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Back to Oncology Diseases
Colorectal cancer
Colorectal cancer includes cancerous growths in the colon, rectum,
anus, and appendix. It is the third most common form of cancer and the
second leading cause of death among cancers in the United States. Many
colorectal cancers are thought to arise from polyps in the colon.
These mushroom-like growths are usually benign, but some may develop
into cancer over time.
Causes of colorectal cancer
Colorectal cancer is a disease resulting from mutations in
epithelial cells of the gastrointestinal tract. Most of the known
abnormalities involve the DNA which regulates cell growth. Though many
of these effects are well known, there are likely environmental,
hereditary, and viral causes for specific cell defects. Because the
changes at the cell level may take years to develop into cancer, it is
generally impossible to track the cause of specific cases of cancer.
Thus efforts at prevention mostly focus on avoiding or identifying
risk factors and early detection.
Risk factors for colorectal cancer
Certain factors increase a person's risk of developing the disease.
These include:
- Age. The risk of developing colorectal cancer increases with age
- History of cancer. Women who have had cancer of the ovary,
uterus, or breast are at higher risk of developing colorectal cancer
- Familial adenomatous polyposis (FAP) carries 100% risk of
developing cancer of the colon
- Long-standing colitis ulcerosa or other chronic inflammatory
diseases, very high risk after 25 years
- Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch
syndrome
- Smoking. Smokers are more likely to die of colorectal cancer
than non-smokers
- Diet. Some studies have shown that people who have diets high in
fresh fruit and vegetables and low in red meat are at reduced risk
of colorectal cancer.
- Virus. Exposure to some viruses may be associated with
colorectal cancer:
- Physical inactivity. People who are physically active are at
lower risk of developing colorectal cancer.
Symptoms of colorectal cancer
- Change in bowel habits.
- Blood in stools.
- Unexplained weight loss.
- Symptoms of anemia including tiredness, malaise, pallor
- It is also possible that there will be no symptoms at all. This
is one reason why screening for the disease is recommended.
Diagnostics, Screening and Monitoring
Colorectal cancer can take many years to develop and early
detection of colorectal cancer greatly improves the chances of a cure.
Therefore, screening for the disease is recommended in individuals who
are at increased risk. There are several different tests available for
this purpose.
Digital rectal exam (DRE)
The doctor inserts a lubricated, gloved finger into the rectum to
feel for abnormal areas.
Fecal Occult Blood Test (FOBT)
A test for blood in the faeces.
Sigmoidoscopy
A lighted probe (sigmoidoscope) is inserted into the rectum and
lower colon to check for polyps and other abnormalities.
Colonoscopy
A lighted probe called a colonoscope is inserted into the rectum
and the entire colon to look for polyps and other abnormalities that
may be caused by cancer. A colonoscopy has the advantage that if
polyps are found during the procedure they can be immediately removed.
Tissue can also be taken for biopsy.
Double contrast barium enema (DCBE)
An enema containing barium, which helps the outline of the colon
and rectum stand out on X-rays, is given to the patient. The doctor
then takes a series of X-rays of the colon and rectum.
Computed axial tomography
Computed axial tomography is used to determine the degree of spread
of cancer. Though it is not generally used for screening, some cancers
are found in CAT scans for other reasons
Blood tests: Measurement of the patients blood for elevated levels of
certain proteins can give an indication of tumor load. In particular,
high levels of carcinoembryonic antigen CEA in the blood can indicate
metastasis of adenocarcinoma
Pathology
The pathology of the tumor is usually reported from the analysis of
tissue taken from a biopsy or surgery. A pathology report will usually
contain a description of cell type and grade. The most common colon
cancer cell type is adenocarcinoma which accounts for 95% of cases.
Other types include squamous cell carcinoma, etc.
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Staging of colorectal cancer
Colon cancer staging is an estimate of the condition of a
particular cancer for patient diagnostic and research purposes. The
systems for staging colorectal cancers largely depend on the extent of
local invasion, the degree of lymph node involvement and whether there
is distant metastases or not.
Treatment of colorectal cancer
The treatment depends on the staging of the cancer. When colorectal
cancer is caught at early stages (with little spread) it can be
curable. However when it is detected at later stages (when distant
metastases are present) it is less likely to be curable.
Surgery remains the primary treatment while chemotherapy and/or
radiotherapy may be recommended depending on the individual patient's
staging and other medical factors.
Surgery
Surgical treatment is by far the most likely to result in a cure of
colon cancer if the tumor is localized. The procedure consists of
removal of the section of colon containing the tumor leaving
sufficient margins to reduce likelihood of re-growth. If possible, the
remaining parts of colon are anastomosed together to create a
functioning colon. In cases when anastomosis is not possible, a stoma
(artificial orifice) is created. Surgery is generally not offered if
significant metastasis are present.
As with any surgical procedure, colorectal surgery can in rare
cases result in complications. These may include Infection, Abscess,
or Fistula.
Radiation therapy
Radiation therapy is used to kill tumor tissue before surgery or
when surgery is not indicated. It is also used to sterilize the
margins after surgery is performed. Sometimes chemotherapy agents are
used to increase the effectiveness of radiation by sensitizing tumor
cells if present.
Chemotherapy
Chemotherapy is used to reduce the likelihood of metastasis
developing, shrink tumor size, or slow tumor growth. Chemotherapy
often applied after surgery (adjuvant), before surgery (neo-adjuvant),
or as the primary therapy if surgery is not indicated (palliative).
The treatments listed here have been shown in clinical trials to
improve survival and/or reduce mortality and have been approved for
use by the US Food and Drug Administration.
Support Therapies
Cancer diagnosis very often results in an enormous change in the
patients sociological wellbeing. Various support resources are
available from, hospitals and other agencies which provide counseling,
social service support, cancer support groups, and other services.
These services help to mitigate some of the difficulties of
integrating a patients medical complications into other parts of their
life.
Follow up
Follow up after surgery occurs usually every 3 to 4 months.
Screening for suspicious symptoms is performed in addition to a tumor
marker (CEA) and computerized tomography of the thorax, abdomen and
pelvis.
Please read this article concerning the value of CEA and CT scan in
the follow up of colorectal cancer patients.
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