Robotic Surgery for Colon and Rectal Cancers
December 07, 2020Information
December 6, 2020
Yale Cancer Center
visit: http://www.yalecancercenter.org
email: canceranswers@yale.edu
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- 00:17Welcome to Yale Cancer Answers with
- 00:19your host, Doctor Anees Chagpar.
- 00:21Yale Cancer Answers features the
- 00:23latest information on cancer care
- 00:25by welcoming oncologists and
- 00:26specialists who are on the
- 00:28forefront of the battle to fight
- 00:30cancer. This week it's a
- 00:31conversation about the use of
- 00:33robotic surgery for colon and
- 00:35rectal cancers with Doctor George
- 00:37Yavorek. Doctor Yavorek is a
- 00:39clinical instructor of surgery
- 00:40specializing in gastro bariatrics
- 00:42at the Yale School of Medicine
- 00:44where Doctor Chagpar is a
- 00:46professor of surgical oncology.
- 00:48George, maybe we can
- 00:50start off by talking
- 00:53about screening for colon cancer.
- 00:55I understand that guidelines
- 00:57have recently changed in
- 00:58that regard.
- 01:00Yes, we've seen over the last 10 years
- 01:02that the incidence of colon
- 01:04cancer in younger individuals has
- 01:06increased by about 2% per year
- 01:08over the last five years or so,
- 01:11so the recommendations have
- 01:13changed to start screening
- 01:14at age 45 rather than age 50.
- 01:17Tell us a little bit more about
- 01:19what that screening entails because
- 01:22there seems to be a potpourri of
- 01:25different screening options for people,
- 01:27and they may be wondering about what
- 01:30screening technique is best for them.
- 01:33There are several options and most people
- 01:35would agree that colonoscopy is the
- 01:38best screening tool because it can
- 01:39also be therapeutic at the time.
- 01:42If you do find a polyp or a larger lesion, it
- 01:46can be removed or biopsied at the same time.
- 01:50Other options would include
- 01:51fecal occult blood testing.
- 01:53Which is not as specific.
- 01:56There is now DNA testing, Cologuard,
- 01:59which is rather specific for advanced
- 02:01lesions, tumors or large polyps,
- 02:04but when you get to smaller polyps,
- 02:07the sensitivity is not very good, it is
- 02:12good for people who don't want
- 02:14to go through a colonoscopy,
- 02:16or perhaps because of medical reasons
- 02:18can't do that.
- 02:19Other options might include
- 02:20what they call ECT collography,
- 02:22which is essentially a virtual colonoscopy.
- 02:24The sensitivity is roughly
- 02:26equivalent to a colonoscopy.
- 02:27However,
- 02:28if something is found then you
- 02:30have to go through a colonoscopy
- 02:32to have it removed or biopsied.
- 02:36And so it sounds like there's
- 02:38so many factors that are involved
- 02:40for people to try to parse out.
- 02:43What's the best technique for them?
- 02:45That's probably a discussion that
- 02:47they have with their family doctor.
- 02:49or gastroenterologist
- 02:52or colorectal surgeon.
- 02:54Someone who does screening and
- 02:56can tailor the screening
- 02:59program to the individual.
- 03:03And so now that the screening
- 03:05guidelines have changed and they've
- 03:07recommended starting screening at 45,
- 03:10is that for average risk people or is
- 03:13that for people who may have other
- 03:16predisposing factors?
- 03:17No, that's for average risk.
- 03:20People with a higher risk
- 03:22actually would start sooner.
- 03:24Typical recommendation for someone with
- 03:26a first degree relative who has had
- 03:30colon cancer is to start at least 10 years
- 03:33younger than when that cancer was diagnosed.
- 03:36So if the person has a parent who
- 03:39had colon cancer at about age 50,
- 03:43they should start at age 40.
- 03:45Other high risk situations might
- 03:47be someone with Crohn's disease
- 03:49or inflammatory bowel disease,
- 03:51or someone with a history of
- 03:53Polyposis syndrome that would
- 03:55increase their risk of developing
- 03:57polyps and possibly cancer.
- 04:00So when should those people be screened?
- 04:02I mean, presumably people with
- 04:04Crohn's disease or other forms of
- 04:07IBD or Polyposis syndrome likely
- 04:09would have already had a colonoscopy,
- 04:11but when would be the bare minimum
- 04:13time that they should actually start
- 04:16getting regular screening for cancer?
- 04:19Well, typically when they first are seen
- 04:21and diagnosed with the problem
- 04:24whatever their condition might be,
- 04:26they're likely going to have an
- 04:28initial colonoscopy to evaluate the
- 04:30situation and then future surveillance
- 04:32colonoscopies would be based on that.
- 04:34So typically if someone were
- 04:36diagnosed with Crohn's and is in their 20s,
- 04:38it's likely they would have a colonoscopy
- 04:41at that time and then basically go
- 04:43from there on an individual basis,
- 04:45but typically every five to 10 years.
- 04:48If there were no
- 04:50significant clinical symptoms at
- 04:52the time of colonoscopy.
- 04:55You mentioend that colonoscopy can be both diagnostic and
- 04:58therapeutic, talk a little bit more about
- 05:01the therapeutic options when you are doing
- 05:03a colonoscopy and you you find a lesion.
- 05:07First of all, what kind of
- 05:09lesions do we find in the colon?
- 05:12And secondly, how can colonoscopy
- 05:14be therapeutic in that regard?
- 05:17So the whole purpose of screening
- 05:20colonoscopy is to evaluate the person
- 05:23to see if they have developed any
- 05:25polyps which we know are precursors
- 05:27to most of the colon cancers,
- 05:29and most of those polyps can be removed
- 05:32at the time of colonoscopy and therefore
- 05:35never go on to progress to a cancer.
- 05:39We have seen that the incidence of
- 05:41colon cancer has dropped over the last
- 05:44few decades and we attributed that to
- 05:47screening colonoscopies and
- 05:49polypectomy's that have removed those
- 05:51potential future cases of cancer.
- 05:53So there are several types of
- 05:55polyps and they vary in size.
- 05:58Most of them can be removed
- 06:00endoscopically, some when they
- 06:02get larger when they are about 2
- 06:06centimeters or an inch get more
- 06:08difficult to be removed and should be
- 06:12removed by someone who has
- 06:15advanced endoscopic skills,
- 06:17these have the potential to have
- 06:22malignant transformation what
- 06:24we called dysplasia or possible
- 06:27early invasion and might need more
- 06:30advanced techniques to remove.
- 06:33And presumably some of these lesions
- 06:35may be flat and colonoscopy,
- 06:38even if you can't remove a polyp,
- 06:41can certainly biopsy potential
- 06:43cancers?
- 06:45Yes, if it is too large to remove safely,
- 06:49then it is generally
- 06:52biopsied and marked with ink as a
- 06:55tattoo and referred for surgery.
- 06:57We think that these polyps should be
- 07:00completely removed again because of
- 07:03their potential to progress to cancer.
- 07:06These lesions being flat are
- 07:08much more difficult to remove,
- 07:11and if they do develop invasion,
- 07:14malignant invasion,
- 07:15they are much more likely to spread
- 07:19faster than a more polypoid lesion.
- 07:23So let's suppose
- 07:26you've done a colonoscopy.
- 07:27You've either found a polyp that
- 07:30you couldn't remove completely,
- 07:32or you found a lesion that you've
- 07:35biopsied, in either of those cases,
- 07:38if cancer was found,
- 07:40that would mean that the
- 07:42patient moves next to surgery.
- 07:44Is that right?
- 07:47Typically yes. Again, depending on
- 07:51the skill and what you're feeling of
- 07:53the whole lesion is
- 07:57there are very advanced techniques
- 07:59where endoscopies will take the
- 08:01first layer off inside called
- 08:03endoscopic mucosal resection,
- 08:05which is adequate for very early
- 08:07stage cancers, but in general,
- 08:09most of those would be referred to a
- 08:12surgeon for removal of the whole area and
- 08:15evaluation of the regional lymph nodes.
- 08:18Now, before you do that,
- 08:20are there any kinds of advanced
- 08:22imaging tests that are required
- 08:24or blood tests to help you get an
- 08:26idea of the extent of disease?
- 08:30Well, certainly if you have a diagnosis
- 08:32of invasive cancer rather than something
- 08:35that's questionable or early stage,
- 08:37you're going to image them with
- 08:39a CAT scan to evaluate the liver
- 08:42for possible metastatic disease.
- 08:44It's been fairly commonplace to also
- 08:46do a CAT scan of the chest to looking
- 08:50for possible spread to the lungs,
- 08:52although that's much more common in
- 08:55rectal cancer than colon cancer.
- 08:59Blood tests the CEA or carcinogenic
- 09:01embryonic antigen is not produced
- 09:04by all tumors,
- 09:05but generally if you have a diagnosis
- 09:08of cancer you will check that if it's
- 09:11elevated it can be used as a marker
- 09:14later to follow the patient to see
- 09:17if there is recurrence,
- 09:19and so presumably if you've
- 09:21caught this cancer early because
- 09:23you started screening per the
- 09:26guidelines and now you you go and
- 09:28you have all of these tests and
- 09:30it doesn't look like there's
- 09:31cancer anywhere else,
- 09:33the next step is to remove that
- 09:35part of the colon that's got
- 09:37the cancer in it and evaluate,
- 09:39as you say, the regional lymph nodes.
- 09:42Now I understand that surgical
- 09:43techniques have improved over the last
- 09:46several decades and this can now
- 09:48be done in a minimally invasive way.
- 09:50Can you talk a little bit about that?
- 09:54Absolutely, so minimally invasive surgery
- 09:56the revolution started
- 09:58probably in the late 80s.
- 10:00Around 1990 we all started
- 10:03doing gallbladders that way and
- 10:05it reduced the incision size.
- 10:07Made recovery a lot faster, less pain and
- 10:10the patients were much more satisfied and that
- 10:13translated to colon surgery in the
- 10:17early 90s and there were several
- 10:20trials to determine whether or not that
- 10:24minimally invasive surgery was equal to
- 10:28conventional open surgery and a
- 10:30trial in 2004 and follow up of
- 10:34those patients over a long period
- 10:37of time proved that the cancer
- 10:40surgery was the same whether it was
- 10:43done minimally invasive or open,
- 10:45so the oncologic results were the
- 10:49same minimally invasive surgery,
- 10:51whether it be laparoscopic or robotic.
- 10:59It hurts a lot less.
- 11:01The recovery is faster,
- 11:04the patients are more satisfied with it.
- 11:08Bowel function tends to return faster,
- 11:11and as several studies over the years
- 11:15have shown it is oncologically
- 11:18the same as open surgery.
- 11:22One of the benefits though,
- 11:24is for people with more advanced surgery,
- 11:27more advanced cancer
- 11:28is that since they recover faster,
- 11:31they feel better.
- 11:32They're much more likely to go on and
- 11:35have chemotherapy if they need it
- 11:37after recovering from big open surgery,
- 11:39sometimes the people have had trouble
- 11:42and they just never get healthy enough to
- 11:45receive chemotherapy.
- 11:46So it sounds
- 11:48like we've moved into
- 11:50an era of of minimally invasive
- 11:52surgery for colon cancer,
- 11:54much like we have for Gallbladder surgery.
- 11:57But you mentioned two terms.
- 11:59One is laparoscopic and
- 12:00one is robotic assisted.
- 12:02Can you help our audience kind of
- 12:05understand the difference between the two.
- 12:08Sure, laparoscopy is something
- 12:10that's been around for a long time,
- 12:13and as I mentioned,
- 12:14the translation to more broad
- 12:16applications began in the early 90s
- 12:18and then into colorectal surgery.
- 12:20But basically what that is, is
- 12:23surgery inside the abdomen,
- 12:25done through several small incisions
- 12:28where you have instruments inserted.
- 12:30It's very good when you don't have to make
- 12:32a bigger incision to take a specimen out.
- 12:35In colon surgery,
- 12:36you have to make an incision that's
- 12:38probably 2 to 3 inches in size to
- 12:40get the piece of colon out with the
- 12:42lymph nodes in the tumor so that
- 12:44does have some pain associated with it
- 12:47when you do laparoscopic hernia's and
- 12:50you only have 3 or 4 little incisions,
- 12:54there's much less pain.
- 12:56Robotic assisted is attaching the
- 12:58robotic system to those instruments an
- 13:01that allows you much more dexterity,
- 13:03especially in smaller confined
- 13:05location like the pelvis when
- 13:07you're operating for rectal cancer,
- 13:10your visualization both laparoscopic
- 13:12and robotic assisted is
- 13:15a lot of times,
- 13:16much better than open because
- 13:18you have magnification.
- 13:20You have a light source that's
- 13:23right down there in his deep dark hole
- 13:27and you have your really dexterous
- 13:29instruments in a small space.
- 13:33And so certainly both laparoscopic and
- 13:35robotic seemed to be an advance over
- 13:38open surgery and allow you to get into
- 13:41small spaces with good visualization
- 13:43that you might not have had before and
- 13:46allow patients to get home sooner.
- 13:48We're going to talk more about
- 13:50robotic surgery and compare that
- 13:52to laparoscopic surgery and talk
- 13:54about what happens after the colon
- 13:56cancer surgery right after we take
- 13:58a short break for a medical minute.
- 14:00Please stay tuned to learn more about
- 14:03robotic surgery for colon and rectal
- 14:05cancers with my guest Doctor George
- 14:07Yavorek.
- 14:08Support for Yale Cancer answers comes from
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- 14:36cancer for lung cancer patients.
- 14:38Clinical trials are currently underway
- 14:40to test innovative new treatments.
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- 15:00at yalecancercenter.org.
- 15:01You're listening to Connecticut Public Radio.
- 15:06Welcome
- 15:06back to Yale Cancer Answers.
- 15:08This is doctor Anees Chagpar
- 15:11and I'm joined tonight by my
- 15:13guest Doctor George Yavorek.
- 15:15We are talking about treating patients with
- 15:18colon cancer with robotic surgery.
- 15:20Now right before the break we were
- 15:22talking about this whole evolution in
- 15:25minimally invasive surgery that really
- 15:27helps patients with colon cancer
- 15:30get that colon resected with minimal
- 15:32intervention, shorter hospital stays,
- 15:34less pain and so on.
- 15:36But George, the question that I often
- 15:40have is in terms of those metrics,
- 15:44getting home faster,
- 15:45amount of pain, blood loss,
- 15:48how long the operation is, and cost?
- 15:51How does robotic surgery stack up
- 15:54to laproscopic surgery which you
- 15:57know we all know has a number
- 16:01of advantages over open surgery.
- 16:03So the big thing I think would be
- 16:07patient satisfaction and patient
- 16:09satisfaction between both laparoscopic
- 16:11and robotic surgery is pretty equal
- 16:14because to them it's minimally invasive
- 16:16in terms of oncologic outcomes.
- 16:18Again, the same thing they've looked
- 16:20at that compared to open and obviously
- 16:23the standard is open surgery,
- 16:25but the oncologic outcomes are the same in
- 16:28terms of all the parameters that we look at.
- 16:32Some of the other things you
- 16:35mentioned though were the big
- 16:37knock on robotic surgery is cost.
- 16:39And the expense of the equipment.
- 16:42What happens with that?
- 16:44Is it can be actually cost effective
- 16:46because the patients tend to
- 16:49stay in the hospital less time.
- 16:51If you have them on what we call
- 16:54an ERAS, enhanced recovery
- 16:57after surgery protocol,
- 16:59which typically a lot of specialties
- 17:01are using for urology, gynecology,
- 17:03colorectal surgery and that goes from the
- 17:06pre op preparation through the surgery,
- 17:09anesthesia and into the postoperative period.
- 17:12These patients are spending
- 17:13less time in the hospital.
- 17:15They are back to normal faster.
- 17:18They are feeling better and
- 17:20there are actually less
- 17:22complications and problems which
- 17:24cut down on hospital costs.
- 17:26So those are things that can negate the
- 17:29extra expense of the robotic surgery
- 17:32and actually make it cost effective.
- 17:35So let me push back a little.
- 17:40Understandably, ERAS protocols
- 17:41would improve all of those metrics,
- 17:43whether the surgery was open,
- 17:45patients who are on any rest protocol,
- 17:48who have open surgery would do better
- 17:51than people who are not.
- 18:00So I can understand how that
- 18:03protocol can reduce the length of stay for
- 18:06patients who are having robotic surgery.
- 18:08But given that robotic surgery
- 18:10and laparoscopic surgery are
- 18:12both minimally invasive,
- 18:13and robotic surgery is much more expensive
- 18:16if you have patients who have laparoscopic
- 18:19surgery who are on an ERAS protocol
- 18:22and patients who have robotic surgery
- 18:25who are on an ERAS protocol,
- 18:31are there really any differences
- 18:34in terms of length of stay,
- 18:36length of hospital time,
- 18:38length of surgical procedure,
- 18:40blood loss that are different between the
- 18:43laparoscopic group and the robotic group?
- 18:46That would tend to favor one over the other.
- 18:52So if you look at it across the board just
- 18:55comparing laparoscopic for robotic surgery,
- 18:58typically the outcomes are
- 18:59going to be very similar.
- 19:01They're going to be about the same.
- 19:04Robotic surgery would be more
- 19:06expensive because of the equipment
- 19:09part of the problem becomes the
- 19:11skill level of the surgeon.
- 19:13Where robotic surgery makes it
- 19:16easier for most surgeons to do
- 19:18more complex operations.
- 19:22The inexperienced laparoscopic surgeon
- 19:24could probably do about the same things
- 19:28that a robotic surgeon does, and
- 19:31most people are well versed in both,
- 19:34but I think you're correct in that
- 19:38across both procedures
- 19:40it's going to be less expensive for
- 19:43laparoscopic surgeon and the results
- 19:45are pretty much going to be the same.
- 19:49Part of the idea behind the robotic
- 19:51surgery is that it takes more
- 19:54open cases and makes them minimally
- 19:56invasive across the country.
- 19:58At least 50% of the colectomies
- 20:00are still done
- 20:02through a traditional incision,
- 20:04only about 50% are done
- 20:05minimally invasively and of those the vast
- 20:08majority are still done laparoscopically.
- 20:10It's somewhere between 5 and 10%,
- 20:13are done robotically the other 40% are
- 20:15done laparoscopic and the other 50%
- 20:18are still done through an open incision.
- 20:21So the penetration is
- 20:23increasing for robotic surgery,
- 20:25but back to the question, I think that
- 20:30all things given certainly
- 20:32laproscopic surgery is more
- 20:35cost effective than robotic surgery.
- 20:37So I guess what I'm getting from
- 20:40you is that robotic surgery may be
- 20:42a good option for some cases where
- 20:45you really don't think that you would
- 20:48be able to do this laparoscopic
- 20:51but given the dexterity that you can get
- 20:54particularly low down in the pelvis,
- 20:57which would otherwise mandate an open
- 20:59surgery, robotic surgery might have an
- 21:01advantage in that realm over
- 21:04laparoscopic is that right?
- 21:06Yes, I agree with that.
- 21:08And in complex surgery so
- 21:10not only for colon cancer,
- 21:11but if it's a complex cancer that may
- 21:14be attached to the bladder of the
- 21:17uterus and even non cancer surgery
- 21:19like complex diverticular disease,
- 21:21I think the robot is an advantage
- 21:24over laparoscopic surgery and the
- 21:26one thing is that conversion rate
- 21:28is lower for robotic surgery.
- 21:30So if you look at it in that
- 21:33light robotic surgery has an
- 21:36advantage over laparoscopic surgery
- 21:38because the conversion from
- 21:39minimally invasive to open surgery,
- 21:42which adds more to cost and
- 21:44actually increases hospital stay
- 21:46for someone who's gone through
- 21:48an open incision to begin with,
- 21:51the robot does decrease the chance
- 21:54of conversion and therefore is an
- 21:57advantage in those situations,
- 21:58so you
- 21:59know with people who have expertise in
- 22:02both laparoscopic and robotic surgery,
- 22:05how do you decide which procedure
- 22:07to offer your patients?
- 22:09Or are you offering all of them one
- 22:12particular route as a first choice?
- 22:16I think it depends on a few things.
- 22:18Depends on the complexity,
- 22:20location of the tumor.
- 22:21If I feel that, especially rectal
- 22:23cancers, down in the pelvis,
- 22:24I really like the robot down there
- 22:27again because of the confined
- 22:29space and the ability to get down
- 22:32there with good visualization.
- 22:34If the person may be someone
- 22:37who I'd like to get in and out
- 22:40of surgery a little bit faster,
- 22:42an older person with a lot of health issues,
- 22:45I may choose to do it laparoscopically,
- 22:48because generally the times
- 22:50for those surgeries are less, so
- 22:52it's an individual basis.
- 22:54I offer all my
- 22:56patients one or the other.
- 22:59And the other question that
- 23:01many of our listeners may have
- 23:03especially thinking about
- 23:04the cost of robotic surgery
- 23:06is, is it covered by insurance?
- 23:10Generally speaking, there's no cost to
- 23:13the patient that if there is a cost,
- 23:16the hospital ends up absorbing it
- 23:18because they can't pass that on to
- 23:22the patient. The insurance company
- 23:24doesn't always reimburse more
- 23:25for a specific procedure,
- 23:27but the hospital has figured out a
- 23:30way to in terms of making things more
- 23:33efficient to make these cost effective.
- 23:37And it sounds like if
- 23:41the patient costs are all equal and
- 23:44oncologic outcomes are all equal,
- 23:47then it sounds like the real cost
- 23:50is to the health care system.
- 23:53And that's something that health care
- 23:55systems will need to figure out
- 23:58now if during that staging work up
- 24:01needed before the the surgery itself,
- 24:04let's suppose you did find a
- 24:07little metastasis to the liver,
- 24:10can you take that out at the same time as
- 24:13you do the colon surgery with the robot?
- 24:17Yes you can. The paddle biliary
- 24:19surgeons are doing liver resections
- 24:22laproscopically and robotically
- 24:24so you can do that if it's the
- 24:27right thing to do at that time.
- 24:33Sometimes it's removed at
- 24:35the same time in the surgery.
- 24:37Sometimes they get chemotherapy first
- 24:39to see if it progresses or regresses,
- 24:42or new lesions pop up so, but it can be done
- 24:47minimally invasive, yes.
- 24:49And so it sounds like you know,
- 24:52there have been so many great advances on
- 24:55the surgical front once patients go home.
- 24:58You mentioned that one of the advantages
- 25:01of minimally invasive surgeries that
- 25:03they can actually get onto their adjutant
- 25:06systemic therapy, their chemotherapy
- 25:08a little bit quicker there.
- 25:10After some older patients may
- 25:13have difficulty in that post
- 25:15operative period recovering and
- 25:17so delay or potentially dismiss
- 25:19their chemotherapy.
- 25:20Can you talk a little bit about
- 25:23whether all patients with colon cancer
- 25:26require chemotherapy after surgery,
- 25:28and whether there have been
- 25:30any advances in that regard?
- 25:33So not all patients require chemotherapy.
- 25:36Cancer is staged one through 4.
- 25:40Obviously one being very early
- 25:42in those patients. Generally,
- 25:44surgery alone is curative between 90-95%
- 25:47of the time they do not require
- 25:51chemotherapy , it does not add to their cure rate.
- 25:56Stage two is the big gray zone.
- 26:00That's a very large stage,
- 26:02and some of those patients,
- 26:04depending on individual tumor characteristics
- 26:07may benefit from chemotherapy.
- 26:09They may be at a higher
- 26:11risk to develop recurrence,
- 26:13and that's something that has really
- 26:16progressed over the last 10 years.
- 26:18Our evaluation of individual tumors
- 26:21and what those individual tumor
- 26:23characteristics mean in terms of prognosis.
- 26:26Stage three,
- 26:27there are lymph nodes involved and those
- 26:30people are all candidates for chemotherapy,
- 26:33which has been shown to have a
- 26:38significant improved survival.
- 26:39And stage four is distant metastases
- 26:42and generally chemotherapies
- 26:44are used there too.
- 26:45Also in more of a palliative manner,
- 26:49and as you kind
- 26:51of mentioned and briefly talked about,
- 26:53in that stage two discussion have there
- 26:56been advances in terms of chemotherapy?
- 26:59I mean the robotic surgery,
- 27:01getting to minimally invasive surgery
- 27:04really seems to be advantageous in
- 27:07terms of fine tuning surgery to an
- 27:10individual patient and you talked
- 27:12a little bit about how you tailor
- 27:14the surgical management
- 27:16according to patients,
- 27:18has that filtered into the
- 27:21medical oncology management as well?
- 27:25Yes, most people will get
- 27:28a combination of chemotherapy drugs,
- 27:31usually two or three, and generally
- 27:33it's tapered to their situation,
- 27:35their age, their medical comorbidities,
- 27:37and also the tumor itself.
- 27:40As I mentioned,
- 27:41they do several analysis of the tumor,
- 27:44and there are some studies that can tell
- 27:47you whether or not they will respond
- 27:50to a particular chemotherapeutic agent.
- 27:52And as with a lot of medicine that's gotten,
- 27:57rather involved and complex over the
- 27:59last few years and most people will
- 28:02end up with an oncology consultation
- 28:04and the medical oncologist
- 28:06will tailor their therapy to that.
- 28:10Now the third arm of the
- 28:12stool is always radiation.
- 28:14Do colorectal patients require
- 28:16radiation after surgery as well?
- 28:19So radiation is generally used for
- 28:21rectal cancer, not colon cancer.
- 28:23When it's out of the pelvis,
- 28:25there's generally not a role for radiation.
- 28:28It's when it's in the fixed
- 28:30confines of the pelvis that
- 28:31radiation is used.
- 28:33It's not used all the time,
- 28:35and we do a lot of work up
- 28:37and staging before hand,
- 28:39and a lot of times radiation is
- 28:42given with chemotherapy before
- 28:44surgery for rectal cancer to shrink
- 28:46the tumor and allow
- 28:49for preservation of these sphincters
- 28:50so you don't have a permanent
- 28:53ostomy bag.
- 28:54Doctor
- 28:54Georgia Yavorek is a clinical instructor
- 28:57of surgery specializing in gastro
- 28:59bariatrics at the Yale School of Medicine.
- 29:01If you have questions,
- 29:03the address is canceranswers@yale.edu
- 29:05and past editions of the program
- 29:07are available in audio and written
- 29:09form at yalecancercenter.org.
- 29:10We hope you'll join us next week to
- 29:13learn more about the fight against
- 29:16cancer here on Connecticut Public Radio.