Good chances for a cure

Stoma consultation before surgery

“It is very important that patients know what to expect and can prepare themselves psychologically,” explains Catherine Bürgi, nursing expert in the ostomy and continence advice team. The first consultation takes place before the operation. “We explain to those affected what to expect and together we decide where the exit should be on the abdomen.” Relatives can also be involved if they wish. During this initial consultation, the shape of the closure and the emptying and cleaning technique are also discussed together.

Even sauna visits are possible

“A big concern is often the smell,” says the care expert. However, this is “no longer an issue at all”, as the bags into which the stool flows are absolutely leak-proof and are also equipped with a carbon filter. Hiking, jogging, swimming and even going to the sauna are now possible with a stoma. Patients with a stoma are also cared for by the stoma and continence counseling service after discharge from hospital, either at the USZ or near their place of residence.

Tumor stage and risk of relapse

According to the Swiss Cancer League, 4750 people in Switzerland are newly diagnosed with colorectal cancer every year. People over 50 are most frequently affected – colonoscopy for early detection and, if necessary, removal of benign intestinal polyps is therefore currently recommended from this age. If someone discovers blood in their stool or if the family doctor diagnoses anemia of unknown cause, a colonoscopy is part of the investigation.

Surgery almost always as initial treatment

If colon cancer (colon carcinoma) is diagnosed, further examinations are carried out to rule out metastases in other organs. The initial treatment for colon cancer without metastases is almost always surgery. The pathologist uses the surgical specimen to determine the exact stage of the tumor, which determines the risk of recurrence and therefore also the treatment. In stages I and II, the tumor is limited to the wall layers of the intestine; in stage III, tumor cells are found in the distant lymph nodes – in such cases, treatment is always followed up with chemotherapy.

In the case of rectal cancer, complex diagnostics with additional magnetic resonance imaging (MRI) and endosonography are carried out before the operation. Pre-treatment, usually with radiotherapy, is intended to shrink the tumor and reduce the risk of recurrence after surgery.

Modern treatment methods

The procedure for large, advanced rectal carcinomas has recently changed completely. “We prefer follow-up treatment with radiotherapy and usually also chemotherapy because studies have shown that patients respond better and have significantly fewer relapses,” says Ralph Fritsch, medical oncologist and head of the Intestinal Tumor Center. Pre-treatment can take up to five months.

Do not provide palliative treatment too early

In stage IV, bowel cancer has already spread to other organs and treatment is now more complex. “Every disease is different, there are considerable differences in aggressiveness and progression,” says Ralph Fritsch. In “molecular profiling”, the pathologists try to find out which changes in the DNA of the tumor have led to the degeneration of the cell. KRAS, NRAS and BRAF are tumor genes in which mutations are frequently found. Some of these gene mutations can be treated with targeted drugs. In rare cases where genetic segments are repeated, cancer immunotherapies are effective.

Interdisciplinary cooperation is the key

“The treatment of bowel cancer is almost always multimodal,” says Ralph Fritsch. The decisive factor for success is that there is a well-coordinated team of bowel and liver surgeons, radiation oncologists, molecular pathologists, oncologists and other disciplines who regularly exchange information in tumor boards.

Added to this is the extensive experience with complex, often advanced tumor diseases, such as those treated at a university center. “We try to cure bowel cancer patients even if metastases have already formed,” says Ralph Fritsch.

However, if the disease is too advanced, a cure is still only possible in exceptional cases. Nevertheless, it often makes sense to obtain a second opinion in the case of complex bowel cancers, emphasizes visceral surgeon Matthias Turina. “We keep seeing cases where colorectal cancer patients have received palliative treatment too early.”