Colon cancer

Introduction
Cancer of the colon or rectum is also called colorectal cancer. In the United
States, it is the fourth most common cancer in men and women. Caught
early, it is often curable.
It is more common in people over 50, and the risk increases with age. You
are also more likely to get it if you have

Polyps - growths inside the colon and rectum that may become
cancerous

A diet that is high in fat

A family history or personal history of colorectal cancer

Ulcerative colitis or Crohn's disease

Over view
The human colon is a muscular, tube-shaped organ length about 4 feet long.
It extends from the end of your small bowel to your anus, twisting and
turning through your abdomen (belly). The colon has 3 main functions.

To digest and absorb nutrients from food

To concentrate fecal material by absorbing fluid (and electrolytes) from

it

To store and control evacuation of fecal material

The right side of your colon plays a major role in absorbing water and
electrolytes, while the left side is responsible for storage and evacuation of
stool.
Cancer is the transformation of normal cells. The transformed cells grow and
multiply abnormally.

Left untreated, these cancers grow and eventually spread through the
colon wall to including the adjacent lymph nodes and organs.
Consequently, they spread to distant organs such as the liver, lungs,
brain, and bones.

Cancers are dangerous because of their unbridled growth. They

overwhelm healthy cells, tissues, and organs by taking their oxygen,
nutrients, and space.

Most colon cancers are adenocarcinomas-tumors that develop from the

glands lining the colon's inner wall.

These tumors are sometimes referred to as colorectal cancer, reflecting

the fact that the rectum, the end portion of the colon, can also be
affected.

In the United States, 1 in 17 people will develop colorectal cancer.

According to reports from the National Cancer Institute, colorectal

cancer is the third most common cancer in US men.

Colorectal cancer is the second most common cancer in US women of

Hispanic, American Indian/Alaska Native, or Asian/Pacific Islander
ancestry, and the third most common cancer in white and African
American women.

The overall incidence of colorectal cancer increased until 1985 and

then began decreasing at an average rate of 1.6% per year.

Deaths from colorectal cancer rank third after lung and prostate cancer
for men and third after lung and breast cancer for women.

As mentioned above Colon, or colorectal, cancer is cancer that starts in the

large intestine (colon) or the rectum (end of the colon).
Other types of cancer can affect the colon, such as lymphoma, carcinoid
tumors, melanoma, and sarcomas. These are rare. In this article, use of the
term "colon cancer" refers to colon carcinoma only.

Causes
There would be many causes for this disease, According to the American
Cancer Society, colorectal cancer is one of the leading causes of cancerrelated deaths in the United States. However, early diagnosis can often lead
to a complete cure.

Almost all colon cancer starts in glands in the lining of the colon and rectum.
When doctors talk about colorectal cancer, this is usually what they are
talking about.
There is no single cause of colon cancer. Nearly all colon cancers begin as
noncancerous (benign) polyps, which slowly develop into cancer.
You have a higher risk for colon cancer if you:

Are older than 60

Are African American of eastern European descent

Eat a diet high in red or processed meats

Have cancer elsewhere in the body

Have colorectal polyps

Have inflammatory bowel disease (Crohn's disease or ulcerative colitis)

Have a family history of colon cancer

Have a personal history of breast cancer

Certain genetic syndromes also increase the risk of developing colon cancer.
Two of the most common are:

Familial adenomatous polyposis (FAP)

Hereditary nonpolyposis colorectal cancer (HNPCC), also known as

Lynch syndrome

What you eat may play a role in your risk of colon cancer. Colon cancer may
be associated with a high-fat, low-fiber diet and red meat. However, some
studies have found that the risk does not drop if you switch to a high-fiber
diet, so this link is not yet clear.
Smoking cigarettes and drinking alcohol are other risk factors for colorectal
cancer.

Symptoms
Many cases of colon cancer have no symptoms. The following symptoms,
however, may indicate colon cancer:

Abdominal pain and tenderness in the lower abdomen

Blood in the stool

Diarrhea, constipation, or other change in bowel habits

Narrow stools

Weight loss with no known reason

Exams and Tests

With proper screening, colon cancer can be detected before symptoms
develop, when it is most curable.
There are 4 basic tests for colon cancer: a stool test (to check for blood);
sigmoidoscopy (inspection of the lower colon; colonoscopy (inspection of the
entire colon); and double contrast barium enema. All 4 are effective in
catching cancers in the early stages, when treatment is most beneficial. A
rectal exam may reveal a mass in patients with rectal cancer, but not colon
cancer.
A fecal occult blood test (FOBT) may detect small amounts of blood in the
stool, which could suggest colon cancer. However, this test is often negative
in patients with colon cancer. For this reason, a FOBT must be done along
with colonoscopy or sigmoidoscopy. It is also important to note that a
positive FOBT doesn't necessarily mean you have cancer.

Imaging tests to screen for and potentially diagnose colorectal cancer

include:

Colonoscopy

Sigmoidoscopy

Note: Only colonoscopy can see the entire colon, and this is the best
screening test for colon cancer.
Blood tests that may be done include:

Complete blood count (CBC) to check for anemia

Liver function tests

If your doctor learns that you do have colorectal cancer, more tests will be
done to see if the cancer has spread. This is called staging. CT or MRI scans
of the abdomen, pelvic area, chest, or brain may be used to stage the
cancer. Sometimes, PET scans are also used.
Stages of colon cancer are:

Stage 0: Very early cancer on the innermost layer of the intestine

Stage I: Cancer is in the inner layers of the colon

Stage II: Cancer has spread through the muscle wall of the colon

Stage III: Cancer has spread to the lymph nodes

Stage IV: Cancer has spread to other organs

Blood tests to detect tumor markers, including carcinoembryonic antigen

(CEA) and CA 19-9, may help your physician follow you during and after
treatment.

Treatment
Treatment depends on many things, including the stage of the cancer. In
general, treatments may include:

Surgery (most often a colectomy) to remove cancer cells

Chemotherapy to kill cancer cells

Radiation therapy to destroy cancerous tissue

SURGERY
Stage 0 colon cancer may be treated by removing the cancer cells, often
during a colonoscopy. For stages I, II, and III cancer, more extensive surgery
is needed to remove the part of the colon that is cancerous. (See: Colon
resection)
CHEMOTHERAPY
Almost all patients with stage III colon cancer should receive chemotherapy
after surgery for approximately 6 - 8 months. This is called adjuvant
chemotherapy. The chemotherapy drug 5-fluorouracil has been shown to
increase the chance of a cure in certain patients.
Chemotherapy is also used to improve symptoms and prolong survival in
patients with stage IV colon cancer.

Irinotecan, oxaliplatin, capecitabine, and 5-fluorouracil are the three

most commonly used drugs.

Monoclonal antibodies, including cetuximab (Erbitux), panitumumab

(Vectibix), bevacizumab (Avastin), and other drugs have been used
alone or in combination with chemotherapy.

You may receive just one type, or a combination of these drugs. There is
some debate as to whether patients with stage II colon cancer should receive
chemotherapy after surgery. You should discuss this with your oncologist.
RADIATION

Although radiation therapy is occasionally used in patients with colon cancer,

it is usually used in combination with chemotherapy for patients with stage III
rectal cancer.
For patients with stage IV disease that has spread to the liver, various
treatments directed specifically at the liver can be used. This may include:

Burning the cancer (ablation)

Delivering chemotherapy or radiation directly into the liver

Freezing the cancer (cryotherapy)

Surgery

Outlook (Prognosis)
Colon cancer is, in many cases, a treatable disease if it is caught early.
How well you do depends on many things, especially the stage of the cancer.
In general, when treated at an early stage, many patients survive at least 5
years after their diagnosis. (This is called the 5-year survival rate.)
If the colon cancer does not come back (recur) within 5 years, it is
considered cured. Stage I, II, and III cancers are considered potentially
curable. In most cases, stage IV cancer is not considered curable, although
there are exceptions.

Possible Complications

Blockage of the colon

Cancer returning in the colon

Cancer spreading to other organs or tissues (metastasis)

Development of a second primary colorectal cancer

When to Contact a Medical Professional

Call your health care provider if you have:

Black, tar-like stools

Blood during a bowel movement

Change in bowel habits

Unexplained weight loss

Prevention
Although the death rate for colon cancer has dropped in the last 15 years.
This may be due to increased awareness and screening by colonoscopy.
Colon cancer can almost always be caught by colonoscopy in its earliest and
most curable stages. Almost all men and women age 50 and older should
have a colon cancer screening. Patients at risk may need earlier screening.
Colon cancer screening can often find polyps before they become cancerous.
Removing these polyps may prevent colon cancer.
For information, see:

Colon cancer screening

Colonoscopy

Changing your diet and lifestyle is important. Some evidence suggests that
low-fat and high-fiber diets may reduce your risk of colon cancer.
Some studies have reported that NSAIDs (aspirin, ibuprofen, naproxen,
celecoxib) may help reduce the risk of colorectal cancer. However, these
medicines can increase your risk for bleeding and heart problems. Most
expert organizations do not recommend that most people take these
medicines to prevent colon cancer. Talk to your health care provider about
this issue.

References

Burt RW, Barthel JS, Dunn KB, et al. NCCN clinical practice guidelines in
oncology. Colorectal cancer screening. J Natl Compr Canc Netw.

2010;8:8-61.
Cunningham D, Atkin W, Lenz HJ, Lynch HT, Minsky B, Nordlinger B, et

al. Colorectal cancer. Lancet. 2010;375:1030-1047.

Smith RA, Cokkinides V, Brooks D, Saslow D, Brawley OW. Cancer
screening in the United States, 2010: a review of current American
Cancer Society guidelines and issues in cancer screening. CA Cancer J
Clin. 2010;60:99-119.