What should you ask your doctor about colorectal cancer? - American Cancer Society

Before meeting the sr. onco surgeon the gastroentreologist had suggested us to make a list of questions. We had made our list. We followed the same procedure with the oncologist. I always keep a note pad and pen handy, so that whatever questions/quires I have I write it down and ask the concerned doctor.When you are asking for 2nd opinion and the doctor's experience treating cancer please be a little sensitive. 

Given below is a list of questions that you can ask your doctor. The list is taken from the American Cancer Society and I think its pretty comprehensive.

It is important to have frank, open discussions with your cancer care team. They want to answer all of your questions, so that you can make informed treatment and life decisions. For instance, consider these questions:

• Where is my cancer located?

• Has my cancer spread beyond where it started?

• What is the stage (extent) of my cancer and what does that mean?

• Will I need other tests before we can decide on treatment?

• How much experience do you have treating this type of cancer?

• Should I get a second opinion?

• What are my treatment choices?

• What do you recommend and why?

• What risks or side effects are there to the treatments you suggest? Are there things I can do to reduce these side effects?

• What should I do to be ready for treatment?

• How long will treatment last? What will it be like? Where will it be done?

• How will treatment affect my daily activities?

• What are the chances my cancer will recur (come back) with these treatment plans?

• What will we do if the treatment doesn't work or if the cancer recurs?

• What type of follow-up might I need after treatment?

Source: American Cancer Society

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

• Write down key personal information, including any major stresses or recent life changes.

• Make a list of all medications, vitamins or supplements that you're taking.

• Consider taking a family member or friend along. Sometimes it can be difficult to take in all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.

• Write down questions to ask your doctor.

Source: Mayo Clinic

Staging & Grading of Cancer - Cancer Research UK

When I first met the sr. onco surgeon he described my colorectal cancer as 'malignant', "2nd or 3rd stage', 'definitely not stage one'. I remember I had started to cry because these words sacred me. Had I been equipped with some basic knowledge, I would happen been more in control of the situation and not killed myself with worry.

Thus I am sharing from vital technical information that every cancer patient and care giver and family members need to understand. I have not written this article. The source of the article is Cancer Research UK

What Staging is

The stage of cancer means how big it is and whether it has spread. This is important because treatment is often based on the stage of cancer.

The tests and scans you have when diagnosing you cancer gives information about the clinical stage. During surgery the doctor finds out more about the stage. The tissue the surgeon removes, including lymph nodes, is carefully examined in the laboratory. These results are combined with the clinical stage to give a pathological stage. This is more accurate than the clinical stage. The pathological stage maybe different from the clinical stage. For example, the surgeon may find the cancer is more advanced than it looked in the scans. On staging your report, you may see a lower case letter (c or p) written before the stage. This shows that it is the clinical or pathological stage.

Many doctors in the UK stage bowel cancers using the 5th version of the TNM staging system, or the number staging system. These staging systems are used across the world. Some doctors use the Dukes' staging system - which I will describe later.


TNM Staging of Bowel Cancer

TNM stands for Tumour, Nodes, Metastases. This staging system describes the size of a primary tumour (T), whether any lymph nodes contain cancer cells (N), and whether the cancer has spread to another part of the body (M).


There are 4 stages of tumour size in bowel cancer

1. T1 means the tumour is only in the inner layer of the bowel
2. T2 means tumour has grown into the muscle layer of the bowel wall
3. T3 means tumour has grown into the outer lining of the bowel wall
4. T4 means the tumour has grown through the outer lining of the bowel wall. It may have grown into another part of the bowel, or other nearby organs or structures. Or it may have broken through thr membrane covering the outside of the bowel ( the peritoneum)

There are 3 possible stages whether cancer cells are in the lymph nodes

1. N0 means there are no lymph nodes containing cancer cells
2. N1 means that 1to 3 lymph nodes close to bowel contain cancer cells
3. N2 means there are cancer cells in 4 or more nearby lymph nodes


There are 2 stages of cancer spread (metastasis)

1. M0 means cancer has not spread to other organs
2. M1 means the cancer has spread to other parts of the body

Your doctor puts T,N and M results together to you your stage. For example, you see a bowel cancer described as T2, N0, M0. This means

• The tumour has grown into the muscle layer of the bowel wall
• There is no evidence of cancer cells in the lymph nodes
• No evidence of spread to other parts of the body

Number Stages of Bowel Cancer

The number system uses TNM stages to group bowel cancers. There are 5 main stages in this system. 

Stage 0 or Carcinoma in Situ (CIS)

If you are told to have CIS or stage0 colorectal cancer, there are cancer cells in your inner bowel lining. But the cancer cells are cintained within this lining. So there is very little risk of any cancer cells having to spread.

Stage 1 Bowel Cancer

The cancer has grown through the inner lining of the bowel, or into the muscle wall, but no further. There is no cancer in the lymph nodes (in TNM staging, this is the same as T1, N0, M0)

 Stage 2 Bowel Cancer
This stage is divided into 2a and 2b

1. Stage 2a means the cancer cells has grown into the outer covering of the bowel wall but there are no cancer cells in the lymph nodes (T3, N0, M0)

2. Stage 2b means that the cancer has grown through the outer covering of the bowel wall and into tissues or organs next to the bowel. There are no cancer cells in the lymph nodes, and the cancer has not spread to another area of the body (T4, N0, M0)

Stage 3 Bowel Cancer
This stage is divided into 3 stages

1. Stage 3a means the cancer is still in the inner layer of the bowel wall or has grown into the muscle layer of the bowel wall or has grown into the muscle layer. Between 1 and 3 nearby lymph nodes contain cancer cells (T1, N1, M0 or T2, N1, MO)

2. Stage 3b means the cancer has grown into the outer lining of the bowel wall or into surrounding body tissues or organs. Between 1 and 3 nearby lymph nodes contain cancer cells (T3, N1, M0 or T4, N1, M0)

3. Stage 3c means that the cancer can be any size and has spread to 4 or more nearby lymph nodes. The cancer has not spread to any other part of the body (ant T, N2, M0)


Stage 4 Bowel Cancer

The cancer has spread to other parts of the body (such as the liver and lungs) through the lymphatic system or blood stream (any T, any N, M1)

Grading of Bowel Cancer

As well as the stage of bowel cancer, doctors also consider what the cancer cells look like under microscope ( the grade) when decoding or treatment. The grade tells you how normal or abnormal the cancer cells are. As normal cell grows and matures, it becomes more specialised for its role and plave in the body. This is called differentiation. A pathologist grades bowel cancer as

1. Grade1 (low grade) - the cancer cells are well differentiated, which means they look similar to normal cells.

2. Grade 2 (moderate grade) - the cancer cells are moderately differentiated, which means the cells look more abnormal.

3. Grade 3 (high grade)- The cancer cells are poorly differentiated, which means they look very abnormal.

The grade gives doctors an idea of how the cancer is likely to behave. A low grade cancer is likely to be slower growing and less likely to spread than high grade cancers.

Source: Cancer Research UK

About colorectal cancer- ULCA Jonsson Comprehensive Cancer Care

Best way to deal with colorectal cancer! ;)

I was detected with Colon Cancer on May 5, 2015. What took be by surprise were the symptoms. I thought I was having a normal diarrhoea and fatigue because of my busy work schedule. Never thought that these so called harmless symptoms can belong to colorectal cancer! It really came as a shock to me when I read about the symptoms of various cancers. Most of them are ordinary symptoms like (weakness, weight loss, fever, fatigue etc.), which can be handled with our basic knowledge of medicines or by going to the local general physician. But these days everything seems upside down, the ordinary has become extra-ordinary specially in case of cancer. 

So today's blog post is about colorectal cancer - description, symptoms, prevention, & tests to screen the disorder. The source of this article is ULCA Jonsson Comprehensive Cancer Care 

About Colorectal Cancer:

Colorectal cancer is a disease in which normal cells in the lining of colon or rectum begin to change, start to grow uncontrollably and no longer die. These changes usually take years to develop; however in some cases of heredity disease, changes can occur within months to years. Both genetic and environmental factors can cause the changes.

Initially the cell growth appears as benign (non cancerous) polyp that can, over time, become a cancerous tumor. If not treated or removed, a poly can become a potentially life-threatening cancer. Recognizing and removing precancerous polyps before they become cancer can prevent colorectal cancer.

Colorectal Cancer - 10 Symptoms:

1.   Constant tiredness or fatigue

2.   Feeling very tired all the time        

3.     Having nausea and vomiting

4.     Losing weight no known reason

5.     Unexplained iron-deficiency anaemia (low number of red blood cells)

6.     A change in bowel habits

7.   Diarrhoea, constipation or feeling that the bowel does not empty completely

8.   Stools that look narrower or thinner than normal ( check internet images for these       because you may to know how they look)

9.   Bright red or very dark stool (check internet images for these because you may not know how they look)

10.   Discomfort in the abdomen, including frequent gas pains, bloating, fullness and cramps

 However, it is important to note that these may also be symptoms of less severe, more conditions.

Colorectal Cancer: Prevention

When colorectal cancer is detected early, it can often be cured. The death rate from this type of cancer has been declining for the past 20 years, possibly because more cases are being detected early amd treatments have improved.

 People in their 50s and older should be screened, and certain people should begin colorectal screening earlier and/or undergo screening more often if they have the following:

1.   A personal history of colorectal cancer or adenomatous polyps

2.   A strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative younger than 60 or in two first-degree relatives of any age). A first degree relative is defined as parent, sibling or child.

3.    A personal history of chronic inflammatory bowel disease

4.    A family history of heredity colorectal cancer symptoms 

5.   If immediate family is diagnosed before 50, other family member should be tested at least ten years earlier, ie, if an individual’s father is diagnosed at age  45, then the children should be screened starting at age 35.

Colorectal Cancer: Tests to screen the disorder

 1. Focal occult blood test (FOBT):  A test used to detect blood in the stool, which can indicate the presence of polyps or cancer. Polyps and cancers do not bleed continually, so the FOBT must be done on several stool samples each year and should be repeated annually. This test has low sensitivity for detecting colon cancer and should not be used alone in screening colon cancer.

2. Flexible sigmoidoscopy: A sidmoidoscope (light tube) is inserted into the rectum and lower colon to check for polyps, cancer and other abnormalities. During the procedure, a doctor cannot check the upper part of the colon (ascending and transverse colon) with the test. If polyps or cancer is detected using this test, a colonoscopy to view the entire colon is recommended.

3. Colonoscopy: This test allows the doctor to look inside the entore rectum and colon while a patient is sedated. A colonscope (light tube) is inserted into the rectum and the entire colon to look for polyps or cancer. During procedure, a doctor can remove polyps and other tissue for examination.

4. Double contrast barium enema (DCBE): For patients who cannot have a colonoscopy, an enema containing barium is given, which helps the outline of the colon and rectum stand out on X-rays.  A series of X-rays is then taken of th colon and rectum.  This test has not been shown to improve outcomes and therefore is not a preferred screening approach.

5. Other: Computed tomography (CT or CAT) colonography and fecal DNA tests are experimental screening methods. CT colonoscopy is offered in some institutions, but people should be aware that it is still considered to be under development and requires interpretation by a skilled radiologist in order to be used to its best advantage.

Beginning at the age 50, both men and women of average risk should follow one of these four testing schedules:

 1. Yearly fecal occult blood test (FOBT)

2. Flexible sigmoidscopy every five years

3. Yearly fecal occult blood test plus flexible sigmoidoscopy every five years

4. Colonoscopy every 10 years.

Source: UCLA Jonsson Comprehensive Cancer Care

 This very valuable information. If any of the points are applicable to you then please get a check up done immediately from a reputed hospital/nursing home/med centre. Please do not ignore because its not worth having a mega disease like cancer!

Cost of coloscopy : Rs 6,500
This is an indicative cost. Cost will vary from hospital to hospital. 

Blue is the color of colorectal cancer!

Blue is also associated with depth & stability.
It symbolises trust, confidence, wisdom
loyalty, intelligence, faith truth and heaven!

Blue is considered to the mind & body!
It slows the human metabolism
and shows a calming effect on the body.

Dealing with cancer patients

'Cancer' is one of the dreaded word in this planet. Its a ‘Stranger’s Disorder’- it happens to others and not to me and my family/friends. That was my perception - until a few months ago! :D

When I first heard the word cancer I was not really terrified, thanks to my doctors. The experts were cool about my cancer, and so I too did not bother much. I even thought that the day after surgery I’ll get to go home! Some optimism!!! 

Also, when you hail from the advertising industry you become a pro in crises management - you have to find a solution and move on. There is nothing called impossible in an ad agency. The teachings always come in handy. Also, as a person … am too high on life to be extra bothered with cancer. Till today I don’t believe that I had cancer. Nor do my mother. She keeps using the word 'tumour' instead of ‘cancer’! And if you insist on using the word cancer she uses her finger to show you how little the cancer was - just like a pinch of salt. :P We have our own little world where cancer does not exist. 

Why this topic? Recently a dear friend’s sister was detected with breast cancer. I could understand her dilemma as to how to handle the C word. Because cancer does not only affect the patient it also spreads its tentacles to the loved ones. Thus I thought of blogging about my experience as to how I and my family/friends handled the C word. 

So here’s some tip on how to handle a cancer patient & how to help a cancer patient to keep a positive attitude: 

• Initial fears for the family : ‘Cancer’ WILL sound deadly to you when you first hear it. It will make you cry because the first thing that hits you is the life span of your loved one who has been diagnosed with it. My husband called up his mom and cried on the phone when he first heard the word. But he never told me about it for a long time. Do not share your fears with the patient. Be brave in front of him/her. You are a big support to him/her. If you break down your patient with further go into depression. This is not good for the patient as it will hinder recovery. 

• Family needs to speak about their fears first to the doctor: Consult the doctor in private, away from the patient, and address your fears/apprehensions/queries. The doctor is the expert and he/she will answer all your questions. Each time a question is answered you get healed, become stronger and empowered with knowledge. 

• Changes in the family: When your loved one is diagnosed with cancer remember that your priorities and routine is going to change. Partying out, going for movies, visiting relatives will take a backseat and the patient and hospital is going to be your priority. Running errands for your patients like buying the grocery, walking the dog, cooking etc will now have to be divided amongst family members and friends. So be ready for this change. Maintain a healthy physical, metal and emotional balance & fitness so that you can deal with your patient. Your health is equally important as your patients.

• Fight cancer with knowledge: Read up on the internet about cancer and the type that your patient has been diagnosed with. In my case, sometimes when  fall I fall in the pit, specially at night, I ask my husband various questions. He has read up on colon cancer, cancer, chemotherapy, medicines etc - so he  fights my depressions with knowledge. The knowledge may not be as through as the doctor’s but it helps you for the time being till you meet the doctor.
• Sites to look up: Johon Hopkins, UCLA Jonsson Comprehensive Cancer Care, American Cancer Society, Harvard Medical, Cancer Research UK, Making Cancer History, MD Anderson Cancer Centre.

•  Watch videos on cancer survivors: I keep watching videos and updates on cancer survivors. They always motivate me to be stronger and keep fighting. If people from the worst stage of cancer can survive and lead a normal life then why cant I? Make your patient watch these videos. Make sure these videos are happy ones, some of them can drain your patient. So screen them first and decide which one is suitable for your patient to watch. Besides videos on cancer survivors I also watch a lot of motivational videos and stand up comedies.

• Let doctors reveal the word cancer to the patient: Its best that doctors reveal the news to your patient. Onco doctors are some of the best human beings - they are sensitive, practical and know how to handle emotional patients. My husband was told not to share the news with me. My gastroenterologist revealed the news to me part by part. Its was like a play with acts and scenes. So when the word cancer finally came to my ears it sounded less dreadful.

• Look for that positive handle: Though the gastroenterologist had revealed cancer to me. But the word really hit me, and hit me hard when I first met the onco surgeon. You don't meet an ONCO surgeon just like that! He/she is not your regular GP. ONCO - its a scary word! The surgeon was very practical - did not mince any words - he used words and phrases like 'malignant', '2nd stage or 3rd stage', 'definitely not stage 1'. I remember I had started crying. But he never let me cry too much. He looked straight into my eyes and said ‘I want you to concentrate on the fact that the cancer has not spread. The rest you leave it to me, I’ll take care of it. Its my guarantee to you.!’ He repeated the word ‘Cancer has not spread’ several times in the conversation. This positive handle helped me remain calm throughout my journey.  Brief your patient before hand to look for a positive handle. The doctors will always give a decisive positive handle to divert the patient’s mind in a positive way. In case he does not, which seldom happens, ASK for one.

Dr. Sanket Mehta,
sr.onco surgeon,
pioneer in HIPEC

• Let the doctors speak with the patient: All my doctors always speak to me directly mostly rather than my husband or mom. Its very important to develop a relationship with your doctors. It makes communication easier- you can easily communicate your fears and apprehensions and the doctors will get a better understanding of you as patient. My relatives never interfered when doctors speak to me directly. This attitude comes handy especially when you are undergoing a surgery. Surgery, I feel, is very personal. Inside the OT its you and your doctor. So the trust needs to be there. I always look directly into the eyes of the doctor when they are speaking … I get a lot of confidence and assurance specially when they are telling something like ‘there is nothing to fear’, ‘you are progressing very well’, ‘we are there for you’! I always recall these precious words and the look of confidence in the doctor’s eyes whenever I feel low. I remember consulting my oncologist and onco surgeon for some pain on my stitches and the operated area. I was really worried and a little petrified. The assurance I got for them made me relaxed and i knew it was just a temporary issue that will disappear once the chemo is over. So break the ice with your doctors - onco doctors are some of the most sensitive and understanding human beings. Always to discuss your deepest fears with them, they will guide you on the right path.

Dr.Ashish Bakshi,
Medical oncologist

• Listen to your doctors: I always listen to my doctors and follow their advice. I never deviate from their instructions. If I have any query I always ask the doctor for their advice. I don’t experiment. Cancer is not just another viral fever, its a serious disorder. It can make you disappear anytime if you deviate from the path even a bit. My friend's uncle refused chemo when his cancer was at a curable stage. He had read some articles on the net where it was claimed that chemo is not necessary these days. Within a year his cancer spread to every part of his body and no medical science could help him. He had to succumb to death. So, please do not experiment, listen to the expert and follow their advice to the tee.

Dr. Geeta Malkan Billa,
Hepatology, liver transplant,
gastroenterology

• Listen to the patient: Patients always want to talk and express their fear and anger on the loved ones. In such a time you must always listen. Remember that the anger is not directed towards you - since you are a trusted person thus the patient is expressing his anger and frustration on you. Please don’t fight back. Just listen. I remember having having a scrap with my husband after the surgery and he reacted by going home and not staying in the hospital with me that night. It surely did not feel good at all.

• Surround yourself with positive people: The moment i got admitted in the hospital I called up friends. I realised that I for this journey I needed my friends. They were always there for me. As a group we never cried or felt low. My friends made sure that I was normal- they would gossip, laugh and talk with me as if they have come to spend the day at my place, instead of the hospital.

• Have faith In Yourself: I always have faith in myself. if I can survive living in Mumbai all by myself for 6 years than why can’t I survive cancer? If i can survive and excel in corporate why can’t I survive cancer? I keep reminding myself of the tough times I faced in my career, relationship, road, etc and excelled. Its a fantastic feeling to remind yourself of the victories and achievements in your life. And I always believed that 'nothing can steal my life from me.' Period.

I always choose the front row!

• Have faith in God: If God gives you a problem he also gives you a solution. Look for that solution - leave no stone unturned. You will find the the solution. Speak to your God. I remember speaking with my Gods, after my first consultation with the ocno surgeon. I was angry that He put in such an unwanted situation. A situation I dod not deserve. I expressed my anger and told HIM to get me out this situation. My prayers were answered. Also, being a Reiki channel I did some self healing too. My reiki friends gave me distant Reiki which helped a lot. 

My fav! First I got angry on HIM.
Then I told HIM to heal me!
HE listened!

• Share your experience:  Some people find it strange that I am so open about my disorder and share my experience so frankly. I look at it this way … if I were stuck in a traffic jam I would immediately call up my friends to avoid that particular route. We all do this. So why not warn them about something as serious as cancer??? Create awareness, you owe it to your family, friends, society, Also, sharing is a cathartic experience. It helps me heal, keeps me busy, helps me fight cancer with knowledge and keeps me away from depressions. I also get to talk nto people who have had a similar journey - road accidents, fighting cancer in a foreign country all alone, over comming cancers etc. They inspire me to fight harder!

• Also, be a little mad. Its okay to have a melt down at times ... just laugh it out.