most people who come in with colon cancer,surgery will be the first thing in the treatment plan for them. the surgeon will order bloodtests to look for levels of the cancer in the blood. they will order a ct scan of theabdomen and pelvis. and occasionally they'll also order a pet/ct. in patients who havecolon cancer after surgical removal of the cancer, many patients may get chemotherapyafter surgery. the exception is if they have metastatic disease meaning spread of the cancerbeyond the colon to other organs such as the liver. in that setting, the first treatmentmay be chemotherapy. rarely will a patient with colon cancer receive radiation therapy.in patients who are diagnosed with rectal cancer, unless it's a very early stage ofrectal cancer, the treatment paradigm involves
first giving them chemo combined with radiotherapy.a rest period of 8 to 12 weeks, followed by surgery. and that surgery often will includea temporary ileostomy. the big concern patients have with having an ileostomy or colostomyis body image. and even with the new pouching systems that we have, that's still a concernfor them. however what i tell patients is that this is life-saving and that in everyprofession, there are people who have stoma bags.you need to know what you're doing when you're working on the rectum because thereis very little leeway for making an error. you're often working in a confined space.and there are several vital and irreplaceable organs in the area including nerves, the bladder,urinary system, the vagina and the uterus.
so there's a lot in a very small space.when we do rectal removal for cancer, it is essential to remove the entire mesorectumwhich is where the lymph nodes are located around the rectum. and colorectal surgeonsin particular are trained to do that without violating that space. the colon is a lot moreforgiving because most of the colon is free within the abdomen or easy to free up withinthe abdomen. once a patient has been diagnosed, we're discussing their treatment plan witha medical oncologist, often times with a radiation oncologist, with a pathologist, the radiologist,the genetic counselors, social workers often times, and sometimes even the nurses thatare involved in the care. dr. phil gold is the leader for gi oncologyin the swedish cancer institute. he has clinical
trials for each stage of colon cancer. heis a national expert. and he knows every study and the results of every study and the numberof patients on every study. and he's really an exceptional guy.there has been an increase in targeted therapies and improvements in chemotherapy. so thateven patients that 10 years ago, we would've said had a six months survival, are livingfor years.
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