WHAT IS COLON CANCER?
The colon makes up the first 4 to 5 feet of the large intestine. Colon cancer begins with abnormal cell growths (also called polyps) that form the inner lining of the colon. As mutations continue to develop within these cells, they can start to become invasive cancer. These cancer cells can invade into the wall of the colon, spread to lymph nodes, or to other organs.
Each year, over 150,000 cases of colorectal cancer are diagnosed in the U.S and about 1 in 20 (5%) Americans will develop colorectal cancer throughout their lifetime. Colorectal polyps are present in about 20% to 30% of American adults.
WHAT ARE THE RISK FACTORS FOR COLON CANCER?
It is often difficult to explain the exact cause of colorectal cancer and why one person develops this disease while others do not. However, the understanding of certain genetic causes continues to expand. The following factors can heighten the risk of colorectal cancers.
Modifiable risk factors. These are behaviors that can be altered or changed based on lifestyle or dietary factors.
They include:
- Obesity
- Smoking
- Heavy alcohol use
- Poorly controlled diabetes
- Sedentary lifestyle
- Unhealthy diet
Non-modifiable risk factors. These are characteristics that cannot be controlled. These include:
- Family history of colon cancer
- Family history of polyps
- Age: Colorectal cancer becomes more common as we age.
- Hereditary disorders or other genetic factors
- Inflammatory bowel disease
- Personal history of breast, uterine, or ovarian cancer
CAN COLON CANCER BE PREVENTED?
Colon cancer is often preventable. The best first step in preventing colon cancer is undergoing a screening test such as a colonoscopy. Screening for colon cancer should begin for all adults who are average risk at age 45. Those who are at higher risk and/or have a close relative with colorectal cancer should start screening earlier.
Almost all instances of colorectal cancer develop from polyps. Detecting and removing these abnormal growths through colonoscopies reduces the risk of cancer maturing. A colonoscopy entails direct examination of the entire large intestine’s inner lining using a flexible, illuminated instrument. There is some evidence that diet may play an important role in preventing colorectal cancer. A high fiber (fruits, whole grains, vegetables, and nuts) and low-fat diet may help prevent the development of colorectal cancer.
WHAT ARE THE SYMPTOMS OF COLON CANCER?
Colon cancers often present with no symptoms and are identified during routine screening exams. Individuals experiencing the following symptoms should seek medical attention promptly to be diagnosed and treated as early as possible.
Symptoms of colon cancer include:
- Altered bowel habits such as constipation, diarrhea, or frequency of bowel movements
- Sometimes blood can appear as bright red or black, tar-like in stool
- Narrow or thin shaped stools
- Ongoing abdominal or pelvic pain and bloating
- Unintentional weight loss, not explained by intentional dieting
- Nausea or vomiting
- Feeling tired all the time
HOW IS COLON CANCER DIAGNOSED
Colonoscopy is the primary method for diagnosing colon cancer, although other tests can indicate the presence of the disease. During colonoscopy, any abnormal growth (such as a polyp, mass, or tumor) is biopsied for cancer cells. A pathologist checks the removed tissue or cells for cancer using a microscope and special stains. Conducting a physical exam and understanding a patient’s medical history is also important in diagnosis. There are currently no reliable blood tests for diagnosing colon cancer.
HOW IS COLON CANCER EVALUATED AND STAGED?
The stage of colon cancer is based on whether the tumor has invaded into the colon, wall lining, spread to lymph nodes, or spread to other organs (lungs/liver).
The following tests may be performed for staging:
· Blood tests: These can include complete cell counts (to check for anemia), standard blood chemistries and CEA (carcinoembryonic antigen) level. CEA is a substance in the blood that may rise in the presence of cancer. There are newer blood tests that detect abnormal DNA produced by cancer cells. Ask your oncologist about these specific tumor markers.
· CT (computed tomography) scan: A highly sensitive radiographic machine able to take a series of detailed pictures of the inside of the body. A CT scan can detect whether cancer has spread to the liver, lungs, or other organs.
· PET (positron emission tomography) scan: An imaging test that uses a specialized dye containing radioactive tracers. This enables physicians to identify the majority of cancer cells that have spread beyond the colon.
· MRI (magnetic resonance imaging): An imaging test utilizing a magnetic field and pulses of radio wave energy to generate pictures of organs and structures inside the body. This aids in determining if the tumor has spread through the rectum wall and invaded nearby structures.
Doctors describe colorectal cancer by the following stages:
Stage 0: The cancer is only found in the innermost lining of the colon or rectum. It may also be referred to as “Carcinoma in situ”.
Stage I: The tumor has spread into the inner lining of the colon or rectum. The tumor has not penetrated the wall.
Stage II: The tumor penetrates through deeper layers of colon or rectum wall. It may invade nearby tissue, but the lymph nodes are free of cancer cells.
Stage III: The cancer involves nearby lymph nodes, without affecting other parts of the body.
Stage IV: The cancer has metastasized to other parts of the body, such as the liver or lungs.
Often, staging is not finalized until after surgery to remove the tumor, allowing for microscopic evaluation of the lymph nodes for cancer.
HOW IS COLON CANCER TREATED?
Surgery is almost always required to remove the colon cancer for a complete cure. The small portion of the colon surrounding the tumor is removed along with the tumor and lymph nodes. Very rarely, a colostomy can be performed by creating an opening in the abdominal wall that connects a part of the colon through the skin.
Chemotherapy can be advised before or after surgery based on the stage of the cancer. Radiation therapy is rarely used for colon cancer, unlike rectal cancer.
WHAT IS THE FOLLOW-UP AFTER SURGERY FOR COLON CANCER?
Follow-up care after treatment for colon cancer is essential. Chemotherapy is normally recommended for patients in whom colon cancer is found in the lymph nodes (stage III) or distant locations (stage IV). Chemotherapy kills cancer by using anticancer drugs and studies have shown that it improves long-term survival by reducing the risk of cancer recurrence. A colonoscopy is conducted one-year post-surgery. The frequency of future exams depends on the findings of the previous exam. Your oncologist will monitor your recovery by performing blood tests, clinical exams, and imaging tests based on the stage of cancer.
ABOUT COLON AND RECTAL SPECIALISTS
Colon and Rectal Specialists was founded in 1913. We are a group of dedicated fellowship-trained colorectal surgeons. We are experts in the surgical and non-surgical treatment of diseases of the colon, rectum and anus. Our surgeons have all completed advanced surgical training in the treatment of these diseases in addition to full general surgical training. We are well-versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions if indicated to do so.
ABOUT C.A.R.E.S. CENTER
Colon and Rectal Endoscopy and Surgery (CARES) Center is our state-of-the-art Ambulatory Surgery Center. Our center has been accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) and has been given Medicare Deemed Status by CMS. We perform a variety of services including: screening colonoscopies, hemorrhoidectomy, abscess and fistula surgery, fissure surgery, pilonidal surgery, and surgery to treat fecal incontinence.
Call today for a consultation or to schedule an appointment at one of our 3 Richmond area locations. Stony Point (804) 249-2465, Hanover (804) 559-3400, or West End (804) 288-7077
