Â鶹ӳ»­

At age 26, Savannah Kaspar was a typical young adult: working, spending time with family and friends and planning trips. But after a colorectal cancer diagnosis, she faced a lot of unknowns.?

³§²¹±¹²¹²Ô²Ô²¹³ó¡¯²õ colorectal cancer symptoms

In February 2023, Savannah started having pain in her lower abdomen. She thought it might be due to an ovarian cyst, so she saw her gynecologist. A routine exam showed there wasn¡¯t any cause for concern, so her doctor had her keep a food diary to see if anything she ate made the pain worse. Her diet didn¡¯t seem to be causing the issues and the pain continued, so her doctor scheduled an ultrasound.

A few months later, Savannah developed more symptoms.

¡°I started having really bloody stools, so I went to the emergency room,¡± she says. ¡°My CT scan was normal, so they referred me to a gastroenterologist who did bloodwork and a stool sample. My stool sample came back positive, but the doctor thought it was due to hemorrhoids. My bloodwork showed a positive inflammatory bowel disease marker, which can be associated with Crohn¡¯s disease.¡±

Savannah was younger than the recommended age to get her first colonoscopy, but she had abdominal pain, bad constipation and bloody stools. She knew her symptoms were serious, so she pushed for a colonoscopy.

In August, a colonoscopy revealed a mass in ³§²¹±¹²¹²Ô²Ô²¹³ó¡¯²õ sigmoid colon. Doctors said it was noncancerous but told Savannah she needed surgery to have it removed.

¡°They said it could develop into cancer later,¡± says Savannah. ¡°They asked if I wanted to go to MD Anderson since I worked there.¡±

Savannah works as a program coordinator for Nephrology at MD Anderson, so she felt comfortable coming here for her surgery. She had her first appointment a couple of weeks later.

³§²¹±¹²¹²Ô²Ô²¹³ó¡¯²õ colorectal cancer diagnosis

At MD Anderson, Savannah had bloodwork and another CT scan. The CT scan showed that her lymph nodes were enlarged.

¡°They suspected I might have stage III colon cancer,¡± Savannah says. ¡°And the tumor could possibly be attached to my uterus.¡±

She had a flexible sigmoidoscopy, which examined the rectum and lower part of the colon. Doctors couldn¡¯t reach her tumor during the procedure, so she had a repeat colonoscopy four days later.

A biopsy confirmed Savannah had colon cancer, but the stage was unknown.

¡°I was shocked,¡± she says. ¡°I went from thinking I didn¡¯t have cancer to learning it could be stage III. I didn¡¯t know if it was genetic, if I needed a hysterectomy or if I¡¯d need an ileostomy. There were so many unknowns, and they hit me all at once.¡±

An MRI showed that the cancer hadn¡¯t spread to ³§²¹±¹²¹²Ô²Ô²¹³ó¡¯²õ uterus, so she could have surgery to remove the tumor. But first, Savannah met with oncofertility specialist , and decided to freeze her eggs. She knew this was important to do before beginning cancer treatment, so she¡¯d have more options for parenthood in the future.

¡°I went to New York City to have one last trip before I started my colorectal cancer treatment,¡± says Savannah. ¡°The trip was planned before my diagnosis. It was an awesome opportunity to clear my head and mentally prepare to begin treatment.¡±

³§²¹±¹²¹²Ô²Ô²¹³ó¡¯²õ colorectal cancer treatment

On Oct. 18, 2023, Savannah underwent a partial colectomy at MD Anderson to remove part of her colon, including the tumor and a small amount of tissue surrounding it. She had 30 lymph nodes tested, and they all came back clear. The cancer was declared stage II.

The pathology report revealed that Savannah had lymphovascular invasion and perineural invasion. This put her at a higher risk for recurrence. So, eight weeks after surgery, she completed four rounds of chemotherapy to make sure all the cancer was gone. She received infusions of oxaliplatin and took oral chemotherapy capecitabine under the care of gastrointestinal medical oncologist , at MD Anderson West Houston, close to her home. Savannah completed her last chemo treatment on Feb. 1.

MD Anderson helps Savannah manage chemotherapy side effects

Like many cancer patients, Savannah says the first round of chemotherapy was the toughest.

¡°That first night, my left hand locked up and became stiff, and my vision in one eye went black,¡± recalls Savannah. ¡°I would blink, and in a few seconds my vision would come back.¡±

Savannah called MD Anderson¡¯s help line and spoke with the on-call oncologist. Because her symptoms were on one side of her body, they had her come to MD Anderson¡¯s Acute Cancer Care Center to make sure she wasn¡¯t having a stroke. Savannah had a CT scan and MRI of her brain. They both came back clear.

³§²¹±¹²¹²Ô²Ô²¹³ó¡¯²õ hair thinned slightly during treatment, she had muscle cramps at times and she had bad nausea the first week.

¡°My care team added in an extra nausea medication for my second round of chemo and prescribed a muscle relaxer for my cramps. That helped a lot,¡± she says. ¡°Dr. Huey and his team had an answer to everything and were so quick to find a solution for my side effects.¡±

Finding support from family, friends and coworkers

Savannah says her mom, boyfriend and other family and close friends were her biggest supporters during treatment.

¡°I called my mom almost every day, even before the diagnosis,¡± she says. ¡°When I was stressed because I knew something was wrong but didn¡¯t know it was cancer, she was always my first phone call. And my boyfriend is my ray of sunshine and positivity. He¡¯s always able to lift my spirits and make me laugh.¡±

Savannah also had the support of her colleagues at work.

¡°I¡¯m thankful to my department managers for allowing me to take time off or work from home when needed,¡± she says. ¡°I¡¯m grateful for the doctors who helped answer my questions. My team collected donations for me and visited me in the hospital. It¡¯s awesome how supportive they were.¡±

Embracing a new outlook after colon cancer treatment

Savannah continues to have bloodwork done every three months. She will have a CT scan and a colonoscopy a year out from surgery. The results will determine how often she¡¯ll need follow-up testing.

Because she was diagnosed at such a young age, Savannah had genetic testing to make sure she didn¡¯t have Lynch syndrome. This would put her at a higher risk for other cancers. Her genetic testing came back negative.

¡°When I first reached out to a former colleague after my diagnosis, she said something that really stuck out to me,¡± recalls Savannah. ¡°She said, ¡®Your life is forever changed. Some days will be hard, but it gets better every day.¡¯¡±

When starting treatment, Savannah wondered if her life had changed forever.

¡°Looking back, I know it¡¯s true. I¡¯ll never be the same person, but it¡¯s changed me for the better,¡± she says. ¡°I¡¯m stronger. I don¡¯t stress about little things anymore. I don¡¯t take my health for granted. It¡¯s made me appreciate the positives in life, and it¡¯s made my faith stronger.¡±

Savannah and her boyfriend are planning a trip to Europe later this year to celebrate the end of her treatment.

She offers this advice for other young people facing a new cancer diagnosis:?¡°Just be open with your care team. They¡¯re always on your side and willing to help.¡±

or call 1-877-632-6789.

Anal cancer is a fairly rare type of cancer that develops in the anus and anal canal. About 8,000 people in the U.S. are diagnosed with anal cancer each year.

If detected early, anal cancer can be treated successfully. Unfortunately, there are a lot of myths regarding anal cancer. We spoke with gastrointestinal radiation oncologist , who debunked three of the most common myths she hears about anal cancer. ???

1. Myth: Anal cancer is the same as colorectal cancer.

Truth: Anal cancer is different from colorectal cancer. These diseases are defined by the location of the tumor and the type of cancer cell that makes up the tumor. In the case of anal cancer, the tumor is located in the anus and anal canal.

Some patients know they have anal cancer but still tell friends and family they are being treated for colorectal cancer. This is because many people feel uncomfortable talking about the anus.

¡°We need to do a better job of removing the discomfort and stigma associated with talking about the anus, so doctors can do a better job of explaining to patients exactly what kind of cancer they have,¡± says Holliday. ¡°This will also help patients feel empowered to share their experience with others if they choose to do so.¡±

2. Myth: Only promiscuous people or people who have receptive anal intercourse get anal cancer.

Truth: The human papillomavirus (HPV) is the biggest risk factor for anal cancer, and it is very common. Eight out of 10 people in the United States will be infected by this virus in their lifetime. It can be transmitted through any intimate skin-to-skin contact. Most people¡¯s immune system gets rid of the virus before it causes any problems. But for some people, the virus will set off changes in cells that could grow into cancer.

Having anal cancer, or another HPV-related cancer, does not mean you are actively infected with HPV. It also doesn¡¯t mean you caught the virus recently. It usually takes decades between HPV infection and the cell changes that turn into cancer. If you¡¯re eligible, you can get the HPV vaccine to help prevent anal cancer and five other types of cancer.

Having anal sex, especially as the receiving partner, has long been listed as a risk factor for anal cancer. However, it doesn¡¯t mean you have to have had anal sex to get anal cancer.

¡°I think this misconception makes patients reluctant to speak openly about their diagnosis,¡± says Holliday. ¡°The anus is just another body part! We should be able to talk about it as if it were the colon, prostate or elbow.¡±

3. Myth: Treatment for anal cancer means I¡¯ll need a colostomy bag.

Truth: The most common type of anal cancer is squamous cell carcinoma, which forms in the cells that line the anus. Anal squamous cell carcinoma is usually successfully treated with radiation therapy and chemotherapy. Most patients do not need surgery for this cancer and do not need a colostomy bag.

If you¡¯re an MD Anderson patient struggling to navigate your anal cancer diagnosis, you can connect with a social work counselor who can provide support and resources to help you cope with your feelings. ?

or by calling 1-877-632-6789.

Rectal cancer can impact many of the body¡¯s most basic functions. So, it¡¯s important to find a surgeon who understands the balance between treating your cancer and preserving the body's functions and quality of life.

To learn about the different types of rectal surgery and what to expect, we spoke with a colon and rectal cancer surgeon.

What types of surgery are used to treat rectal cancer?

There are three types of surgery used to treat rectal cancer.

• Transanal local excision: This procedure treats very early-stage rectal cancers. During this procedure, a surgeon removes a small area of the rectum wall that contains the early tumor through instruments that are passed through the anus.?
  
  
• Proctectomy: During this surgery, a surgeon removes all or part of the rectum that contains the tumor. Usually, the colon can be brought down and connected to the remaining rectum or directly to the anus in sphincter-preserving surgery. This allows the patient to retain bowel passage through the anus, although the stool frequency and patterns will likely be different. Often to protect the new connection, the surgeon will make a temporary diverting ileostomy bag, a plastic bag that collects waste from the digestive tract and needs to be emptied throughout the day. This is done to divert the stool away from the colon and give the new connection the best chance to heal. If the sphincter can¡¯t be preserved, the surgeon will create a permanent colostomy and insert a colostomy bag, a plastic bag that collects waste from the digestive tract and needs to be emptied throughout the day.
  
  
• Pelvic exenteration: This type of surgery is needed if rectal cancer has spread to the surrounding organs within the pelvis. During this highly specialized operation, surgeons will remove the rectum containing the tumor and any part of any adjacent organs that may be also directly involved by the tumor ¡ª including other bowel or intestine, reproductive organs, bladder, bone or other tissue ¡ª and then perform the reconstruction. Patients who have had a pelvic exenteration often need a colostomy bag.

What is recovery from rectal cancer surgery like? What can patients expect?

Your recovery depends on what type of surgery you undergo. Patients who have a proctectomy typically stay in the hospital for two to five days, or they may have to stay until they have a bowel movement. Patients are usually up and walking around about 24 hours after surgery. Typically, bowel function will return about two to three days following surgery. Pain is the strongest for the first 48 hours and then begins to subside. MD Anderson surgery teams rely on an enhanced recovery process that helps patients recover faster and limit their use of pain medication.

For patients who have undergone a pelvic exenteration, the recovery process is slower. Typically, these patients stay in the hospital for two to three weeks and spend the following months getting their strength back by working with a physical therapist.

Patients who have had a temporary ileostomy or permanent colostomy as a part of their proctectomy or pelvic exenteration may need to stay in the hospital longer as they adjust to using the ostomy bag.

What is life like after rectal cancer surgery? Do patients with an ileostomy or colostomy bag need to make dietary changes?

An ostomy bag may be temporary. Patients may only need it for two to six months, or it may be permanent. Your care team will work with you to show you how to empty the bag and make any other changes. Having an ostomy will require some adjustment and adaptation. However, most importantly, contrary to common belief, patients with ostomy bags can resume an active lifestyle and get back to activities they enjoyed before surgery.

Read how one young patient has learned to live with her ostomy bag.

What other methods are used to treat rectal cancer?

Many rectal cancer patients will need additional treatments, typically a combination of chemotherapy and radiation and typically before surgery. For rectal cancer, it¡¯s important to see a specialized care team with experience treating rectal cancer and who understand all aspects of your rectal cancer treatment. When you¡¯re choosing a care team, look for one that will coordinate your care and enable you to receive the best treatment possible.

Overall, the cancer stage determines the type of treatments a rectal cancer patient received. But an experienced team also takes into account the patient¡¯s tumor molecular characteristics and personal wishes to design a personalized treatment regimen. In addition, MD Anderson is conducting clinical trials to use liquid biopsies to more accurately determine what next steps to take. The biopsies show how cancer has impacted the bloodstream and helps guide the use of chemotherapy after surgery.

1 in 4 new cases of rectal cancer in the U.S. is diagnosed at or under age 50. What should young rectal cancer patients know?

Young rectal cancer patients face a unique set of challenges. They have so many years left ahead of them, but they¡¯re facing big changes as survivors. For these patients, it¡¯s particularly important to select a cancer center like MD Anderson where the doctors are not only experts in treating rectal cancer, but also understand what¡¯s critical to a young patient. At MD Anderson, one-third of all of our new colorectal cancer patients are younger than age 50. ?Programs like MD Anderson¡¯s Young-Onset Colorectal Cancer Program provide cancer care and connect patients to services they may need in addition to treatment, including genetic testing and counseling, fertility services, wound ostomy service, supportive care and connection to our Adolescent and Young Adult Oncology Program.

What should patients preparing for rectal cancer surgery know?

Look for a care team where the surgeons both perform a high number of rectal cancer surgeries and are also experts in treating rectal cancer and in understanding the best coordination of surgery with other treatments, such as chemotherapy and radiation.

Rectal cancer impacts an area that is key to many bodily functions, so it¡¯s essential to seek a care team that truly understands it and with whom you feel comfortable discussing your worries and concerns. ?

Often, we see patients who first underwent surgery at another hospital. In many cases, the patient¡¯s cancer has returned and they now need a pelvic exenteration. While MD Anderson surgeons are skilled at performing this complicated surgery, it would be easier on the patient if they sought care from leading experts first. It might be difficult to decide to have more of the rectum removed initially, but it¡¯s better in the long run. At MD Anderson, our doctors understand how to balance this.

or by calling 1-877-632-6789.

Surgery is a common part of colon cancer treatment. Just about every patient diagnosed with stage I-III colon cancer will have surgery at some point. The type of surgery you¡¯ll need depends on the stage of the cancer. ?

We spoke with colon and rectal cancer surgeon ., about what colon cancer patients should know about surgery.

What types of surgery are used to treat colon cancer?

Typically, we treat colon cancer with one of two types of surgery. These include:

• Polypectomy: This type of surgery is performed through a colonoscope, typically by a gastroenterologist with specialized training. It is used when the cancer is located entirely within the polyps. The entire polyp is removed by passing a wire loop and cutting it off from the colon's wall with an electric current.
  
  
• Large bowel resection/colectomy: A colectomy is another word for a large bowel resection. During this procedure, a surgeon removes part of the large intestine, which is another name for the colon. While a bowel resection can be done through open, traditional surgery, it is most commonly performed through minimally invasive surgery today. The surgeon makes a short incision, then inserts a few ports. The surgeon inserts a camera and uses either laparoscopic instruments or robotic surgical arms to remove the impacted part of the colon. This minimally invasive approach typically offers faster recovery for the patient.

What is recovery from colon cancer surgery like? What can patients expect?

Recovery from colon cancer surgery often isn¡¯t as difficult as patients anticipate, particularly if the surgery is minimally invasive. The pain is the worst for the first 48 hours, and after that, it generally subsides.

As part of our enhanced recovery system at MD Anderson, we use a long-lasting local anesthetic that helps limit the need for additional pain medication. Patients are usually up and walking around about 24 hours after surgery. Typically, their bowel functions will return about 2 to 3 days following surgery. Most patients stay in the hospital anywhere from 2 to 5 days.? An MD Anderson-spearheaded clinical trial showed that it was safe for select patients to stay in the hospital after surgery for as little as 24 hours in combination with a telemedicine-based recovery program out of the hospital.

Recovery from rectal cancer surgery can take longer.

What is life like after colon cancer surgery? Are there any long-term side effects?

Patients can return to their normal diet. They often don¡¯t experience any long-term side effects in terms of bowel patterns from a colectomy.

A common myth surrounding colon cancer is that patients will require an ostomy bag after surgery. But this is only true for patients who had a surgery called a colostomy. During a colostomy procedure, a surgeon will connect the healthy end of the colon to the skin which is surrounded by a plastic bag that collects waste from the digestive tract and needs to be emptied throughout the day. Most colon cancer patients do not need a colostomy; the procedure is more commonly used to treat rectal cancer.

What other methods are used to treat colon cancer?

Historically, the type of treatment a colon cancer patient received was determined by the stage of the cancer. Patients with stage II or III colon cancer usually underwent chemotherapy following surgery. But not all such colon cancer patients need chemotherapy.

MD Anderson has launched several clinical trials through our Intercept program. As a part of this program, following surgery patients undergo a liquid biopsy that shows if any of the cancer cells remain in the blood and helps their care team determine what type of additional treatment might be best for them. This is a unique additional tool that we offer at MD Anderson.

In addition, patients with stage IV colon cancer that has spread to other parts of the body may not have colon surgery. These patients often have chemotherapy or another targeted therapy.

What should patients know when preparing for colon cancer surgery?

Find a hospital that treats all the issues you may face. Across the nation, nearly 1 in 10 new colon cancer patients are diagnosed before age 50. At MD Anderson, about one-third of our new colorectal cancer patients are age 50 or younger.? These relatively young patients face a unique set of challenges that impact multiple dimensions of their lives. MD Anderson addresses these through our Young-Onset Colorectal Cancer Program, which connects patients with the services they may need in addition to cancer treatment, including genetic testing and counseling, fertility services, supportive services, and connection to our Adolescent and Young Adult Oncology Program.

In addition, while it¡¯s understandable that most colon cancer patients want their tumors removed as quickly as possible, it¡¯s worth taking the time to find the most experienced surgical team. Find someone who truly specializes in colon cancer, so they understand what unique challenges colon cancer patients face. It also helps to select a hospital like MD Anderson that specializes in multidisciplinary care and will coordinate with your medical oncologist, so you don¡¯t have to find a separate surgeon and oncologist. This will ensure you receive the best possible care and have the best chance for successful treatment.

or by calling 1-877-632-6789.

¡°Exenteration¡± refers to a complex surgery in which organs, bones and other structures are removed from the pelvis in order to treat cancer. A pelvic exenteration might involve the bladder, rectum, anus and/or sacrum (tailbone), as well as the prostate gland in men and the vagina and/or uterus in women.??

While this procedure may sound fairly extreme, it is often the best ¡ª and only potentially curative ¡ª option for some types of cancer. It also provides the best possible chance of long-term cancer control.?

But which cancers does a pelvic exenteration typically treat? What makes you a good candidate for one? How will it affect your sex life and bathroom habits? And, what else should you know about this life-changing operation? Read on for answers.?

Which cancers is a total pelvic exenteration used most frequently to treat?

A total pelvic exenteration (TPE) is most commonly used for locally advanced rectal cancer?or another type of cancer that involves the rectum. This is because of the way cancer grows and spreads in the rectum. But TPE is also used to treat:?

• Anal cancer
• Bladder cancer
• Cervical cancer
• Colon cancer
• Prostate cancer

In fact, pelvic exenteration was originally designed to treat recurrent cervical cancer. It originated as an operation for this gynecologic cancer because the cervix is located in the center of the pelvis. In the days before HPV vaccinations prevented most cervical cancers and radiation therapy was used to treat it, cervical cancer often grew into the structures around it. This procedure was seen as a way of clearing it out.?

Are there different types of exenterations?

An exenteration used to treat rectal cancer usually involves the removal of the rectum, plus something else. That could be the bladder, the bone behind the rectum (the sacrum), or any of the other structures surrounding it that are not normally removed during rectal surgery. Generally speaking, though, there are three types of exenterations:

Anterior exenteration

In a male, this entails removing the bladder and the prostate, but leaving the rectum intact. In a female, this involves removing the bladder, uterus and possibly the vagina, but leaving the rectum intact.??

Posterior exenteration

This involves the removal of the rectum and sacrum, as well as the uterus (if present) and possibly part of the vagina in a female.?

Total pelvic exenteration

In a male, this involves removal of the rectum, bladder and prostate. In a female, this normally entails the removal of the rectum, bladder and uterus (if present) and can also include the vagina.?

Which patients make the best candidates for an exenteration?

Ideally, we want you to be at your very fittest before an exenteration. That way, you¡¯ll have some strength in reserve if any complications arise. So, any therapies we might recommend before that are all part of a plan to get your body prepared for surgery, not to help you avoid it.??

Your best chance for a cure is when we can do a TPE early as a planned part of your treatment, rather than waiting to do it as a last resort when systemic treatments are no longer working. But a TPE is a long and very complex operation, and the recovery can be prolonged. Not all patients will be able to undergo it. So, the first thing we ask is, ¡°Do you have a cancer that¡¯s resectable?¡± That is: ¡°Can your tumor be removed with surgery? Then, your surgeon will determine if you are fit enough to undergo it.??

Unfortunately, a lot of patients are told elsewhere that this type of surgery is impossible, even when their cancer is not metastatic and is still potentially curable. They only come to MD Anderson after other treatments have failed. Other patients are so leery of the procedure itself that they¡¯ll try almost anything to avoid it.?

The trouble is that while chemotherapy and radiation therapy can sometimes slow a cancer¡¯s growth, the problems caused by a locally advanced tumor in the pelvis often become worse. These can include severe pain, obstructions, infections, blood supply problems, and nerve damage. All of those may end up becoming much bigger issues than they would¡¯ve been if someone had gotten the surgery earlier.?