Colon Cancer


General Information

What is colon cancer?

Colon cancer is a disease in which malignant (cancer) cells form in the tissues of the colon. The colon is part of the body's digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The first 6 feet of the large intestine are called the large bowel or colon. The last 6 inches are the rectum and the anal canal. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).

Age and health history can affect the risk of developing colon cancer.
Risk factors include the following:

-Age 50 or older.
-A family history of cancer of the colon or rectum.
-A personal history of cancer of the colon, rectum, ovary, endometrium, or breast.
-A history of polyps (small noncancerous growths) in the colon.
-A history of ulcerative colitis (ulcers in the lining of the large intestine).
-Certain hereditary conditions, such as familial adenomatous polyposis and hereditary nonpolyposis colon cancer (HNPCC; Lynch Syndrome).

Possible signs of colon cancer include a change in bowel habits or blood in the stool.
These and other symptoms may be caused by colon cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

-A change in bowel habits.
-Blood (either bright red or very dark) in the stool.
-Diarrhea, constipation, or feeling that the bowel does not empty completely.
-Stools that are narrower than usual.
-General abdominal discomfort (frequent gas pains, bloating, fullness, or cramps).
-Weight loss with no known reason.
-Constant tiredness.
-Vomiting.

Tests that examine the rectum, rectal tissue, and blood are used to detect (find) and diagnose colon cancer. The following tests and procedures may be used:

Fecal occult blood test: A small stool sample is placed on a special card and returned to the doctor or lab. This test examines the stool for occult (hidden) blood.

Digital rectal examination: The doctor or nurse inserts a lubricated gloved finger into the rectum and feels for lumps or abnormal areas and tests any stool for blood.

Barium enema: A procedure in which a liquid containing barium is put into the rectum by way of the anus. Barium is a silver-white metallic compound that helps to show the image of the lower gastrointestinal tract on an x-ray.

Sigmoidoscopy: An examination in which a doctor uses a sigmoidoscope (a thin, lighted instrument) to view the inside of the lower colon and rectum for polyps, tumors, or abnormal areas. If the doctor sees a polyp or other abnormal tissue during the procedure, it can be removed and further examined under a microscope.

Colonoscopy: An examination of the inside of the entire colon and rectum using a colonoscope (a thin, lighted instrument) inserted into the rectum. If the doctor sees a polyp or other abnormal tissue during the procedure, it can be removed and further examined under a microscope.

Biopsy: The removal of cells or tissues for examination under a microscope.

Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether the cancer is in the inner lining of the colon only, involves the whole colon, or has spread to other places in the body) and the patient's general health.

Stages of Colon Cancer

After colon cancer has been diagnosed, tests are done to find out if cancer cells have spread within the colon or to other parts of the body.
The process used to find out if cancer has spread within the colon or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment.

The following stages are used for colon cancer:

Stage 0 (Carcinoma in Situ)
In stage 0, the cancer is found in the innermost lining of the colon only. Stage 0 cancer is also called carcinoma in situ.

Stage I
In stage I, the cancer has spread beyond the innermost lining of the colon to the second and third layers and involves the inside wall of the colon, but it has not spread to the outer wall of the colon or outside the colon. Stage I colon cancer is sometimes called Dukes' A colon cancer.

Stage II
In stage II, cancer has spread outside the colon to nearby tissue, but it has not gone into the lymph nodes. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.) Stage II colon cancer is sometimes called Dukes' B colon cancer.

Stage III
In stage III, cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body. Stage III colon cancer is sometimes called Dukes' C colon cancer.

Stage IV
In stage IV, cancer has spread to other parts of the body, such as the liver or lungs. Stage IV colon cancer is sometimes called Dukes' D colon cancer.

Recurrent Colon Cancer
Recurrent colon cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the colon or in other parts of the body, such as the liver, lungs, or both.

Treatment Option Overview

There are different types of treatment for patients with colon cancer.
Different types of treatment are available for patients with colon cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used. These include the following:

Surgery
Surgery (removing the cancer in an operation) is the most common treatment for all stages of colon cancer. A doctor may remove the cancer using one of the following types of surgery:

Local excision: If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall. Instead, the doctor may put a tube through the rectum into the colon and cut the cancer out. This is called a local excision. If the cancer is found in a polyp (a small bulging piece of tissue), the operation is called a polypectomy.

Resection: If the cancer is larger, the doctor will perform a colectomy (removing the cancer and a small amount of healthy tissue around it). The doctor may then perform an anastomosis (sewing the healthy parts of the colon together). The doctor will also usually remove lymph nodes near the colon and examine them under a microscope to see whether they contain cancer.

Resection and colostomy: If the doctor is not able to sew the 2 ends of the colon back together, a stoma (an opening) is made on the outside of the body for waste to pass through. This procedure is called a colostomy. Sometimes the colostomy is needed only until the lower colon has healed, and then it can be reversed. If the doctor needs to remove the entire lower colon, however, the colostomy may be permanent.

Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be offered chemotherapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Colon cancer may be treated with external radiation.

After treatment, a blood test to measure carcinoembryonic antigen (CEA; a substance in the blood that may be increased when colon cancer is present) may be done along with other tests to see if the cancer has come back.

Other types of treatment are being tested in clinical trials. These include the following:

Biological therapy
Biological therapy is treatment to stimulate the ability of the immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options by Stage

Stage 0 Colon Cancer (Carcinoma in Situ)
Treatment of stage 0 (carcinoma in situ) may include the following types of surgery:

1.Local excision (surgery to remove the tumor without cutting through the abdominal wall) or simple polypectomy (surgery to remove the cancer from a small bulging piece of tissue).
2.Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon). This is done when the cancerous tissue is too large to remove by local excision.

Stage I Colon Cancer
Treatment of stage I colon cancer is usually the following:

Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon).

Stage II Colon Cancer
Treatment of stage II colon cancer may include the following:

1.Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon).
2.Clinical trials of chemotherapy, radiation therapy, or biological therapy after surgery.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage III Colon Cancer
Treatment of stage III colon cancer may include the following:

1.Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon), with chemotherapy.
2.Clinical trials of chemotherapy, radiation therapy, and/or biological therapy after surgery.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage IV Colon Cancer
Treatment of stage IV colon cancer may include the following:

1.Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon or to bypass the tumor).
2.Surgery to remove parts of other organs such as the liver, lungs, and ovaries where the cancer may have spread.
3.Chemotherapy.
4.Clinical trials of chemotherapy or biological therapy.
5.Radiation therapy may be offered to some patients as palliative therapy (to relieve symptoms).

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Recurrent Colon Cancer

Treatment of recurrent colon cancer depends on where the cancer has recurred (come back) and the general health of the patient. Treatment for recurrent colon cancer may include the following:

1.Surgery to remove cancer that may have spread to the liver, lungs, or ovaries.
2.Surgery to remove cancer cells that have recurred (come back) in the colon.
3.Radiation therapy as palliative therapy (to relieve symptoms).
4.Chemotherapy as palliative therapy (to relieve symptoms).
5.Clinical trials of biological therapy or chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.





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