Colorectal cancer

Overview

Colorectal cancer is a type of cancer that starts in the large intestine. It is also called colon cancer or rectal cancer.

Colorectal cancer is the third most common cancer and the second most common cause of cancer deaths in Canada. If detected early, over 90% of cases are curable.

Colorectal cancer typically develops from polyps. Polyps are clusters of non-cancerous cells that can become cancerous over time. It usually takes 10 years for cancer to develop in a polyp.

Diagnosis & testing

We recommend adults aged 50 to 75 get regular colorectal cancer screening. If you are under 50 and have symptoms of colorectal cancer, you should also get screened. Colorectal cancer rates are rising among younger people.

Symptoms can include:

Changes in bowel habits, such as constipation or diarrhea
Bright red blood on toilet paper after wiping or in your stool
Narrow stool
Fatigue or anemia
Sudden or unexplained weight loss

Do not hesitate to discuss your symptoms with your health care provider at Providence Health Care. Many people feel uncomfortable discussing their symptoms. Early detection is crucial for effective treatment and better outcomes.

Your health care provider will perform general physical and digital rectal exams. They will use a gloved finger to feel inside your rectum. They will be respectful of your boundaries and sensitivities throughout this exam.

Screening tests

The BC Cancer Agency provides a BC Colon Screening Program.

Your doctor will refer you to have your initial screening and follow-up screenings through the BC Colon Screening Program.

You will get a reminder from the program when you need a follow up screening. If you need a colonoscopy, the program also has patient navigator services to help you with the process.

Stool tests check for microscopic blood in your stool. Blood tests look for carcinoembryonic antigen (or CEA) levels. CEA is a protein produced in large amounts by some types of tumours.

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A colonoscopy is used to look inside your colon or rectum for polyps, growths and tumours. During a colonoscopy, a tube is inserted through the anus into the colon. This thin, flexible tube has a light and a tiny camera. Colonoscopies are accurate and have a miss rate of less than three per cent.
- If we find a polyp, we will remove it during the colonoscopy.
- If we find a growth, we will take a biopsy (a sample of body tissue) to examine.
- If a tumour is blocking your colon, we will remove the tumour and repeat the colonoscopy.
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Tests to see the tumour and if the cancer has spread.

- Stage I and II: the cancer is only in the colon and rectum.
- Stage III: the cancer has spread to your lymph nodes but not your other organs.
- Stage IV: the cancer has spread to your other organs, such as your liver and lungs.
Knowing the stage of your cancer will help us decide the best treatment for you.

Treatment & management

If you are diagnosed with colorectal cancer, surgery may be part of your treatment plan.

Most people with colorectal cancer get surgery before radiation or chemotherapy. People with some rectal cancers may get radiation or chemotherapy before their surgery.

Clinics that treat colorectal cancer

Surgery

We perform colorectal surgery at St. Paul’s Hospital.

St. Paul’s Hospital (SPH) is a centre of excellence in colorectal surgery. It is the only centre in British Columbia that performs certain colorectal procedures. SPH surgeons work with the BC Cancer Agency to provide state-of-the-art care.

Colorectal surgery takes about two to six hours. Your surgeon takes out the part of the colon or rectum that has cancer. Then, if possible, your surgeon will reconnect the healthy ends of your gastrointestinal tract. We usually reconstruct the colon so people can have normal bowel movements after surgery.

In some cases, your surgeon may have to create a stoma. A stoma is an opening in your abdomen where stools leave your body and are collected in a bag. Stomas can be temporary or permanent. Your surgeon will only create a stoma if necessary.
After your surgery, you will usually stay at SPH for two to five days. Some patients will stay longer if it is taking longer for their bowel to work normally or if they experience a complication. This happens for less than 10% of patients.

If you have a stoma, your health care team will teach you how to use it while you are in the hospital. A home care nurse will also visit you after you leave the hospital.

If we remove your lower rectum and you do not have a stoma, you will not be able to store stool inside your body like before. You will need to learn how to manage your new bowel movement patterns, which will become much more frequent.

A pathologist will also examine your tumour and any lymph nodes under a microscope. A pathologist is a doctor that studies body tissues. Based on what they see, they will determine the stage of your cancer.

Colorectal surgery is a big surgery. It is helpful to have friends and family to care for you afterward.

If we remove your cancer and do not find signs that it may return, we will continue to follow you for at least five years.

Your health care provider at Providence Health Care will do this with
- Physical examinations
- Blood tests
- X-rays
- Colonoscopies

Radiation and chemotherapy before your surgery might shrink the size of the tumour. This makes it easier for us to rejoin the healthy parts of your colon so that you do not need a permanent stoma.
You may also get radiation and chemotherapy after your surgery. This happens if we find signs that your cancer might return — such as cancer cells in your lymph nodes. We usually start chemotherapy within eight weeks after surgery. A course of chemotherapy usually takes six months.
If we cannot do surgery on your tumour, we may suggest radiation and chemotherapy. This is to try and shrink your tumour so we can remove it with surgery.

Hospice palliative care

If your cancer cannot be cured, we will work to give you the highest quality end-of-life care.

You are at the centre of this process. We will ask you for your care goals. These could be extending life, relieving pain, preventing bowel obstruction, treating anemia, or providing comfort. We will involve the appropriate physicians, which may include palliative care doctors.

At every step, we will strive to give you the best care in a sensitive and supportive manner.

Hospice palliative care

Support services

Providence offers a variety of services to support those we care for. The following services may be of use or benefit to you and your families.

To help with communicating with your health care team, we offer interpretation services 24-hours-a-day. Please ask your care team to place a request if you need an interpreter including a sign language interpreter.

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Our psychology services can provide emotional support to our patients living with ACHD who may need help coping with their condition and its treatment.

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Our social work team helps patients and their families by providing emotional support and connecting them to helpful resources and services. This team can also assist in planning for the future, advocate for patients' needs, and help with practical concerns like finances and social support.

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We offer pastoral care services to support you and your loved ones. Our professional staff, including chaplains from different faiths, are here to accompany you, provide counselling, and create spaces for reflection, prayer, and meditation.

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We strive to offer you the best and most compassionate care possible. If we succeed, please let us know. If we fall short of our goal “How you want to be treated,” please also let us know.

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Support for Indigenous Peoples

The Indigenous Wellness Liaison Team is here to support your health journey. Team members offer cultural support and healthcare advocacy. Learn more below or call them at 604-682-2344,62937 or email IWL@providencehealth.bc.ca.

Indigenous wellness services

The Indigenous Wellness Team at Providence is available to support Indigenous patients and their families. We are here to coordinate culturally safe wellness supports and services.

Education & resources

Before your Colonoscopy (multiple languages)

Clinical trials & research

Advances in treatments for colorectal cancer are all thanks to medical research. While participating in research is a decision you should make in consultation with your care team, there is much activity in this field, so please ask us about our research programs if you’re interested.

By taking part in research, you can help us all learn more about heart disease and find better ways to help people like you live and thrive. While you cannot assume benefit to yourself, your participation can improve care for future patients.

The following clinical trials are currently enrolling volunteers. Please ask your care team for more information or contact the research team listed on each study or trial. For other information about research at Providence Health Care, please visit Providence Research.

Overview

Colorectal cancer is a type of cancer that starts in the large intestine. It is also called colon cancer or rectal cancer.