ABOUT COLORECTAL CANCER

SOOO, WHAT IS COLORECTAL CANCER? It is 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 also may be called colorectal cancer. Colorectal cancer occurs when some of the cells that line the colon or the rectum become abnormal and grow out of control. The abnormal growing cells create a tumor, which is the cancer.

GET TO KNOW YOUR COLON.

(1) CECUM

(2) ASCENDING COLON

(3) HEPATIC FLEXURE

(4) TRANSVERSE COLON

(5) SPLENIC COLON

(6) DESCENDING COLON

(7) SIGMOID COLON

COLORECTAL CANCER STARTS FROM A POLYP, MOST OF THE TIME.

What’s a polyp? Well, it’s a growth of tissue on the inner lining of the colon or rectum. Polyps are benign (non-cancerous) growths, but cancer can start in some types of polyps if they are not removed.

There are three kinds of polyps. The chance of one becoming cancer depends on what type of polyp it is. Oh look, below would be said three polyps types:

About two-thirds of all polyps fall into this category. Although only a small percentage of these polyps actually become cancerous, nearly all malignant polyps are adenomatous.
Most of the remaining polyps are hyperplastic. These polyps occur most often in your left (descending) colon and rectum. Usually less than a quarter of an inch (5 millimeters) in size, they’re very rarely malignant.
These polyps may follow a bout of ulcerative colitis or Crohn’s disease of the colon. Although the polyps themselves are not a significant threat, having ulcerative colitis or Crohn’s disease of the colon increases your overall risk of colon cancer.
If cancer forms in a polyp, it can eventually begin to grow into the wall of the colon or rectum. When cancer cells are in the wall, they can then grow into blood vessels or lymph vessels. Lymph vessels are thin, tiny channels that carry away waste and fluid. They first drain into nearby lymph nodes, which are bean-shaped structures containing immune cells that help fight against infections. Once cancer cells spread into blood or lymph vessels, they can travel to nearby lymph nodes or to distant parts of the body, such as the liver. Spread to distant parts of the body is called metastasis.
Fortunately, colon cancer grows much slower than many other cancers. Specifically, adenomas (the more dangerous polyps) can sometimes take more than ten years to grow.

COLORECTAL CANCER IS THE #2 LEADING CAUSE OF CANCER DEATHS AMONG MEN AND WOMEN IN THE U.S.

SYMPTOMS OF COLORECTAL CANCER. 

EARLY COLORECTAL CANCER OFTEN HAS NO SYMPTOMS, WHICH IS WHY SCREENING IS SO IMPORTANT. MOST COLORECTAL CANCERS BEGIN AS A POLYP, A SMALL GROWTH IN THE WALL OF THE COLON. AS A POLYP GROWS, IT CAN BLEED OR OBSTRUCT THE INTESTINE. SEE YOUR DOCTOR IF YOU HAVE ANY OF THESE WARNING SIGNS >>>

X BLEEDING FROM THE RECTUM

x BLOOD IN THE STOOL OR IN THE TOILET AFTER HAVING A BOWEL MOVEMENT

X DARK-OR BLACK-COLORED STOOLS

X A CHANGE IN THE SHAPE OF THE STOOL

X CRAMPING PAIN IN THE LOWER STOMACH

X A FEELING OF DISCOMFORT OR URGE TO HAVE A BOWEL MOVEMENT WHEN THERE’S NO NEED TO

X NEW ONSET OF CONSTIPATION OR DIARRHEA THAT LASTS FOR MORE THAN A FEW DAYS

X BLOOD IN THE STOOL OR IN THE TOILET AFTER HAVING A BOWEL MOVEMENT

X UNINTENTIONAL WEIGHT LOSS

RISK FACTORS:

If you, a parent, sibling or child has had polyps and/or colon cancer in the past, you may be at a much higher risk for developing it. Screening earlier and more often is very important in these cases. 

People who have Inflammatory Bowel Disease are also at a higher risk of getting colon cancer. 

Those who have type 2 diabetes have an increased risk of developing colon cancer. Along with a greater cancer risk, people already dealing with diabetes also tend to have a more difficult time treating it than those who don’t have diabetes. 

LIFESTYLE RISKS:

Vegetables, fruits, and whole grain foods have all been linked with a lower risk of getting colon cancer. Red meats (steak, beef, lamb) and processed meats (deli meats), on the other hand, can raise your risk. 

Being severely overweight increases the risk of developing colon cancer in both men and women. 

Smokers, especially long-term ones, are more likely to develop colon cancer and have high mortality rates. 

THE STAGES OF COLORECTAL CANCER.

Once polyps develop into cancer, doctors describe the cancer using something called “summary staging.”

Summary staging is a basic way to classify the growth and development of colon cancer. There are 4 main categories in this staging system. 

STAGE I:

The cancer has begun growing through the thin muscles in the colon. It has not yet affected nearby lymph nodes or other parts of the body. 

STAGE II:

Cancer has grown into or all the way through the wall of the colon but has not yet spread to other tissues, organs, or lymph nodes. 

STAGE III:

The cancer has either grown into the outer layers of the colon or expanded through the wall of the colon. It may have affected any number of lymph nodes and attached itself to nearby organs or tissues. It has not traveled to distant sites in other parts of the body. 

STAGE IV:

At this last stage of the disease, the cancer may or may not have grown through the wall of the colon, and may have spread to any number of nearby lymph nodes.

To classify as Stage IV, the cancer must have spread to at least one distant organ. The three organs most commonly affected are the lungs, liver, and the lining of the abdominal cavity, also called the peritoneum.7
 

COLORECTAL CANCER ISN’T JUST YOUR GRANDFATHER’S DISEASE. WHILE CASES HAVE DROPPED STEADILY IN ADULTS OVER 50, THEY’VE INCREASED BY MORE THAN 2% EACH YEAR IN YOUNGER ADULTS.

PERCENT OF NEW CASES BY AGE GROUP  COLON AND RECTUM CANCER

AGE:

  • <20 .001%
  • 20-34 01.2%
  • 35-44 04.1%
  • 45-54 21.2%
  • 65-74 23.9%
  • 75-84 23.2%
  • 75-84 23.2%
  • >84 12.1%

PERCENT OF DEATHS BY AGE GROUP  COLON AND RECTUM CANCER

AGE:

  • <20 0.0%
  • 20-34 0.6%
  • 35-44 2.5%
  • 45-54 8.9%
  • 55-64 17.0%
  • 65.74 21.9%
  • 75.84 28.2%
  • >84 20.8%

COLORECTAL CANCER RATES ARE HIGHEST IN AFRICAN AMERICAN MEN AND WOMEN. COMPARED TO CAUCASIANS, AFRICAN AMERICAN COLORECTAL CANCER RATES ARE 20% HIGHER AND DEATH RATES ARE ABOUT 45% HIGHER. 

COLORECTAL CANCER INCIDENCE RATES  BY RACE/ETHNICITY 

NUMBER OF NEW CASES PER 100,000 PERSONS BY RACE/ETHNICITY & SEX: COLON AND RECTUM CANCER 

MEN AREN’T THE ONLY ONES DIAGNOSED WITH COLORECTAL CANCER. IN 2012, THE AMERICAN CANCER SOCIETY ESTIMATED ABOUT 73,000 MEN AND 70,000 WOMEN WOULD BE DIAGNOSED WITH COLORECTAL CANCER IN THE UNITED STATES. REGULAR SCREENING IS A MUST FOR EVERYONE. 

GETTING SCREENED CAN MAKE ALL THE DIFFERENCE.

IF FOUND EARLY, COLORECTAL CANCER IS HIGHLY TREATABLE.¹

STAGE 1 = 94%* SURVIVAL RATE

STAGE 2 = 82%* SURVIVAL RATE

STAGE 3 = 67%* SURVIVAL RATE

STAGE 4 = 11%* SURVIVAL RATE

*Based on 5-year survival rate.

 

  • STAGE 1* 94%
  • STAGE 2* 82%
  • STAGE 3* 67%
  • STAGE 4* 11%

1 Lansdorp-Vogelaar I, van Ballegooijen M. Zauber A, Habbema J. Kulpers E. Effect of rising chemotherapy costs on the cost of savings of colorectal cancer screenings. J Natl Cancer Inst. 2009; 101:1412-1422 

©2014 Exact Sciences Corporation. All rights reserved. BeSeenGetScreened.com

SCREENING IS RECOMMENDED BEFORE AGE 50 FOR THOSE WITH A FAMILY HISTORY OF COLORECTAL CANCER AND FOR PEOPLE WITH HEREDITARY GENETIC SYNDROMES SUCH AS FAP AND LYNCH SYNDROME. ULCERATIVE COLITIS, CROHN’S AND OTHER INFLAMMATORY BOWEL DISEASES INCREASE RISK AS WELL.

COLORECTAL CANCER SCREENING OPTIONS.

While some screening options like colonoscopy still require special preparation like taking medication and changing what you eat, many of the tests don’t require any prep work—some can even be done from the privacy of your own home!

Here’s a brief explanation of the five most common screening methods. Click through the tabs below to get a better understanding of your screening options:

For this test, the doctor looks at the entire length of the colon and rectum with a colonoscope, which is basically a longer version of a sigmoidoscope. It is inserted through the rectum into the colon. The colonoscope has a video camera on the end that is connected to a display monitor so the doctor can see and closely examine the inside of the colon. Special instruments can be passed through the colonoscope to biopsy (sample) or remove any suspicious-looking areas such as polyps, if needed.

Colonoscopy may be done in a hospital outpatient department, in a clinic, or in a doctor’s office.

BEFORE THE TEST: Be sure your doctor knows about any medicines you are taking, as you might need to change how you take them before the test. The colon and rectum must be empty and clean so your doctor can see their inner linings during the test. You will need to take laxatives (usually a large volume of a liquid, but sometimes pills, as well) the day before the test and possibly an enema that morning.

DURING THE TEST: The test itself usually takes about 30 minutes, but it may take longer if a polyp is found and removed. Before the colonoscopy begins, you will be given a sedating medicine (usually through your vein) to make you feel comfortable and sleepy during the procedure. You will probably be awake, but not be aware of what is going on and probably won’t remember the procedure afterward. Most people will be fully awake by the time they get home from the test.

This test is an advanced type of computed tomography (CT or CAT) scan of the colon and rectum. A CT scan is an x-ray test that produces detailed cross-sectional images of your body. Instead of taking one picture, like a regular x-ray, a CT scanner takes many pictures as it rotates around you while you lie on a table. A computer then combines these pictures into images of slices of the part of your body being studied.

For CT colonography, special computer programs create both 2-dimensional x-ray pictures and a 3-dimensional “fly-through” view of the inside of the colon and rectum, which lets the doctor look for polyps or cancer.

BEFORE THE TEST: It is important that the colon and rectum are emptied before this test to provide the best images, so the preparation for this test is similar to that for a double-contrast barium enema or colonoscopy. You will probably be told to follow a clear liquid diet for a day or 2 before the test. You will also be given instructions for taking strong laxatives and/or enemas the night before or morning of the exam. This will probably require you to be in the bathroom quite a bit.

DURING THE TEST: This test is done in a special room with a CT scanner, and takes about 10 minutes. You may be asked to drink a contrast solution before the test to help “tag” any remaining stool in the colon or rectum, which helps the doctor when looking at the test images. You will be asked to lie on a thin table that is part of the CT scanner, and will have a small, flexible tube inserted into your rectum. Air is pumped through the tube into the colon to expand it to provide better images. The table then slides into the CT scanner, and you will be asked to hold your breath while the scan takes place. You will likely have 2 scans: one while you are lying on your back and one while you are on your stomach. Each scan typically takes only about 10 to 15 seconds.

During this test, the doctor looks at part of the colon and rectum with a sigmoidoscope – a flexible, lighted tube about the thickness of a finger with a small video camera on the end. It is inserted through the rectum and into the lower part of the colon. Images from the scope are viewed on a display monitor.

Using the sigmoidoscope, your doctor can view the inside of the rectum and part of the colon to detect (and possibly remove) any abnormality. Because the sigmoidoscope is only 60 centimeters (about 2 feet) long, the doctor is able to see the entire rectum but less than half of the colon with this procedure.

BEFORE THE TEST: The colon and rectum must be empty and clean so your doctor can view the lining of the sigmoid colon and rectum. Your doctor will give you specific instructions to follow to clean them out. You may be asked to follow a special diet (such as drinking only clear liquids) for a day before the exam. You may also be asked to use enemas or to use strong laxatives to clean out your colon before the exam. Be sure to tell your doctor about any medicines you are taking, as you might need to change how you take them before the test.

DURING THE TEST: A sigmoidoscopy usually takes 10 to 20 minutes. Most people do not need to be sedated for this test, but this may be an option you can discuss with your doctor. Sedation may make the test less uncomfortable, but you will need some time to recover from it, you’ll need someone with you to take you home after the test.

The fecal occult blood test (FOBT) is used to find occult blood (blood that can’t be seen with the naked eye) in feces. The idea behind this test is that blood vessels at the surface of larger colorectal polyps or cancers are often fragile and easily damaged by the passage of feces. The damaged vessels usually release a small amount of blood into the feces, but only rarely is there enough bleeding for blood to be visible in the stool.

The FOBT detects blood in the stool through a chemical reaction. This test cannot tell if the blood is from the colon or from other parts of the digestive tract (such as the stomach). If this test is positive, a colonoscopy will be needed to find the reason for the bleeding. Although cancers and polyps can cause blood in the stool, other causes of bleeding can occur, such as ulcers, hemorrhoids, diverticulosis (tiny pouches that form at weak spots in the colon wall), or inflammatory bowel disease (colitis).

This screening test is done with a kit that you can use in the privacy of your own home that allows you to check more than one stool sample. An FOBT done during a digital rectal exam in the doctor’s office is not sufficient for screening (it only checks one stool sample). Also, unlike some other tests (like colonoscopy), this one must be repeated every year.

BEFORE THE TEST: Some foods or drugs can affect the test, so your doctor may suggest that you avoid the following before this test:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), naproxen (Aleve), or aspirin (more than 1 adult aspirin per day), for 7 days before testing. (They can cause bleeding, which can lead to a false-positive result.) Acetaminophen (Tylenol) can be taken as needed.
  • Vitamin C in excess of 250 mg daily from either supplements or citrus fruits and juices for 3 days before testing. (This can affect the chemicals in the test and make it appear negative, even when blood is present.)
  • Red meats (beef, lamb, or liver) for 3 days before testing. (Components of blood in the meat may cause the test to show positive.)

Some people who are given the test never do it or don’t give it to their doctor because they worry that something they ate may interfere with the test. For this reason, many doctors tell their patients it isn’t essential to follow any restrictions in their diet. The most important thing is to get the test done. People should try to avoid taking aspirin or related drugs for minor aches. But if you take these medicines daily for heart problems or other conditions, don’t stop them for this test without talking to your doctor first.

COLLECTING THE SAMPLES: Have all of your supplies ready and in one place. Supplies will include a test kit, test cards, either a brush or wooden applicator, and a mailing envelope. The kit will give you detailed instructions on how to collect the specimen.

The fecal immunochemical test (FIT), also called an immunochemical fecal occult blood test (iFOBT), is a newer kind of test that also detects occult (hidden) blood in the stool. This test reacts to part of the human hemoglobin protein, which is found in red blood cells.

The FIT is done essentially the same way as the FOBT, but some people may find it easier to use because there are no drug or dietary restrictions (vitamins or foods do not affect the FIT) and sample collection may take less effort. This test is also less likely to react to bleeding from parts of the upper digestive tract, such as the stomach.

Like the FOBT, the FIT may not detect a tumor that is not bleeding, so multiple stool samples should be tested. And if the results are positive for hidden blood, a colonoscopy is required to investigate further. In order to be beneficial the test must be repeated every year.

COLLECTING THE SAMPLES: Have all of your supplies ready and in one place. Supplies will include a test kit, test cards, long brushes, waste bags, and a mailing envelope. The kit will give you detailed instructions on how to collect the specimen.

STOOL DNA TESTS

Instead of looking for blood in the stool, these tests look for certain abnormal sections of DNA (genetic material) from cancer or polyp cells. Colorectal cancer cells often contain DNA mutations (changes) in certain genes. Cells from colorectal cancers or polyps with these mutations are often shed into the stool, where tests may be able to detect them.

Although stool DNA tests have been used for colorectal screening in the past, they are no longer available in the US.