible
• Imaging for stage 2 and 3 cancers for 3 years after treatment

Recovery may also include support for changes caused by treatment. Anal cancer survivorship may involve bowel changes, bladder changes, sexual health concerns, early menopause, mental health support and ostomy care. Possible bowel and bladder changes after radiation include fecal incontinence, more frequent bowel movements, gas, urgent need to pass stool, watery stool, urinary incontinence and urinary urgency.

Support may include diet changes, anti-diarrheal medicine, pelvic floor physical therapy, sexual health therapy or ostomy support, depending on what you are experiencing.

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