Crystal S. Denlinger, MD, FACP, Chief, Division of Gastrointestinal Medical Oncology, works in a multidisciplinary fashion with her colleagues in surgery, radiation oncology, and gastroenterology to provide a holistic approach to the patient and his or her cancer.

Once it’s been determined that colorectal cancer is present, the next step is determining the type and stage of cancer. Why does this matter: Because it will be the basis of your entire treatment plan.

Information about the tumor that is provided on reports from preliminary and diagnostic screenings — like location and size — will help your physician at Fox Chase determine if surgery, chemotherapy, or radiation are the right options. Getting an exact diagnosis will set you on a path to the right treatment plan.

How Colorectal Cancer Is Diagnosed

The purpose of a diagnostic testing is to:

• Look at any areas that might be cancerous
• Determine if and how far cancer has spread
• Determine if treatment is working effectively

There are many tools we use at Fox Chase to diagnose colorectal cancer, many of which are similar to the screening tools. In fact, an important piece of information for your diagnosis is the results from these screenings.

During your colorectal cancer screening colonoscopy, our skilled gastroenterologists will look inside the colon and rectum for any growths, called polyps. During this procedure, a physician inserts a colonoscope — a thin, flexible tube with lights and a small camera on the end — into the anus and up through the colon in order to see the entire length of the colon. Your gastroenterologist will note the exact location of any polyps and also take samples during the screening.

This information and tissue samples will be passed to the pathologist, who will view the tissue under a microscope for more detailed information on whether there is cancer in the sample.

Based on the results of the screening and the pathology report, we have a number of tests that we use to further determine the location and stage of colorectal cancer:

A diagnostic colonoscopy — similar to a screening colonoscopy — is done for a person whose colon and/or rectum needs further examination because of abnormalities found during a screening test.

During this procedure, a physician inserts a colonoscope — a thin, flexible tube with lights and a small camera on the end — into the anus and up through the colon in order to see the entire length of the colon.

Imaging tests can also be done to view where cancer is and if it has spread by taking pictures of the inside of your colon.

A CT colonography is an alternative to a routine colonoscopy. During the procedure, a short tube is inserted a short distance into the rectum. This allows for slight inflation of the colon while pictures of the colon and rectum are taken using a CT scan.

An endoscopic rectal ultrasound is an ultrasound taken inside the rectum. An ultrasound uses sound waves and their echoes to create pictures of the inside of your body. Using a small microphone-like instrument that is inserted into the rectum — called a transducer — sound waves “bounce off” your organs. These waves are then converted into an image by a computer, allowing your physician to see if the cancer has spread into surrounding areas and lymph nodes.

The Basics of a Colorectal Cancer Diagnosis

A diagnosis of colorectal cancer contains important information, including the type and the stage of cancer. Both are essential and determine the treatment plan.

If an abnormality or polyp is found in the colon or rectum, a tissue sample — usually taken out during a screening test — will be sent to a pathologist. The pathologist’s job is to study the sample and determine if the microscopic cells are cancerous. At Fox Chase, the normal turnaround time for this is 3 to 5 days. It can then take another week to get those results to the correct physician to begin a comprehensive treatment plan, which begins with getting an exact diagnosis. 

With colorectal cancer, you can either have colon cancer, which begins in the colon, or rectal cancer, which forms in the rectum. Even if the cancer cells move throughout the body, it remains the same type of cancer — colon or rectal.

The stages of cancer range from 0 — a very early cancer — to 4. The lower the number, the less the cancer has spread. The determination of the stage of cancer depends largely on if and how much it has spread throughout the body.

These stages include:

• Stage 0: Abnormal cells — which may become cancer — have been found in the innermost layers of the colon and/or rectal wall.
• Stage 1: Cancer has formed in the innermost layer of the colon and/or rectal wall and has spread to the next layer of tissue or the muscle layer.
• Stage 2: Cancer has spread to the outermost layer of the colon and/or rectal wall, to the tissue that lines the organs in the abdomen, or to nearby organs.
• Stage 3: Cancer has spread to or been found in the nearby lymph nodes. This stage is broken into sub-levels that are based on the amount of lymph nodes that have cancer cells in them.
• Stage 4: Cancer has spread to an area or organ that is not near the colon or rectum, like the liver, lung, ovary, distant lymph node, or abdomen wall.

Why Choose Fox Chase Cancer Center?

Fox Chase’s colorectal cancer specialists are trained specifically in gastrointestinal (GI)- based oncology. This extensive, specialized training and expertise sets us apart from more general hospitals and medical centers.

Our specialists work together to provide a holistic view of each of our patients. This means we take into account your entire medical history, your family medical history, and your current lifestyle when outlining your treatment plan. Communication is a key part of our multidisciplinary approach. This also makes it easier to find the right treatment plan for patients who begin their care at Fox Chase.

Patients seeking a second opinion can also benefit from our expertise and approach to diagnosis and treatment. The goal of a second opinion could be to confirm or change a diagnosis from another physician, or help you explore your treatment options. Our comprehensive approach allows for patients at any stage to benefit from the skill and expertise of our cancer center specialists.