“Tests and procedures used for colon/rectal cancer diagnosis include:

• Using a scope to examine the inside of the colon. Colonoscopy uses a long, flexible and slender tube attached to a video camera and monitor to view the whole colon and rectum. A doctor may pass surgical tools through the tube to take tissue samples and remove polyps.
• Removing a sample of tissue for testing. A biopsy is a procedure to remove a sample of tissue for testing in a lab. For colon cancer, the tissue sample is often collected during a colonoscopy. Sometimes surgery is needed to get the tissue sample. In the lab, tests can show whether the cells are cancerous and how quickly they’re growing. Other tests can give more information about the cancer cells. Your health care team uses the results to understand your prognosis and create a treatment plan.
• Blood tests. Blood tests aren’t used to diagnose colon cancer. But blood tests can give clues about overall health, such as how well the kidneys and liver are working. A blood test might be used to look for a low level of red blood cells. This result might indicate that a colon cancer is causing bleeding.

Stage II colorectal cancer is divided into three subcategories: IIA, IIB and IIC.

The difference between the categories lies in the extent to which the cancer has spread.

• Stage IIA (T3, N0, M0): The cancer has grown into the outermost layers of the colon or rectum, but has not grown through them. It has not reached nearby organs or lymph nodes, and has not spread to distant organs.
• Stage IIB (T4a, N0, M0): The cancer has grown through all of the layers of the colon or rectum, but has not grown into other organs or tissues.
• Stage IIC (T4b, N0, M0): The cancer has grown through all of the layers of the colon or rectum, and has grown into nearby organs or tissues. The cancer has not spread to the lymph nodes Surgery
• Initial treatment for stage II colon cancer is surgery to remove the section of colon that contains the tumor and surrounding tissue with its blood vessels and lymph nodes.
• The most commonly recommended protocols for patients diagnosed with stage II colon cancer:

Colectomy

A colectomy (or colon resection) is abdominal surgery that removes the section of colon where the tumor is located, tissue containing blood and lymph vessels surrounding the colon (mesentery), healthy tissue margins on either side and, if possible, at least 12 lymph nodes.  Then the remaining ends of colon are reconnected with sutures or staples.  This connection is called an anastomosis.

There are two types of surgery:

• Open colectomy:  An incision is made in the abdomen, surgery performed through the opening, and the incision closed with sutures and/or staples.
• Laparoscopic colectomy:  Three small keyhole incisions are made in the abdomen to insert a lighted instrument and specially designed surgical instruments that can be manipulated within the abdomen.  Sometimes an incision is made just long enough for the surgeon’s hand to assist during laparoscopy. This is also known as minimally invasive surgery.If your lymph nodes are cancer-free (also known as node-negative), your diagnosis is stage II colon cancer
• The tumor, tissue on either side of it (the margins), and fat and lymph nodes attached to the colon are removed for further study by a pathologist.  The pathologist evaluates the cancer cells in the tumor itself, looks for cancer in the margins and other tissue, and studies as many lymph nodes as possible in order to provide an accurate diagnosis.

Chemotherapy

Treatment of node-negative stage II colon cancer is controversial. While surgery to remove the tumor in the colon is universally accepted as initial treatment, the value of chemotherapy after that surgery to keep cancer from recurring (coming back) is hard for patients and doctors to judge.

It’s estimated that between four and five percent of patients with stage II colon cancer will benefit from chemotherapy. However, there are also side effects, some severe, associated with chemotherapy. Very few patients will die as a result of chemotherapy.

Because of the risks of treatment, researchers are looking for ways to identify patients who are at higher risk for recurrence, who are most likely to benefit from chemotherapy.

Some factors have been identified that lead to higher risk for stage II patients including:

• T4 tumors that extend beyond the outer wall of the colon into adjacent tissues and organs
• Too few lymph nodes removed and examined (less than 12)
• Cancer cells in blood and lymph vessels surrounding the tumor (not the same as lymph nodes)
• Undifferentiated or poorly differentiated tumors
• Perforation (a hole) of the colon by the tumor
• A tumor that obstructs (closes off) the colonFor high-risk stage II patients, the number needed to prevent one recurrence or death is smaller, probably 15 to 30 patients.
• It may help your decision to think about the problem in terms of numbers:  In order to prevent one recurrence or death from all cases of stage II colon cancer, 25 to 50 patients need to receive chemotherapy. One in six of those patients will have a severe side effect; one in 100 to 200 will die as a result of treatment.

Chemotherapy regimens for high-risk stage II colon cancer:

• FOLFOX:  combination treatment with infusional 5-FU (fluorouracil), leucovorin, and oxaliplatin
• FLOX: combination with bolus 5-FU, leucovorin, and oxaliplatin (severe diarrhea is more common with FLOX than FOLFOX but outcomes are similar)
• Xeloda (capecitabine): oral “prodrug” which is converted to 5-FU in the tumor
• 5-FU and leucovorinThere are some indicators of a patient’s risk of recurrence of their cancer, but no clear information that higher risk means they may benefit from therapy  — thus there are research efforts underway to better define “risk” and develop treatments that will benefit the higher risk patient in a predictable way.
• Stage III colorectal cancer treatments:In this article
• Your doctor can discuss the advantages and disadvantages of the different chemotherapy regimens if you decide to proceed with chemotherapy after your surgery.  Chemotherapy usually lasts about six months.

Stage III Colorectal Cancer Treatments

Stage III colorectal cancers have spread outside the colon to one or more lymph nodes (small structures that are found throughout the body that produce and store cells that fight infection). Tumors within the colon wall, which also involve the lymph nodes are classified as stage IIIA, while tumors that have grown through the colon wall and have spread to one to four lymph nodes are classified as stage IIIB cancers. Those tumors, which have spread to more than four lymph nodes are classified as stage IIIC colon cancers.

Treatment involves:

• Surgery to remove the tumor and all involved lymph nodes if possible.
• After surgery, the patient will receive chemotherapy with 5-FU, leucovorin and oxaliplatin, capecitabine with oxaliplatin or capecitabine alone.
• Radiation may be needed if the tumor is large and invading the tissue surrounding the colon.

The five-year survival rate for stage III colon cancer is about 64%. Patients with one to four positive lymph nodes have a higher survival rate than people with more than five positive lymph nodes.

 Stage IV Colorectal cancer treatments:

Stage IV colorectal cancers have spread outside the colon to other parts of the body, such as the liver or the lungs. Cancer that has spread is also called “metastatic.” The tumor can be any size and may or may not include affected lymph nodes (small structures that are found throughout the body that produce and store cells that fight infection).

Treatment may include:

• Removal of the cancer surgically or another surgical procedure to bypass the colon cancer and hook up healthy colon (an anastomosis).
• Surgery to remove parts of other organs such as the liver, lungs, and ovaries, where the cancer may have spread.
• Chemotherapy to relieve symptoms and improve survival.
• Erbitux, Avastin, or Vectibix in combination with standard chemotherapy, depending upon tumor characteristics.
• Zaltrap is a drug also approved for use with chemotherapy in cases where the cancer has progressed or is resistant to treatment.
• Stivarga is a targeted therapy approved in patients whose cancer has progressed after previous therapy.
• Clinical trials of new chemotherapy regimens, or immunological therapy.
• Radiation to relieve symptoms.

The five-year survival rate for stage IV colon cancer is nearly 8% or less.

“It’s important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. It’s also very important to ask questions if there’s anything you’re not sure about.

If time permits, it is often a good idea to seek a second opinion. A second opinion can give you more information and help you feel more confident about the treatment plan you choose.

Based on your treatment options, you might have different types of doctors on your treatment team. These doctors could include:

• A gastroenterologist: a doctor who treats disorders of the gastrointestinal (GI or digestive) tract
• A surgical oncologist (oncologic surgeon): a doctor who uses surgery to treat cancer
• A colorectal surgeon: a doctor who uses surgery to treat diseases of the colon and rectum
• A radiation oncologist: a doctor who treats cancer with radiation therapy.”

American Cancer Society (https://www.cancer.org/cancer/types/colon-rectal-cancer/treating.html)

Part II Treatment & Care

Many colon cancer treatment options are available for colorectal cancer, including surgery, chemotherapy, and radiation. Here’s what to expect from each type of treatment and tips for recovery.

Polyp Removal and Other Precancerous Conditions

Precancerous conditions of the colon or rectum are changes to cells that make them more likely to develop into cancer. These conditions are not yet cancer, but there is a higher chance these abnormal changes will become colorectal cancer.

The most common precancerous conditions of the colon or rectum area:

–adenomas

–hereditary colorectal syndromes

If you have a precancerous condition, you will likely have regular follow-up and screening tests to find cancer as early as possible if it develops. Some precancerous conditions can be treated with surgery to help reduce the risk that they will become cancer.

Colorectal Cancer Treatment

Stages of the cancer with TNM system for colorectal cancer helps determine the RX.

The most commonly used colorectal cancer staging system is known as the TNM system, which has been established by the American Joint Committee on Cancer. The TNM staging system looks at three key factors to determine the stage of cancer:

• Tumor (T) looks at how far the primary tumor has grown into the wall of the colon or rectum, and if it has expanded into nearby areas.
• Lymph node (N) examines the extent of the cancer spread to nearby lymph nodes.
• Metastasis (M) refers to whether cancer has spread to other parts of the body, such as the liver, lungs or brain.

A number (0-4 stages) or the letter X is assigned to each factor. Using this colorectal cancer staging system, a higher number indicates increasing severity. For instance, a T1 score indicates a smaller tumor than a T2 score. The letter X means the information could not be assessed.

Stages of colorectal cancer diagnosis occurs in conjunction with the following TNM categories:

• T1-T2: If the cancer has grown through the muscularis mucosa and into the submucosa, it is considered T1. Or, if the cancer has grown into the muscularis propria, then it is classified as T2.
• N0: The cancer has not spread to the lymph nodes.
• M0: There has been no spreading to organs or other nearby areas
• Stage I colorectal cancer treatments

Once the T, N and M scores have been assigned, an overall stage is determined, and thus treatment options can be explored.

Here’s a quick rundown of the options available for colorectal cancer treatment from surgery to cutting-edge biologic therapy.

Colorectal Cancer: Treatment by Stages

STAGE 0 (IN SITU) Colorectal Cancer Treatment

Surgery for colon cancer

• Polypectomy: snaring and removing polyps containing cancer during a colonoscopy.
• Local excision: removal of flat colon growths “piecemeal” during colonoscopy.
• Open abdominal surgery to remove cancer, part of colon, and nearby lymph nodes in high risk situations where:
  • There is a spread to polyp stalk
  • There is spread to lymphatic vessels (not lymph nodes)
  • Cells look very abnormal under the microscope (high grade)
  • Surgical margins (edge of tissue) contain cancer cells or can’t be evaluated or contain cancer cells.
  • Local excision would be too time-consuming or difficult to perform.

Chemotherapy

Chemotherapy is not recommended for stage 0 colon cancer.

Stage I Colorectal Cancer Treatment

Surgery

Colectomy (resection): Abdominal surgery to remove the section of colon where the tumor is located, tissue containing blood and lymph vessels surrounding the colon (mesentery), healthy tissue margins on either side, and at least 12 lymph nodes, if possible. Then the remaining ends of colon are reconnected with sutures or staples. This connection is called an anastomosis.

Open colectomy: An incision is made in the abdomen, surgery performed through the opening, and the incision closed with sutures and/or staples.

Laparoscopic colectomy: Three small keyhole incisions are made to insert a lighted instrument and specially designed surgical instruments that can be manipulated within the abdomen. Sometimes an incision is made just long enough for the surgeon’s hand to assist during laparoscopy.

Chemotherapy

Chemotherapy is not recommended for stage I colon cancer.

Part III on continuation of treatments of other stages of this condition (Stage II & III)

“In the United States in 2020—

This is held in March each year, offers healthcare providers who care for patients with diseases of the colon and rectum a valuable opportunity to educate their community about these diseases and promote awareness of the importance of colorectal cancer screening, prevention, and treatment. These efforts may also provide a window into the profession and encourage others to consider careers in the field of colon and rectal surgery.

Not counting some kinds of skin cancer, colorectal cancer is the fourth most common cancer in men and women. It is the fourth leading cause of cancer-related deaths in the United States.

Colorectal cancer is now the fourth most common cancer in men and women.  It is the fourth leading cause of cancer related deaths in the United States stated the Center for Disease Control (CDC) and Prevention. Colorectal cancer affects people in all racial and ethnic groups and is most often found in people age 50 and older.

CDC states today counting some kinds of skin cancer, colorectal cancer is the fourth most common cancer in men and women. It is the fourth leading cause of cancer-related deaths in the United States.

The good news? If everyone age 50 and older were screened regularly, 6 out of 10 deaths from colorectal cancer could be prevented. Communities, health professionals, and families can work together to encourage people to get screened.

How can Colorectal Cancer Awareness Month make a difference?

We can use this month to raise awareness about colorectal cancer and take action toward prevention. Communities, organizations, families, and individuals can get involved and spread the word.

Here are just a few ideas:

• Encourage families to get active together – exercise may help reduce the risk of colorectal cancer.
• Talk to family, friends, and people in your community about the importance of getting screened for colorectal cancer starting at age 50.
• Encourage people over 50 to use this interactive tool to decide which colorectal cancer screening test they prefer.
• Ask doctors and nurses to talk to patients age 50 and older about the importance of getting screened

Among cancers that affect both men and women, colorectal cancer is the second leading cause of cancer deaths in the United States. Every year, about 140,000 Americans get colorectal cancer, and more than 50,000 people die from it.

• Risk increases with age. More than 90% of colorectal cancers occur in people aged 50 and older.
• Precancerous polyps and colorectal cancer don’t always cause symptoms, especially at first. You could have polyps or colorectal cancer and not know it. That is why having a screening test is so important. If you have symptoms, they may include—
  • Blood in or on the stool (bowel movement).
  • Stomach pain, aches, or cramps that do not go away.
  • Losing weight and you don’t know why.

  These symptoms may be caused by something other than cancer. If you have any of them, see your doctor.

• There are several screening test options. Talk with your doctor about which is right for you.

“According to the National Institute of Neurological Disorders and Stroke (NINDS), traumatic brain injury is an acquired type of brain injury that takes place as a result of a sudden trauma that causes injury to the brain. For example, during skiing, if someone were to collide with a tree and hit their head at full-on impact that could certainly cause them to develop traumatic brain injury.

TBI is quite common and there are over 3.8 million TBIs in sports, in general, on a yearly basis within the United States alone. The NINDS has again reported that possibly half of the persons who are severely injured patients will need surgery to remove or repair ruptured blood vessels or bruised brain tissue. Sometimes, long-term effects, including disabilities may be a resulting issue.

Safety Precautions:

• Wear protective gear, such as a helmet.
• Be vigilant and avoid idling. This helps you to keep focused on what’s in your path ahead so you don’t collide with objects.
• Be mindful of the situation with the snow and ice. Is the ice super slippery or if there are hanging blankets of snow that may cause an avalanche?
• Ensure that wherever you take yourself or your family has a medical team on standby.”

Sioux Center Health – An Avera Partner

(https://www.siouxcenterhealth.org/latest-news-and-blog/national-winter-sports-traumatic-brain-injury-tbi-awareness-month/)

A Brain Injury is damage to the brain that results in a loss of function such as mobility or feeling.  Brain injury can also cause cognitive dysfunction.

Traumatic Brain Injuries can result from a closed head injury or a penetrating head injury.

There are two broad types of head injuries: Penetrating and non-penetrating.

1. Penetrating Injury: A penetrating injury occurs when an object pierces the skull and enters brain tissue. As the first line of defense, the skull is particularly vulnerable to injury. Skull fractures occur when the bone of the skull cracks or breaks. A depressed skull fracture occurs when pieces of the broken skull press into the tissue of the brain. A penetrating skull fracture occurs when something pierces the skull, such as a bullet, leaving a distinct and localized injury to brain tissue. Skull fractures can cause cerebral contusion. Brain trauma occurs when a person has an injury to the brain, and can be mild or severe. When a person sustains trauma or injury to the brain, he or she may lose motor functions along with cognitive and physical abilities. Physicians use the Glasgow Coma Scale to determine the extent of brain trauma. This is a neurological scale that measures the level of a person’s consciousness.  A mild injury may cause temporary symptoms, like a concussion; while a severe injury could require years of rehabilitation, like a stoke or tumor.
2. Closed Injury:  A closed injury occurs when the head suddenly and violently hits an object but the object does not break through the skull. It is caused by an external force strong enough to move the brain within the skull. Causes include falls, motor vehicle crashes, sports injuries, blast injury, or being struck by an object.

There are two most common types of brain trauma, which are:

1. traumatic brain injuries  2. acquired brain injuries.

1-Traumatic brain injury

This occurs from external force on the head or neck. These injuries can occur from blows to the head or aggressive twisting of the neck. Some ways this could happen include falls, motor vehicle accidents, sports, and vigorous shaking. In infants, Shaken Baby Syndrome is a type of traumatic brain injury.

2-Acquired brain injury

This means simply you got this injury after you were born and it was caused by a condition or illness after birth. This type of injury can result from several different causes like strokes, toxic poisoning or brain tumors. Degenerative diseases and lack of oxygen may also cause this type of brain trauma. Here are some examples of acquired brain injuries:

-Bleeding in the brain which can lead to brain injury. Blood Vessels in the brain can rupture resulting in an intra-cerebral hemmorage (one of the causes of a stroke). Symptoms may include headaches, loss of vision, weakness to one side of the body and eye pain to even garbled speech.

-Anoxia is another insult to the brain that can cause injury to it. Anoxia is a condition in which there is an absence of oxygen supply to an organ’s tissues, even if there is adequate blood flow to the tissue.  Common causes of anoxia are near drowning, choking, suffocation, strangulation, heart attacks, lung damage, or very low blood pressure.

–Hypoxia refers to a decrease in oxygen supply rather than a complete absence of oxygen, and ischemia is inadequate blood supply, as is seen in cases in which the brain swells. In any of these cases, without adequate oxygen, a biochemical cascade called the ischemic cascade is unleashed, and the cells of the brain can die within several minutes. This type of injury is often seen in near-drowning victims, in heart attack patients, or in people who suffer significant blood loss from other injuries that decrease blood flow to the brain decreasing oxygen supply to the tissue.

-Toxemia, which is poisoning from chemical or biological factors that can damage the brain. Toxemia can be caused by drugs, chemicals of several types, gases or even toxic foods.

-Viruses or types of bacteria. An infection of the brain can be very damaging; here are some examples:

*Meningitis is a inflammation of the lining around the brain or spinal cord, usually due to infection; Neck stiffness, headache, fever, and confusion are common symptoms.

*Encephalitis (en-sef-uh-LIE-tis) is inflammation of the brain. Viral infections are the most common cause of the condition. Encephalitis can cause flu-like symptoms, such as a fever or severe headache. It can also cause confused thinking, seizures, or problems with senses or movement.

**HIV can lead to brain injury. HIV, can affect the brain in different ways. HIV-meningoencephalitis is infection of the brain and the lining of the brain by the HIV virus. It occurs shortly after the person is first infected with HIV and may cause headache, neck stiffness, drowsiness, confusion and/or seizures. HIV-encephalopathy (HIV-associated dementia) is the result of damage to the brain by longstanding HIV infection.  It is a form of dementia and occurs in advanced HIV infection. Mild Neurocognitive Disorder is problems with thinking and memory in HIV, however is not as severe as HIV-encephalopathy. Unlike HIV-encephalopathy it can occur early in HIV infection and is not a feature of Aquired Immune Deficiency Syndrome – AIDS.

*Lastly Herpes. There are two types of herpes simplex virus (HSV). Either type can cause encephalitis. HSV type 1 (HSV-1) is usually responsible for cold sores or fever blisters around your mouth, and HSV type 2 (HSV-2) commonly causes genital herpes. Encephalitis caused by HSV-1 is rare, but it has the potential to cause significant brain damage or death.

*Other herpes viruses. Other herpes viruses that may cause encephalitis include the Epstein-Barr virus, which commonly causes infectious mononucleosis, and the varicella-zoster virus, which commonly causes chickenpox and shingles.*Viral infections due to blood sucking insects like mosquitoes and ticks to animals with rabies a rapid progression to encephalitis once symptoms begin. Rabies is a rare cause of encephalitis in the U.S.

When a person is diagnosed with a brain trauma, doctors will decide if rehabilitation is needed. Rehabilitation programs may vary depending on the type of brain injury and estimated recovery time. Treatment usually consists of physical therapy and daily activities. In extreme cases, patients may need to learn how to read and write again.

Therapy for brain trauma typically takes place on an outpatient basis or through an assisted living facility. Therapy may last several weeks, months or even years, and sometimes the patient is not able to make a full recovery.

It may not always be obvious when a person has sustained a brain injury. The patient may have hit his or her head and not have symptoms until a few hours later. Some signs of a possible brain injury are headaches, confusion and loss of memory. If brain trauma is not treated, it could cause permanent damage or death.

Brain injuries can affect the patient and the patient’s family, with emotional and financial hardship. When problems arise with treatment or financial issues, a specialist or brain injury lawyer may need to intervene.