Colorectal Cancer

Colorectal Cancer Risk Factors

Age 50 or older
Family history of colorectal cancer
Previous cancer of the colon, rectum, ovary, uterine lining or breast
History of colon polyps
History of ulcer in the lining of the large intestine
Crohn’s disease
Ashkenazi Jewish ethnicity
African American
Diet rich in red meats, processed meats and/or animal fats
Heavy alcohol consumption
Lack of exercise
Smoking (Smokers have a 30-40% higher risk of dying form colon cancer than non-smokers.)
Obesity
Diabetes (Diabetics have a 30% greater risk of getting colon cancer.)

To find out if you’re at risk for developing colorectal cancer, take this brief risk assessment.

Colorectal Cancer Warning Signs

Change in bowel habits
Blood in the stool
Diarrhea
Constipation
Bowel does not empty completely
Stools narrower than usual
Frequent gas, bloating or cramps
Unexplained weight loss
Fatigue
Vomiting

Colorectal Cancer Screening and Diagnosis

Fecal Occult Blood Test

A microscopic examination of feces is checked for blood.

Digital Rectal Exam

A physical examination of the inside of the rectum to feel for lumps or any unusual masses.

Barium Enema

A series of X-rays of the lower gastrointestinal tract taken after barium is put into the rectum to coat the gastrointestinal tract.

Sigmoidoscopy

An examination of the rectum and lower colon with a lighted fiber-optic tube inserted through the anus. In addition to looking for polyps, abnormal areas or cancer, the sigmoidoscope can often take samples of suspicious areas for biopsy. To learn more about a flexible sigmoidoscopy, watch this video.

Colonoscopy

An examination of the rectum and entire colon with a flexible lighted fiber-optic tube inserted through the anus. The colonoscope is long enough to examine the entire colon. Like a sigmoidoscope, a colonoscope can take samples of suspicious areas for biopsy In addition to looking for polyps, abnormal areas or cancer. To learn more about a colonoscopy, watch this video.

Virtual Colonoscopy

Virtual colonoscopy (or colonography) uses computed tomography to assemble a series of X-rays into a highly-detailed image of the inside of the colon. Any polyps and other unusual masses can be seen on the CT images.

Genetic Counseling

Thompson’s genetics clinic identifies individuals who are likely to have a hereditary predisposition to colon and/or uterine cancer. Individuals who are identified as at risk are offered additional counseling on the genetics of hereditary cancer, genetic testing options and risk reduction. Indications for a colon/uterine cancer genetics evaluation include:

Individuals who have had colon or uterine cancer prior to age 50.
Individuals who have had two separate colon cancers or both colon and uterine cancer at any age.
Individuals who have two close relatives with colon and/or uterine cancer at any age.
Individuals who have been diagnosed with polyposis ( > 10 polyps found in the colon) or close relatives of an individual diagnosed with polyposis.

Colon Cancer

More than 95,000 colon cancer cases are diagnosed in the United States each year. It is the third most common cancer in women and men. Click here to watch a video about colon cancer screening.

Colon Cancer Staging

After colon cancer is detected and diagnosed, tests are done to find out the extent to which it has grown or spread. The stage of the cancer is an important factor is choosing the appropriate treatment. The tests include:

Computerized Tomography Scan

A CT (or CAT) scan uses detailed X-rays from different angles – often made after the patient had drunk a dye or had it injected to make the tissues being studied show up more clearly.

Lymph Node Biopsy

All or part of a lymph node is removed for microscopic examination by a pathologist.

Complete Blood Count

Blood is checked for the number of red blood cells, white blood cells and platelets, the amount of hemoglobin in the red cells and the proportion of red cells in the blood.

Carcinoembryonic Antigen Assay

Blood levels of carcinoembryonic antigen (CEA) are tested. Higher than normal levels of CEA in the blood can indicate colon cancer.

Magnetic Resonance Imaging

In magnetic resonance imaging (or MRI) gadolinium is injected into the patient’s bloodstream and the area in which cancer is suspected is scanned using magnetism and radio waves. The scans are digitally manipulated to produce an extremely detailed images without radiation. Because of the extremely powerful magnetism of MRI scanners they cannot be used on patients with any metal implants or pacemakers.

Chest X-ray

X-rays are used to determine if colon cancer has spread into the torso.

Surgery

The tumor may be removed to see how far it has spread.

Stages of Colon Cancer

Stage 0 is cancer which has not spread past the inner lining of the colon. It is also called carcinoma in situ.

Stage I is colon cancer which has spread to the middle layers of the colon walls. This is sometimes called Dukes’ A colon cancer.

Stage IIA is colon cancer which has spread to the outer layer of the colon wall or past the colon wall to nearby tissues outside the colon.

Stage IIB is colon cancer which has spread past the colon wall into nearby organs and/or has spread through the abdominal lining.

Stage IIIA is colon cancer which has spread to the middle layer of the colon wall and has spread to from one to three lymph nodes.

Stage IIIB is colon cancer which has spread to from one to three lymph nodes and has also spread:

Past the middle layer of the colon wall to the outer layer
To nearby tissue
Into nearby organs or through the abdominal lining

Stage IIIC is colon cancer which has spread to four or more lymph nodes and has also spread:

Past the middle layer of the colon wall to the outer layer
To nearby tissue
Into nearby organs or through the abdominal lining

Stage IV is colon cancer which has spread to other parts of the body. Stage IV is sometimes called Dukes’ D colon cancer.

Recurrent colon cancer is cancer which has come back after being treated and apparently eliminated. The cancer may reappear in the colon or in other parts of the body.

Colon Cancer Treatment

The choice of colon cancer treatment or treatments will depend on the stage of the disease and the general physical condition of the patient.

Surgery

Surgery is the most frequent treatment for all stages of colon cancer.

Local Excision

If cancer is found before it has spread beyond the colon wall it can be removed without cutting through the abdominal wall. A laparoscope, which has a fiber-optic viewing device and a cutting and grasping tool, is passed up the rectum to the site of the cancer and cuts out and removes the tumor.

Polypectomy

Local excision of a cancerous polyp or polyps is called a polypectomy. The laparoscopic procedure is the same as that for small tumors on the colon wall.

Colectomy and Anastomosis

Larger tumors may require a partial colectomy, which is removal of the tumor and a section of healthy tissue surrounding it. It is often possible to reattach the sections of healthy colon, a procedure called anastomosis.

Colectomy and Colostomy

When some larger tumors are removed with a partial colectomy, it is often not possible to rejoin the cut ends of the colon. In those cases a stoma (an opening in the body) is made for waste to pass through into a colostomy bag. In some cases, the colon may be rejoined after the colon has healed. When the entire lower colon has been removed the colostomy is usually permanent.

Radiofrequency Ablation

Radiofrequency Ablation uses high intensity radio signals emitted by a small probe to kill cancer cells.

Intensity Modulated Radiation Therapy

IMRT used high-energy X-rays to destroy cancer cells. Thompson Cancer Survival Center was one of the first facilities in the world to treat patients with intensity modulated radiation therapy. Since 1998 more than 1,000 patients have received IMRT treatment at Thompson. In IMRT the multileaf collimator reshapes the treatment field between individual doses of radiation.

Cryosurgery

Cryosurgery uses a probe is inserted into the tumor to pump argon gas or liquid nitrogen in to freeze the cancerous cells. This treatment is principally used for Stage 0 colon cancer.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or block their growth. In addition to the established chemotherapy drugs.

Biological Therapy

Biological therapy for colon cancer is still in the experimental phase. This therapy uses substances made or introduced into the body to strengthen the immune system to fight cancer.

Rectal Cancer Staging

Computerized Tomography Scan

A CT (or CAT) scan uses detailed X-rays from different angles – often made after the patient had drunk a dye or had it injected to make the tissues being studied show up more clearly.

Magnetic Resonance Imaging

The area in which cancer is suspected is scanned using magnetism and radio waves. The scans are digitally manipulated to produce an extremely detailed images without radiation. Because of the extremely powerful magnetism of MRI scanners they cannot be used on patients with any metal implants or pacemakers.

Biopsy

A sigmoidoscope or colonoscope is used to remove a small sample of the tumor for microscopic analysis by a pathologist.

Endoscopic Ultrasound

An endoscope is inserted into the rectum and generates high-energy ultrasound which bounces off tissue and forms echoes which are used to form images of internal structures called sonograms. This is also called endosonography.

Stages of Rectal Cancer

Stage 0 is cancer which has not spread past the inner lining of the rectum. It is also called carcinoma in situ.

Stage I rectal cancer has spread past the inner lining of the rectum to the second or third layers, but has not spread to the outer wall or to other areas. This is sometimes called Dukes’ A rectal cancer.

Stage II rectal cancer has spread beyond the rectum, but not into the lymph nodes. This is sometimes called Dukes’ B rectal cancer.

Stage III is rectal cancer which has spread to lymph nodes, but not to other parts of the body. This is sometimes called Dukes’ C rectal cancer.

Stage IV is rectal cancer which has spread beyond the rectum to other parts of the body. This is sometimes called Dukes’ D rectal cancer.

Recurrent rectal cancer is cancer which has come back after being treated and apparently eliminated. The cancer may reappear in the rectum or in other parts of the body.

Rectal Cancer Treatment

The choice of rectal cancer treatment or treatments will depend on the stage of the disease and the general physical condition of the patient.

Surgery

Surgery is the most frequent treatment for all stages of rectal cancer.

Local Excision

If cancer is found at an early stage, it can be removed without cutting through the abdominal wall.

Polypectomy

Local excision of a cancerous polyp or polyps in the rectum is called a polypectomy. The procedure is the same as that for small tumors on the rectum wall.

Resection and Anastomosis

Larger tumors may require a resection of the rectum which is removal of the tumor and a section of healthy tissue surrounding it. It is often possible to attach the remaining section of the rectum to the anus or the colon, a procedure called anastomosis.

Resection and Colostomy

When some larger tumors are removed with a resection of the rectum it may not be possible to reattach it to the anus or colon. In those cases a stoma (an opening in the body) is made for waste to pass through into a colostomy bag. In some cases, the colostomy may be reversed after the rectum has healed. When the entire rectum has been removed the colostomy is usually permanent.

Intensity Modulated Radiation Therapy

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or block their growth.

Biological Therapy

Biological therapy for colon cancer is still in the experimental phase. This therapy uses substances made or introduced into the body to strengthen the immune system to fight cancer.