Colon Cancer

It is obvious that colon cancer and rectal cancer are two different terms given for separate diseases and should not confuse the concerned patients.

By name, the terms colon cancer refers to the cancer of colon whereas rectal cancer refers to that of rectum.

Colorectal cancer is a collective term for cancers of either colon or rectum or both.

Colon cancer may start as small, noncancerous (benign) clumps of cells (adenomatous polyps) and over time some of the benign polyps convert into colon cancer.

Regular screening for polyps helps to determine if they are progressing into colon cancer.

Signs and symptoms of colon cancer are as follows:

• A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
• Rectal bleeding or blood in your stool
• Persistent abdominal discomfort, such as cramps, gas or pain
• A feeling that your bowel doesn't empty completely
• Weakness or fatigue
• Unexplained weight loss

Generally sign and symptoms do not appear in early stages of colon cancer. Later, when symptoms are prominent, they vary according to cancer size and location.

When to see a doctor

Consult your doctor when you experience symptoms like blood in your stool changes in bowel habits. Generally, you are recommended to have colon cancer screenings when you turn 50 or earlier screening is recommended if you have family history of the disease or any other risk factors.

The exact cause of colon cancer is still unknown. At the beginning of colon cancer, polyps can be observed on the inside lining of the colon. If detected at this stage, the polyps can be removed surgically to prevent full blown colon cancer. Genetic mutations also increase your cancer risk but these inherited mutated genes account for only a small percentage of the cases.

The most common forms of inherited colon cancer syndromes are:

• Familial adenomatous polyposis (FAP): It is an inherited condition in which numerous polyps form on the lining of your colon and rectum. If left untreated, these polyps can turn into cancer.
• Hereditary nonpolyposis colorectal cancer (HNPCC): It is a common risk factor for colon cancer and many other cancers. People with HNPCC, also called Lynch syndrome, are likely to develop colon cancer before age 50.

Genetic testing is used to detect FAP, HNPCC and other inherited colon cancer conditions. You might be at an increased risk of colon cancer if any member of your family had had colon cancer. Talk to your doctor about the concerns.

In case your doctor suspects you have colon cancer, he/she may refer you to specialists in digestive diseases (gastroenterologist) to make a diagnosis. Afterwards, if diagnosed, you might be referred to an Oncologist.

Be prepared before visiting a doctor.

Follow these tips to make the conversation clear, precise and fruitful:

What to expect from your doctor

Note down symptoms you are experiencing and list out all medications, vitamins or supplements that you're taking currently.

Make a list of questions you wish to ask your doctor. Few important questions might be as follows:

• Do I have colon cancer? If yes, which stage?
• Has my colon cancer spread to other parts of my body?
• What are the tests for further diagnosis?
• What are the treatment options and side effects associated?
• Is there a cure for colon cancer? If yes, what are the chances of cure?
• Will treatment affect my daily routine?
• What will that cost, and will my insurance cover it?
• Are there any brochures or other printed material that I can take with me?
• What websites do you recommend?
• Is there an increased risk for my family members?
• Feel free to talk to your doctor if you have any other queries.

What your doctor may ask

• When was the first time you experienced symptoms?
• Are your symptoms severe?
• Is there any factor that improves or worsens your symptoms?
• Do you have history of cancer in your family?

Diagnosing colon cancer

Tests for diagnosis of colon cancer are as follows:

• Colonoscopy: Colonoscopy is used to visualize interior of colon and rectum. A long, flexible and slender tube attached to a camera is inserted into the colon through mouth and images are displayed on the monitor. Suspicious tissues may be removed and analyzed further.
• CT Colonography: This technique is used to locate any polyps if present in colon using X-rays to create a three dimensional image of the interior lining of colon. It is often termed as Virtual colonoscopy and is not widely available but is beneficial for patients who cannot undergo colonoscopy.
• Staging Colon Cancer: Staging helps for selection of appropriate treatment plan. Staging is carried out by using imaging procedures such as abdominal and chest CT scans.

Stages of colon cancer

Stage I :

Cancer has grown through the superficial lining (mucosa) of the colon or rectum but has not spread beyond the colon wall or rectum.

Stage II :

Cancer has grown into or through the wall of the colon or rectum but has not spread to nearby lymph nodes.

Stage III :

Cancer has invaded nearby lymph nodes but has not affecting other parts of your body yet.

Stage IV :

Cancer has spread to distant sites and organs such as liver and lungs.

Treatment plan for colon cancer depends solely on the size and stages of cancer.

Three primary treatment options are: surgery, chemotherapy and radiation.

Surgery

Surgery is recommended for small, localized polyp. Colonoscopy is effective during early stage while larger polyps may be removed using endoscopic mucosal resection. Polyps which can't be removed during colonoscopy may be removed using laparoscopic surgery. During this procedure, several small incisions are made in abdominal wall and instruments with attached cameras are inserted that displays your colon on a video monitor. The surgeon may also take samples from lymph nodes in the area where the cancer is located.

If colon cancer has grown into or through your colon, surgeon may recommend a partial colectomy to remove the part of your colon that contains the cancer, along with a margin of normal tissue on either side of the cancer. Nearby lymph nodes are usually also removed and tested for cancer. Your surgeon is often able to reconnect the healthy portions of your colon or rectum. But when that's not possible, for instance if the cancer is at the outlet of your rectum, you may need to have a permanent or temporary colostomy. This involves creating an opening in the wall of your abdomen from a portion of the remaining bowel for the elimination of body waste into a special bag. Sometimes the colostomy is only temporary, allowing your colon or rectum time to heal after surgery. In some cases, however, the colostomy may be permanent.

If your cancer is very advanced or your overall health is very poor, your surgeon may recommend an operation to relieve a blockage of your colon or other complications. This process is more focused on relieving disease associated pain rather than curing the cancer. In specific cases where the cancer has spread only to the liver and if overall health is good then your doctor may recommend surgery to remove the cancerous lesion from the liver.

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. It is provided usually after surgery if the cancer has spread to the lymph nodes. It may help to reduce the risk of recurrence of cancer. As well as relieve the symptoms of colon cancer that has spread to other areas of the body. Chemotherapy may be used before surgery to shrink the cancer before an operation. In people with rectal cancer, it is typically used along with radiation therapy.

Radiation therapy

Radiation therapy uses ionizing radiations such as X-rays to destroy cancer cells. Radiation therapy is usually combined with chemotherapy or may be used after surgery to reduce the chance of recurrence. Radiation therapy is rarely used in early-stage colon cancer, but is a routine part of treating rectal cancer, especially if the cancer has penetrated through the wall of the rectum or traveled to nearby lymph nodes.

Targeted drug therapy

Targeted drugs are typically reserved for people with advanced colon cancer. Drugs including bevacizumab (Avastin), cetuximab (Erbitux), panitumumab (Vectibix) and regorafenib (Stivarga) are used for the treatment. However, the extent of benefits of such drugs varies for individual patients.

Several methods are used to prevent colon cancer.

People with an average risk of colon cancer can consider screening at the age of 50 an people with an increased risk, such as those with a family history of colon cancer should consider screening sooner. African-Americans and American Indians may consider beginning colon cancer screening at age 45.

Several screening options exist — each with its own benefits and drawbacks.

• Talk about treatment plans and options appropriate for you with your doctor.
• Make lifestyle changes to reduce your risk. Exercise most days of the week: Try to get at least 30 minutes of exercise for at least three days a week. If you've been inactive, start slowly and build up gradually to 30 minutes. Also, talk to your doctor before starting any exercise program.
• Maintain a healthy weight: Know if you're overweight or obese and reduce the number of calories you consume each day. Adopt some strategies to help lose weight.
• Take steps to: Eat a variety of fruits, vegetables and whole grains. Fruits, vegetables and whole grains contain vitamins, minerals, fiber and antioxidants, which may play a role in cancer prevention.
• Quit smoking: Support programs, medications and nicotine replacement products can help quit smoking.
• Limit the consumption of alcohol if you are a regular drinker.

Colon Cancer prevention for people with a high risk

People with high risks can undergo medications and surgery for the prevention of precancerous polyps or colon cancer. However, not enough evidence exists to recommend these medications to people who have an average risk of colon cancer.

Medicines like Aspirin are suggested to reduce the risk of polyps and colon cancer when administered regularly in high dose. Other drugs like Celecoxib and other COX-2 inhibitors provide relieves the associated pain as well as reduce the risk of precancerous polyps. However, such drugs carries unavoidable side effects like aspirin causes gastrointestinal bleeding and ulcers and COX-2 drugs carries a risk of heart problems, including heart attack.

In cases of rare, inherited syndromes such as familial adenomatous polyposis, or inflammatory bowel disease such as ulcerative colitis, your doctor may recommend removal of entire colon and rectum in order to prevent cancer.

Apparently no complementary or alternative remedies exist to cure colon cancer. However, they can help you better cope with cancer associated symptoms like sadness, anger, difficulty concentrating, difficulty sleeping and loss of appetite.

Few complementary therapies are as follows:

• Art therapy
• Dance or movement therapy
• Exercises
• Meditation
• Music therapy
• Relaxation techniques
• Exercises

Few tips to standardize your lifestyle to cope with the existing colon cancer are as follows:

• Find a good source of knowledge like books, information centers or any reliable sources to know about the disease and assist your doctor in preparing an effective treatment plan.
• Stay positive and gather a supportive network of friends and family.
• Focus on balanced diet, include fruits and vegetables in the diet and do exercise to stay fit.
• Set aside time for yourself each day. Reading books, relaxing or listening to music can help relieve your stress.

Following factors may increase the risk of Colon cancer:

• Older age: Colon cancer can occur in younger people but Risk increases after the age of 50.
• Race: African-Americans have a greater risk of colon cancer than do people of other races.
• Inflammatory intestinal conditions: Chronic inflammatory diseases of the colon, such as ulcerative colitis and Crohn's disease can increase your risk of colon cancer.
• Obesity: People who are obese are at higher risk
• A personal history of colorectal cancer or polyps. If you've already had colon cancer or adenomatous polyps, you have a greater risk of colon cancer in the future.
• Genetic syndromes: passed through generations of your family can increase your risk of colon cancer. These syndromes include familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, which is also known as Lynch syndrome.
• Family history of colon cancer and colon polyps: You're more likely to develop colon cancer if you have a parent, sibling or child with the disease. If more than one family member has colon cancer or rectal cancer, your risk is even greater.
• Low-fiber, high-fat diet: Colon cancer and rectal cancer may be associated with a diet low in fiber and high in fat and calories. Research in this area has had mixed results. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat.
• Diabetes: People with diabetes and insulin resistance may have an increased risk of colon cancer.
• Smoking: Smokers are at greater risk.
• Alcohol: Alcoholic person are at greater risk.
• Radiation therapy for cancer: Radiation therapy directed at the abdomen to treat previous cancers may increase the risk of colon cancer.