Colorectal Cancer (Colon Cancer)

Cancer of the colon or rectum is also called colorectal cancer. Colon cancer and cancer of the rectum usually begin as a small polyp. While most colon polyps are benign, some do become cancerous. Colon cancer symptoms may include a change in bowel habits or bleeding, but usually colon cancer strikes without symptoms. That’s why it’s important to get a colon cancer screening test, such as a colonoscopy. If the cancer is found early, the doctor can use surgery, radiation, and/or chemotherapy for effective treatment. In the United States, it is the fourth most common cancer in men and women. Caught early, it is often curable. It is more common in people over 50, and the risk increases with age. You are also more likely to get it if you have :

• Polyps - growths inside the colon and rectum that may become cancerous
• A diet that is high in fat
• A family history or personal history of colorectal cancer
• Ulcerative colitis or Crohn's disease

Although the exact cause for colon and rectal cancers is unknown, there is a great deal of ongoing research being done to find out more information.  Scientists are beginning to understand the link between changes in deoxyribonucleic acid (DNA) and how the changes can cause normal cells to turn into cancer. Some genes contain instructions on how cells grow and divide and go through apoptosis (death).  Genes that result in a speeding up of cellular division are called oncogenes, genes that slow cellular division or cause apoptosis are called tumor suppressor genes.  Changes within several different genes have been linked to the development of cancers.

A small number of colorectal cancers are caused by inherited gene mutations such as; familial adenomatous polyposis (FAP), hereditary nonpolyposis colon cancer (HNPCC) and Peutz-Jeghers syndrome.

Colon cancer symptons include:

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

Surgery is the most common treatment for colorectal cancer. During surgery, the tumor, a small margin of the surrounding healthy bowel, and adjacent lymph nodes are removed. The surgeon then reconnects the healthy sections of the bowel. In patients with rectal cancer, the rectum is permanently removed. The surgeon then creates an opening (colostomy) on the abdomen wall through which solid waste in the colon is excreted. Specially trained nurses (enterostomal therapists) can help patients adjust to colostomies, and most patients with colostomies return to a normal lifestyle.

The long-term prognosis after surgery depends on whether the cancer has spread to other organs (metastasis). The risk of metastasis is proportional to the depth of penetration of the cancer into the bowel wall. In patients with early colon cancer which is limited to the superficial layer of the bowel wall, surgery is often the only treatment needed. These patients can experience long-term survival in excess of 80%. In patients with advanced colon cancer, wherein the tumor has penetrated beyond the bowel wall and there is evidence of metastasis to distant organs, the five-year survival rate is less than 10%.

In some patients, there is no evidence of distant metastasis at the time of surgery, but the cancer has penetrated deeply into the colon wall or reached adjacent lymph nodes. These patients are at risk of tumor recurrence either locally or in distant organs. Chemotherapy in these patients may delay tumor recurrence and improve survival.

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