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Cancers of the Colon and Rectum
The diagnosis of cancer of the colon or rectum, also called colorectal
cancer, raises many questions and a need for clear, understandable answers. This
page provides information on the symptoms, detection and diagnosis, and
treatment, in addition to information on possible causes and prevention of
cancers of the colon and rectum. Having this important information can make it
easier for patients and their families to handle the challenges they face.
| Together, cancers of the colon and rectum are among
the most common cancers in the United States. They occur in both men and
women and are most often found among people who are over the age of 50. |
Cancer research has led to real progress against colorectal cancer -- a lower
chance of death and an improved quality of life for people with this
disease.
Understanding the Cancer Process
Cancer affects our cells, the body's basic unit of life. To understand
cancer, it is helpful to know what happens when normal cells become cancerous.
The body is made up of many types of cells. Normally, cells grow, divide, and
produce more cells as they are needed to keep the body healthy and functioning
properly. Sometimes, however, the process goes astray -- cells keep dividing
when new cells are not needed. The mass of extra cells forms a growth or tumor.
Tumors can be either benign or malignant.
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Benign tumors are not cancer. They often can be removed and, in
most cases, they do not come back. Cells in benign tumors do not spread to
other parts of the body. Most important, benign tumors are rarely a threat
to life.
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Malignant tumors are cancer. Cells in malignant tumors are
abnormal and divide without control or order. These cancer cells can invade
and destroy the tissue around them. Cancer cells can also break away from a
malignant tumor. They may enter the bloodstream or lymphatic system (the
tissues and organs that produce and store cells that fight infection and
disease). This process, called metastasis, is how cancer spreads from the
original (primary) tumor to form new (secondary) tumors in other parts of
the body.
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The Colon and Rectum
The colon and rectum are parts of the body's digestive system, which removes
nutrients from food and stores waste until it passes out of the body. Together,
the colon and rectum form a long, muscular tube called the large intestine (also
called the large bowel). The colon is the first 6 feet of the large intestine,
and the rectum is the last 8 to 10 inches.
Colon, rectum, and other parts of digestive system
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Understanding Colorectal Cancer
Cancer that begins in the colon is called colon cancer, and cancer that
begins in the rectum is called rectal cancer. Cancers affecting either of these
organs may also be called colorectal cancer.
Colorectal Cancer: Who's at Risk?
The exact causes of colorectal cancer are not known. However, studies show
that the following risk factors increase a person's chances of developing
colorectal cancer:
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Age. Colorectal cancer is more likely to occur as people get
older. This disease is more common in people over the age of 50. However,
colorectal cancer can occur at younger ages, even, in rare cases, in the
teens.
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Diet. Colorectal cancer seems to be associated with diets that are
high in fat and calories and low in fiber. Researchers are exploring how
these and other dietary factors play a role in the development of colorectal
cancer.
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Polyps. Polyps are benign growths on the inner wall of the colon
and rectum. They are fairly common in people over age 50. Some types of
polyps increase a person's risk of developing colorectal cancer.
A rare, inherited condition, called familial polyposis, causes
hundreds of polyps to form in the colon and rectum. Unless this condition is
treated, familial polyposis is almost certain to lead to colorectal cancer.
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Personal medical history. Research shows that women with a history
of cancer of the ovary, uterus, or breast have a somewhat increased chance
of developing colorectal cancer. Also, a person who has already had
colorectal cancer may develop this disease a second time.
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Family medical history. First-degree relatives (parents, siblings,
children) of a person who has had colorectal cancer are somewhat more likely
to develop this type of cancer themselves, especially if the relative had
the cancer at a young age. If many family members have had colorectal
cancer, the chances increase even more.
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Ulcerative colitis. Ulcerative colitis is a condition in which the
lining of the colon becomes inflamed. Having this condition increases a
person's chance of developing colorectal cancer.
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| Risk Factors Associated with Colorectal Cancer
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Age
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Diet
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Polyps
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Personal History
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Family History
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Ulcerative Colitis
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Having one or more of these risk factors does not guarantee that a person
will develop colorectal cancer. It just increases the chances. People may want
to talk with a doctor about these risk factors. The doctor may be able to
suggest ways to reduce the chance of developing colorectal cancer and can plan
an appropriate schedule for checkups.
Colorectal Cancer: Reducing the Risk
The National Cancer Institute supports and conducts research on the causes
and prevention of colorectal cancer. Research shows that colorectal cancer
develops gradually from benign polyps. Early detection and removal of polyps may
help to prevent colorectal cancer. Studies are looking at smoking cessation, use
of dietary supplements, use of aspirin or similar medicines, decreased alcohol
consumption, and increased physical activity to see if these approaches can
prevent colorectal cancer. Some studies suggest that a diet low in fat and
calories and high in fiber can help prevent colorectal cancer.
Researchers have discovered that changes in certain genes (basic units of
heredity) raise the risk of colorectal cancer. Individuals in families with
several cases of colorectal cancer may find it helpful to talk with a genetic
counselor. The genetic counselor can discuss the availability of a special blood
test to check for a genetic change that may increase the chance of developing
colorectal cancer. Although having such a genetic change does not mean that a
person is sure to develop colorectal cancer, those who have the change may want
to talk with their doctor about what can be done to prevent the disease or
detect it early.
Detecting Cancer Early
People who have any of the risk factors should ask a doctor when to begin
checking for colorectal cancer, what tests to have, and how often to have them.
The doctor may suggest one or more of the tests listed below. These tests are
used to detect polyps, cancer, or other abnormalities, even when a person does
not have symptoms. Your health care provider can explain more about each test.
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A fecal occult blood test (FOBT) is a test used to check for
hidden blood in the stool. Sometimes cancers or polyps can bleed, and FOBT
is used to detect small amounts of bleeding.
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A sigmoidoscopy is an examination of the rectum and lower
colon (sigmoid colon) using a lighted instrument called a sigmoidoscope.
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A colonoscopy is an examination of the rectum and entire
colon using a lighted instrument called a colonoscope.
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A double contrast barium enema (DCBE) is a series of x-rays of the
colon and rectum. The patient is given an enema with a solution that
contains barium, which outlines the colon and rectum on the x-rays.
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A digital rectal exam (DRE) is an exam in which the doctor inserts
a lubricated, gloved finger into the rectum to feel for abnormal areas.
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Recognizing Symptoms
Common signs and symptoms of colorectal cancer include:
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A change in bowel habits
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Diarrhea, constipation, or feeling that the bowel does not empty
completely
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Blood (either bright red or very dark) in the stool
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Stools that are narrower than usual
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General abdominal discomfort (frequent gas pains, bloating, fullness,
and/or cramps)
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Weight loss with no known reason
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Constant tiredness
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Vomiting
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These symptoms may be caused by colorectal cancer or by other conditions. It
is important to check with a doctor.
Diagnosing Colorectal Cancer
To help find the cause of symptoms, the doctor evaluates a person's medical
history. The doctor also performs a physical exam and may order one or more
diagnostic tests.
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X-rays of the large intestine, such as the DCBE, can reveal polyps
or other changes.
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A sigmoidoscopy lets the doctor see inside the rectum and the lower
colon and remove polyps or other abnormal tissue for examination under a
microscope.
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A colonoscopy lets the doctor see inside the rectum and the entire
colon and remove polyps or other abnormal tissue for examination under a
microscope.
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A polypectomy is the removal of a polyp during a sigmoidoscopy or
colonoscopy.
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A biopsy is the removal of a tissue sample for examination under a
microscope by a pathologist to make a diagnosis.
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Stages of Colorectal Cancer
If the diagnosis is cancer, the doctor needs to learn the stage (or extent)
of disease. Staging is a careful attempt to find out whether the cancer has
spread and, if so, to what parts of the body. More tests may be performed to
help determine the stage. Knowing the stage of the disease helps the doctor plan
treatment. Listed below are descriptions of the various stages of colorectal
cancer.
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Stage 0. The cancer is very early. It is found only in the
innermost lining of the colon or rectum.
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Stage I. The cancer involves more of the inner wall of the colon
or rectum.
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Stage II. The cancer has spread outside the colon or rectum to
nearby tissue, but not to the lymph nodes. (Lymph nodes are small,
bean-shaped structures that are part of the body's immune system.)
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Stage III. The cancer has spread to nearby lymph nodes, but not to
other parts of the body.
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Stage IV. The cancer has spread to other parts of the body.
Colorectal cancer tends to spread to the liver and/or lungs.
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Recurrent. Recurrent cancer means the cancer has come back after
treatment. The disease may recur in the colon or rectum or in another part
of the body.
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Treatment for Colorectal Cancer
Treatment depends mainly on the size, location, and extent of the tumor, and
on the patient's general health. Patients are often treated by a team of
specialists, which may include a gastroenterologist, surgeon, medical
oncologist, and radiation oncologist. Several different types of treatment are
used to treat colorectal cancer. Sometimes different treatments are combined.
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Surgery to remove the tumor is the most common treatment for
colorectal cancer. Generally, the surgeon removes the tumor along with part
of the healthy colon or rectum and nearby lymph nodes. In most cases, the
doctor is able to reconnect the healthy portions of the colon or rectum.
When the surgeon cannot reconnect the healthy portions, a temporary or
permanent colostomy is necessary. Colostomy, a surgical opening (stoma)
through the wall of the abdomen into the colon, provides a new path for
waste material to leave the body. After a colostomy, the patient wears a
special bag to collect body waste. Some patients need a temporary colostomy
to allow the lower colon or rectum to heal after surgery. About 15 percent
of colorectal cancer patients require a permanent colostomy.
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Chemotherapy is the use of anticancer drugs to kill cancer cells.
Chemotherapy may be given to destroy any cancerous cells that may remain in
the body after surgery, to control tumor growth, or to relieve symptoms of
the disease. Chemotherapy is a systemic therapy, meaning that the drugs
enter the bloodstream and travel through the body. Most anticancer drugs are
given by injection directly into a vein (IV) or by means of a catheter, a
thin tube that is placed into a large vein and remains there as long as it
is needed. Some anticancer drugs are given in the form of a pill.
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Radiation therapy, also called radiotherapy, involves the use of
high-energy x-rays to kill cancer cells. Radiation therapy is a local
therapy, meaning that it affects the cancer cells only in the treated
area. Most often it is used in patients whose cancer is in the rectum.
Doctors may use radiation therapy before surgery (to shrink a tumor so that
it is easier to remove) or after surgery (to destroy any cancer cells that
remain in the treated area). Radiation therapy is also used to relieve
symptoms. The radiation may come from a machine (external radiation) or from
an implant (a small container of radioactive material) placed directly into
or near the tumor (internal radiation). Some patients have both kinds of
radiation therapy.
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Biological therapy, also called immunotherapy, uses the body's
immune system to fight cancer. The immune system finds cancer cells in the
body and works to destroy them. Biological therapies are used to repair,
stimulate, or enhance the immune system's natural anticancer function.
Biological therapy may be given after surgery, either alone or in
combination with chemotherapy or radiation treatment. Most biological
treatments are given by injection into a vein (IV).
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Clinical trials (research studies) to evaluate new ways to treat
cancer are an appropriate option for many patients with colorectal cancer.
In some studies, all patients receive the new treatment. In others, doctors
compare different therapies by giving the promising new treatment to one
group of patients and the usual (standard) therapy to another group.
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Research has led to many advances in the treatment of colorectal cancer.
Through research, doctors explore new ways to treat cancer that may be more
effective than the standard therapy.
Side Effects
The side effects of cancer treatment depend on the type of treatment and may
be different for each person. Most often the side effects are temporary. Doctors
and nurses can explain the possible side effects of treatment. Patients should
report severe side effects to their doctor. Doctors can suggest ways to help
relieve symptoms that may occur during and after treatment.
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Surgery causes short-term pain and tenderness in the area of the
operation. Surgery for colorectal cancer may also cause temporary
constipation or diarrhea. Patients who have a colostomy may have irritation
of the skin around the stoma. The doctor, nurse, or enterostomal therapist
can teach the patient how to clean the area and prevent irritation and
infection.
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Chemotherapy affects normal as well as cancer cells. Side effects
depend largely on the specific drugs and the dose (amount of drug given).
Common side effects of chemotherapy include nausea and vomiting, hair loss,
mouth sores, diarrhea, and fatigue. Less often, serious side effects may
occur, such as infection or bleeding.
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Radiation therapy, like chemotherapy, affects normal as well as
cancer cells. Side effects of radiation therapy depend mainly on the
treatment dose and the part of the body that is treated. Common side effects
of radiation therapy are fatigue, skin changes at the site where the
treatment is given, loss of appetite, nausea, and diarrhea. Sometimes,
radiation therapy can cause bleeding through the rectum (bloody stools).
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Biological therapy may cause side effects that vary with the
specific type of treatment. Often, treatments cause flu-like symptoms, such
as chills, fever, weakness, and nausea.
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| The health care team can explain the possible side
effects of treatment. Patients should report severe side effects.
Doctors and nurses can suggest ways to help relieve symptoms that may
occur during and after treatment. |
The Importance of Followup Care
Followup care after treatment for colorectal cancer is important. Regular
checkups ensure that changes in health are noticed. If the cancer returns or a
new cancer develops, it can be treated as soon as possible. Checkups may include
a physical exam, a fecal occult blood test, a colonoscopy, chest x-rays, and lab
tests. Between scheduled checkups, a person who has had colorectal cancer should
report any health problems to the doctor as soon as they appear.
Providing Emotional Support
Living with a serious disease, such as cancer, is challenging. Apart from
having to cope with the physical and medical challenges, people with cancer face
many worries, feelings, and concerns that can make life difficult. Some people
find they need help coping with the emotional as well as the practical aspects
of their disease. In fact, attention to the emotional burden of having cancer is
often a part of a patient's treatment plan. The support of the health care team
(doctors, nurses, social workers, and others), support groups, and
patient-to-patient networks can help people feel less alone and upset, and
improve the quality of their lives. Cancer support groups provide a setting
where cancer patients can talk about living with cancer with others who may be
having similar experiences. Patients may want to speak to a member of their
health care team about finding a support group.
Questions for Your Doctor
This booklet is designed to help you get information you need from your
doctor, so that you can make informed decisions about your health care. In
addition, asking your doctor the following questions will help you understand
your condition better. To help you remember what the doctor says, you may take
notes or ask whether you may use a tape recorder. Some people also want to have
a family member or friend with them when they talk to the doctor -- to take part
in the discussion, to take notes, or just to listen.
Diagnosis
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What tests can diagnose colorectal cancer? Are they painful?
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How soon after the tests will I learn the results?
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Are my children or other relatives at higher risk for colorectal cancer?
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Treatment
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What is the stage of my cancer?
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What treatments are recommended for me?
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Should I see a surgeon? Medical oncologist? Radiation oncologist?
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What clinical trials might be appropriate?
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Will I need a colostomy? Will it be permanent?
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What will happen if I don't have the suggested treatment?
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Will I need to be in the hospital to receive my treatment? For how long?
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How might my normal activities change during my treatment?
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After treatment, how often do I need to be checked? What type of followup
care should I have?
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Side Effects
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What side effects should I expect? How long will they last?
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What side effects should I report? Whom should I call?
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The Health Care Team
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Who will be involved with my treatment and rehabilitation? What role will
each member of the health care team play in my care?
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What has been your experience in caring for patients with colorectal
cancer?
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Resources
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Are there support groups in the area with people I can talk to?
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Where can I get more information about colorectal cancer?
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National Cancer Institute Information Resources
You may want more information for yourself, your family, and your doctor. The
following National Cancer Institute (NCI) services are available to help you.
Telephone
Cancer Information Service
(CIS)
Provides accurate, up-to-date information on cancer to patients and their
families, health professionals, and the general public. Information specialists
translate the latest scientific information into understandable language and
respond in English, Spanish, or on TTY equipment.
Toll-free: 1-800-4-CANCER (1-800-422-6237)
TTY (for deaf and hard of hearing callers): 1-800-332-8615
Internet
http://cancer.gov
NCI's Web site contains comprehensive information about cancer causes and
prevention, screening and diagnosis, treatment and survivorship; clinical
trials; statistics; funding, training, and employment opportunities; and the
Institute and its programs.
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