Colon and Rectal Cancer

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Definition

By Mayo Clinic staff

CLICK TO ENLARGE

Image of colon cancer locations Colon cancer

Colon cancer is cancer of the large intestine (colon), the lower part of your digestive system. Rectal cancer is cancer of the last several inches of the colon. Together, they're often referred to as colorectal cancers.

Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps become colon cancers.

Polyps may be small and produce few, if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying polyps before they become colon cancer.

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2 Definition of colon cancer: Cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).

Definition of rectal cancer: Cancer that forms in the tissues of the rectum (the last several inches of the large intestine closest to the anus).

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Introduction

Colorectal cancer is cancer that forms in either the colon or the rectum. The colon and rectum are parts of the body's gastrointestinal (digestive) system. They form a long, muscular tube called the large intestine (or large bowel).

After food is chewed and swallowed, it travels down the esophagus to the stomach and then to the small intestine. From the small intestine, partly digested food enters the colon (the first five feet of the large intestine), which removes water and nutrients from the food and turns the rest into waste (stool). The waste then passes from the colon (which consists of four sections) into the rectum (the last six inches of the large intestine) and then out of the body.

Colorectal cancer can start in the tissues of any of the four sections of the colon or in the rectum. When cells that line either of these organs become abnormal and grow out of control, a cancerous tumor forms. In most cases, colorectal cancers develop slowly over a period of several years. Adenocarcinomas account for about 95 percent of colorectal cancers. Adenocarcinomas (e.g., mucinous, signet ring cell) begin in the intestinal gland cells that line the inside of the colon and rectum.

If you or a loved one has been recently diagnosed with colorectal cancer, or have been battling colorectal cancer for some time and are exploring your treatment options, you have come to the right place. Cancer Treatment Centers of America (CTCA) offers a comprehensive, individualized approach to colorectal cancer treatment. Here, we are committed to caring for you like family. Our doctors and practitioners will empower you with information, listen to your concerns, and deliver an integrative colorectal treatment plan tailored to your needs.
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Colon Cancer
(Colorectal Cancer)

Medical Author: Dennis Lee, MD
Medical Reviewing Editor: Jay Marks, MD

 

A Surprising Colon Cancer

From diagnosis to treatment, a fighting tale.

An Unexpected Challenge
Wed., Dec. 7, 2005

Patti faces colon cancerAt the time, I had no idea anything at all was wrong. I just knew it was time for a colonoscopy. In fact it was past time, since I was 61 years old.

I don't remember the procedure itself. What I do remember is waking up at home and Kim, my husband, telling me that they'd found a tumor at the very far end of my colon and that the doctor wanted to speak to me when I was awake and ready to talk. I called the doc right away. The doctor told me that he was totally surprised when he found the tumor, that it was being biopsied, and that he asked them to rush the results.

No matter what the outcome of the biopsy; the tumor had to be removed, the doc said. He asked who I wanted to do the surgery. I somehow remembered that a lady I play golf with is a nurse for a gastro practice. I called her and found out who she'd ask for if she needed colon surgery. Once I got a name, I called my gastroenterologist back, told him who I wanted, and asked for an appointment.

Patti deals with her diagnosis »


 
Patient to Patient

 

What is cancer?

 

Cancer is a group of more than 100 different diseases. They affect the body's basic unit, the cell. Cancer occurs when cells become abnormal and divide without control or order. Like all other organs of the body, the colon and rectum are made up of many types of cells. Normally, cells divide to produce more cells only when the body needs them. This orderly process helps keep us healthy.

If cells keep dividing when new cells are not needed, a mass of tissue forms. This mass of extra tissue, called a growth or tumor, can be benign or malignant.

Benign tumors are not cancer. They can usually be removed and, in most cases, they do not come back. Most important, cells from benign tumors do not spread to other parts of the body. Benign tumors are rarely a threat to life.

Malignant tumors are cancer. Cancer cells can invade and damage tissues and organs near the tumor. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. This is how cancer spreads from the original (primary) tumor to form new tumors in other parts of the body. The spread of cancer is called metastasis.

When cancer spreads to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if colon cancer spreads to the liver, the cancer cells in the liver are colon cancer cells. The disease is metastatic colon cancer (it is not liver cancer).

 

What is cancer of the colon and rectum?

 

The colon is the part of the digestive system where the waste material is stored. The rectum is the end of the colon adjacent to the anus. Together, they form a long, muscular tube called the large intestine (also known as the large bowel). Tumors of the colon and rectum are growths arising from the inner wall of the large intestine. Benign tumors of the large intestine are called polyps. Malignant tumors of the large intestine are called cancers. Benign polyps do not invade nearby tissue or spread to other parts of the body. Benign polyps can be easily removed during colonoscopy and are not life-threatening. If benign polyps are not removed from the large intestine, they can become malignant (cancerous) over time. Most of the cancers of the large intestine are believed to have developed from polyps. Cancer of the colon and rectum (also referred to as colorectal cancer) can invade and damage adjacent tissues and organs. Cancer cells can also break away and spread to other parts of the body (such as liver and lung) where new tumors form. The spread of colon cancer to distant organs is called metastasis of the colon cancer. Once metastasis has occurred in colorectal cancer, a complete cure of the cancer is unlikely.

Colon cancer (colorectal cancer) picture

Globally, cancer of the colon and rectum is the third leading cause of cancer in males and the fourth leading cause of cancer in females. The frequency of colorectal cancer varies around the world. It is common in the Western world and is rare in Asia and Africa. In countries where the people have adopted western diets, the incidence of colorectal cancer is increasing.
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Colorectal Cancer

Facts:

  • Colorectal cancer is the second leading cause of cancer death.
  • Colorectal cancer is the fourth most common malignancy in the United States.
  • Colon cancer is the third most common cancer in women and men.
  • The American Cancer Society estimates that in 2005 approximately 56,660 women and 48,290 men diagnosed with colon cancer.
  • The American Cancer Society also estimates that in 2005 approximately 16,810 women and 23,530 men diagnosed rectal cancer.
  • About 75% of all new cases of colon cancer occur in people with no known risk factors for this disease.
  • Screening for colorectal cancer and polyps has decreased the incidence of this disease by nearly 2% per year during the past decade.

The colon and rectum are part of the digestive system. Together, they form a long muscular tube known as the large intestine or bowel. The upper 4-6 feet of the large intestine is the colon, and the lower 5-6 inches is the rectum. Cancer occurs when cells of the colon or rectum become abnormal and grow uncontrollably, interfering with the function of these organs. The majority of colorectal cancers arise from the cells lining the inside wall of the colon and rectum. This lining is called the mucosa.

Polyps are non-cancerous growths that can occur anywhere in the colon or rectum. Though they are not cancer, polyps should be removed because they can become cancerous. Individuals who have had a colon or rectal polyp are likely to develop more and should be examined regularly by a doctor.

Colon and rectal cancer are often asymptomatic. As a tumor grows, symptoms that may be indicative of cancer include:

  • Bright red blood in the stool
  • Persistent diarrhea or constant constipation
  • Crampy pain in the abdominal region which does not subside
  • Continuing decrease in the size of stool
  • Frequent feeling of bloating in the abdominal or bowel region
  • Unexplained weight loss
  • Unexplained fatigue

Colon Cancer
When colon cancer is detected in its early phase, surgery is normally performed in order to remove the affected part(s) of your colon. Surrounding tissue is also removed to assure that associated lymph nodes (which may control cancer cells) are removed. This procedure is called a colectomy. Additional therapy may be required if pathology reports indicate that surrounding tissue and/or lymph nodes contain cancer cells. Consultation with a medical oncologist will be advised for discussions regarding the risks and benefits of adjuvant chemotherapy. Adjuvant chemotherapy works by destroying cancer cells that may have spread from the original cancer site.

Rectal Cancer
Rectal cancer occurs in the lower 5-6 inches of the large intestine. Historically many patients with rectal cancer were treated with removal of the rectum and anus, and formation of a permanent colostomy. Our surgeons utilize advanced techniques in anal sphincter preservation with rectal reconstruction. These techniques help in minimizing the need for a colostomy. Great care is taken to identify and preserve the nerves that control bladder and bowel function to maximize quality of life after surgery.

Cancer that occurs in the very low portion of the rectum may require removal of the anus. In order to allow waste to exit the body, an opening called a stoma is created in the abdomen. A special bag covers the stoma so that waste may be collected. If a colostomy is needed, our patients are assisted by enterostomal therapists who work closely with patients teaching them how to care for their colostomy.

Anal Cancer
Anal cancer is relatively uncommon, accounting for 1.5 percent of all gastrointestinal cancers in the United States. Treatment typically involves chemo and radiation therapy, and close follow-up. The Center for Colorectal and Pelvic Floor Disorders has an on-site laboratory with state-of-the-art equipment that allows careful follow-up of patients who have been treated with anal cancer. Surgery is not usually required for this type of cancer.

Therapy

Chemotherapy – Chemotherapy is a form of drug which is used to eliminate cancer cells. It is given through the veins with the use of an IV which can be kept in place for the duration of treatment.

Adjuvant chemotherapy – This type of therapy is used after surgery has been performed. Adjuvant chemotherapy removes cancer cells that may have traveled to other sites of the body.

Neoadjuvant chemotherapy – This type of therapy is used before surgery takes place in order to shrink the size of the cancerous tumor.

Radiation Therapy - Radiation therapy is used mainly with rectal cancers. This form of therapy does not remove cancer cells which may have spread to other sites of the body. It is used before surgery for tumor shrinkage, and after surgery for prevention of local recurrence.

Colorectal Cancer Screening
Screening for colorectal cancer has been proven to decrease mortality in randomized clinical trials. Unfortunately, most individuals are not screened due to either fear or lack of adequate education regarding the benefits. Recommendations for screening begin at age 50 for the average risk population, and at 40 years of age (or younger) for higher risk groups.

Fecal Occult Blood Test (FOBT) – This screening uses a guaiac-based test with dietary restriction or an immunochemical test without dietary restriction. Two samples from each of 3 consecutive stools will be examined without rehydration. Patients with a positive test on any specimen should be followed up with colonoscopy.

Colonoscopy – This short preventative procedure allows your physician to look inside your large intestine using a colonoscope, to look for early warning signs of colon or rectal cancer. If anything abnormal is seen in your colon such as a polyp or inflamed tissue, the physician can remove all or part of it using tiny instruments passed through the scope. That tissue (biopsy) is then sent to a lab for testing. Colonoscopy takes 30 to 60 minutes.

Flexible Sigmoidoscopy – A thin lighted tube called a sigmoidscope is utilized to look inside the rectum and lower colon for polyps, tumors or other abnormalities. Only the lower ¼ to 1/3 of the colon is visualized.

Double Contrast Barium Enema - This test is used to obtain an x-ray of the colon and rectum. It consists of a white, chalky substance given to patients prior to the x-ray. The barium outlines the colon and rectum on the x-rays to help the doctor see tumors or other abnormal tissue. The doctor may also expand the colon by gently pumping air during the test to look for small tumors.

Screening Modalities Under Investigation:

Virtual Colonoscopy – Advances in computer processing speed and imaging software have allowed for the development of “virtual colonoscopy” (CT colonography). This test still requires an intestinal cleansing but is performed rapidly, without sedation, and without the invasiveness of flexible video colonoscopy. Other intra-abdominal abnormalities may be diagnosed with this screening device. CT colonography is an exciting technique for screening for colon cancer. Images can be viewed shortly after acquisition in a multiplanar reformatted (MPR) display or after processing with the “fly through” view
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3 Brian Nelson

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