Yes, diarrhea can be a consequence of the surgery you had. With time, this should improve. However, if it persists, you should consult with a gastroenterologist for further evaluation and consideration of possible treatment. Q2. Over the past few months, I’ve noticed some blood in my stool. It lasts for a day or two then goes away. Is this something to worry about? Is it a symptom of colon cancer? Not necessarily, but you should get this checked out. Bright red blood in the stool may indicate a number of things. The most common is minor bleeding from hemorrhoids that ooze slightly with the pressure of a bowel movement. Though hemorrhoids are generally not a serious condition, you still need your doctor to make this diagnosis, and then he or she can recommend measures you can take to decrease the chance that the hemorrhoids will bleed. Sometimes bright red blood from the rectum is an indication of a much more serious problem — bleeding from somewhere inside the intestines (usually the large intestine). A doctor’s advice should be sought right away if the amount of blood you see is more than just streaks mixed with normal-appearing stool. Your doctor will determine whether you need to have a procedure to look inside the intestines for the source of the bleeding. Occult (hidden) blood in the stool is a different matter. Doctors can check normal-appearing stool by putting a small touch of stool on a card and testing it for the presence of blood that is not detectable to the eye. The presence of occult blood may indicate that something abnormal in the large intestine is causing very slow bleeding from time to time — and this can sometimes be a sign of colon cancer. Finding occult blood in the stool generally requires a further evaluation, such as a look inside the intestines to determine whether colon cancer is present. Q3. My mom has been battling colon cancer since late 2005. She had surgery in 2006, and they removed part of her colon. She has been on different types of chemo as well. Recently the doctors told us that it may have spread to the lymph nodes in her lower back. She went into the hospital a couple of days ago due to severe pain in her abdomen that she has had for quite some time. She had to have her gall bladder removed. While in surgery the doctor saw several lesions on her stomach lining and also one on her liver. He did a biopsy to be sure, but he already told us he thinks it will come back positive. Her doctor also thinks the cancer is in the lymph node in her neck from recent tests. What are the odds of this cancer going back into remission again? In general, when cancer has spread and is metastatic, it cannot be cured. However, it can go into remission. Depending on the type of chemotherapy your mother gets, there is a 25 percent to 50 percent chance that her cancer can go into remission for a period of time. If standard therapies have been exhausted, you should also consider enrollment in clinical trials. They can provide your mother the opportunity to try new forms of treatment, which could potentially put the cancer in remission. Q4. My husband had rectal cancer in 2004 and had surgery, radiation and chemo. He did fine until recently when his cancer came back in the lung. They did surgery again and removed a section. Now, he has cancer in the lymph nodes in his chest (not in any organ). He is currently on chemo with CPT-11 (irinotecan). Is it possible for this to go into remission again after chemo? Also, I don’t understand the difference between lymphoma and having cancer in the lymph nodes in the chest area. The oncologist says nothing shows up below the waist. Any information will be helpful for me. Thank you. Your husband has stage IV or metastatic rectal cancer which has spread to the lungs. It appears that when the cancer came back initially, it was localized and hence amenable to surgery. However, at this point the disease has spread to the lymph nodes in the lung. While it is possible for him to go into remission using the current chemotherapy, his disease is not curable. In other words, as there are cancer cells circulating in his body, there is a potential for eventually developing resistance to the chemotherapy and for the tumors to emerge once again. Of course, additional therapies are available which can be used if that happens. Lymphoma is a separate and distinct type of cancer that originates in the lymph nodes. However, cancer that starts elsewhere – such as rectal cancer – can also spread to the lymph nodes. This is what happened in your husband’s case. The two types of cancer are very different and have different types of therapies. Q5. Does blood in the stool usually mean colon cancer? Not necessarily. There could be many reasons for blood in the stool, including relatively mild conditions like hemorrhoids or diverticulosis, or more serious problems such as inflammatory bowel disease, ulcerations or possibly colon cancer. It’s good to be concerned about blood in your stool, because it’s an abnormal finding and should prompt you to visit your doctor for a full examination. This can include checking a blood count, and possibly sigmoidoscopy or colonoscopy. Only with further investigation can the cause of the blood in the stool be identified. Q6. My mom had colon cancer when she was 93 years old. She is now 96 and occasionally gets diarrhea. What type of foods should she avoid? She takes Coumadin (warfarin) so she avoids green vegetables, and she has a hard time digesting lettuce. These are foods she loves. Also, she can’t eat apples or a lot of other fruits (gives her diarrhea). What about the fat content in meat? Any advice? Thank you. In general, the best approach for cancer patients – and the general population – is to have a well-balanced diet that includes carbohydrates, proteins and fats (in lower amounts). During an episode of diarrhea, it’s best to stick with soft, bland foods that are low in fat, such as banana, plain rice or pasta, dry toast and potatoes. Diarrhea can occur for many reasons – mechanical issues (such as problems with absorption in the bowels), underlying inflammatory conditions, or infections. If this is a reoccurring problem, your mother should seek the attention of her physician to see if there’s an underlying condition that wouldn’t be solved by dietary changes alone. Given her food restrictions, she could also seek a consultation with a nutritionist for help forming a well-balanced diet plan, including the green vegetables she loves in moderation rather than complete avoidance. Q7. I understand that for colon cancer the standard chemotherapy treatment is six months, or 12 treatments. For rectal cancer patients who have gotten radiation, I read online that some get 8 treatments of FOLFOX, and some go on to get 12. Is there a “standard” for rectal cancer, and how do you decide how many chemo treatments to go with? The treatment of rectal cancer depends on the stage of the cancer at the time of diagnosis. Each person is unique, and treatment recommendations may vary depending on the details of each patient’s case. In general, for rectal tumors that are larger and/or involve regional lymph nodes, initial treatment with a combination of chemotherapy and radiation followed by surgery has been proven in research studies to be better than surgery alone. In those cases in which the tumor is large and/or there is lymph node involvement, it is typically suggested that patients receive additional chemotherapy following surgery. There are no formal data showing that a specific number of treatments — 8 or 12 — is the correct amount for every patient. In general, if a patient has had chemotherapy with radiation before surgery, I tend to give eight sessions of FOLFOX, a chemotherapy “cocktail” containing leucovorin, fluorouracil (5-FU), and oxaliplatin (Eloxatin). Again, please note that this is not a standard recommendation that every doctor would make for every patient — you need to discuss the details of your own treatment with your oncologist. Q8. My husband had colorectal cancer four years ago and recurrences two times. Remissions have been 28 months within the four years. He has suffered with terrible side effects, especially diarrhea. Is this common? His cancer metastasized into lymph nodes and he is on his third round of treatments of chemo, Camptosar (irinotecan) and Avastin (bevacizumab). Please help! Diarrhea is a side effect of several chemotherapy drugs used to treat colon cancer, including capecitabine (Xeloda), oxaliplatin (Eloxatin), fluorouracil (5-FU), and irinotecan (Camptosar). Among these medications, diarrhea is most common with irinotecan. Several medications, including diphenoxylate and atropine (Lomotil and other brands) or loperamide (Imodium and other brands) can be used to alleviate the symptoms of diarrhea. In more severe cases, an injectible drug called octreotide (Sandostatin) can be used. Finally, if these supportive medications don’t help, you can consider a dose reduction in the chemotherapy. You should consult with your physician about the appropriate medications for your husband. Q9. Can surgery be considered in a case where cancer has been diagnosed in the colon but near the rectum? Would it be possible to cut out the bad and reattach to the upper bowel? Resection of rectal tumors and anastomosis (reattachment) of the bowels is possible in certain cases of rectal cancer, depending on the location of the tumor. The rectum refers to the portion of the bowel that is located within the pelvis, and this space is more confined than the abdomen. Other nearby organs in the pelvis – the lower spine, bladder, prostate for men, uterus and ovaries for women – make surgery more complicated. If the tumor is very low and close to the anus, it may not be possible to do a reattachment. In cases like this, the surgeon may have to remove the anus in addition to the cancerous portion of the rectum, installing a permanent colostomy to divert waste to a bag outside the body. Q10. Three years ago, I had an ileostomy after rectal cancer surgery. Since it was removed, a year later, I have experienced frequent need to eliminate and some diarrhea . It has been two years since the reversal and I am still not comfortable traveling or going out for long periods of time. Do you have any suggestions to ameliorate this situation? I think that first and foremost, you should undergo evaluation by a gastroenterologist to get a more clear understanding of the degree of your frequent need for elimination and diarrhea. Depending of the type of diarrhea, different treatment methods can be tried. Medications that have been useful in alleviating symptoms like yours include loperamide (Imodium), codeine, clonidine (Catapres), octreotide (Sandostatin) or cholestyramine (Questran, Previlite, Locholest). However, I want to reiterate that a thorough check-up is necessary to see which medication is best for your condition. Learn more in the Everyday Health Colon Cancer Center.
