Tag Archives: Sigmoid Colon

Infographics, Medicine, Reviews

Colon Cancer Options: Intraoperative Radiation Therapy Vs Radiation

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What is the difference between intraoperative radiation therapy and normal radiation? Is radiation a standard treatment option, or are there other approaches?

Mayo Clinic (March 28, 2023):

ANSWER: Colon cancer is one of the most common malignancies in the U.S., with more than 100,000 new cases diagnosed each year. Over a lifetime, it is estimated that 1 in 23 men and 1 in 26 women will be diagnosed with colon cancer. Typical colon cancers start as a polyp-like growth in the inside layer of the colon, which can be seen during a colonoscopy. Most cancer organizations recommend starting colonoscopy screenings at age 45.

When the treatment team is concerned about achieving negative margins, or removing the entire tumor with an edge of normal tissue around the specimen, intraoperative radiation therapy may be considered. Intraoperative radiation therapy rarely is used for colon cancer, but, when necessary, the area of concern is directly targeted with a single fraction of radiation during surgery. 

When a mass is found during a colonoscopy or cancer is suspected, biopsies are taken and reviewed by a pathologist. In this scenario, most patients are asymptomatic. Without preventive colon cancer screenings, a tumor may grow to an advanced stage before it causes any symptoms that a patient or health care professional would recognize. The most common signs and symptoms of colon cancer are anemia, which may lead to fatigue; abdominal pain; blood in the stool or other bowel changes; weight loss; and signs of obstruction.

Once colon cancer is diagnosed, the next step is a staging examination. This involves a history and physical examination; blood work; confirmation that a full colonoscopy has been performed; and CT scans of the chest, abdomen and pelvis. The results of these tests will allow your health care professional to assign a clinical stage. In stages 1 and 2, the tumor remains in the colon wall with no evidence that it has spread further. With stage 3, there is concern that the tumor cells have spread to the regional lymph nodes, and in stage 4 colon cancer, the tumor cells have spread outside of the local area to other organs — most commonly the liver, lungs or peritoneum.

Surgery is the mainstay of treatment for stages 1, 2 and 3 disease and is usually the first step in the treatment process. The segment of the colon bearing the tumor is removed, along with the draining lymph nodes. The ends of the intestine are reconnected, and the specimen is sent to the pathologist who then performs a histologic examination of the colon and the associated lymph nodes. The pathologist will assign a final pathologic stage to the tumor, which will dictate the need for any additional treatment.

Conditions, Medicine, Reviews

Diverticulitis: Diagnosis And Testing (Mayo Clinic)

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Mayo Clinic – Diverticulitis is usually diagnosed during an acute attack. Because abdominal pain can indicate a number of problems, your doctor will need to rule out other causes for your symptoms.

Your doctor will start with a physical examination, which will include checking your abdomen for tenderness. Women generally have a pelvic examination as well to rule out pelvic disease.

After that, the following tests are likely:

  • Blood and urine tests, to check for signs of infection.
  • A pregnancy test for women of childbearing age, to rule out pregnancy as a cause of abdominal pain.
  • A liver enzyme test, to rule out liver-related causes of abdominal pain.
  • A stool test, to rule out infection in people who have diarrhea.
  • A CT scan, which can identify inflamed or infected pouches and confirm a diagnosis of diverticulitis. CT can also indicate the severity of diverticulitis and guide treatment.

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Infographics, Medicine, Uncategorized

Infographic: Colonic Diverticular Disease

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Medicine, Men's Health, Women's Health

HEALTH: LOOKING OUT FOR DIVERTICULITIS (HARVARD)

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What is diverticulitis?

Diverticulitis arises from a condition called diverticulosis, which occurs when weak areas in the inner wall of the colon bulge outward and form tiny pouches. Many people get diverticulosis as they age. In fact, diverticulosis affects about 58% of US adults over age 60. Getting enough fiber in your diet can help protect against diverticulosis.

Know the signs of diverticulitis

The most common symptoms of diverticulitis are abdominal pain (usually on the lower left side) and fever. The pain is distinct and sharp, and may strike over a few hours. Other symptoms may include a combination of loss of appetite, nausea, vomiting, abdominal bloating and cramping, and not passing gas or stool.

A mild case of diverticulitis that causes only minimal pain in the lower abdomen can resolve on its own within a day or two. However, you should seek immediate medical attention if your symptoms are not going away or you are feeling worse, such as having increasing pain, fever, bloody stools, or abdominal bloating with vomiting.

Treatment depends on whether you have uncomplicated or complicated diverticulitis. Your doctor can determine this by using a combination of blood tests and imaging studies, such as a CT scan.

How is uncomplicated diverticulitis treated?

As the name implies, uncomplicated diverticulitis is the less serious of the two. It means that the inflammation or infection is confined to one section of the colon, and that there is no evidence of complicating factors.

Uncomplicated diverticulitis is typically treated at home with oral antibiotics. You’ll also be prescribed “bowel rest” for a few days, which often includes a clear liquid diet. This gives your bowel a chance to rest and heal, and may reduce pain. Additionally, you’ll follow a low-fiber diet (about 10 to 15 grams of fiber a day) until your symptoms improve.

Some people may need to be hospitalized to receive intravenous (IV) antibiotics. A hospital stay is more likely if you’re 65 or older or have other medical conditions, such as heart disease, diabetes, or chronic obstructive pulmonary disease.

People usually begin to feel improvement from treatment after about three days. If you feel well enough and the symptoms have subsided, you can gradually resume your regular diet.

If symptoms haven’t responded to antibiotics after a week, you probably will undergo CT scans and other tests to see if you have complicated diverticulitis.

How is complicated diverticulitis treated?

Complicated diverticulitis means you have a specific complication that requires a longer course of IV antibiotics, and possibly surgery.

Pope Francis had scarring in a segment of colon where he previously had diverticulitis, which had caused a narrowing in the colon called stenosis. In a case like this, the unhealthy part of the colon is removed, and the remaining colon is then reconnected.

Other types of complications that may occur during an active diverticulitis infection include:

  • Abscess. A diverticular abscess is a collection of pus (a fluid that can form at the site of infection) outside of the intestinal wall. If the abscess doesn’t get better with antibiotics, a doctor will need to drain the pus using a needle, under guidance through images on a CT scan.
  • Perforation. Diverticulitis can cause a hole in the colon that allows bowel contents to spill into the abdominal cavity. If you have a perforation, your abdomen may feel tender to touch, hard, or enlarged. Surgery repairs the hole. Sometimes part of the colon around the hole must be removed.
  • Fistula. A fistula is an abnormal connection between the inflamed and infected segment of the colon and adjacent organs, such as other parts of the intestine or the bladder. Surgery consists of colon resection and removing the fistula.

Can diverticulitis be prevented?

Eating a high-fiber diet and managing stress may lower the risk of developing pouches in the colon known as diverticula. So it makes sense that these lifestyle interventions might help make diverticulitis less likely to occur. However, once you have diverticulosis, there is no proven way to prevent one of the diverticula from becoming infected or inflamed.