Colorectal Cancer

Intestinal Cancer

Intestinal cancer refers to a malignant colorectal tumour that most often originates from an adenomatous polyp of the mucous membrane. The most common symptom is bloody stool or anaemia as well as changed bowel movement. Intestinal cancer is also screened with the help of a stool blood test in many municipalities in people aged over 60.

Intestinal cancer is the third most common type of cancer among Finns and is slightly more common among men than women. Over 2,000 Finns are diagnosed with intestinal cancer, which means hundreds of patients in the Tays district. Approximately 80% of the patients are over 60.

The prognosis is largely dependent on the spread of the disease at the time of diagnosis. The prognosis of a local disease, i.e. restricted to the intestinal wall, is fairly good, and the five-year survival rate is 80–90%.

Disease diagnosis and spread examination

Intestinal cancer is diagnosed with the help of colonoscopy and biopsies taken in the same connection. These examinations can also be performed in primary health care.

When intestinal cancer has been diagnosed in colonoscopy, the patient is referred to special health care. Cases of intestinal cancer are always urgently treated. The spread of cancer is determined in special health care in order to plan the best possible treatment for each patient.

The spread examination involves a full-body CT scan, in order to eliminate the possibility of metastases, and an ultrasound examination or pelvic MRI to determine the possible penetration of the intestinal wall in the case of tumours discovered in the rectal area.

Treatment negotiation at Tays

We invite the patient to the gastroenterology outpatient clinic for a treatment negotiation to discuss the treatment of the disease. The treatment must take into consideration the disease’s spread, nature, other diagnosed diseases and the overall ability to withstand treatment.

If the referring unit has already established that the disease has sent metastases, we refer the patient to a treatment negotiation at the cancer outpatient clinic.

The multi-professional treatment negotiation of intestinal cancer patients is held once a week. Surgeons, oncologists, pathologists and radiologists discuss the status of each patient’s disease before and after surgery as well as in other regards when necessary to ensure the best possible treatment practices for each patient.

Radiation and cytostatic therapy

Radiation therapy is often arranged for rectal cancer patients before their surgery. Radiation therapy is individually planned and precisely targeted at the tumour according to the examinations of spread.

Radiation therapy is provided either briefly as a course of five days, often followed by the surgery the following week, or not until after 8–12 weeks. Another method is to provide radiation therapy together with a radiosensitizer as a course of five weeks and the surgery follows approximately 8–12 weeks after the end of radiation therapy.

Cytostatic therapy is usually not provided until the information on the spread gained during surgery is available. If intestinal cancer has already spread to the liver at the diagnosis phase and there are no problems with the intestinal passage, the treatment often begins with cytostatics in order to destroy the liver metastases and at least to restrict the primary tumour.

Surgical treatment of intestinal cancer

Surgical treatment aims at the removal of the tumour. This usually means the removal of a section of the colon, but in some cases it is necessary to remove larger intestinal sections. Such situations include situations where there are several tumours or the tumour is suspected to be hereditary.

When the cancerous tumour is located at the end of the rectum, a stoma solution may be unavoidable. Most often, however, the defecation passage can be preserved, even if a temporary or protective stoma is needed due to the treatments.

Over half of the intestinal cancer surgeries can be performed laparoscopically, which means that the surgery incisions are fairly small and painless. The surgery lasts 2–4 hours.

For some patients, surgical treatment is just to relieve symptoms, i.e. palliative, and some patients also undergo the removal of metastases, for example from the liver, when allowed by the overall situation.

Before the day of surgery, the patient is scheduled a pre-visit at the gastroenterology outpatient clinic, where he/she meets with the surgeon and nurse as well as a stoma nurse and anaesthetist as necessary. Usually the patient does not arrive at the surgical ward until the morning of the surgery.

Post-operative ward treatment

After surgery, we treat the patient at gastroenterology ward. The recovery time varies from a few days to approximately one week.

If a stoma has been placed during the surgery, the stoma nurse instructs the patient and his/her close relatives individually to ensure that the stoma care also continues as required at home. The patient also receives help from a social worker and a physiotherapist when necessary.

Discharging is possible when pain is under control with typical medication, bowel movement and urination are successful and the patient is able to take care of the possible stoma.

However, intestinal cancer surgeries may involve complications that extend the treatment time. When necessary, treatment is continued at the patient’s own health centre or district hospital.

Further treatment and monitoring

The first control visit at the gastroenterology outpatient clinic takes place approximately four weeks after discharging. By that time, the pathologist has examined the surgical sample and we have planned further treatments and monitoring in the multi-professional treatment negotiation. During the visit, we inform the patient of the plans and he/she may ask for clarification of unclear matters.

Monitoring lasts approximately five years. Some of the follow-up visits take place in primary health care and some at the cancer outpatient clinic of Tays.

Division of work between the hospitals

Cancer of the colon area may be operated on at Hatanpää Hospital. Rectal cancer is operated on at Tays Central Hospital. Radiation and cytostatic therapy is provided at the cancer clinic of Tays. Patients from Tampere undergo further treatment and monitoring at Hatanpää Hospital

Persons in charge

Chief Physician of the Unit Marja Hyöty
Specialists in gastroenterological surgery:  Eija Haukijärvi, Ilona Helavirta, Sannamari Kotaluoto, Kirsi Lehto, Päivi Pappinen, Timo Tomminen, Mika Ukkonen
Specialists in oncology: Tapio Salminen; Nina Paunu, Maarit Bärlund