Colon, Rectal and Anal Cancer

The Ochsner Cancer Institute is at the forefront of colon, rectal and anal cancer prevention through patient screening, education, detection and treatment. For over 70 years, Ochsner has been dedicated to cancer research and new cancer treatment development, bringing innovations to the fight against cancer— including more clinical trials than anywhere else in the region.

Ochsner's colorectal surgeons specialize in the surgical removal of malignancies of the colon, rectum and anus. They offer a full range of surgical options and are nationally recognized authorities on anal and perianal tumors. When possible, our colorectal surgeons can perform sphincter-saving surgery for low rectal cancer. In some other cases, chemotherapy and radiotherapy are given before surgery to reduce the size of the tumor. Using a multi-disciplinary team approach, Ochsner's colorectal surgeons participate in chemotherapy protocols with our medical oncology team and research studies, such as ongoing clinical trials for colon cancer.

Colorectal cancer starts in the colon or rectum. These are called colon cancer or rectal cancer, depending on where they start. Most colorectal cancers start as a growth, known as polyps, on the inner lining of the colon or rectum. Depending on the type of polyp, polyps can change into cancer over time. The wall of the colon and rectum is made of many layers, with colorectal cancer starting in the innermost layer and can grow through other layers. When cancer cells are in the wall, they can grow into blood vessels or lymph vessels and travel to other parts of the body.

Anal cancer is an uncommon type of cancer that occurs in the anal canal, which is a short tube at the end of your rectum. Anal cancer forms when normal healthy cells experience a genetic mutation, making the cells abnormal. The healthy cells in your body grow, multiply and die at a set rate. Abnormal cells grow and multiply out of control. These accumulating abnormal cells form a mass, also known as a tumor. They invade nearby tissues and can spread to other organs in your body or metastasize.

Types of colorectal cancer:

• Adenocarcinomas: These cancers start in cells that make mucus to lubricate the inside of the colon and rectum. A common type of colorectal cancer.
• Carcinoid tumors: These start from special hormone-making cells in the intestine.
  • Learn more about neuroendocrine tumors.
• Gastrointestinal stromal tumors (GISTs): Start from special cells in the wall of the colon.
• Lymphoma: Cancers of immune system cells.
• Sarcomas: Start in blood vessels, muscle layers or other connective tissues in the wall of the colon and rectum.

Our team of gastroenterologists, surgical oncologists, colorectal surgeons, radiation oncologists, medical oncologists and other healthcare professionals dedicated to colon, rectal and anal cancer diagnosis and treatment work together to deliver the most effective treatment and support available. We provide our patients with specialized knowledge that can make all the difference in treatment, quality of life and recovery.

Meet Our Team

• 2019: Benson Cancer Center Earns National Re-accreditation with Commendation from the Commission on Cancer of the American College of Surgeons. Read more about our re-accreditation.

• 2018: Ochsner Health is recognized by the QOPI (Quality Oncology Practice Initiative) Certification Program for meeting nationally recognized standards for high quality cancer care. Ochsner is the only health system in the New Orleans region with an Oncology practice certification. Read more about this recognition and what it means for care of our patients.

• Ochsner Cancer Institute is proud to be a Commission on Cancer accredited cancer program. Programs with this distinction have demonstrated an uncompromising commitment to improving survival and quality of life for cancer patients by providing the highest-quality, patient-centered cancer care. Learn more at facs.org/coc
• Nationally recognized as “High Performing” for Colon Cancer Surgery by U.S. News & World Report in 2023-2024.

To schedule an appointment, request a second opinion or to refer a patient, please call 504-842-4060.

You may call the Ochsner Cancer Institute oncology team directly at 504-842-3910 for urgent symptoms and health issues, 24 hours a day.

We offer virtual visits. If you are a new patient, your first virtual appointment is at the discretion of the provider. Learn more about virtual visits, here.

You may also schedule online through the MyOchsner patient portal. This allows you to conveniently schedule your next appointment yourself.

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We have several resources available for patients. From chemotherapy treatments and support groups to financial and patient information, Ochsner Health provides support.

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Colon Cancer Screening

Early detection is critical to winning the fight against colorectal cancer.

Recommended for adults without other risk factors, starting at age 45.

Although a colonoscopy is the preferred method of screening because it allows for both diagnosis of cancer and removal of early pre-cancerous growths (polyps), there are a number of other approved screening tests. If you have a normal colonoscopy, then a repeat colonoscopy is recommended 10 years later for screening. This interval may be shorter if any polyps are detected, or you have certain risk factors.

Flexible sigmoidoscopy is a screening test that is similar to a colonoscopy, but it does not evaluate the entirety of the colon. Thus, it is recommended that this be performed at more frequent intervals and potentially in combination with stool-based tests. There are multiple approved stool-based tests that evaluate for blood or abnormal DNA, which may indicate the presence of colorectal cancer, and need to be performed every one to two years. An additional screening test utilizes a CT scan to visualize the inside of the colon and rectum. If CT or stool-based screening tests are utilized, any abnormal result is usually further investigated with a colonoscopy.

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Anal Cancer Screening

Although anal cancer screening is not recommended for the general population, screening tests may diagnose anal cancer early in those that are high risk. Those that are high risk may include:

• Age: Most cases occur in people aged 50 and older.
• Multiple Sexual Partners: People who have had many sexual partners over their lifetime has a greater risk of anal cancer.
• Anal sex. Those who engage in receptive anal sex have an increased risk.
• Smoking cigarettes.
• History of cancer. People who have had cervical, vulvar or vaginal cancer have an increased risk.
• HIV (Human immunodeficiency virus) and Human papillomavirus (HPV). These viruses can increase your risk of anal and cervical cancer.
• Drugs or conditions that suppress your immune system. Taking drugs to suppress their immune systems, including those who have received organ transplants, may have an increased risk.

If you are at higher risk, an anal pap smear is recommended for men who have sex with men, every one to two years for those who are HIV positive and every two to three years for HIV negative men. For women who are HIV positive or who have a history of cervical dysplasia, an anal pap smear is recommended.

Prevention of Anal Cancer

• Practice safe sex.
• Get vaccinated against HPV.
• Stop smoking.

Interested in other screenings? Click here.

Symptoms of Colorectal Cancer

• A change in bowel habits.
• Blood in or on your stool (bowel movement).
• Diarrhea, constipation or feeling that the bowel does not empty all the way.
• Abdominal pain, aches or cramps that don’t go away.
• Losing weight without trying.

Symptoms of Anal Cancer

• Bleeding from the anus or rectum
• Pain in the anus
• Anal itching
• A mass or growth in the anal canal

How is Colorectal Cancer Diagnosed?

• Medical history and exam
• Tests to look for blood in your stool
• Blood tests
• Diagnostic colonoscopy or flexible sigmoidoscopy
• Proctoscopy
• Biopsy
• Lab tests of biopsy samples
• Imaging tests
  • Computed tomography
  • Ultrasound
  • Magnetic resonance imaging (MRI) scan
  • Positron emission tomography (PET) scan

How is Anal Cancer Diagnosed?

• Visually examining your anal canal and rectum for abnormalities.
• Taking an ultrasound of your anal canal.
• Removing a sample of tissue for laboratory testing.

If it’s confirmed you have anal cancer, additional tests such as computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) may be ordered to determine the extent of the cancer.

Talk to your doctor if you experience any concerning signs of symptoms.

Chemotherapy

Each treatment plan is personalized for each patient and includes many factors such as health status, the type of tumor and how far it has spread.

Chemotherapy, also known as chemo, is a treatment for cancer that uses drugs to kill cancer cells. It is a systemic treatment, where the drugs travel throughout the whole body to reach cancer cells that may have spread to other areas of the body. Chemotherapy may be injected directly into a vein intravenously (IV), given through a catheter (thin tube placed into a large vein) or in a pill form taken orally. It is used to cure, control and relieve symptoms caused by the cancer.

Ochsner Health offers a free chemotherapy class for patients who will be receiving chemotherapy as part of their treatment plan. These classes are available online and in-person.

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Radiation Therapy

Radiation therapy is the use of high energy X-rays to kill cancer cells. For early-stage patients who may not safely tolerate surgery, high-dose focused radiation known as Stereotactic Body Radiation Therapy (SBRT) is often used as primary treatment. For more advanced cancers, radiation therapy is often given in combination with chemotherapy. In very advanced disease it may be used to provide relief from pain, blocked airways, or bleeding. Side effects depend on the part of the body that is treated but may include sore throat, difficulty swallowing, inflammation of the lung, fatigue or skin changes at the site of treatment.

Targeted Therapies

As researchers learn more about the molecular make-up of colorectal cancer, we have identified a number of mutations in cancer cells that drive the growth and spread of colorectal cancer. At Ochsner, we perform molecular testing from tumor biopsies for all of our patients with colorectal cancer. Increasingly, we are identifying mutations in patients’ cancers for which we have targeted therapies either as standard-of-care or as part of a clinical trial. This individualized approach to cancer treatment for each patient’s cancer is called precision cancer medicine. Targeted therapies are a newer class of drugs that act against cancer cells with a specific mutation. These can be taken orally or by IV.

Immunotherapy

The role of the immune system is to defend the body against microorganisms (bacteria, viruses, fungus) and cancer cells. Specialized immune cells, called T cells, can learn and remember specific foreign proteins called antigens. Many cancers are probably recognized and eliminated by our immune system, but some cancer cells can outsmart it. While chemotherapy and tumor-targeted drugs directly affect the growth and spread of cancer cells, immunotherapies are designed to re-activate our T cells to attack and destroy cancer. Immune checkpoints are natural markers on our immune cells designed to turn off the immune system to prevent damage to healthy cells. Cancer can hijack these markers to turn our T cells off when they try to attack a cancer cell. Intravenous medications known as immune checkpoint inhibitors (ICI) allow a patient’s immune system to fight cancer. While the majority of patients with colorectal cancer unfortunately tend to not benefit from treatment with immunotherapy, a small but important subset do have the potential to have a significant response to immunotherapy. Patients with a feature in their colorectal cancer cells called “microsatellite instability high” or with “deficient mismatch repair proteins” are those who have been shown to potentially respond well to immunotherapy. For patients with advanced anal cancer, immunotherapy represents a standard treatment option after chemotherapy.

Surgery

Procedures are based on the stage of the cancer.

• Surgery to remove early-stage anal cancers. Very small cancers may be removed through surgery. During this procedure, the surgeon will remove the tumor and a small amount of healthy tissue that surrounds it. Depending on your cancer, your doctor may also recommend chemotherapy and radiation after surgery.
• Surgery for cancer that hasn’t responded to other treatments. If your cancer hasn’t responded to chemotherapy and radiation, your doctor may recommend abdominoperineal resection.

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There are now indications for chemotherapy, surgery or radiation, targeted therapies, and immunotherapy for both early and advanced stages of lung cancer. Sometimes these treatments are used alone, in combination, or in sequence. We use a multidisciplinary approach to tailor a treatment plan specific for each patient with colon, rectum or anal cancer at Ochsner.

Participating in a clinical trial may be a treatment of choice for some patients. Ochsner has over 100 cancer clinical trials both in early and late phases. Phase 1 clinical trials are conducted to find out if new cancer treatments are safe, which is usually reserved for patients with advanced cancer and limited treatment options. When treatments are deemed safe during Phase I, Phase II clinical trials are conducted to find out how effective these newer treatments can be. Phase II trials usually add newer study drugs to already accepted standard treatment regimens in an effort to improve responses and survival. If a treatment regimen in Phase II is found to be very effective, randomized Phase III clinical trials are conducted to compare the newer regimen to already existing standard treatments.

Clinical trials are designed to ensure patients enrolled are either receiving standard treatments or a potentially more effective study treatment regimen. The standard treatments we use today were effective on earlier clinical trials. Our patients who enroll in a clinical trial may be the first to receive a cutting edge, prospective new treatment. These patients also help improve the way cancer will be treated in the future. If the trial does not lead to new treatments that are more effective than standard, they still pave the way for our researchers to answer important questions moving forward that will help future cancer patients.

Explore Clinical Trials

In selected patients with unresectable colorectal metastases, liver transplantation provides a significant benefit and may a life-saving option for many patients.

Overview

Almost half of patients who have cancer in the colon or rectum will see their cancer spread to the liver at some point during their disease. The spread, known as metastases, has significant impact on survival, quality of life and treatment options. Without treatment, the outcomes are poor: 10-20% survival at 5-years. Resection of the affected area of the liver is the best option for those patients with liver only metastases since it improves the overall 5-year survival to 40-60%. Unfortunately for most of the patients, the disease usually presents too advanced for resection.

More than 3 decades ago, liver transplantation was used to treat colorectal liver metastasis, sadly with very poor outcomes. However, over the last few years, there have been significant advances in the fields of colorectal cancer and liver transplantation. Thus, a unique approach developed at University of Oslo combining different therapeutic options that include liver transplantation has obtained a promising survival of 83% at 5 years in selected patients with unresectable liver metastases of colorectal cancer.

Even though those impressive outcomes have been reached in a very select group of patients, this approach provides the longest overall survival reported at this advance stage of disease where other therapies are not feasible.

The goal of this protocol is to provide an alternative of care to patients with liver metastases from colorectal cancer that have failed other therapeutics options and/or are not candidates for extensive liver surgeries by removing a diseased liver and replacing it with a healthy one.

Although each case will be carefully evaluated by our multi-disciplinary team to develop a personalized treatment approach, to be eligible for a liver transplantation, patients must have:

• Unresectable colorectal liver metastases
• No evidence of cancer outside of the liver
• Their primary colorectal tumors must have been removed
• Stable disease for at least 5 months
• Be in a condition to accept and tolerate the liver transplant

Liver transplantation for colorectal metastases is part of our Colorectal Cancer Liver Metastases program. This is a personalized program that integrate a multidisciplinary team that includes oncology, surgery, radiology, hepatology, and transplantation that work together to implement this novel protocol that is offered in only a few centers in the world.

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Why Ochsner for Colorectal Cancer Liver Metastases Program?

Ochsner has one of the largest liver transplant programs in the country with excellent outcomes in the top percentile in the nation. Our dedicated multi-disciplinary team works closely together to develop a treatment plan that is clear, coordinated, and efficient. We welcome patients with a new diagnosis, those looking for a second opinion or seeking alternative treatment options.

Our Multidisciplinary Team

Our dedicated multi-disciplinary team works closely together to develop a treatment plan that is clear, coordinated, and efficient. We welcome patients with a new diagnosis, those looking for a second opinion or seeking alternative treatment options.

Our services include:

• Medical Oncology
• Liver Transplantation
• Interventional Radiology
• Clinical Trials

Meet our team

• Jonathan Mizrahi, MD
• Lingling Du, MD
• George Therapondos, MD
• Humberto Bohorquez, MD
• John Seal, MD
• Juan Gimenez, MD
• Tyler Sandow, MD
• Shelly Camardelle

Schedule an Appointment

To schedule an appointment, please call our office at (504) 842-3925. If you'd like to refer a patient, please email us at livertransplant@ochsner.org.

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