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What Is It?
Colon cancer is cancer of the large intestine or the rectum, and is often called colorectal cancer.
Colorectal cancer is one of the most common cancers in the United States. About one in 23 women (one in 21 men) will develop cancer of the colon or rectum in their lifetimes. It also is the second leading cause of cancer deaths when men and women are considered together and is the third leading cause of cancer death among women.
There are regional differences in colorectal cancer's incidence and mortality throughout the country, with the lowest rates occurring among those living in Western states, and survival rates lowest among African Americans.
The good news is that the disease is not only highly beatable and treatable, but also highly preventable. Regular screening and removal of polyps can reduce colorectal cancer risk by up to 90 percent. But unfortunately, fear, denial and embarrassment keep many people from being screened.
When colon cancer is caught and treated in stage I, there is a 92 percent chance of survival at five years. Once the cancer is larger and has spread to the lymph nodes, however, the five-year survival rate drops to between 53 and 89 percent, depending on the number of nodes involved. If the cancer has already spread to distant parts of the body such as the liver or lungs, the five-year survival rate goes down to 11 percent. Click here for more on staging and survival rates.
The large intestine is the last section of the digestive tract and consists of the colon and rectum. The colon is four to six feet long, and the last seven to nine inches of it is called the rectum. After food is digested in the stomach and nutrients are absorbed in the small intestine, waste from this process moves into the colon, where it solidifies and remains for one or two days until it passes out of the body.
Sometimes the body produces tissue too rapidly, ultimately forming a tumor. These tumors can be benign (not precancerous), precancerous or malignant (cancerous). In the large intestine, these growths are called polyps. Polyps are found in about 30 percent to 50 percent of adults. People with polyps in their colon tend to continue producing new polyps even after existing polyps are removed.
There are several types of polyps, the most common being hyperplastic polyps, adenomatous polyps, sessile serrated polyps and malignant polyps. Hyperplastic polyps are typically not precancerous. Adenomatous polyps (also called "adenomas") and sessile serrated polyps may undergo cancerous changes, becoming adenocarcinomas. Malignant polyps are already cancerous.
Colon cancers develop from precancerous polyps that grow larger and eventually transform into cancer. It is believed to take about 10 years for a small precancerous polyp to grow into cancer. Therefore, if appropriate colorectal cancer screening is performed, most of these polyps can be removed before they turn into cancer, effectively preventing the development of colon cancer.
Besides adenocarcinomas, there are other rare types of cancers of the large intestine, including carcinoid tumors typically found in the appendix and rectum; gastrointestinal stromal tumors found in the connective tissue of the colonic or rectal wall; and lymphomas, which are malignancies of immune cells that can involve the colon, rectum and lymph nodes.
Risk Factors
The exact cause of colon cancer is unknown, but it appears to be influenced both by hereditary and environmental factors. People at an increased risk of colon cancer include those with either a personal or family history of colorectal cancer or polyps, individuals with a long-standing history of inflammatory bowel disease and people with familial colorectal cancer syndromes. Some of those at high risk may have a 100 percent chance of developing colorectal cancer.
Specific risk factors include:
Screening Tests
The United States Preventive Services Task Force (USPSTF) recommends all women and men between the ages of 50 and 75 who are at average risk of colorectal cancer get screened for colon cancer.
The USPSTF says that screening in adults between 76 and 85 years should be an individual decision based on the patient's overall health and screening history. People at increased risk for colon cancer due to a personal or family history of colorectal cancer, certain genetic conditions, previous growths in the colon or rectum, or a history of inflammatory bowel disease should talk to their doctors about getting screened before age 50. The American College of Gastroenterology screening guidelines recommend starting screening of average-risk African Americans at age 45.
Here are the screening options: Keep in mind these tests differ in their pros and cons. Talk to your doctor about the screening test that is right for you.
Most women find sigmoidoscopies and colonoscopies much more tolerable than they expect. Worrying about the process and undergoing the necessary bowel preparation beforehand are often more unpleasant than the exam itself. Of the above-mentioned tests, colonoscopy is the preferred screening/prevention test, and FIT is the preferred test for patients who decline invasive cancer prevention tests.
Other tests that your health care provider might perform include:
If there is a reason to suspect that you have colorectal cancer, your health care professional will take a complete medical history and perform a physical examination as part of an initial evaluation.
Symptoms
Symptoms of colorectal cancer include:
Contact your health care professional if you experience one or more of these symptoms. Keep in mind that colon cancer often causes no symptoms in the early stages, when it's most treatable. That's why it's important to get routine screenings.
Because the symptoms of colon cancer are vague and typically occur late in the development of the cancer, a variety of tests are used to both screen and diagnose the disease. Screening tests look for disease in those who look and feel healthy, ideally catching the disease as early as possible or, in the case of colon cancer, even before the precancerous lesion has turned into cancer. Diagnostic tests look for the cause and determine the extent of the disease in someone who has obvious symptoms.
A bowel preparation is often required before many of these tests, especially a colonoscopy. This involves cleaning out your bowel the night before the test with a laxative solution. It is important that the bowel be clean so the physician performing the colonoscopy gets the best look at your colon. Since some preparations can affect your blood level for certain electrolytes, your health care professional will tell you which preparation to use for your procedure.
Diagnostic Tests
Colorectal Cancer Stages
As with all cancers, there are various stages of colon cancer:
Surgery is often required to treat colorectal cancer. The surgical procedure used depends on where the cancer is located. Most patients who undergo surgery for colon cancer have an open abdominal operation, where the surgeon makes an incision in the abdomen and removes the tumor and any affected lymph nodes. In some cases, however, a procedure called laparoscopic colon cancer resection may be used. Like open abdominal surgery, laparoscopic surgery is performed under general anesthesia, but multiple, much smaller incisions are made, which leads to a shorter recovery time. Studies have shown similar results when open abdominal and laparoscopic techniques are used to remove colon cancer. A surgeon experienced at laparoscopic surgery should perform these surgeries.
Occasionally, early cancerous changes may be limited to a portion of an otherwise noncancerous polyp. In these cases, it is sometimes possible to remove some very early colon cancers during a colonoscopy.
If part of the colon needs to be removed due to a larger cancerous tumor, the surgeon will remove the affected portion and leave as much of the healthy colon behind as possible. In rectal cancer, the rectum is removed.
In many cases, the surgeon will be able to reconnect the healthy portions of the colon and rectum, which allows waste to flow through the colon to the rectum. If this is not possible, you may need to have a colostomy. A colostomy (stoma) involves creating a hole in the wall of abdomen to which an end of your colon is attached so you can eliminate waste into a special bag. Depending on the situation, a colostomy may be temporary or permanent.
You may be referred to an enterostomal therapist (a health care professional, often a nurse, trained to help people with their colostomies) as part of your initial workup. The enterostomal therapist can address concerns about how a colostomy might affect your daily activities.
Even after colon cancer has been completely removed with surgery, cancer cells can remain in the body and cause relapse. To kill these cells and decrease the chances of a relapse, health care professionals use chemotherapy. Not all people need chemotherapy after surgery. Those most likely to receive chemotherapy are people at risk for recurrence, namely, those with stage III colon cancer or high risk stage II.
For some rectal cancers, chemotherapy is given along with radiation therapy in an attempt to shrink the tumor before surgery. This is called neoadjuvant chemotherapy.
Several chemotherapy drugs are used to treat colon cancer. In many cases, two or more of these drugs are combined for more effective treatment:
Individuals with advanced colon cancer may receive targeted drugs that help stop cancerous tumors from growing. These drugs include bevacizumab (Avastin), cetuximab (Erbitux) and panitumumab (Vectibix). They may be given alone or together with chemotherapy.
Not all people benefit from targeted medications. Researchers are currently examining who are most likely to respond. Until then, health care professionals will continue to weigh the risks and benefits of targeted drugs before they prescribe them for people with advanced disease.
Radiation therapy may benefit some people with rectal cancer, but it is not usually used in the treatment of early stage colon cancer. Like chemotherapy, radiation may be helpful for patients who are at high risk of cancer recurrence, for instance if the cancer has spread to nearby organs. In general, the goal of radiation is to reduce chances of colon cancer recurrence rather than to improve survival.
For those whose colorectal cancer has metastasized to a few areas in the liver, lungs or elsewhere in the abdomen, surgically removing or destroying these metastases can increase survival.
If the cancer comes back in only one part of the body, you may need surgery again. If it has spread to several parts of the body, you may receive chemotherapy and/or radiation therapy.
The most important line of defense against colorectal cancer is screening for colorectal cancer. You should follow the established guidelines for screening procedures so that any precancerous polyps can be removed before they turn into cancer and, if cancer exists, it can be detected at the earliest possible stage. Talk to your health care provider about the best screening method for you, including your willingness to complete the screening and follow-up as recommended.
If you are at average risk of colorectal cancer, the American Cancer Society recommends that all women and men over the age of 50 undergo one of the following:
Any positive screening test should be followed by an appropriate and complete diagnostic evaluation of the colon including a colonoscopy with biopsies, if necessary.
If you are at an increased risk of colorectal cancer or adenomas because of a family history of cancer or polyps, you should follow the above recommendations and also:
If you are at an increased risk for colorectal cancer for a reason other than family history, such as a personal history of inflammatory bowel disease, you may also need to begin screening before age 50. Screening recommendations vary based on your particular risk factors; discuss your individual screening schedule with your health care professional.
Modifying your diet and exercise may help decrease your risk of forming colon polyps and/or colon cancer. A diet rich in vegetables, fruit and fiber and low in fat may reduce the risk of developing colon cancer. Some suggest that increasing intakes of calcium and vitamin D can help prevent colon cancer. (Men should keep their intake below 1,500 milligrams because of the increased risk of prostate cancer associated with high levels of calcium.) Calcium can be found in dairy products, calcium-fortified products such as orange juice, soy and dark green vegetables. Other research has shown that taking a multivitamin containing folic acid (a B complex vitamin) decreases the risk of colon cancer, but other studies show folic acid may help existing tumors to grow, so more study is needed. There is some research suggesting that a diet high in magnesium may decrease colon cancer risk, especially in women. More research is necessary to find out if this link exists.
Regular exercise is important in preventing colon cancer. Experts say that vigorous exercise is not necessary. Instead, just incorporate more activity into your daily routine, such as taking the steps instead of the elevator or parking your car farther from the building you are entering. Overall, the American Cancer Society recommends 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity per week.
It is also advisable to drink alcohol only in moderation (no more than one alcoholic beverage per day for women, for a total of less than seven drinks per week, and no more than two alcoholic beverages for men, for a total of less than 14 drinks per week) and abstain from tobacco use.
Results from multiple studies show that people who regularly take aspirin and other non-steroidal anti-inflammatory medications (NSAIDS) have a lower risk of colorectal cancer and adenomatous polyps. However, the risk of stomach ulcers and other side effects associated with aspirin and NSAIDS may outweigh the benefits. Therefore, experts do not recommend people at average risk of colorectal cancer take NSAIDS as a prevention strategy. There may be some value of NSAIDS in people at increased risk of colorectal cancer, which is being studied. The drug celecoxib (Celebrex) has been approved by the United States Food and Drug Administration (FDA) for reducing polyps in people with FAP. Celebrex may cause less bleeding in the stomach than other NSAIDs, but it may increase risk for heart attack and stroke.
Discuss the potential risks and benefits of taking NSAIDS with your health care professional.
Review the following Questions to Ask about colon cancer so you're prepared to discuss this important health issue with your health care professional.
First, realize the disease is highly curable when diagnosed early. When the cancer spreads to other distant places like the lung or liver, however, the survival rate is less than 10 percent. A family history of colon cancer or adenomatous polyps significantly increases your chances of developing the disease, and the more family members you have with colon cancer, the higher your risk. Make an appointment with your health care professional now to discuss your personal and family health history and to determine the next steps you should take. You will need to have colorectal cancer screening starting at the age of 40 or 10 years before the age at which the youngest relative was diagnosed with cancer, whichever is earlier. You will probably have regular surveillance of your colon by colonoscopy.
Most important is to ask your health care professional about colorectal cancer screening beginning at age 50 (45 for African Americans) if you are at average risk or earlier if you have family members (such as your father, mother, sister or brother) who had colorectal polyps or cancer. If you undergo appropriate screening for colorectal cancer, you may decrease your risk of death from colorectal cancer by 90 percent. This is because physicians can detect and remove precancerous polyps before they turn into cancer, most effectively by colonoscopy. Talk to your health care provider about choosing the screening option that is best for you. Research increasingly suggests that a diet high in fiber, fruits and vegetables and low in fat may help reduce your risk for colon cancer. Losing weight if you are obese may decrease your risk of colorectal cancer. Taking calcium and vitamin D may prevent formation of precancerous polyps and colon cancer. And getting regular exercise may help, too.
There are many factors that can influence this choice, and you and your health care provider will want to make the decision together. The U.S. Preventive Services Task Force (USPSTF) recommends screening for everyone age 50 years through 75 years. From age 76 to 85, screening is an individual decision, factoring in your overall health and screening history. Studies have shown that no screening method is decidedly more effective than others—they all have strengths and limitations. The USPSTF encourages health care providers to talk with their patients about what screening strategy they are most likely to complete. This can depend on your personal preferences, as well as access to the various methods. For example, colonoscopy requires a significant commitment over a short time to complete the preparation, procedure and recovery, but the time between screenings is greater than with stool-based screening. Stool-based screening is quick, noninvasive and can be done at home, but it requires you to handle your feces to send them to the lab. Flexible sigmoidoscopy combined with annual fecal immunochemical test may appeal if you want the reassurance from endoscopic screening but want to avoid colonoscopy. The best method for you is the one you and your health care provider select.
No one really knows if cancer is totally cured. But it is sometimes pushed back so far it never grows again, which is called achieving remission or long-term survival. Your chances of surviving for a long time largely depend on the stage of your cancer at the time of diagnosis and the success of treatments you receive. The earlier the cancer is detected, the higher your chances for long-term survival.
Any number that a health care professional gives you is based on estimates derived from experiences with other patients. No one can tell you what your specific chances are. Survival averages are just that: averages.
One of the worst things that cancer patients do is to suffer pain when they do not have to! Discuss your pain with your health care professional so that you can get the relief you need. It might be necessary to see a pain specialist. Most health care professionals can refer you to someone who specifically handles chronic pain problems. If you have severe pain, narcotics may be the best type of medicine.
No one is really sure what causes colorectal cancer. It's very unlikely that it was something you did. The tendency to get the disease may be hereditary, that is, it may run in families. A polyp in your colon can take as many as 10 years to become cancerous. Colorectal cancer is difficult to find without regular screening and often does not cause symptoms until it's already well developed. So, don't beat yourself up that you didn't "catch" it a few months ago.
Organizations and Support
For information and support on coping with Colon Cancer, please see the recommended organizations, books and Spanish-language resources listed below.
American Cancer Society (ACS)
Website: http://www.cancer.org
Address: 250 Williams Street
Atlanta, GA 30303
Hotline: 1-800-ACS-2345 (1-800-227-2345)
Phone: 404-315-1123
American College of Gastroenterology
Website: https://gi.org/
Address: P.O. Box 342260
Bethesda, MD 20827
Phone: 301-263-9000
American Institute for Cancer Research
Website: http://www.aicr.org
Address: 1759 R Street, NW
Washington, DC 20009
Hotline: 1-800-843-8114
Phone: 202-328-7744
Email: aicrweb@aicr.org
Association of Cancer Online Resources, Inc.
Website: http://www.acor.org
Address: 173 Duane Street, Suite 3A
New York, NY 10013-3334
Phone: 212-226-5525
Cancer Care, Inc.
Website: http://www.cancercare.org
Address: 275 Seventh Ave., Floor 22
New York, NY 10001
Hotline: 1-800-813-HOPE (1-800-813-4673)
Phone: 212-712-8400
Email: info@cancercare.org
Cancer Information and Counseling Line (CICL)
Address: AMC Cancer Research Center
1600 Pierce Street
Denver, CO 80214
Hotline: 1-800-525-3777
Email: contactus@amc.org
Cancer Support Community
Website: http://www.gildasclub.org/
Address: Gilda's Club Worldwide
48 Wall Street, 11th Floor
New York, NY 10005
Phone: 888-GILDA-4-U
Email: info@gildasclub.org
Corporate Angel Network
Website: http://www.corpangelnetwork.org
Address: Westchester County Airport
One Loop Road
White Plains, NY 10604-1215
Hotline: 1-866-328-1313
Phone: 914-328-1313
Email: info@corpangelnetwork.org
Gathering Place
Website: http://www.touchedbycancer.org
Address: The Arnold & Sydell Miller Family Campus 23300 Commerce Park
Beachwood, OH 44122
Phone: 216-595-9546
Email: info@touchedbycancer.org
Memorial Sloan-Kettering Cancer Center, New York
Website: http://www.mskcc.org
Address: 1275 York Ave
New York, NY 10065
Phone: 212-639-2000
Email: publicaffairs@mskcc.org
National Cancer Institute (NCI)
Website: http://www.nci.nih.gov
Address: NCI Public Inquiries Office
6116 Executive Boulevard, Room 3036A
Bethesda, MD 20892
Hotline: 1-800-4-CANCER (1-800-422-6237)
Phone: TTY: 1-800-332-8615
National Coalition for Cancer Survivorship (NCCS)
Website: http://www.canceradvocacy.org
Address: 1010 Wayne Ave., Suite 770
Silver Spring, MD 20910
Hotline: 1-877-NCCS-YES (1-877-622-7937)
Phone: 301-650-9127
Email: info@canceradvocacy.org
National Comprehensive Cancer Network
Website: http://www.nccn.org
Address: 275 Commerce Dr, Suite 300
Fort Washington, PA 19034
Phone: 215-690-0300
Native American Cancer Research
Website: http://www.natamcancer.org
Address: 3022 South Nova Rd.
Pine, CO 80470
Phone: 303-838-9359
Email: info@natamcancer.net
Prevent Cancer Foundation
Website: http://www.preventcancer.org
Address: 1600 Duke Street, Suite 500
Alexandria, VA 22314
Hotline: 1-800-227-2732
Phone: 703-836-4412
Women's Cancer Resource Center
Website: http://www.wcrc.org
Address: 5741 Telegraph Avenue
Oakland, CA 94609
Hotline: 1-888-421-7900
Phone: 510-420-7900
Email: info@wcrc.org
Books
The Colon Cancer Survivors' Guide, Second Edition: Living Stronger, Longer
by Curtis Pesmen
Understanding Colon Cancer
by A. Richard M.D. F.A.C.P. Adrouny
Living With Colon Cancer: Beating the Odds
by Eliza Wood Livingston, David, M.D. Spiegel
Intimacy After Cancer: A Woman's Guide
by Dr. Sally Kydd, Dana Rowett
What to Do If You Get Colon Cancer: A Colon Cancer Specialist Helps You Take Charge and Make Informed Choices
by Paul Miskovitz, Marian Betancourt
Spanish-language resources
National Cancer Institute
Website: http://www.cancer.gov/espanol/pdq/tratamiento/colon/patient
Hotline: 1-800-422-6237
Emails: nciespanol@mail.nih.gov
Medline Plus: Colon Cancer
Website: http://www.nlm.nih.gov/medlineplus/spanish/ency/article/000262.htm
Address: Customer Service
US National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov
Family Doctor
Website: http://familydoctor.org/online/famdoces/home/common/cancer/treatment/026.html
HealthyWomen content is for informational purposes only. Please consult your healthcare provider for medical advice, diagnosis or treatment.
Cuando tenía 29 años, me dijeron que mis síntomas eran de un embarazo, pero un año después, me diagnosticaron cáncer de colon de etapa 4
It feels strange to say, but I’m healthier now than I’ve ever been
Es raro decirlo, pero ahora tengo mejor salud que nunca