Colorectal Cancer is when cancer cells grow and form a tumor in your colon or rectum. It can also spread to other parts of your body.
Colon cancer can occur at any age, but it most commonly happens to people over 50. Some health conditions like inflammatory bowel disease or smoking may raise your risk.
With screening colonoscopies, most colorectal cancers are caught before they can cause symptoms. If symptoms do occur, they usually include rectal bleeding or abdominal pain. The type of symptoms depends on the location of the tumor and its size.
If the cancer has not spread to other organs, surgery may be enough treatment. But in some cases, chemotherapy is also needed before or after surgery.
Surgical resection removes the part of your colon that has cancer and reconnects the healthy ends. Doctors can do this with either open or laparoscopic surgery. For open surgery, doctors make one long cut (incision) on your belly and use normal surgical tools to remove a portion of the colon. For laparoscopic resection, doctors make two to four small cuts (incisions) on your belly and insert a thin tube with a camera in one of the incisions. The surgeon uses this tube to see inside your belly and pass the other surgical tools.
In addition to removing the colon, your surgeon may remove some nearby lymph nodes. These are removed through an opening in your skin (called a stoma) made by the surgeon from the top end of the colon or the end of the small intestine, called the ileum. This opening, which is usually only needed for a short time, is called a colostomy or ileostomy.
Some patients with stage IV colon cancer have a disease that’s spread to other parts of the body. These areas are called metastatic disease or stage IV disease. Cancer cells can also break off from the bowel and travel through your bloodstream to other organs in your body, including your liver and lungs. In these cases, surgery can’t remove the metastatic cancer, but it can help control your symptoms and prevent the spread of the disease.
Your doctor may recommend a surgery called a sigmoid colectomy or low anterior resection for colon adenocarcinomas that haven’t spread to other parts of the colon. This surgery removes the sigmoid colon and part of your rectum. If the cancer has spread to the hepatic flexure or transverse colon, doctors can do an extended right hemicolectomy. They can also perform a total mesorectal excision to remove the fat in the lining of your abdomen that contains lymph nodes and blood vessels.
A treatment that uses medicine to kill cancer cells and stop them from growing. Chemotherapy can be given by mouth (pills) or into a vein (IV). Some chemotherapy drugs are combined in a combination called a combination therapy. Other chemotherapy drugs are used alone or with other treatments, such as radiation and targeted therapy.
The type of chemotherapy that is used depends on the stage and location of the colon cancer. It also depends on whether the cancer has spread to other parts of the body. If the cancer has not spread, surgery and chemotherapy may be enough to cure the disease. If the cancer has spread, other treatments are needed to prevent the cancer from coming back. These other treatments might include chemotherapy, targeted therapy, and immunotherapy.
Colon and rectal cancer are the most common types of bowel cancer in both men and women. They can start in the large intestine (colon) or the back passage (rectum). Bowel cancer that has spread to other parts of the body is called advanced colon cancer.
Systemic medical therapy has been an important part of the treatment of colorectal cancer for many decades. The addition of oxaliplatin to the 5-FU/LV monotherapy backbone has improved the mean overall survival (mOS) of patients with colon cancer to nearly 24 months. Recent advances with the addition of monoclonal antibodies targeting vascular endothelial growth factors and epidermal growth factor receptors, have further enhanced the efficacy of standard systemic chemotherapy.
In some cases, neoadjuvant chemotherapy is recommended for people with stage II colon cancer. This is usually if the tumor has invaded into other tissue or attached to nearby organs. It is also recommended if the tumor has a high risk feature, such as dMMR or MSI-H.
If the cancer has spread to other parts of the colon or to other parts of the body, treatment is more difficult. Treatment can involve radiation, chemotherapy, and sometimes other treatments such as a vaccine or a drug that stops the cell from making proteins that allow it to grow.
Before each chemotherapy cycle, it is important to get a complete physical and mental health exam. The health care team will check for side effects from the chemotherapy and will order blood work to see how your body is responding. The doctor will also perform a CT or MRI scan to check for new or recurrent cancers.
Radiation therapy uses a high-energy beam of X-rays or protons to kill cancer cells. It also damages nearby cells, but healthy cells repair themselves more quickly than the cancer cells and return to normal. For this reason, doctors have developed techniques to target only the cancer cells and minimize damage to surrounding tissues.
Your doctor may use radiation along with chemotherapy or other treatments for colon cancer. For example, your doctor might use it before surgery to shrink a large tumor or after surgery to kill any remaining cancer cells. They might also use it to relieve symptoms of advanced colon cancer.
If your cancer has spread to other parts of your body, the treatment plan will depend on whether it has affected your liver or lungs. Your doctor might use chemotherapy and/or immunotherapy, along with radiation, to treat this.
Your doctors might need to remove part of your colon or rectum (colectomy) to get rid of all the cancer. They might also need to remove the surrounding lymph nodes. Sometimes these cancer cells can grow back even after surgery and chemotherapy, so your doctors might give you other treatments to help prevent the cancer from returning.
For stage 0 colon cancer or cancer that hasn’t spread, surgery might be the only treatment needed. A surgeon might remove a polyp or take out the area of the colon with the cancer through a colonoscopy (local excision).
If you have stage 1 or 2 colon cancer, your doctors might also use radiation along with chemotherapy or other treatments to reduce the chance of the cancer coming back. This is called adjuvant therapy.
Before you start radiation, your doctors will mark the area that will be treated. This might involve making marks with a marker or using small tattoos. You will lie down on a table and wear a protective mask. Then your radiation oncologist will direct a machine located outside your body to focus the radiation on the area with the cancer. This is called external-beam radiation therapy (EBRT).
During your treatment, you might have regular CT scans or blood work to see how well the treatment is working. Your doctors might ask you to stop taking supplements that contain antioxidants (like vitamins C and E) during radiation therapy because they can interfere with the ability of X-rays or protons (the radiation treatment) to destroy cancer cells. After your radiation is done, you can resume taking these supplements.
A new type of treatment that uses medicines to attack cancer cells directly. These medicines stop signals that promote growth of cancer cells or blood vessels that supply them with oxygen and nutrients, or they block other proteins that cause cancer cells to grow and divide too quickly. They can be used alone or with chemotherapy and radiation therapy. The medicine can be targeted to specific genetic mutations in a tumor (such as RAS or BRCA1) or non-specific, or “tumor agnostic,” inhibitors that block a tumor’s ability to use cellular energy or inhibit invasiveness.
If the cancer has spread too much to be cured with surgery or chemotherapy, it can sometimes be treated by removing only a portion of the colon. This operation is called a colectomy. Surgery might also be needed if the cancer is blocking the colon’s waste passage, in which case it might be necessary to create a way for waste to leave the body, such as by putting a stent in the colon during a colonoscopy or performing a diverting colostomy (cutting part of the colon above the site of the cancer and attaching it to an opening in the abdomen that allows waste to go out).
Some people who have advanced colorectal cancer may be candidates for a clinical trial. These trials compare different treatments to see which is best for a person with colorectal cancer.
Several web-based tools are available to help determine whether or not someone with colon cancer is a candidate for an investigational therapy, such as the ACCENT tool by Mayo Clinic and Adjuvant! Online. In addition, genomic profiling using tests such as Oncotype DX Colon, Colorectal Cancer Assay or ColoPrint can provide important prognostic information and influence the choice of treatment for a particular patient.
Care coordination is vital to ensuring seamless, efficient care for people with colorectal cancer. Physicians, advanced practitioners, nurses, nutritionists, palliative service providers, and others must collaborate to streamline the patient journey from screening for colorectal cancer to creating and implementing an evidence-based management strategy. Care coordination reduces errors, minimizes delays, and enhances safety, ultimately resulting in better quality of life for patients with colorectal cancer.
People with colorectal cancer have a variety of symptoms. They may also need treatment that includes surgery or chemotherapy.
Sometimes the cancer spreads from the colon or rectum to other parts of the body. This is called advanced colorectal cancer or metastatic colon cancer. It’s harder to treat. But it still can be cured.
Aches and pains in the belly area (abdomen) are common, and most often aren’t serious. However, if abdominal pain is sudden and severe, or continues for more than a few hours, it can be a sign of a health condition that needs medical attention.
Abdominal pain feels different from person to person, and may be felt as a dull ache or sharp cramps. It can also be a feeling of fullness or bloating. Sometimes the pain is relieved by passing wind or having a bowel movement. Pain in the upper abdomen may be due to inflammatory bowel disease (Crohn’s and ulcerative colitis). It can also be caused by a hernia or gallstones.
If cancer spreads to your colon, you may have pain in the lower abdomen. If this happens, you may also experience nausea and vomiting.
Your doctor will ask you questions about your symptoms and give you a physical examination, including a digital rectal exam. They will check for lumps in your abdomen or a change in your stool color and consistency. They will also do blood tests to see if you have any signs of anemia, which can be caused by bleeding in your digestive tract.
Surgery is the main treatment for colon cancer. It aims to remove any tumours, and prevent the cancer from spreading. They will usually reconnect the section of your bowel removed from your abdomen, but you might need to have a stoma for drainage into a bag (colostomy). Your surgeon will explain this to you if it’s necessary.
Blood in the stools isn’t always a sign of colorectal cancer, but it should never be ignored. It can indicate a number of different problems and needs to be checked out as soon as possible. The type of blood in the stool will help doctors decide which area to look at. For example, bright red blood in the stools indicates the bleeding is from the large intestine or rectum. This type of blood may be mixed in with the poo or seen as separate specks. Dark, tarry or black blood in the stools suggests the bleeding is higher up in the gastrointestinal tract, such as the stomach and small intestines.
Blood may also be present in the esophagus (food pipe). This occurs when you have varicose veins or tear the lining of the esophagus. It can also occur if you are taking blood thinners.
Other signs of blood in the stools include a sudden and strong pain in your abdomen, feeling light-headed or your heart beating faster. These can be a sign that you are having a bowel obstruction and need to see your GP or go to the accident and emergency department of your local hospital as soon as possible. A bowel obstruction can be a medical emergency as it can stop digestive waste from passing through the colon and can cause severe pains in the stomach, bloating and vomiting.
Diarrhea is a common Colorectal Cancer symptom. It occurs when your colon and rectum, the lower part of your large intestine, aren’t working properly. Normally, the colon receives liquefied food waste from your small intestine and gradually condenses it into solid poop. When something disrupts this process, it produces diarrhea.
Your body’s digestive system breaks down food into nutrients to fuel the cells that keep you healthy and functioning. But sometimes the digestive tract can get overactive and overdo it, passing more fluid than necessary through the system and causing diarrhea.
If you have blood in your stool, it’s important to see a doctor immediately. You might notice visible red or black blood in your stools, or the bleeding may be more subtle and appear as dark red or even black bowel movements. Bleeding from higher up in the colon can also make bowel movements look like they have tar.
If you are experiencing any of these symptoms, it is important to consult with a doctor and go through regular screenings to catch colon cancer before it spreads. Early diagnosis and treatment can greatly increase your chances of survival. For more information, visit our resources page. You can find support from others who have experienced bowel cancer and get answers to your questions. You can also learn more about how a bowel cancer diagnosis will affect your daily life.
Often, the first signs of colon cancer are changes in your bowel habits. These can include a feeling that your bowel isn’t emptying completely or the sensation that you haven’t passed any stool for a long time. If you notice any of these symptoms, talk to your doctor.
Abdominal pain may also occur. This symptom is common, and it can be caused by many things, such as hemorrhoids or IBS (irritable bowel syndrome). However, if the abdominal pain is severe and lasting, it could be a sign of colorectal cancer.
The most alarming symptom of colorectal cancer is blood in the stool. It can sometimes appear bright red, but it may also be dark or black. In some cases, the color of your stool is a result of a build-up of iron or certain foods, such as beets or beans.
Having a large amount of blood in the stool can cause you to lose a lot of blood, which makes you tired. If you’re losing a lot of blood, your doctor will likely order a blood test to check for anemia.
The earliest stage of colorectal cancer is polyps. Polyps and cancer don’t always cause symptoms, so it is important to get screened regularly for colorectal cancer. In some people, a tumor may grow to the point where it causes symptoms. The best way to diagnose colorectal cancer is to have a colonoscopy. This is a procedure in which a doctor inserts a thin tube called a colonoscope into your colon and rectum. During a colonoscopy, the doctor can look for tumors and remove any that are present. They can also take a sample of the tissue for testing.
Having a low appetite and losing weight can be related to the cancer, but this can also be caused by other things such as pain and diarrhea. If you are experiencing unexplained weight loss, make sure to talk to your care team.
In the early stages, colorectal polyps and colon cancer may not cause any symptoms, especially in people with a family history of colon cancer or a sedentary lifestyle. This is why regular screenings are important.
The most common symptom of colorectal cancer is blood in the stool (bowel movement). It can also be accompanied by pain or other problems such as diarrhea or constipation.
If the cancer is caught in a very early stage, it can be treated surgically. This will involve removing the tumour and nearby lymph nodes. In some cases, doctors may recommend chemotherapy before surgery (neoadjuvant chemotherapy) to shrink the tumour or radiation therapy after surgery to reduce the risk of cancer recurring.
Colorectal cancer can be prevented by avoiding unhealthy eating habits, maintaining a healthy diet and having regular health screenings. In addition, people who have a high family history of colon cancer and/or a family history of inflammatory bowel disease are at higher risk for developing colorectal cancer. The onset of colorectal cancer can be slow and can take years to develop, which is why early detection and treatment are so important.
Cancers in the colon that haven’t spread might be treated with surgery and chemotherapy. This might cure the cancer or relieve symptoms like pain and blockages.
Chemotherapy uses strong medicines to kill cancer cells and lower the chance of the tumor coming back. It might also be used before surgery to shrink a large cancer and make it easier to remove.
A colonoscopy is a test that doctors use to look for signs of cancer in the large intestine (colon). It may also be used to remove polyps or tissue samples. It is a common procedure, and it is usually covered by medical insurance. However, people should be aware of its risks and complications.
Before a colonoscopy, patients must follow special instructions about diet and laxatives. They should not eat solid food the day before the procedure and only drink clear liquids, such as water, broth and tea without milk. They should also take a laxative, either in pill form or an enema, on the morning of the procedure.
During the procedure, doctors place an IV in your arm or hand to give you sedatives and pain medicine. This will help you stay unconscious and relaxed during the exam. The health care provider will then check your colon and may take photos of it. If they find a polyp, they will take it out or leave it in the colon for further testing.
After the colonoscopy, you should read your discharge instructions carefully. The doctor may ask you to avoid certain medications, such as blood-thinning agents, for a while. They may also recommend a diet and other lifestyle changes.
The most important thing to remember is that most polyps are not cancerous and do not cause symptoms. However, some types of polyps, such as villous adenomas or sessile serrated polyps, increase the risk of colon cancer. These polyps need to be removed and analyzed in the lab. This can take a few weeks. If the results are positive, your doctor will tell you what to do next.
A CT scan gives detailed pictures of any part of the body including bones, muscle, fat and organs. It can reveal cancerous areas more clearly than regular X-rays and shows the size, location and extent of the tumor. A dye can be injected into the body to help blood vessels, organs and tissues stand out more clearly. The contrast material may be injected into a vein (intravenously) or swallowed (orally). You will need to drink plenty of fluids afterwards to help your kidneys get rid of the dye.
A doctor might also order a CT scan to determine whether cancer has spread. This is called staging. The results of the staging tests can help create a treatment plan. Staging tests might include a CT scan of the abdomen and pelvis or a chest X-ray.
For advanced colon cancer that cannot be removed completely, radiation and chemo are often recommended. If the cancer is in a lymph node or has invaded the colon wall, neoadjuvant chemotherapy might be recommended to shrink it before surgery.
A doctor might also use a CT scan to help with a surgical procedure. The test is used to identify the extent of a tumor and find out how deep it has invaded. It can also show the extent of any surgical margins. Specimen integrity is important because it helps with a definitive pathological diagnosis. Surgical resection with negative margins is associated with improved survival.
MRI scans create powerful images of the colon using magnetic energy. This is a safe, painless and non-invasive procedure. You will be asked to lie on a table, and the scanner will take pictures from different angles. You will be given earplugs or headphones to reduce the noise. Some people feel closed in (claustrophobic) while in the scanner, which can be difficult for those with a fear of enclosed spaces.
You may have a contrast dye injected into your vein before an MRI scan to show blood vessels and tissue more clearly. This is done in some cases to help your doctor identify areas of cancer that have spread to nearby blood and lymph vessels. The contrast agent has side effects, such as a metallic taste in the mouth, and you should not have it if you are pregnant or have severe kidney disease.
Your doctor will use the results of your MRI and CT scans to make a diagnosis and plan your treatment. The type of surgery you have will depend on the location and grade of the tumor, your age, and other factors. In general, the more of the colon cancer is removed, the better your chances of living longer.
If the cancer is in a polyp, surgery to remove the polyp and surrounding lymph nodes may be enough. However, if the cancer is in an area that cannot be safely removed, more surgery might be needed. For advanced colon cancer that isn’t in a polyp, partial colectomy (surgery to remove part of the colon) and removal of nearby lymph nodes is standard treatment.
Various blood tests can help detect early signs of colorectal cancer, such as elevated levels of tumor markers. These are proteins produced in response to cancer and can indicate the presence of colon cancer. One of the most common tumor marker blood tests is carcinoembryonic antigen (CEA). In a recent clinical trial, the FDA approved a new type of blood test, called cfDNA, which uses DNA shed from tumors in the colon to detect colon cancer. In a trial of more than 7,800 people, it was found to be 87% accurate at detecting colon cancer in its early, treatable stage. The blood-based test is less effective than a fecal test or colonoscopy at detecting advanced precancerous lesions, however.
A full blood count (CBC) is another blood test that may be used to diagnose bowel cancer. This tests the level of different components in the blood, including red and white cells and platelets. It can also check for anemia, which is a common symptom of bowel cancer. Doctors can also use a liver enzyme test to determine how well the liver is working.
Other types of blood tests can help find out how far a cancer has spread. These include a transrectal ultrasound or pelvic magnetic resonance imaging scan, which are similar to CAT scans and can show how far a cancer has grown into the wall of the rectum. Doctors may also perform a digital rectal exam (DRE), in which they insert a gloved finger into the rectum to look for signs of cancer, such as lumps or bleeding.
The best way to prevent colorectal cancer is to commit to a screening schedule based on your age and risk factors. Current guidelines suggest a colonoscopy every 10 years for average-risk adults, or annual fecal tests for people at higher risk.
If the colon cancer is in a polyp, surgery to remove the polyp and nearby lymph nodes might be all you need. For colon cancer that has spread to other parts of the body, chemotherapy and other treatments might be needed. These treatments might also help relieve symptoms and improve your quality of life.
If your colorectal cancer has not spread to other areas of the body, chemotherapy can be used to help you live longer. It is usually given with other treatments, such as surgery or radiation therapy. These are called adjuvant therapies. You might also need to take drugs that target specific genes or other proteins that control cell growth. You might also need to take other medicines, such as antibiotics.
Chemotherapy as a colorectal cancer treatment became standard following the NSABP C-01 trial in the 1990s. This randomized clinical trial showed that 6-months of fluorouracil/leucovorin (FOLFOX) improved disease-free survival (DFS) and overall survival (OS) compared with bolus 5-FU/LV alone. This prompted the development of combinations with oxaliplatin and irinotecan, which further enhanced DFS and OS. These new regimens have become the backbone of systemic therapy for stage III colorectal cancer.
These drugs are still used today, but the landscape is changing rapidly. Many colorectal cancer patients develop resistance to these traditional chemotherapies, so scientists are looking for new, more targeted arrows in the quiver. The most promising developments are targeting the epidermal growth factor receptor and vascular endothelial growth factor, which are key molecules in cancer cell growth. These drugs are currently in clinical trials, and may soon be available for use in patients with colorectal cancer.
