What Is Colorectal Cancer (Colon and Rectal Cancer)?
Colorectal cancer is a term used to refer to cancer that starts in the colon or rectum. Colon and rectal cancers begin in the digestive system, also called the GI (gastrointestinal) system. This is where food is processed to create energy and rid the body of solid waste matter (stool).
After food is chewed and swallowed, it travels down to the stomach. There it is partly broken down and sent to the small intestine. The word "small" refers to the width of the small intestine. The small intestine is really the longest part of the digestive system. It is about 20 feet long.
The small intestine continues breaking down the food and absorbs most of the nutrients. The small intestine joins the large intestine (also called the large bowel or colon), a muscular tube about five feet long. The first part of the colon absorbs water and nutrients from the food and also serves as a storage place for waste matter. The waste matter moves from the colon into the rectum, the last 6 inches of the digestive system. From there the waste passes out of the body through the opening called the anus.
The colon has 4 sections, as shown in the picture above. Cancer can start in any of the 4 sections or in the rectum. The wall of each of these sections (and rectum) has several layers of tissues. Cancer starts in the inner layer and can grow through some or all of the other layers. Knowing a little about these layers is helpful because the stage (extent of spread) of a cancer depends to a great degree on which of these layers it affects.
Cancer that starts in the different areas may cause different symptoms. But colon cancer and rectal cancer, together known as colorectal cancer, have many features in common. They will be discussed together in this document except for the section about treatment. There they will each be discussed separately.
In most cases, colorectal cancers develop slowly over a period of several years. We now know that most of these cancers begin as a polyp--a growth of tissue that starts in the lining and grows into the center of the colon or rectum. A type of polyp known as an adenoma can become cancerous. Removing the polyp early may prevent it from becoming cancer.
Over 95% of colon and rectal cancers are adenocarcinomas. These are cancers of the cells that line the inside of the colon and rectum. There are some other, more rare, types of tumors of the colon and rectum, but the facts given here refer only to adenocarcinomas.
Causes of colorectal cancer
There is no single cause of colorectal cancer, but some factors appear to increase the risk of developing it : -
age - particularly after 50.
having polyps (small growths on the inner wall of the colon and rectum).
family history of colorectal cancer - especially if the relative (parent, sibling, child) developed colorectal cancer before the age of 45.
having familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon cancer (HNCC).
inflammatory bowel disease (ulcerative colitis or Crohn's disease).
high-fat diet.
alcohol consumption.
smoking.
physical inactivity.
obesity.
ethnic background - people of Ashkenazi (Eastern European Jewish) descent.
Researchers are also looking at how diet affects the risk of developing colorectal cancer. A diet high in vegetables and fruit is known to lower risk. A diet high in fiber and low in animal fats also seems to decrease risk, but more research is necessary to be sure.
Some people develop colorectal cancer without any of these risk factors.
Symptoms of Colorectal Cancer (Colon and Rectal Cancer)
The following are the most common symptoms of colorectal cancer. However, each person may experience symptoms differently : -
A change in bowel habits-such as diarrhea, constipation, or narrowing of the stool-that lasts for more than a few days.
Bright red or very dark blood in the stool.
Discomfort in the stomach area, such as frequent gas pain, cramps, and feelings of being full or bloated.
Constant weakness and fatigue.
Jaundice - yellowing of the skin and eyes.
Weight loss for no known reason.
The diagnosis of Colorectal Cancer (Colon and Rectal Cancer)
The first step in the diagnosis of colorectal cancer may be a "digital rectal exam." In this test, which is often part of a routine physical exam, the doctor inserts a gloved finger into the rectum to feel for abnormal growths and may test your stool for occult blood. If colorectal cancer is suspected, you and your doctor have many tests to choose from to make sure the diagnosis is correct. Since there is a wide range of options, knowing the differences can help you make a smart decision.
Before these tests (except the fecal occult blood test), your colon must be completely empty. To clean out your bowels before the procedure, you may be instructed to have an enema or drink a large volume of a liquid laxative prescribed by your doctor. This preparation is very important in ensuring the accuracy of the test.
Fecal occult blood test : -
In this simple, initial screening test for colorectal cancer, a stool sample is applied to a special card that turns color if any blood is detected.
Barium enema : -
A narrow tube is inserted into the rectum to allow liquid barium (a white, chalky liquid) into the colon. A special x-ray is then taken, on which tumors or masses appear as dark shadows. The barium makes it easier to see the tumors. Before this test, you will be told to fast (not eat or drink) for several hours.
Flexible sigmoidoscopy : -
A thin, lighted tube inserted into the rectum allows the doctor to look into the rectum and first section of the colon (where half of all polyps are found).
Colonoscopy : -
The most accurate and thorough test for colorectal cancer (colon and rectal cancer). A long, thin, lighted tube inserted into the rectum allows the doctor to look into the entire colon, remove polyps, and take tissue for biopsy. Polyp removal will prevent cancer from developing. A mild sedative is usually given with this test.
Ultrasound : -
This noninvasive test uses images and sound waves to take a picture of the inside of the body. Unusual patterns in this image can indicate a mass or tumor. This test is used primarily to find cancer that has already spread to other organs.
Virtual colonoscopy (CT colonography) : -
This test creates a 3-dimensional reconstruction of the colon to reveal any abnormal masses. Images are taken seconds after the colon is inflated with carbon dioxide through a small rectal tube. Virtual colonoscopy is a fairly new technology, so it is not yet clear how accurate it is.
Treatment options for Colorectal Cancer in India : -
Treatment options for colorectal cancer depend on the stage of the tumor-that is, how far it has spread or how deeply it is affecting the intestinal wall and other tissues. Treatment is also determined by the patient's age, medical history, overall health, and tolerance for specific medications and therapies.
Standard options for colorectal cancer treatment in India include : -
Partial colectomy for colorectal cancer in India (also called partial bowel resection)-The tumor and normal tissue on either side of the diseased area in the colon are removed. The surgeon then reconnects the healthy colon. Sometimes the physician may have to create a temporary colostomy, or an opening for solid waste from the bowel to a special bag a patient wears outside the body, until the healthy tissue has healed. At times, the colostomy is permanent.
Laparoscopic surgery or keyhole surgery for colorectal cancer in India -Small tube-like instruments and an extremely small camera are inserted into the abdomen through incisions made in the abdominal wall. The surgeon sees what the camera sees on a television-type screen and can cut out a large section of the bowel and adjacent tissue, called the mesentery.
Radiation therapy for colorectal cancerin India - High-energy radiation is used to kill cancer cells. Radiation may be used in conjunction with surgery as definitive therapy, or may be used to reduce, or palliate, the symptoms of colorectal cancer such as pain, bleeding, or blockage. Radiation therapy is usually delivered as external-beam radiation. Radiation comes from outside the patient's body and is directed onto the cancer and surrounding tissues.
Chemotherapy for colorectal cancer in India -Drugs are given intravenously or orally to kill cancer cells. Chemotherapy is often given to decrease the chance of the tumor returning elsewhere in the body. Like radiation therapy, chemotherapy can ease disease symptoms and increase length of survival for patients with tumors that have spread.
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