COLORECTAL CANCER

Definition:

Colorectal cancer, also known as bowel cancer, is a type of cancer that affects
the colon or rectum, which are parts of the digestive system. It usually starts
as a small growth called a polyp on the inner lining of the colon or rectum,
which can develop into cancer over time if not detected and treated.

Types:

Colorectal cancer can be categorized into different types based on the specific
location and characteristics of the cancer cells. The main types include:

1. Adenocarcinomas: This is the most common type of colorectal cancer,

accounting for over 95% of cases. Adenocarcinomas develop from the
glandular cells that line the inner walls of the colon and rectum.

2. Carcinoid Tumors: Carcinoid tumors are rare and develop from the
hormone-producing cells in the intestine. They grow slowly and are
typically less aggressive than adenocarcinomas.

3. Gastrointestinal Stromal Tumors (GISTs): GISTs are rare tumors that can
develop in the gastrointestinal tract, including the colon and rectum.
They originate from specialized cells called interstitial cells of Cajal.

Causes and Risk Factors:

The exact cause of colorectal cancer is often unknown, but certain factors can
increase the risk of developing the disease. These include:

1. Age: The risk of colorectal cancer increases with age, with the majority of
cases occurring in individuals over 50 years old.

2. Family History and Genetics: Having a family history of colorectal cancer

or certain genetic conditions, such as familial adenomatous polyposis
(FAP) or Lynch syndrome, increases the risk.
 3. Personal History of Polyps or Inflammatory Bowel Disease: Previous
colorectal polyps, especially adenomatous polyps, or a history of
inflammatory bowel disease (e.g., ulcerative colitis or Crohn's disease)
increase the risk.

4. Lifestyle Factors: Unhealthy lifestyle choices such as a diet high in red

and processed meats, low in fiber, and lacking in fruits and vegetables,
sedentary behavior, obesity, smoking, and excessive alcohol
consumption can increase the risk of colorectal cancer.

5. Race and Ethnicity: African Americans have a higher incidence of

colorectal cancer compared to other racial and ethnic groups.

Diagnosis:

Diagnosing colorectal cancer involves several steps, including:

1. Screening Tests: Various screening tests are available to detect colorectal

cancer or precancerous polyps, such as colonoscopy, flexible
sigmoidoscopy, fecal occult blood tests (FOBT), and stool DNA tests.

2. Diagnostic Tests: If an abnormality is found during screening or if

symptoms are present, further diagnostic tests may be conducted. These
include imaging tests like computed tomography (CT) scan, magnetic
resonance imaging (MRI), and positron emission tomography (PET) scan.
A biopsy may also be performed to examine a sample of tissue for cancer
cells.

3. Staging: Once diagnosed, the cancer is staged to determine the extent of

its spread. Staging helps guide treatment decisions and prognosis.

Treatment:

The treatment of colorectal cancer depends on several factors, including the

stage of cancer, location of the tumor, overall health of the patient, and
individual preferences. The main treatment modalities for colorectal cancer
include:

1. Surgery: Surgery is the primary treatment for localized colorectal cancer.

The goal is to remove the tumor and nearby lymph nodes. The type of
surgery may vary based on the location and size of the tumor. It can
involve removing a portion of the colon or rectum (colectomy or
proctectomy) and reconnecting the remaining healthy portions.

2. Radiation Therapy: Radiation therapy uses high-energy X-rays or other

types of radiation to kill cancer cells or shrink tumors. It may be used
before surgery to shrink the tumor (neoadjuvant therapy) or after surgery
to destroy remaining cancer cells (adjuvant therapy). In some cases,
radiation therapy may also be used to relieve symptoms in advanced
stages of the disease.

3. Chemotherapy: Chemotherapy involves the use of anti-cancer drugs to

destroy cancer cells throughout the body. It can be administered orally
or through intravenous infusion. Chemotherapy may be used before
surgery (neoadjuvant therapy) to shrink tumors, after surgery (adjuvant
therapy) to destroy remaining cancer cells, or in advanced stages to
control the growth and spread of cancer.

4. Targeted Therapy: Targeted therapy medications are designed to

specifically target cancer cells by interfering with specific molecules
involved in cancer growth. Examples include medications that target the
epidermal growth factor receptor (EGFR) or vascular endothelial growth
factor (VEGF). Targeted therapies may be used in combination with
chemotherapy or as standalone treatments, depending on the specific
characteristics of the tumor.

5. Immunotherapy: Immunotherapy is a type of treatment that helps the

immune system recognize and attack cancer cells. It can be used in
 certain cases of colorectal cancer, such as tumors with high levels of
microsatellite instability (MSI-H) or deficient mismatch repair (dMMR).

Prevention:

While it may not be possible to completely prevent colorectal cancer, certain

lifestyle changes and screenings can help reduce the risk and detect the
disease at an early stage:

1. Screening: Regular screening tests, such as colonoscopy, are

recommended for individuals at average risk starting at the age of 50
(earlier for those with increased risk). Screening helps detect and remove
polyps before they become cancerous or identify cancer in its early stages
when treatment is more effective.

2. Healthy Diet: A diet rich in fruits, vegetables, whole grains, and low in
processed meats and saturated fats may help reduce the risk of
colorectal cancer. Adequate fiber intake and limited alcohol consumption
are also recommended.

3. Physical Activity: Engaging in regular physical activity can help maintain

a healthy weight and reduce the risk of colorectal cancer. Aim for at least
150 minutes of moderate-intensity exercise or 75 minutes of vigorous
exercise per week.

4. Smoking and Alcohol: Avoid smoking and limit alcohol consumption, as

both are associated with an increased risk of colorectal cancer.

5. Weight Management: Maintaining a healthy weight can lower the risk of

colorectal cancer. If overweight or obese, strive to achieve and maintain a
healthy body weight through a balanced diet and regular physical
activity.
 Prognosis:

The prognosis for colorectal cancer depends on various factors, including

the stage of cancer at diagnosis, tumor characteristics, response to
treatment, and individual factors. Generally, early detection and treatment
lead to better outcomes.

The five-year survival rate for colorectal cancer varies depending on the
stage:

 Stage I: The five-year survival rate is around 90-95%, indicating a

favorable prognosis.

 Stage II: The five-year survival rate ranges from 55-80%, depending on

The role of occupational therapy in the management of colorectal cancer.

1. Activities of Daily Living (ADL) Training: Occupational therapists help

individuals regain or adapt their skills for self-care activities such as
bathing, dressing, grooming, and toileting. They may provide education
on energy conservation techniques, recommend adaptive equipment or
strategies to promote independence, and modify the environment to
enhance safety and accessibility.

2. Fatigue Management: Fatigue is a common side effect of colorectal

cancer treatment. Occupational therapists assist individuals in
developing strategies to manage fatigue and conserve energy during daily
activities. They may help establish structured routines, teach pacing
techniques, and recommend modifications to reduce physical exertion.

3. Bowel and Bladder Management: Following colorectal cancer treatment,

individuals may experience changes in bowel and bladder function.
Occupational therapists provide education on bowel and bladder
management techniques, such as dietary modifications, scheduling
 routines, and pelvic floor exercises. They also address any associated
psychological and emotional aspects.

4. Cognitive Rehabilitation: Some individuals may experience cognitive

changes as a result of colorectal cancer or its treatment. Occupational
therapists can assess cognitive function and provide interventions to
address difficulties with memory, attention, problem-solving, and
executive functioning. They may use compensatory strategies, cognitive
exercises, and assistive technology to improve cognitive abilities.

5. Upper Extremity Rehabilitation: Surgical procedures and other

treatments for colorectal cancer can impact upper extremity function.
Occupational therapists can assess and provide interventions to improve
strength, range of motion, and coordination in the arms and hands. They
may use therapeutic exercises, splinting, and adaptive equipment to
facilitate optimal upper extremity function.

6. Psychosocial Support: Occupational therapists provide emotional

support, coping strategies, and stress management techniques to
individuals and their families throughout the cancer journey. They help
individuals navigate the emotional challenges associated with diagnosis,
treatment, and survivorship, promoting mental well-being and overall
adjustment.

7. Work and Vocational Rehabilitation: Occupational therapists assist

individuals in returning to work or exploring vocational options post-
treatment. They assess work-related abilities, recommend workplace
modifications, provide job retraining, and facilitate a gradual return to
work process. They also address the psychosocial and emotional aspects
of vocational reintegration.

8. Leisure and Recreational Activities: Occupational therapists help

individuals engage in meaningful leisure and recreational activities that
promote overall well-being and quality of life. They assess interests,
 abilities, and physical limitations, and provide adaptations or
recommendations for participation in hobbies, sports, and social
activities.

9. Education and Self-Management: Occupational therapists educate

individuals about managing treatment-related side effects, maintaining a
healthy lifestyle, and self-managing their condition. They provide
information on community resources, support groups, and strategies for
long-term management and survivorship.

The role of occupational therapy in the management of colorectal cancer is to

enhance individuals' physical, cognitive, emotional, and functional well-being.
By addressing the unique challenges associated with colorectal cancer,
occupational therapists help individuals regain independence, improve their
quality of life, and maximize their participation in meaningful activities.