Lankenau Hospital's Colorectal Cancer Program offers patients the most advanced medical and surgical expertise available today.

Our unmatched expertise in colorectal surgery is the reason why patients travel from all over the country to receive surgical care here at the Lankenau Hospital Cancer Center, located in the Philadelphia suburbs. The cutting edge technology that is used in our minimally-invasive surgical suite has resulted in a colostomy rate that is well below the national average -- dramatically improving the lives of our patients. In addition, Lankenau's section of Colorectal Surgery serves as a teaching center for surgeons nationally and internationally and enjoys the status as the headquarters of The International Network of Comprehensive Rectal Cancer Centers.

Our Commitment to Research and Teaching
We are proud of having the first program of pre-operative radiation and sphincter preservation surgery for rectal cancer, known as the Marks-Mohiuddin method. That program boasts the largest databank of patients so treated and is at the core of ongoing vital research.

Lankenau Hospital has a long-standing tradition of medical education and was one of the first hospitals in the country to offer a minimally-invasive colorectal surgical fellowship program. To continue this tradition of teaching, Lankenau has established the Gerald J. Marks, MD, Annual Rectal Cancer Lectureship. The Lecture is held in conjunction with the International Rectal Cancer Consensus Conference, under the auspices of the section of Colorectal Surgery. These two collaborative educational events are held each year in Lankenau's Annenberg Conference Center and bring together experts from more than 35 universities and medical centers around the world, including Brazil, Italy, China, Israel, France, Norway and others. The conference is critical to defining standards of rectal cancer treatment.

As part of our commitment to providing the latest medical advances, Lankenau Cancer Center participates in clinical trials of new cancer treatments through the Main Line Health Community Clinical Oncology Program (CCOP), one of only 50 nationwide. The CCOP allows our patients to participate in large, national trials for the prevention and treatment of cancer. Dr. John Marks, Main Line Health and Lankenau chief of Colorectal Surgery, served as the area’s only principal investigator in the National Cancer Institute-sponsored trial demonstrating the efficacy of laparoscopic surgery to open colectomy.

About Colorectal Cancer
Colorectal cancer is believed to develop from non-cancerous growths, called polyps that form on the walls of the colon or rectum. Over time, polyps may begin to grow abnormally and become cancerous. If undiagnosed and untreated, colorectal cancer can spread to other parts of the body.

According to the American Cancer Society, colorectal cancer is the third most common cancer diagnosed in American men and women, and the most common affecting this population in Eastern Pennsylvania. Although colorectal cancer is the second-leading cause of cancer-related deaths in the U.S., death rates have decreased over the last 15 years, a direct result of increased screening, earlier detection, and treatment advances. If detected early, the cure rate may exceed 95 percent.

In the early stages of colorectal cancer, patients often experience no symptoms. This is why early detection and screening is essential. Once symptoms appear, they may include:

• Rectal bleeding or blood in the stool
• Recurrent stomach pain or cramping
• Changes in bowel habits, such as constipation or diarrhea
• Discomfort during bowel movements or constantly feeling the urge to have a bowel movement
• Loss of appetite, unexplained weight loss

For all types of cancer, routine screening and early detection are essential to successful treatment and recovery. In addition to a physical examination and a review of personal medical history, familyhistory, risk factors, and potential symptoms, you also may receive one or more of the followingmedical tests:

• Digital Rectal Examination (DRE): By inserting a gloved, lubricated finger into the rectum, doctors can feel for lumps or unusual masses in the rectum.

• Fecal Occult Blood Test: A test kit you complete in the privacy of your own home and return to your doctor's office for evaluation of hidden blood in the stool.

• Sigmoidoscopy: An outpatient procedure using a long, flexible, lighted tube to check the rectum and lower part of the colon for polyps and cancerous tumors.

• Colonoscopy: An outpatient procedure using a colonoscope, which is a long, flexible, lighted tube (much longer than a sigmoidoscope), that allows inspection of the entire colon and rectum. The American Cancer Society recommends screening with a colonoscopy beginning at age 50, or earlier for those individuals with a personal family history.

• Barium Enema: An x-ray examination of the entire colon and rectum.

• Virtual Colonoscopy: A new technique that employs three dimensional computed tomography. This may be used in combination with more definitive diagnostic tests in selected clinical situations.

Together, these experts work collaboratively to individualize the care we provide, offering supportive guidance each step of the way. We directly communicate our team's recommendations to primary care and referring physicians as part of our collaborative approach.

Treatment for colorectal cancer is based on the type, stage, and size of the tumor, prognosis, and ability to tolerate certain medical procedures or medications as well as individual patient requirements. The goal of treatment is to preserve normal function, minimize the need for a colostomy, and eliminate cancerous cells at the primary tumor site, as well as any cells that have spread throughout the body.

Surgical Treatment
The board-certified colorectal surgeons at Lankenau Cancer Center use minimally invasive procedures, such as laparoscopy, as well as conventional open surgery as indicated. Laparoscopic procedures when used may minimize blood loss and scarring, and reduce recovery time. In both techniques, surgeons remove cancerous cells and some of the nearby healthy tissue with adjacent lymph nodes.

Lankenau surgeons have been responsible for several innovative surgical techniques, to improve the quality of life for patients with colorectal cancer. These include Marks-Mohiuddin, a rectal cancer management program of pre-operative radiation and sphincter preservation that helped establish the current worldwide standard and allows many patients to avoid a colostomy bag in 93% of our patients, well below the national average. Our group was the first to perform local excision of rectal cancer after pre-operative radiation. Dr. John Marks performs local excision by the transanal endoscopic microsurgery (TEM) technique. This allows a transanal approach to lesions that otherwise would require an abdominal or transsacral approach for resection. He heads one of two TEM training centers in the United States that teaches other surgeons this innovative technique.

Multidisciplinary Treatment

• Chemotherapy: May be provided before or after surgery, or used alone or in combination with radiation therapy. Chemotherapy enhances the effects of irradiation which together can reduce the size of rectal cancer so that diverse surgical options can be explored. Medical oncologists and oncology certified nurses provide the latest therapies in a supportive and caring environment.

• Radiation Therapy: Radiation therapy is a non-surgical method of treating cancer through penetrating beams of high-energy waves. Treatment is designed to shrink or eliminate tumors, while minimizing damage to healthy tissue nearby. Radiation injures or destroys tumor cells by damaging their genetic material, making it impossible for these cells to multiply or continue to grow. Pre-operative treatment for rectal cancer may result in dramatic tumor shrinkage increasing the cure rate and the likelihood of preservation of normal function.

• John Marks, MD; Chief Colorectal Surgery
• Gerald Marks, MD; Colorectal Surgeon
• Robert B. Noone, Jr., MD; Colorectal Surgeon

Other Team Members:

• Albert DeNittis, MD; Chief, Radiation Oncology
• Erik L. Zeger, MD 

• Colon Cancer: Common and Curable
• In Her Own Words: Living with Colon Cancer
• Calcium Intake May Reduce Risk of Colon Cancer

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