March is National Colorectal Cancer Awareness Month. According to the American Cancer Society, colorectal cancer is the third leading cause of cancer deaths.
The best ways to protect yourself from colorectal cancer are to exercise regularly; eat a high-fiber, low-fat diet; and undergo a screening colonoscopy once you turn 50. Depending on the results of your first colonoscopy, you should have subsequent ones every five to 10 years.
It also is important to know your family health history, including whether any direct relatives have had colorectal cancer, and to discuss this information with your doctor. He or she can determine if you should start screening before 50.
A colonoscopy is a procedure in which a physician feeds a tool equipped with a small camera through the colon and rectum to check for growths called polyps, which may or may not be cancerous. Benign polyps may become cancerous, so doctors often remove them and perform biopsies during a colonoscopy.
Sanda Tan, M.D., Ph.D., an assistant professor of surgery; Emina Huang, M.D., an associate professor of surgery; and Atif Iqbal, M.D., an assistant professor of surgery, are UF’s colorectal surgeons. For patients who have colorectal cancer, our surgeons offer a wide range of multidisciplinary treatments. Most people with colorectal cancer require surgery. Chemo or radiation therapy may shrink the size of a tumor before surgery or provide an extra boost of treatment after surgery.
Iqbal is focused on the best ways to combine surgery and radiation therapy for patients with certain cancers. He is “working on establishing a program for treatment of early rectal cancers with transanal endoscopic microsurgical excision and radiation therapy.”
All our surgeons employ minimally invasive methods during surgery and make every effort to preserve as much of the colon and rectum as possible.
One option is transanal endoscopic microsurgery. This procedure, like a colonoscopy, avoids a surgical incision by placing a camera into the anus so surgeons can view the inside of the colon and rectum while they work. During this procedure, the surgeon may remove portions of the colon and rectum, or only polyps and lesions that are cancerous.
Total mesorectal excision is another type of procedure, offered for patients with rectal cancer that may have spread to nearby lymph nodes. This procedure involves removing the mesorectum, a fatty tissue surrounding the rectum that contains blood vessels and lymph nodes.
Tan said the colorectal surgery team now offers operations performed through a single “port” for patients who have cancer in the right side of the colon. UF colorectal surgeons also are integrating robotic surgery into their clinical offerings. UF liver surgeons sometimes join with the colorectal team in cases where a colorectal tumor has spread to the liver, sparing patients at least one additional operation.
Extensive research on colorectal cancer and how it develops is an important component of UF’s work to fight colorectal cancer.
Huang focuses on the link between colitis, a form of inflammatory bowel disease, and colorectal cancer.
Funded by the National Cancer Institute, she and collaborators in her lab at UF are investigating cells afflicted with colitis to learn about the chemical signals they send, and what causes some of these cells eventually to become tumor cells. One effort to understand this transition includes mapping the genetic alterations found in so called “tumor-initiating cells” that Huang and her research team have collected from samples of diseased colon cells. They have identified a specific mutation present in many of their samples and are investigating its potential role in tumor formation.
Tan and Huang are working on ways to improve hydration in patients who have a portion of the colon surgically removed, and to reduce hospital readmissions caused by dehydration after surgery.
“The colon is responsible for the absorption of water from the stool and therefore contributes to hydration,” reads a document describing the surgeons’ project on hydration. “During surgery for several colorectal conditions, including cancer, or inflammatory conditions, the stool must be diverted from the remaining colon or rectum. Diverting the flow of stool from the colon with an ileostomy (loop of small bowel brought to the skin), may result in dehydration or electrolyte imbalance.”
Huang and Tan hope to reduce post-surgical dehydration and related hospitalizations by assigning a health-care provider to call ileostomy patients and inquire about factors related to hydration once a day for three weeks after surgery. Patients may choose not to participate in this experimental initiative.
Information from the phone calls and rates of hospital readmission will be recorded and Myron Chang, Ph.D., a professor in the UF College of Medicine’s department of biotatistics, will analyze the data to determine if the phone calls are effective.