Colorectal Cancer guide for you

Colorectal Cancer, also called colon cancer or large bowel cancer, includes cancerous growths in the colon, rectum and appendix. Many colorectal cancers are thought to arise from adenomatous polyps in the colon. The majority of the time, the diagnosis of localized colon cancer is through colonoscopy.

Certain local effects of colorectal cancer occur when the disease has become more advanced.

Colorectal cancer most commonly spreads to the liver.

Endoscopic image of Colon Cancer identified in sigmoid colon on screening colonoscopy in the setting of Crohn's disease.

Colorectal cancer can take many years to develop and early detection of colorectal cancer greatly improves the chances of a cure. The National Cancer Policy Board of the Institute of Medicine estimated in 2003 that even modest efforts to implement colorectal cancer screening methods would result in a 29 percent drop in cancer deaths in 20 years. Despite this, colorectal cancer screening rates remain Fecal occult blood test (FOBT): a test for blood in the stool.

Micrograph of an invasive adenocarcinoma (the most common type of colorectal cancer).

Colon cancer staging is an estimate of the amount of penetration of a particular cancer. It

Treatment

The treatment depends on the staging of the cancer. When colorectal cancer is caught at early stages (with little spread) it can be curable.

Curative Surgical treatment can be offered if the tumor is localized.

• In colon cancer, a more advanced tumor typically requires surgical removal of the section of colon containing the tumor with sufficient margins, and radical en-bloc resection of mesentery and lymph nodes to reduce local recurrence (i.e., colectomy).
• Curative surgery on rectal cancer includes total mesorectal excision (lower anterior resection) or abdominoperinea excision.

As with any surgical procedure, colorectal surgery may result in complications including

• wound infection, Dehiscence (bursting of wound) or hernia
• Cardiorespiratory complications such as myocardial infarction, pneumonia, arrythmia, pulmonary embolism etc

Chemotherapy is used to reduce the likelihood of metastasis developing, shrink tumor size, or slow tumor growth. In colon cancer, chemotherapy after surgery is usually only given if the cancer has spread to the lymph nodes (Stage III).

• Colon cancer
• pain relief and palliation - targeted at metastatic tumor deposits if they compress vital structures and/or cause pain
• Rectal cancer
• adjuvant - where a tumor perforates the rectum or involves regional lymph nodes (AJCC T3 or T4 tumors or Duke's B or C tumors)

Bacillus Calmette-Guérin (BCG) is being investigated as an adjuvant mixed with autologous tumor cells in immunotherapy for colorectal cancer.

Phase III trials are underway for renal cancers and planned for colon cancers.

Treatment of liver metastases

Patients with colon cancer and metastatic disease to the liver may be treated in either a single surgery or in staged surgeries (with the colon tumor traditionally removed first) depending upon the fitness of the patient for prolonged surgery, the difficulty expected with the procedure with either the colon or liver resection, and the comfort of the surgery performing potentially complex hepatic surgery.

Support Therapies

Cancer diagnosis very often results in an enormous change in the patient's psychological wellbeing.

Survival rates for early stage detection is about 5 times that of late stage cancers.

The U.S. National Comprehensive Cancer Network and American Society of Clinical Oncology provide guidelines for the follow-up of colon cancer.

Most Colorectal Cancer arise from adenomatous polyps.

The Task Force acknowledged that aspirin may reduce the incidence of colorectal cancer, but "concluded that harms outweigh the benefits of aspirin and NSAID use for the prevention of colorectal cancer". A second randomized controlled trial reported reduction in all cancers, but had insufficient colorectal cancers for analysis.