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Colon and Rectal Cancer

Colorectal cancer is cancer that develops in the tissues of the colon and/or rectum. The colon and the rectum are both found in the lower part of the gastrointestinal (digestive) system. They form a long, muscular tube called the large intestine (or large bowel). The colon absorbs food and water and stores waste. The rectum is responsible for passing waste from the body.

If the cancer began in the colon, which is the first four to five feet of the large intestine, it may be referred to as colon cancer. If the cancer began in the rectum, which is the last several inches of the large intestine leading to the anus, it is called rectal cancer.

Colorectal cancer starts in the inner lining of the colon and/or rectum, slowly growing through some or all of its layers. It typically starts as a growth of tissue called a polyp. A particular type of polyp, called an adenoma, can then develop into cancer.

Types of colorectal cancer

Adenocarcinoma is the most common type of colorectal cancer. Other colorectal cancers include gastrointestinal carcinoid tumors, gastrointestinal stromal tumors, primary colorectal lymphoma, leiomyosarcoma, melanoma and squamous cell carcinoma.

Colorectal cancer symptoms

Colorectal cancer signs and symptoms can be broken down into two general categories: local and systemic.

Local colorectal cancer symptoms

Local symptoms are those that have a direct effect on the colon or rectum. If you experience symptoms of colorectal cancer for an extended period of time, it is important that you visit your healthcare professional. Common local symptoms include:

  • Changes in your bowel habits
  • Constipation
  • Diarrhea
  • Alternating diarrhea and constipation
  • Rectal bleeding or blood in your stool
  • Abdominal bloating, cramps or discomfort
  • A feeling that your bowel doesn’t empty completely
  • Stools that are thinner than normal

Systemic colorectal cancer symptoms

Systemic colorectal cancer symptoms are those that affect your entire body. If you experience any of these for any length of time, even for only a couple of days, it is important to have your doctor or healthcare provider diagnose your symptoms. Common systemic symptoms of colorectal cancer include:

  • Unexplained weight loss
  • Unexplained loss of appetite
  • Nausea or vomiting
  • Anemia
  • Jaundice
  • Weakness or fatigue

Colorectal cancer risk factors

GENERAL

  • Age: Although colorectal cancer can occur at any age, the chances of developing the disease dramatically increase after the age of 50.
  • Racial and ethnic background: African Americans have the highest incidence of this disease in the United States. Ashkenazi Jews also have a higher risk of developing colorectal cancer.

BODY

  • Obesity: Being overweight increases your risk of developing colorectal cancer.

GENETICS

  • Family history of colorectal cancer: Although the reasons are not clear in all cases, inherited genes, shared environmental factors, or a combination of these factors can increase your colorectal cancer risks.
  • Inherited syndromes: The two most common inherited syndromes linked with colorectal cancers are familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC). Other syndromes that can increase the risk of developing colorectal cancer include Lynch Syndrome, Turcot Syndrome and Peutz-Jeghers Syndrome.

LIFESTYLE

  • Diet: Diets that are high in red and processed meats (e.g., beef, lamb, hot dogs) can increase your colorectal cancer risks. Frying, grilling, broiling or other methods of cooking meats at very high temperatures create chemicals that may also contribute to an increased risk.
  • Inactive lifestyle: Individuals that live a sedentary lifestyle without physical activity have an increased chance of developing colorectal cancer.
  • Smoking: Some of the cancer-causing substances associated with smoking are swallowed and can increase the risk of developing this disease.
  • Alcohol use: Heavy alcohol use can lead to an increased risk of colorectal cancer.

OTHER CONDITIONS

  • Personal history of colorectal cancer or polyps: If you have had colorectal cancer before, you are more likely to develop cancer in other areas of the colon and rectum.
  • History of inflammatory bowel disease (IBD): Having IBD, including ulcerative colitis and Crohn’s disease, increases your chances for developing colorectal cancer.
  • Type II diabetes: There may be an increased risk for rectal cancer associated with type II diabetes. This condition may also affect the prognosis (outlook).

Colorectal cancer stages

Making an educated treatment decision begins with the stage, or progression, of the disease. The stage of colorectal cancer is one of the most important factors in evaluating treatment options.

Our cancer doctors use a variety of diagnostic tests to evaluate colorectal cancer and develop an individualized treatment plan. If you have been recently diagnosed, we will review your pathology to confirm you have received the correct diagnosis and staging information, and develop a personalized treatment plan. If you have a recurrence, we will perform comprehensive testing and identify a treatment approach that is suited to your needs.

The most commonly used colorectal cancer staging system is known as the TNM system, which has been established by the American Joint Committee on Cancer. The TNM staging system looks at three key factors to determine the stage of cancer:

  • Tumor (T) looks at how far the primary tumor has grown into the wall of the colon or rectum, and if it has expanded into nearby areas.
  • Lymph node (N) examines the extent of the cancer spread to nearby lymph nodes.
  • Metastasis (M) refers to whether cancer has spread to other parts of the body, such as the liver, lungs or brain.

A number (0-4) or the letter X is assigned to each factor. Using this colorectal cancer staging system, a higher number indicates increasing severity. For instance, a T1 score indicates a smaller tumor than a T2 score. The letter X means the information could not be assessed.

Once the T, N and M scores have been assigned, an overall stage is determined, and thus treatment options can be explored.

Treatment strategies

Early stage – surgery + or – chemotherapy

Locally advanced – surgery + chemotherapy

Advanced stage – chemotherapy + or – surgery

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