Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
What are the treatments and survival for colon
cancer?
Surgery is the most common treatment for colorectal
cancer. During surgery, the tumor, a small margin of the surrounding
healthy bowel, and adjacent lymph nodes are removed. The surgeon
then reconnects the healthy sections of the bowel. In patients
with rectal cancer, the rectum is permanently removed. The surgeon
then creates an opening (colostomy) on the abdomen wall through
which solid waste in the colon is excreted. Specially trained
nurses (enterostomal therapists) can help patients adjust to
colostomies, and most patients with colostomies return to a normal lifestyle.
The long-term prognosis after surgery depends on
whether the cancer has spread to other organs (metastasis). The
risk of metastasis is proportional to the depth of penetration
of the cancer into the bowel wall. In patients with early colon
cancer which is limited to the superficial layer of the bowel
wall, surgery is often the only treatment needed. These patients
can experience long-term survival in excess of 80%.
In patients with advanced colon cancer, wherein the tumor has
penetrated beyond the bowel wall and there is evidence of metastasis
to distant organs, the five-year survival rate is less than 10%.
In some patients, there is no evidence of distant
metastasis at the time of surgery, but the cancer has penetrated
deeply into the colon wall or reached adjacent lymph nodes. These
patients are at risk of tumor recurrence either locally or in
distant organs. Chemotherapy in these patients may delay tumor
recurrence and improve survival.
Chemotherapy is the use of medications to kill cancer
cells. It is a systemic therapy, meaning that the medication travels
throughout the body to destroy cancer cells. After colon cancer
surgery, some patients may harbor microscopic metastasis (small
foci of cancer cells that cannot be detected). Chemotherapy is
given shortly after surgery to destroy these microscopic cells.
Chemotherapy given in this manner is called adjuvant chemotherapy.
Recent studies have shown increased survival and delay of tumor
recurrence in some patients treated with adjuvant chemotherapy
within five weeks of surgery. Most drug regimens have included
the use of 5-flourauracil (5-FU). On the other hand, chemotherapy
for shrinking or controlling the growth of metastatic tumors has
been disappointing. Improvement in the overall survival for patients
with widespread metastasis has not been convincingly demonstrated.
Chemotherapy is usually given in a doctor's office,
in the hospital as a outpatient, or at home. Chemotherapy is usually
given in cycles of treatment periods followed by recovery periods.
Side effects of chemotherapy vary from person to person, and also
depend on the agents given. Modern chemotherapy agents are usually
well tolerated, and side effects are manageable. In general,
anticancer medications destroy cells that are rapidly growing and dividing.
Therefore, red blood cells, platelets, and white blood cells are
frequently affected by chemotherapy. Common side effects include
anemia, loss of energy, easy bruising, and a low resistance to
infections. Cells in the hair roots and intestines also divide
rapidly. Therefore, chemotherapy can cause hair loss, mouth sores,
nausea, vomiting, and diarrhea.
Radiation therapy in colorectal cancer has been limited
to treating cancer of the rectum. There is a decreased local
recurrence of rectal cancer in patients receiving radiation either prior
to or after surgery. Without radiation, the risk of rectal cancer
recurrence is close to 50%. With radiation, the risk
is lowered to approximately 7%. Side effects of radiation
treatment include fatigue, temporary or permanent pelvic hair
loss, and skin irritation in the treated areas.
Other treatments have included the use of localized
infusion of chemotherapeutic agents into the liver, the most common
site of metastasis. This involves the insertion of a pump into
the blood supply of the liver which can deliver high doses of
medicine directly to the liver tumor. Response rates for these
treatments have been reported to be as high as eighty percent.
Side effects, however, can be serious. Additional experimental
agents considered for the treatment of colon cancer include the
use of cancer-seeking antibodies bound to cancer-fighting drugs.
Such combinations can specifically seek and destroy tumor tissues
in the body. Other treatments attempt to boost the immune system,
the bodies' own defense system, in an effort to more effectively
attack and control colon cancer. In patients who are poor surgical
risks, but who have large tumors which are causing obstruction
or bleeding, laser treatment can be used to destroy cancerous
tissue and relieve associated symptoms. Still other experimental
agents include the use of photodynamic therapy. In this treatment,
a light sensitive agent is taken up by the tumor which can then
be activated to cause tumor destruction.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Rectal bleeding may be moderate to severe and most bleeding comes from the colon, rectum, or anus. Common causes include anal fissures, hemorrhoids, diverticulitis, and more.
Constipation is defined medically as fewer than three stools per week and severe constipation as less than one stool per week. Constipation usually is caused by the slow movement of stool through the colon. There are many causes of constipation including medications, poor bowel habits, low fiber diets, abuse of laxatives, hormonal disorders, and diseases primarily of other parts of the body that also affect the colon.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Though uterine cancer's cause is unknown, there are many factors that will put a woman at risk, including: over age 50, endometrial hyperplasia, using hormone replacement therapy, obesity, using tamoxifen, being Caucasian, having colorectal cancer. Symptoms of cancer of the uterus (endometrial cancer) include abnormal vaginal bleeding, painful urination, painful intercourse, and pelvic pain. Treatment depends on staging and may include radiation therapy or hormone therapy.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
A colon polyp is a benign tumor of the large intestine. Benign polyps do not invade nearby tissue or spread to other parts of the body. Benign polyps can easily be removed during colonoscopy and are not life threatening. If benign polyps are not removed from the large intestine, they can become malignant over time.
Anal cancer, cancer located at the end of the large intestine, has symptoms that include anal or rectal bleeding, anal pain or pressure, anal discharge or itching, a change in bowel movements, and/or a lump in the anal region. Treatment for anal cancer may involve radiation, chemotherapy, or surgery and depends upon the stage of the cancer, its location, whether cancer is eradicated after the first treatment, and whether the patient has HIV.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Gardners' syndrome, or familial adenomatous polyposis (FAP), is an inherited condition in which cancer of the colon and rectum develop. Colon polyps and growths may develop as early as the teens. If these polyps are not removed, they will become cancerous. There are different inheritance patterns for familial adenomatous polyposis.
Most often, caregivers take care of other adults who are ill or disabled. Less often, caregivers are grandparents raising their grandchildren. The majority of caregivers are middle-aged women. Caregiving can be very stressful, so it's important to recognize when it's putting to much strain on you and to take steps to prevent/relieve stress.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
Endometrial cancer, or uterine cancer, affects the endometrium of the uterus. It's the most common invasive cancer of the female reproductive system. Risk factors include smoking, obesity, lack of exercise, taking estrogen-only hormone therapy, early menstruation, late menopause, and never being pregnant.
Your health care provider may refer you to a genetic professional. Universities and medical centers also often have affiliated genetic professionals, or can provide referrals to a genetic professional or genetics clinic. Genetic counseling provides patients and family members the tools to make the right choice in regard to test for a disease or condition.
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