Q: My mother, who is 85 years old, has recently had surgery for colon cancer. It was a ring type and they were able to get it all so she did not need a colostomy. They are not giving her any radiation or chemotherapy. Does this mean that she will be OK without those treatments, or are they merely giving up on her because of her age? It was a small tumour. She has a weak heart, but did not seem to have any problems with the anaesthetic and the surgery.
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A: Colorectal cancer is often staged according to the Dukes system, which categorizes cancers by letters A to D.
- Dukes A means the cancer is only affecting the innermost lining of the colon or rectum.
- Dukes B means the cancer has grown into the muscle layer of the colon or rectum.
- Dukes C means the cancer has spread to at least one lymph node in the area.
- Dukes D means the cancer has spread somewhere else in the body such as the liver or lung.
There are other systems used to classify bowel cancer. Doctors increasingly use the TNM system because it is understood worldwide. It gives a detailed description of the size of the tumour and whether it has spread to nearby lymph nodes or another part of your body. This is a numbering system which is approximately equivalent to the lettering system shown above. Stage 1 is equivalent to Dukes A and so on.
There are many types of cancer. One type is called an adenocarcinoma. These develop in tiny glands in the lining tissues of organs.
Signet ring cell cancer is a type of adenocarcinoma that develops in the glands in the lining of the intestines and stomach. It gets its name from the appearance of the cancer cells, which resemble a signet ring when looked at under a microscope. Only about one in 100 cases of colon or rectal cancer are of this type, so it is quite rare.
When they develop in the stomach, signet ring cell cancers are often found at an earlier stage than other adenocarcinomas and so may be more curable. Signet ring cell cancers of the colon and rectum tend to be more aggressive than other types of adenocarcinoma and are more difficult to cure. Surgery is the first line of treatment.
If the cancer is only a Duke A or at Stage 1 and has not spread beyond the lining of the bowel, then surgery may be all that is required. It is a good sign that the surgeons risked your mother’s heart problems to remove the tumour so they must have felt it was worthwhile.
Radiation is problematic for bowel tumours because it can cause permanent damage and scarring to otherwise healthy parts of the intestines. Chemotherapy may still be offered since the doctors require the bowel to heal before they start treatment.
Doctors do not give up on people, even if the patient requests that they do nothing. Many people are living healthy, happy lives well into their 90s these days.
It is important for all people over the age of 50 to have regular colo-rectal tests. Microscopic amounts of blood in the feces may be the first sign of cancer of the intestinal system, before there is any discomfort or obvious blood in the stool.
Clare Rowson is a retired medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
