• Incidence :

• Colorectal cancer is the third most common cancer worldwide, accounting for approximately 10% of all cancer cases and is the second leading cause of cancer-related deaths worldwide.
• It predominantly affects older individuals, with the majority of cases occurring in people aged 50 and above.
• Several lifestyle factors contribute to the development of colorectal cancer such as a high intake of processed meats and low intake of fruits and vegetables, sedentary lifestyle, obesity, smoking, and excessive alcohol consumption.
• Colorectal cancer is often diagnosed at advanced stages when treatment options are limited.
• Colon cancer affects men and women about equally. 

 

• Symptoms and Signs :

Potential symptoms and signs of colon cancer include: 

• A change in bowel habits. 
• Blood (either bright red or very dark) in the stool. 
• Diarrhea, constipation, or feeling that the bowel does not empty all the way. 
• Stools that are narrower than usual. 
• Frequent gas pains, bloating, fullness, or cramps. 
• Weight loss for no known reason. 
• Feeling very tired. 
• Vomiting. 
• Anemia (low red blood cell count). 

• Risk Factors:

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors does not mean that you will not get cancer. Risk factors for colon cancer include: 

• Increasing age: Most people who develop colon cancer are 50 or older. 
• A family history of cancer of the colon or rectum. 
• Certain hereditary conditions, such as familial adenomatous polyposis, and hereditary nonpolyposis colon cancer, called Lynch syndrome. 
• A history of inflammatory bowel disease (IBD), such as ulcerative colitis and Crohn's disease 
• A personal or family history of adenomas (polyps) in the colon or rectum. These growths can be pre-cancerous. Most adenomas will not turn into cancer. However, regular screening to remove them reduces the risk of developing colon cancer. 
• Environmental and lifestyle-related factors, such as lack of exercise, obesity, smoking, and alcohol consumption. 
• Diagnose and Stage Colorectal Cancer:

Medical history and physical exam:

Your doctor will ask about your medical history to learn about possible risk factors, including your family history. As part of a physical exam, your doctor will feel your abdomen for masses or enlarged organs, and also examine the rest of your body. You may also have a digital rectal exam (DRE).

Blood tests

Your doctor might also order certain blood tests to help determine if you have colorectal cancer. These tests also can be used to help monitor your disease if you’ve been diagnosed with cancer.

Complete blood count (CBC): This test measures the different types of cells in your blood. It can show if you have anemia (too few red blood cells).

Liver enzymes: You may also have a blood test to check your liver function, because colorectal cancer can spread to the liver.

Tumor markers: Colorectal cancer cells sometimes make substances called tumor markers that can be found in the blood. The most common tumor marker for colorectal cancer is the carcinoembryonic antigen (CEA).

Blood tests for this tumor marker can sometimes suggest someone might have colorectal cancer, but they can’t be used alone to screen for or diagnose cancer. This is because tumor marker levels can sometimes be normal in someone who has cancer and can be abnormal for reasons other than cancer.

Diagnostic colonoscopy

A diagnostic colonoscopy is just like a screening colonoscopy, but it’s done because a person is having symptoms, or because something abnormal was found on another type of screening test.

For this test, the doctor looks at the entire length of the colon and rectum with a colonoscope, a thin, flexible, lighted tube with a small video camera on the end. It is inserted through the anus and into the rectum and the colon. Special instruments can be passed through the colonoscope to biopsy or remove any suspicious-looking areas such as polyps, if needed.

Biopsy

If a suspected colorectal tumor is found during a screening or diagnostic test, it usually is biopsied. In a biopsy, the doctor removes a small piece of tissue with a special instrument passed through the scope. Less often, part of the colon may need to be surgically removed to make the diagnosis.

 Imaging tests to look for colorectal cancer and the spread

Computed tomography (CT or CAT) scan

This test can help tell if colorectal cancer has spread to nearby lymph nodes or to your liver, lungs, or other organs.

CT-guided needle biopsy: If a biopsy is needed to check for cancer spread, this test can also be used to guide a biopsy needle into the mass (lump) to get a tissue sample to check for cancer.

Magnetic resonance imaging (MRI) scan :Like CT scans, MRI scans show detailed images of soft tissues in the body. MRI can be used to look at abnormal areas in the liver or the brain and spinal cord that could be cancer spread.

Positron emission tomography (PET) scan

For a PET scan, a slightly radioactive form of sugar (known as FDG) is injected into the blood and collects mainly in cancer cells. PET scans are generally done to help see if the cancer has spread to other parts of the body, outside of the colon or rectum. However, they do not show if cancer has spread to the brain.

• Treatment:

The most common treatment for colorectal cancer is surgery to remove the tumor. Chemotherapy and radiation therapy are also frequently involved in plans for therapy. In some cases, a combination of all three will be employed.

Standard treatments include:

Surgery

Surgery (removing the cancerous growth in an operation) is usually the key component of treatment for most patients with colon cancer. It is the most common treatment for people with all stages of colon cancer. Our colorectal surgical team is one of the most experienced in the country.

A surgeon may remove the cancerous growths through:

• Local excision: If the cancer is found at a very early stage, the surgeon may remove it without cutting through the abdominal wall. The surgeon may put a tube through the rectum into the colon to cut the cancer out. This is called a local excision. If the cancer is in a polyp, the operation is called a polypectomy.
• Resection of the colon with anastomosis (colectomy or hemicolectomy): Part of the colon containing the cancer and nearby healthy tissue is removed, and then the cut ends of the colon are joined.
• Resection of the colon with colostomy: If the doctor is not able to sew the two ends of the colon back together, an opening is made on the outside of the body for waste to pass through. This is called a colostomy.
• Lower anterior resection, or LAR, removes the part of the rectum that has cancer. The colon is then reattached to the remaining rectum.
• Abdominoperineal resection, or APR, removes the entire rectum and anus, including the sphincter muscle. The site of the anus is completely closed, and a permanent stoma is created.

Chemotherapy

Chemotherapy is a treatment that uses drugs to either kill cancer cells or stop them from growing.

Exciting advances in chemotherapy are allowing patients with advanced disease to get combinations of drugs to shrink tumors, making it easier to take them out later with surgery.

 And for cancer that has spread to the liver, we offer leading-edge therapies like hepatic arterial infusion: a small disc implanted under the skin that sends chemotherapy drugs directly into the artery that feeds the liver.

Throughout your treatment, our team of medical oncologists, nurse practitioners, nurses, dietitians, social workers, and other staff will work to minimize the side effects of chemotherapy and maximize your quality of life.

Targeted Therapy:

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

Some targeted therapies used in colon cancer focus on certain changes that occur around tumors, specifically the blood supply to tumors. These therapies are called angiogenesis inhibitors, and they stop the growth of new blood vessels that tumors need to grow and spread.

Another kind of targeted therapy for colon cancer attacks a protein on the cell – called the epidermal growth factor receptor (EGFR) - that drives cells to divide and spread.

Immunotherapy

Immunotherapy, also known as biological therapy, uses the body’s own immune system to fight cancer. Cancer cells can trick the immune system so that it does not attack them. Immunotherapy works in a variety of ways to help the immune system spot and destroy colorectal cancer cells.

Radiation Therapy

Our radiation oncologists are national leaders in the use and study of radiation therapy. Radiation therapy uses high-energy x-rays to eliminate cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

While radiation therapy is not as commonly used in colon cancer as in other cancer types, there are times when radiation therapy is recommended:

• After surgery and chemotherapy to further decrease the chance of the cancer returning.
• To reduce the tumor prior to surgical resection.
• To help control cancers that cannot be removed surgically.
• To help symptoms from specific metastases, to reduce pain in that area.

Colorectal cancer care at Shefa-El Orman:

Our team of experts works together to provide compassionate, comprehensive, and highly coordinated care for patients with colon cancer.

 We see about 1,000 cases of colon cancer a year, and offer patients the most advanced treatments, It’s important to note that at Shefa-Orman Hospital there is no one-size-fits-all approach to colorectal cancer. We treat the patient, not the disease, and afford each person the compassion and dignity that everyone deserves. Our nationally renowned physicians will work closely with you and your family to customize your treatment plan according to the characteristics of the disease as well as your own goals, values and preferences.

Multidisciplinary Team: Your team (including gastroenterologists, medical oncologists, radiation oncologists, surgical oncologists, pathologists, radiologists, nurses, social workers, and nutritionists) works together throughout your entire treatment and recovery, ensuring that your care is highly coordinated.

Shefa- Elorman doctors have access to the latest treatment techniques, including:

• Minimally invasive surgery: also called laparoscopic surgery, for colon cancer, several small incisions are made in the abdomen. Special tools and a camera are inserted through the incisions and allow the surgeon to remove the cancer without making one large incision.  Today, colon cancer operations are performed using a minimally invasive approach when possible.
• Optimized adjuvant therapy: Chemotherapy given after colon cancer surgery, called adjuvant chemotherapy, to reduce the risk of recurring disease. Shefa-El Orman oncologists continue to study the best medicine combinations and treatment lengths to make adjuvant therapy most effective and minimize the side effects.
• Innovative treatments for liver metastases: Shefa-El Orman offers the latest treatments for colon cancer that spreads to the liver. This includes surgical mastectomy.

We offer our patients targeted therapies, advanced surgical procedures, and the full range of nutritional and other support services, from a top-ranked hospital and leading cancer center. 

We provide comprehensive services to patients with these cancers, including:  

• Personalized treatment plans: every patient treated as an individual with unique needs 
• Innovative surgical techniques including laparoscopic surgeries 
• Our unique Enhanced Recovery After Surgery program
• Multidisciplinary care delivered by qualified team. _____________________________________________________________________

• Diagnosis:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
• complete blood count
• biochemical analysis of blood
• tumor markers
• inflammation markers (CRP, ESR)
• blood coagulation analysis (aPTT, PT, INR)
• ultrasound of the abdomen
• CT/MRI scan of the chest and abdomen or PET CT (if clinically indicated).
• colonoscopy with biopsy, histological and immunohistochemical study
• nursing services
• services of all leading experts
• explanation of individual treatment plan

Required documents

• Medical records
• Esophagogastroduodenoscopy (EGD), MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: On request

Type of program: Outpatient

Expected duration of the program: 5 days

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• Chemotherapy and targeted therapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• analysis of medical records
• physical examination
• laboratory tests:

• complete blood count
• biochemical analysis of blood
• tumor markers
• inflammation indicators
• indicators of blood coagulation
• ultrasound scan of the abdomen, CT / MRI scan  (if indicated).
• 1 course of chemotherapy
• consultations of related specialists
• symptomatic and specific treatment
• the cost of essential medicines and materials
• nursing services
• control examinations
• full hospital accommodation
• recommendations for further treatment

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy is carried out as the inpatient procedure or outpatient according to chemotherapy protocol type. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. After the completion of the chemotherapy course and control examinations you will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

Required documents

• Medical records
• Esophagogastroduodenoscopy (EGD), MRI/CT scan (not older than 3 months)
• Biopsy results
• Any recent laboratory results.

Price from: On request (regarding chemotherapy protocol)

Type of program: Inpatient or outpatient (regarding chemotherapy protocol)

Expected duration of the program: from 1 to 4 days per cycle (regarding chemotherapy protocol)

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• Surgery:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• physical examination
• laboratory tests:
• complete blood count
• biochemical analysis of blood
• tumor markers
• inflammation indicators
• indicators of blood coagulation
• ultrasound scan of the abdomen (if indicated)
• CT/MRI scan (if indicated)
• colonoscopy with biopsy (if indicated)
• preoperative care
• resection of affected parts of the intestine 
• Endoscopic Excision Of Left Sided Colon Or Rectal Tumor With Stapler
• Endoscopic Excision Of Right Sided Colon With Stapler
• Excision Of Left Sided Colon Tumor With Stapler
• Excision Of Right Sided Colon Tumor With Stapler
• Total Colectomy With Anastomosis Of Colon
• endoscopic resection of the tumor
• colostomy closure
• surgical trans anal excision
• lower anterior resection
• Abdominoperineal resection
• histological and immunohistochemistry analysis
  of the removed tissues
• nutrition consultation
• symptomatic treatment
• control examinations
• cost of essential medicines and materials
• nursing services
• full hospital accommodation
• explanation of future recommendations

 

How program is carried out

During the first visit, the physician will conduct a clinical examination and go through the results of the available diagnostic tests. After that, you will undergo the necessary additional examinations, such as the assessment of liver and kidney function, abdominal ultrasound scan, CT scan and MRI (if indicated). Based on the results of an additional examination, the physician will clarify the stage of the oncological process, choose the volume of the intervention and the type of anesthesia.

Surgery starts with general anesthesia. After anesthesia, the surgeon makes small incision on the anterior abdominal wall, the doctor litigates large blood vessels and removes the affected areas of the intestine. The surgeon installs drainage into the abdominal cavity and finishes the operation.

After the completion of the operation, you will be transferred back to the ward, under the supervision of the attending physician and nursing staff.

Finally, the attending physician will evaluate the results of control examinations, schedule the date of discharge from the hospital and give you detailed recommendations for further follow-up and treatment.

Required documents

• Medical records
• Esophagogastroduodenoscopy (EGD), MRI/CT scan (not older than 3 months)
• Biopsy results (if available)
• Recent laboratory results

Price from: on request

Type of program: Inpatient

Expected duration of the program: 8 days

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• chemo radiotherapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• CT /MRI (if indicated clinically) 
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• tumor markers (AFP, CEA, СА-19-9)
• indicators of inflammation (CRP, ESR)
• indicators of blood coagulation
• CT simulation and planning of radiation therapy
• Physics calculation
• full course of radiation therapy with different modalities (3D, IMRT, VMAT) according to your treatment plan.
• individual plan of the chemotherapy, the cost of medicines is included
• symptomatic treatment (for side effects of chemo and radiotherapy that may developed).
• cost of essential medicines and materials
• nursing services
• control examinations
• consultations of related specialists
• explanation of future recommendations

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will elaborate the chemotherapy regimen, conduct radiotherapy CT or MRI SIMULATION then planning, make the permanent tattoo marks on the skin to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy and radiation therapy are carried out as the day hospital procedure, without mandatory admission to the hospital. At each visit, the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded linear accelerator radiation therapy room.

Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will visit the hospital from 1 to 3-5 times a week.

Chemotherapy may be through oral or intravenous route according to your treatment plan, during the chemotherapy session, after the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

During radiotherapy, you are under close follow-up daily from doctors and nurses.

After the completion of the chemotherapy and radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results

Price from: on request

Type of program: Outpatient

Expected duration of the program: 39 days

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