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Colon cancer is staged between stages one and four. Stage one is when it is very superficial in the colonic wall. Stage two is when he has gone a little further or deeper into the colon wall. Stage three is when it involves the lymph nodes around the colon and stage four is when it has spread to other organs such as the liver, lungs, etc.
Colon cancer is staged between stages one and four. Stage one is when it is very superficial in the colonic wall. Stage two is when he has gone a little further or deeper into the colon wall. Stage three is when it involves the lymph nodes around the colon and stage four is when it has spread to other organs such as the liver, lungs, etc.
If someone is concerned about an underlying colon cancer, the first doctor they need to see is a gastroenterologist who will do a colonoscopy for them and see if there's any evidence of any abnormal lesions. Who should be screened for colon cancer? Everyone over the age of 50 needs one screening colonoscopy at age 50 and every 5-10 years thereafter. If there's a family history, then I would definitely recommend doing a colonoscopy before the age of 50. The exact age is not clear, but it's up to the patient and the family. Lately we have noticed an increased incidence of colon cancer in patients under 50 years of age, and if someone is having any symptoms of weight loss or abdominal pain, cramping, nausea, or rectal bleeding, then for sure they should go for a screening colonoscopy.
Once the diagnosis of colon cancer or rectal cancer has been made, the first question that needs to be answered is: is the tumor resectable. Therefore, the patient needs to undergo a staging workup with CT and PET scans, or sometimes with an additional endoscopic ultrasound of the rectum to really get a good idea of the stage of the tumor. At that point, they need to be seen by a colorectal surgeon if we think they are potentially resectable, and once they've seen the surgeon, a recommendation will be made regarding surgery versus some systemic treatment with chemotherapy andor a combination of chemo radiation in case it is a rectal cancer primary.
The best option for screening for colon cancer is a colonoscopy, which is done by a gastroenterologist. This is highly recommended for everyone over the age of 50, and if you have a family history, you should do it earlier. Other options include CT colonography, which is a CT scan of the colon. It is a little bit less invasive and if there's a suspicious lesion that is found on CT colonography, those people still have to undergo a regular colonoscopy for biopsying of the suspicious lesion. I have some patients who absolutely refuse to do any colonoscopy. For those patients, I recommend to do a stool occult blood tests that will detect any microscopic evidence of bleeding in the stool as well as a Cologuard test, which is a newer test that looks for any evidence of DNA from any underlying potential tumors in the colon.
In addition to chemotherapy for stage four colon cancer, recently, there has been some research that has shown the effectiveness of immune therapy in a subset of patients with colon cancer who have a certain mutation. So if these mutations are found in the tumor cells, based on studies that are done after surgery or biopsy, we know that those patients can actually benefit from chemotherapy for their stage four colon cancer, which is a very exciting new development and a great new option for these patients who will not have had this option in the past and often would have had no option after a recurring from their treatment or becoming resistant to the chemotherapy.
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