What is colon cancer?
Colon cancer, also known as colorectal cancer, is a type of cancer that begins in the colon or rectum. The colon and rectum are parts of the digestive system, where waste material is stored before being eliminated from the body.
Colon cancer typically starts as small, noncancerous clumps of cells called polyps that form on the inner lining of the colon or rectum. Over time, some of these polyps can become cancerous. The exact cause of colon cancer is not fully understood, but factors such as age, family history, diet high in red or processed meats, lack of physical activity, obesity, smoking, heavy alcohol use, and certain genetic conditions can increase the risk.
What are symptoms of colon cancer?
Many patients with colon cancer will not experience any symptoms. This is why screening colonoscopy is so important. Some patients may experience symptoms from colon cancer. These may include
- Blood in the stool
- Anemia
- Fatigue
- Weight Loss
- Abdominal Pain
- Constipation
- Change in bowel habits
What are the risk factors for colon cancer?
Several factors can increase the risk of developing colon cancer. While having one or more risk factors does not necessarily mean that an individual will develop colon cancer, being aware of these factors can help individuals and healthcare providers make informed decisions about screening and preventive measures. Some common risk factors for colon cancer include:
- Family History and Genetics: Individuals with a family history of colon cancer or certain genetic conditions, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary nonpolyposis colorectal cancer), have an increased risk of developing colon cancer.
- Personal History of Colorectal Polyps or Cancer: Individuals who have previously been diagnosed with colorectal polyps or cancer are at increased risk of developing new polyps or cancer in the future.
- Inflammatory Bowel Disease (IBD): Chronic inflammatory conditions of the colon, such as ulcerative colitis and Crohn's disease, can increase the risk of colon cancer over time.
- Dietary Factors: A diet high in red and processed meats, as well as low in fiber, fruits, and vegetables, has been associated with an increased risk of colon cancer. Consuming alcohol in excess and being overweight or obese may also contribute to an elevated risk.
- Lack of Physical Activity: Sedentary lifestyle and lack of regular physical activity have been linked to an increased risk of colon cancer.
- Smoking: Smoking cigarettes has been shown to increase the risk of colon cancer, as well as other types of cancer and various health conditions.
- Race and Ethnicity: African Americans have a higher incidence of colon cancer compared to other racial and ethnic groups in the United States. The reasons for this disparity are not fully understood but may involve a combination of genetic, environmental, and healthcare-related factors.
- Type 2 Diabetes: Individuals with type 2 diabetes have an increased risk of colon cancer, particularly if the diabetes is poorly controlled.Certain Lifestyle Factors: Other factors that may increase the risk of colon cancer include being overweight or obese, consuming a diet high in processed foods and low in fiber, heavy alcohol consumption, and being physically inactive.
It's important to note that while these factors can influence the risk of developing colon cancer, many cases of colon cancer occur in individuals with no known risk factors. Additionally, having one or more risk factors does not guarantee that an individual will develop colon cancer, and conversely, not having any risk factors does not eliminate the possibility of developing the disease. Regular screening and early detection are crucial for improving outcomes and reducing the risk of advanced disease.
How is colon cancer diagnosed?
Colon cancer can be diagnosed through various methods, including screening tests and diagnostic procedures. Here are some common approaches to diagnosing colon cancer:
Colonoscopy: A colonoscopy is considered the gold standard for colon cancer screening and diagnosis. During this procedure, a flexible, lighted tube called a colonoscope is inserted into the rectum and guided through the colon. The doctor can view the inside of the colon and rectum and identify any abnormalities, such as polyps or tumors. If abnormal tissue is found, a biopsy may be taken for further analysis to determine if it is cancerous.
Flexible sigmoidoscopy: Similar to a colonoscopy, a flexible sigmoidoscopy uses a flexible tube to examine the lower part of the colon (sigmoid colon) and rectum. However, it does not examine the entire colon like a colonoscopy. This procedure may be used as a screening tool or to evaluate symptoms, but it is not as comprehensive as a colonoscopy.
Stool tests: Stool tests, such as fecal occult blood tests (FOBT), fecal immunochemical tests (FIT), and Cologuard, are non-invasive tests that detect blood in the stool, which can be a sign of colon cancer. These tests may be used for screening purposes or to evaluate symptoms. If blood is detected, further testing, such as a colonoscopy, is usually recommended to determine the cause.
Imaging tests: Imaging tests, such as CT scans, MRI scans, and PET scans, may be used to evaluate the extent of the cancer and detect any spread (metastasis) to other parts of the body. These tests can provide detailed images of the colon, rectum, and surrounding tissues, helping doctors determine the stage of the cancer and plan treatment accordingly.
Biopsy: If suspicious areas are found during a colonoscopy or imaging tests, a biopsy may be performed to obtain a sample of tissue for analysis. The tissue sample is examined under a microscope by a pathologist to determine if cancer cells are present and to determine the type and grade of the cancer.
Genetic testing: In some cases, genetic testing may be recommended to identify specific genetic mutations that increase the risk of colon cancer, such as Lynch syndrome or familial adenomatous polyposis (FAP). Genetic testing may also be used to guide treatment decisions for certain types of colon cancer.
Diagnosing colon cancer often involves a combination of these tests and procedures, tailored to the individual patient's symptoms, risk factors, and medical history. Early detection and diagnosis are key to improving outcomes and increasing the chances of successful treatment.
What are treatment options for colon cancer?
Treatment for colon cancer depends on several factors including the stage of the cancer, the location of the tumor, the patient's overall health, and personal preferences. Typically, a combination of treatments is used to effectively manage colon cancer.
Your colorectal surgery has specialized training and advanced board certification in the treatment of this disease. Your surgeon will work closely with a team involving Gastroenterologists, Radiologists, Medical Oncologists, Radiation Oncologists, and your Primary Care Provider to help determine the best individualized treatment plan for each patient.
Surgery: Surgery is often the primary treatment for colon cancer. The goal of surgery is to remove the cancerous tumor along with a margin of healthy tissue. In some cases, nearby lymph nodes may also be removed to check for the spread of cancer. The type of surgery may vary depending on the size and location of the tumor. Common procedures include:
- Polypectomy: Removal of small polyps during a colonoscopy.
- Colectomy: Removal of a portion of the colon containing the tumor.
- Laparoscopic or robotic-assisted surgery: Minimally invasive techniques that involve smaller incisions and shorter recovery times compared to traditional open surgery.
Chemotherapy: Chemotherapy involves the use of drugs to kill cancer cells or prevent them from growing and dividing. It may be used before surgery (neoadjuvant chemotherapy) to shrink the tumor, after surgery (adjuvant chemotherapy) to kill any remaining cancer cells, or as the primary treatment for advanced or metastatic colon cancer.
Radiation therapy: Radiation therapy uses high-energy beams to target and destroy cancer cells. It may be used in combination with surgery and/or chemotherapy, particularly for rectal cancer, to shrink tumors before surgery or to kill remaining cancer cells after surgery.
Targeted therapy: Targeted therapy drugs are designed to specifically target certain molecules or pathways that are involved in the growth and spread of cancer cells. These drugs may be used alone or in combination with chemotherapy for advanced colon cancer that has specific genetic mutations, such as KRAS or BRAF mutations.
Immunotherapy: Immunotherapy drugs work by stimulating the body's immune system to recognize and attack cancer cells. While not yet as commonly used in colon cancer as in some other types of cancer, immunotherapy is being studied in clinical trials and may be an option for certain patients, particularly those with advanced or metastatic disease.
Palliative care: Palliative care focuses on relieving symptoms and improving the quality of life for patients with advanced or metastatic colon cancer. It may include pain management, nutritional support, emotional support, and other supportive care services.
Treatment plans are often personalized based on the individual patient's needs and may involve a multidisciplinary team of healthcare professionals, including surgeons, medical oncologists, radiation oncologists, and other specialists. It's important for patients to discuss their treatment options and goals with their healthcare team to make informed decisions about their care.
The approach to colon cancer treatment depends heavily on whether the cancer is contained within the colon. Once a tumor is identified and marked, most patients are referred to surgery for treatment. Surgery is very effective for colon cancer, but if the cancer has metastasized outside of the colon, treatment looks different.
For cancers contained within the colon, treatment is almost always surgical. In many cases, the surgical treatment is curative. However, curative surgical treatment doesn’t mean that recurrences are completely out of the question. In the category of early stage cancer where surgery has cured, a patient’s GI or endoscopist will ensure they have colonoscopies at the appropriate intervals (early and frequent). Once a patient has a history of colon cancer, they are considered high risk for repeat cancers. They’ll have colonoscopies more frequently than patients with an average risk.
A need for a colostomy bag is one of the most common fears patients might have, but it is very rarely needed. An ostomy isn’t used unless it’s necessary. In most patients, reconnect is completed which eliminates the need for an ostomy bag.
What should I expect after colon cancer surgery?
Surveillance after colon cancer surgery involves regular monitoring and follow-up care to detect any recurrence of cancer, manage treatment-related side effects, and address any new or ongoing health concerns. The specific surveillance plan may vary depending on factors such as the stage of the cancer, the type of treatment received, and the individual patient's overall health and risk factors. However, some general principles and practices typically apply:
Follow-up Visits: After colon cancer surgery, patients usually have regular follow-up visits with their healthcare provider. These visits may occur every few months initially and then less frequently over time. During these visits, the healthcare provider will review the patient's medical history, perform a physical examination, and discuss any symptoms or concerns.
Imaging Tests: Imaging tests such as CT scans, MRI scans, or PET scans may be performed periodically to monitor for any signs of cancer recurrence or spread (metastasis). The frequency and type of imaging tests recommended will depend on factors such as the stage of the cancer and the individual patient's risk profile.
Blood Tests: Blood tests may be used to monitor tumor markers or other indicators of cancer activity. For example, levels of a protein called carcinoembryonic antigen (CEA) may be measured, as elevated levels can be a sign of colorectal cancer recurrence.
Colonoscopy: Colonoscopy may be recommended periodically to examine the inside of the colon and rectum for any signs of recurrence or new polyps. The timing and frequency of colonoscopies will depend on factors such as the stage of the cancer, the presence of risk factors for recurrence, and the results of previous colonoscopies.
Genetic Counseling and Testing: Some individuals with colon cancer may benefit from genetic counseling and testing to identify specific genetic mutations that increase the risk of cancer recurrence or the development of new cancers. This information can help guide surveillance and treatment decisions.
Lifestyle Modifications: Patients may be advised to make lifestyle modifications to reduce their risk of cancer recurrence and improve overall health. This may include maintaining a healthy weight, eating a balanced diet, engaging in regular physical activity, avoiding tobacco use, and limiting alcohol consumption.
Psychosocial Support: Coping with a cancer diagnosis and undergoing treatment can be emotionally challenging. Patients may benefit from psychosocial support services such as counseling, support groups, or other resources to help them navigate the emotional and psychological aspects of survivorship.
Surveillance after colon cancer surgery is aimed at detecting any recurrence of cancer at an early stage when it may be more effectively treated. It's important for patients to actively participate in their follow-up care and communicate openly with their healthcare team about any symptoms, concerns, or changes in their health.