Colon and Rectal Cancer

1. What is colon?

A colon, also called the large intestine or large bowel, is part of the body’s digestive system. The colon is a muscular tube about five feet long and three inches wide. During digestion, food moves from the stomach to the small intestine and then to the colon. The colon absorbs water and nutrients from the body’s waste, creates stool and then pushes that stool into the rectum.

2. What is the differences between colorectal, colon and rectal cancer?

Colorectal cancer is the term used to describe cancer of the colon and/or rectum. The two cancers are grouped together because they share many common characteristics. Together, the colon and rectum make up the large intestine, a question mark-shaped bowel four feet in length. Colon cancer develops in all but the last few inches of the large intestine, between the appendix and rectum. Rectal cancer develops in the rectum, the last few inches of the large intestine that attaches to the anus. Colon cancer is more common.

3. What are polyps?

A polyp is a clump of cells that forms on the lining of the colon giving rise to swelling that project from wall of colon into lumen of colon. Most polyps are not harmful, but some may develop into colon cancer. Colonoscopies can help detect pre-cancerous polyps

4. What are sign and symptoms of colon cancer?

Colorectal cancer may develop when benign polyps in the large intestine grow and become cancerous. If early-stage colorectal cancer does cause symptoms, early warning signs may include sudden weight loss and/or narrow, ribbon-like stools. Other common early warning signs of colorectal cancer include:

  1. Rectal bleeding, either bright or dark red in color
  2. Tenesmus, which is the feeling that you have to empty your bowel but nothing passes
  3. Anemia caused by iron deficiency
  4. Persistent abdominal pain

As the cancer grows, symptoms may include:

  1. Abdominal pain or cramps
  2. Constipation
  3. Diarrhea
  4. Blood in your stool
  5. Bloating or a sense of not feeling empty after a bowel movement
  6. Flat or ribbon-shaped stool
  7. Unexplained weight loss
  8. Fatigue
  9. Loss of appetite

5. What are risk factors for colon cancer?

A risk factor is something that increases your chances of getting a disease. Having a risk factor does not mean that you will definitely get a disease, only that you and your doctor should watch more carefully for warning signs. Some risk factors can be avoided through lifestyle changes and some cannot. Some of the risk factors for colon cancer include:

  1. Age 50 or older
  2. Type-II diabetes
  3. Personal or family history of colon cancer or polyps
  4. Personal history of inflammatory bowel disease
  5. Some inherited genetic syndromes
  6. Diet high in fat and/or low in fiber or calcium
  7. Obesity
  8. Smoking
  9. Heavy drinking
  10. Physical inactivity

6. How is colon cancer diagnosed?

Doctors use many tools and techniques to diagnose colon cancer including:

  1. History and physical examination by a physician
  2. Testing blood and stool
  3. Performing colonoscopies
  4. Performing CT scans, PET scans, MRIs, endoscopies, and ultrasounds

7. How can we prevent / decrease risk of colon cancer?

The risk factors for colorectal cancer may be reduced with regular checkups and lifestyle changes. In western countries it is recommended that men and women have a colonoscopy beginning at age 50 as the rates of cancer are higher in west. If you have a family history of colorectal cancer, you should get screened 10 years earlier than when your family member was diagnosed. For example, if your father was diagnosed with colon cancer at 48, you should talk to your doctor about getting a colonoscopy at 38. Talk to your doctor about how often you should get a colonoscopy. The procedure may be able to help your doctor spot cancer in its early stages. Pre-cancerous polyps are removed and biopsies are performed during the procedure, if necessary.
Changes in your lifestyle may also help you lower your risk and prevent colorectal cancer from developing. Obesity, smoking, alcohol, diet and a sedentary lifestyle have been linked to an increased risk for colorectal cancer

8. Is colon cancer hereditary?

Colorectal cancer isnt always passed down in families, but it can be. If someone in your family has had colorectal cancer, you may be more likely to develop it.

Colorectal cancer can sometimes be caused by Lynch syndrome, a genetic condition also called hereditary nonpolyposis colorectal cancer (HNPCC). About one in 30 colorectal cancer cases are a result of Lynch syndrome. Patients with Lynch syndrome tend to get colorectal cancer at a younger age than others, with a higher likelihood of developing other types of cancer as well, such as:

  • Stomach cancer
  • Liver Cancer
  • Ovarian Cancer
  • Uterine Cancer

9. How is colon cancer treated?

Surgery is the most common form of treatment for colorectal cancer. Surgery is used to remove the tumor and surrounding tissue. A portion of the colon or rectum may need to be removed, and a colostomy( part of colon is brought out through abdominal wall and bag if fixed over it in which stool gets collected) may be required—permanently or temporarily, depending on the extent of the cancer and how much of the colon or rectum is removed. Other treatment options include chemotherapy and/or targeted therapy drugs, which may also be used in addition to surgery. Radiation therapy is usually an option only for rectal cancer, not colon cancer.

10. What types of doctors will I see during my treatment?

Your colorectal cancer care team may include one or more of these doctors:

  • A gastroenterologist, who specializes in the digestive system and performs colonoscopies
  • Surgical gastroenterologist/ GastroIntestinal Surgeon – who performs surgery to remove tumors and provide best functional outcome e.g pouch formation in case of hereditary cancers. If disease is early only surgery can be curative.
  • A radiation oncologist, who uses radiation therapy to treat cancer
  • A medical oncologist, who treats cancer with drug therapies.

Surgery is the mainstay of treatment in colon cancer. Preoperative chemoradiation is used in rectal cancer in locally advanced cases. Surgeon can assess the local stage of disease on scans and thus can plan upfront surgery or chemoradiation. Postoperative chemotherapy/radiation therapy is decided after final stage of disease is determined after examining removed specimen.

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