Colon Cancer Symptoms, Causes and Treatments - Fact Book
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Understanding the Cancer Process
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The Colon and Rectum
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Understanding Colorectal Cancer
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Colorectal Cancer: Who's at Risk?
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Colorectal Cancer: Reducing the Risk
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Detecting Cancer Early
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Colon Cancer Symptoms
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Diagnosing Colorectal Cancer
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Stages of Colorectal Cancer
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Treatment for Colorectal Cancer
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Side Effects
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The Importance of Followup Care
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Providing Emotional Support
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Questions for Your Doctor
- Keeping on Top of Your Condition
Common misspelling: colon cancer symptons
Understanding the Cancer Process
Cancer
affects our cells, the body's basic unit of life. To understand cancer, it
is helpful to know what happens when normal cells become cancerous.
The body is made up of many types of cells. Normally, cells grow,
divide, and produce more cells as they are needed to keep the body healthy
and functioning properly. Sometimes, however, the process goes astray --
cells keep dividing when new cells are not needed. The mass of extra cells
forms a growth or
tumor.
Tumors can be either
benign
or
malignant.
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Benign tumors are not cancer. They often can be removed and,
in most cases, they do not come back. Cells in benign tumors do not
spread to other parts of the body. Most important, benign tumors are
rarely a threat to life.
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Malignant tumors are cancer. Cells in malignant tumors are
abnormal and divide without control or order. These cancer cells can
invade and destroy the tissue around them. Cancer cells can also break
away from a malignant tumor. They may enter the bloodstream or
lymphatic
system (the tissues and organs that produce and store cells that
fight infection and disease). This process, called
metastasis,
is how cancer spreads from the original (primary) tumor to form new
(secondary) tumors in other parts of the body.
The Colon and Rectum
The colon and rectum are parts of the body's digestive system, which
removes nutrients from food and stores waste until it passes out of the
body. Together, the colon and rectum form a long, muscular tube called the
large intestine (also called the large bowel). The colon is the first 6
feet of the large intestine, and the rectum is the last 8 to 10
inches.
Colon, rectum, and other parts of digestive
system
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Understanding Colorectal Cancer
Cancer that begins in the colon is called colon cancer, and cancer that
begins in the rectum is called rectal cancer. Cancers affecting either of
these organs may also be called
colorectal
cancer.
Colorectal Cancer: Who's at Risk?
The exact causes of colorectal cancer are not known. However, studies
show that the following
risk
factors increase a person's chances of developing colorectal
cancer:
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Age. Colorectal cancer is more likely to occur as people get
older. This disease is more common in people over the age of 50.
However, colorectal cancer can occur at younger ages, even, in rare
cases, in the teens.
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Diet. Colorectal cancer seems to be associated with diets that
are high in fat and calories and low in fiber. Researchers are exploring
how these and other dietary factors play a role in the development of
colorectal cancer.
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Polyps.
Polyps
are benign growths on the inner wall of the colon and rectum. They are
fairly common in people over age 50. Some types of polyps increase a
person's risk of developing colorectal cancer.
A rare, inherited condition, called
familial
polyposis, causes hundreds of polyps to form in the colon and
rectum. Unless this condition is treated, familial polyposis is almost
certain to lead to colorectal cancer.
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Personal medical history. Research shows that women with a
history of cancer of the ovary, uterus, or breast have a somewhat
increased chance of developing colorectal cancer. Also, a person who has
already had colorectal cancer may develop this disease a second
time.
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Family medical history. First-degree relatives (parents,
siblings, children) of a person who has had colorectal cancer are
somewhat more likely to develop this type of cancer themselves,
especially if the relative had the cancer at a young age. If many family
members have had colorectal cancer, the chances increase even more.
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Ulcerative colitis.
Ulcerative
colitis is a condition in which the lining of the colon becomes
inflamed. Having this condition increases a person's chance of
developing colorectal cancer.
| Risk Factors Associated with Colorectal Cancer
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Age
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Diet
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Polyps
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Personal History
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Family History
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Ulcerative Colitis |
Having one or more of these risk factors does not guarantee that a
person will develop colorectal cancer. It just increases the chances.
People may want to talk with a doctor about these risk factors. The doctor
may be able to suggest ways to reduce the chance of developing colorectal
cancer and can plan an appropriate schedule for checkups.
Colorectal Cancer: Reducing the Risk
The National Cancer Institute supports and conducts research on the
causes and prevention of colorectal cancer. Research shows that colorectal
cancer develops gradually from benign polyps. Early detection and removal
of polyps may help to prevent colorectal cancer. Studies are looking at
smoking cessation, use of dietary supplements, use of aspirin or similar
medicines, decreased alcohol consumption, and increased physical activity
to see if these approaches can prevent colorectal cancer. Some studies
suggest that a diet low in fat and calories and high in fiber can help
prevent colorectal cancer.
Researchers have discovered that changes in certain genes (basic units
of heredity) raise the risk of colorectal cancer. Individuals in families
with several cases of colorectal cancer may find it helpful to talk with a
genetic counselor. The genetic counselor can discuss the availability of a
special blood test to check for a genetic change that may increase the
chance of developing colorectal cancer. Although having such a genetic
change does not mean that a person is sure to develop colorectal cancer,
those who have the change may want to talk with their doctor about what
can be done to prevent the disease or detect it early.
Detecting Cancer Early
People who have any risk factors
should ask a doctor when to begin checking for
colorectal cancer, what tests to have, and how often to have them. The
doctor may suggest one or more of the tests listed below. These tests are
used to detect polyps, cancer, or other abnormalities, even when a person
does not have symptoms. Your health care provider can explain more about
each test.
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A
fecal
occult blood test (FOBT) is a test used to check for hidden
blood in the stool. Sometimes cancers or polyps can bleed, and FOBT is
used to detect small amounts of bleeding.
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A
sigmoidoscopy
is an examination of the rectum and lower colon (sigmoid colon)
using a lighted instrument called a
sigmoidoscope.
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A
colonoscopy
is an examination of the rectum and entire colon using a lighted
instrument called a
colonoscope.
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A double contrast
barium
enema (DCBE) is a series of x-rays of the colon and rectum.
The patient is given an enema with a solution that contains barium,
which outlines the colon and rectum on the x-rays.
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A
digital
rectal exam (DRE) is an exam in which the doctor inserts a
lubricated, gloved finger into the rectum to feel for abnormal
areas.
Colon Cancer Symptoms
Colon cancer symptons include:
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A change in bowel habits
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Diarrhea, constipation, or feeling that the bowel does not empty
completely
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Blood (either bright red or very dark) in the stool
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Stools that are narrower than usual
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General abdominal discomfort (frequent gas pains, bloating, fullness,
and/or cramps)
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Weight loss with no known reason
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Constant tiredness
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Vomiting
These symptoms may be caused by colorectal cancer or by other
conditions. It is important to check with a doctor.
Diagnosing Colorectal Cancer
To help find the cause of symptoms, the doctor evaluates a person's
medical history. The doctor also performs a physical exam and may order
one or more diagnostic tests.
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X-rays
of the large intestine, such as the DCBE, can reveal polyps or other
changes.
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A sigmoidoscopy lets the doctor see inside the rectum and the
lower colon and remove polyps or other abnormal tissue for
examination under a microscope.
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A colonoscopy lets the doctor see inside the rectum and the
entire colon and remove polyps or other abnormal tissue for
examination under a microscope.
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A polypectomy is the removal of a polyp during a sigmoidoscopy
or colonoscopy.
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A
biopsy
is the removal of a tissue sample for examination under a microscope by
a pathologist to make a diagnosis.
Stages of Colorectal Cancer
If the diagnosis is cancer, the doctor needs to learn the
stage
(or extent) of disease.
Staging
is a careful attempt to find out whether the cancer has spread and, if so,
to what parts of the body. More tests may be performed to help determine
the stage. Knowing the stage of the disease helps the doctor plan
treatment. Listed below are descriptions of the various stages of
colorectal cancer.
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Stage 0. The cancer is very early. It is found only in the
innermost lining of the colon or rectum.
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Stage I. The cancer involves more of the inner wall of the
colon or rectum.
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Stage II. The cancer has spread outside the colon or rectum to
nearby tissue, but not to the
lymph
nodes. (Lymph nodes are small, bean-shaped structures that are
part of the body's immune system.)
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Stage III. The cancer has spread to nearby lymph nodes, but
not to other parts of the body.
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Stage IV. The cancer has spread to other parts of the body.
Colorectal cancer tends to spread to the liver and/or lungs.
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Recurrent.
Recurrent
cancer means the cancer has come back after treatment. The
disease may recur in the colon or rectum or in another part of the body.
Treatment for Colorectal Cancer
Treatment depends mainly on the size, location, and extent of the
tumor, and on the patient's general health. Patients are often treated by
a team of specialists, which may include a
gastroenterologist,
surgeon,
medical
oncologist, and
radiation
oncologist. Several different types of treatment are used to treat
colorectal cancer. Sometimes different treatments are combined.
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Surgery to remove the tumor is the most common treatment for
colorectal cancer. Generally, the surgeon removes the tumor along with
part of the healthy colon or rectum and nearby lymph nodes. In most
cases, the doctor is able to reconnect the healthy portions of the colon
or rectum. When the surgeon cannot reconnect the healthy portions, a
temporary or permanent
colostomy
is necessary. Colostomy, a surgical opening (
stoma)
through the wall of the
abdomen
into the colon, provides a new path for waste material to leave the
body. After a colostomy, the patient wears a special bag to collect body
waste. Some patients need a temporary colostomy to allow the lower colon
or rectum to heal after surgery. About 15 percent of colorectal cancer
patients require a permanent colostomy.
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Chemotherapy
is the use of anticancer drugs to kill cancer cells. Chemotherapy may be
given to destroy any cancerous cells that may remain in the body after
surgery, to control tumor growth, or to relieve symptoms of the disease.
Chemotherapy is a
systemic
therapy, meaning that the drugs enter the bloodstream and travel
through the body. Most anticancer drugs are given by injection directly
into a vein (
IV)
or by means of a
catheter,
a thin tube that is placed into a large vein and remains there as long
as it is needed. Some anticancer drugs are given in the form of a pill.
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Radiation
therapy, also called radiotherapy, involves the use of
high-energy x-rays to kill cancer cells. Radiation therapy is a
local
therapy, meaning that it affects the cancer cells only in the
treated area. Most often it is used in patients whose cancer is in the
rectum. Doctors may use radiation therapy before surgery (to shrink a
tumor so that it is easier to remove) or after surgery (to destroy any
cancer cells that remain in the treated area). Radiation therapy is also
used to relieve symptoms. The radiation may come from a machine (
external
radiation) or from an implant (a small container of radioactive
material) placed directly into or near the tumor (
internal
radiation). Some patients have both kinds of radiation therapy.
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Biological
therapy, also called immunotherapy, uses the body's immune
system to fight cancer. The immune system finds cancer cells in the body
and works to destroy them. Biological therapies are used to repair,
stimulate, or enhance the immune system's natural anticancer function.
Biological therapy may be given after surgery, either alone or in
combination with chemotherapy or radiation treatment. Most biological
treatments are given by injection into a vein (IV).
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Clinical
trials (research studies) to evaluate new ways to treat
cancer are an appropriate option for many patients with colorectal
cancer. In some studies, all patients receive the new treatment. In
others, doctors compare different therapies by giving the promising new
treatment to one group of patients and the usual (standard) therapy to
another group.
Research has led to many advances in the treatment of colorectal
cancer. Through research, doctors explore new ways to treat cancer that
may be more effective than the standard therapy.
. PDQ, NCI's cancer information database, contains
detailed information about ongoing studies for colorectal cancer.
Side Effects
The
side
effects of cancer treatment depend on the type of treatment and
may be different for each person. Most often the side effects are
temporary. Doctors and nurses can explain the possible side effects of
treatment. Patients should report severe side effects to their doctor.
Doctors can suggest ways to help relieve symptoms that may occur during
and after treatment.
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Surgery causes short-term pain and tenderness in the area of
the operation. Surgery for colorectal cancer may also cause temporary
constipation or diarrhea. Patients who have a colostomy may have
irritation of the skin around the stoma. The doctor, nurse, or
enterostomal
therapist can teach the patient how to clean the area and
prevent irritation and infection.
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Chemotherapy affects normal as well as cancer cells. Side
effects depend largely on the specific drugs and the dose (amount of
drug given). Common side effects of chemotherapy include nausea and
vomiting, hair loss, mouth sores, diarrhea, and fatigue. Less often,
serious side effects may occur, such as infection or bleeding.
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Radiation therapy, like chemotherapy, affects normal as well
as cancer cells. Side effects of radiation therapy depend mainly on the
treatment dose and the part of the body that is treated. Common side
effects of radiation therapy are fatigue, skin changes at the site where
the treatment is given, loss of appetite, nausea, and diarrhea.
Sometimes, radiation therapy can cause bleeding through the rectum
(bloody stools).
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Biological therapy may cause side effects that vary with the
specific type of treatment. Often, treatments cause flu-like symptoms,
such as chills, fever, weakness, and nausea.
| The health care team can explain the possible
side effects of treatment. Patients should report severe side
effects. Doctors and nurses can suggest ways to help relieve
symptoms that may occur during and after treatment.
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The Importance of Followup Care
Followup care after treatment for colorectal cancer is important.
Regular checkups ensure that changes in health are noticed. If the cancer
returns or a new cancer develops, it can be treated as soon as possible.
Checkups may include a physical exam, a fecal occult blood test, a
colonoscopy, chest x-rays, and lab tests. Between scheduled checkups, a
person who has had colorectal cancer should report any health problems to
the doctor as soon as they appear.
Providing Emotional Support
Living with a serious disease, such as cancer, is challenging. Apart
from having to cope with the physical and medical challenges, people with
cancer face many worries, feelings, and concerns that can make life
difficult. Some people find they need help coping with the emotional as
well as the practical aspects of their disease. In fact, attention to the
emotional burden of having cancer is often a part of a patient's treatment
plan. The support of the health care team (doctors, nurses, social
workers, and others), support groups, and patient-to-patient networks can
help people feel less alone and upset, and improve the quality of their
lives. Cancer support groups provide a setting where cancer patients can
talk about living with cancer with others who may be having similar
experiences. Patients may want to speak to a member of their health care
team about finding a support group.
Questions for Your Doctor
This booklet is designed to help you get information you need from your
doctor, so that you can make informed decisions about your health care. In
addition, asking your doctor the following questions will help you
understand your condition better. To help you remember what the doctor
says, you may take notes or ask whether you may use a tape recorder. Some
people also want to have a family member or friend with them when they
talk to the doctor -- to take part in the discussion, to take notes, or
just to listen.
Diagnosis
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What tests can diagnose colorectal cancer? Are they painful?
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How soon after the tests will I learn the results?
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Are my children or other relatives at higher risk for colorectal
cancer?
Treatment
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What is the stage of my cancer?
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What treatments are recommended for me?
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Should I see a surgeon? Medical oncologist? Radiation oncologist?
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What clinical trials might be appropriate?
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Will I need a colostomy? Will it be permanent?
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What will happen if I don't have the suggested treatment?
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Will I need to be in the hospital to receive my treatment? For how
long?
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How might my normal activities change during my treatment?
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After treatment, how often do I need to be checked? What type of
followup care should I have?
Side Effects
The Health Care Team
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Who will be involved with my treatment and rehabilitation? What role
will each member of the health care team play in my care?
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What has been your experience in caring for patients with colorectal
cancer?
Resources
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Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
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