How Do You Know That You Have Colorectal Cancer

Overview

What is colorectal cancer?

Cancer that begins in the colon is called colon cancer, while cancer in the rectum is known every bit rectal cancer. Cancers that affect either of these organs may be called colorectal cancer. Though not true in all cases, the majority of colorectal cancers generally develop over fourth dimension from adenomatous (precancerous) polyps. Polyps (growths) can change after a series of mutations (abnormalities) arise in their cellular DNA. Some of the adventure factors for colorectal cancer involve a family history of colon or rectal cancer, diet, booze intake, smoking and inflammatory bowel affliction.

What parts of the body are affected by colorectal cancer?

To understand colorectal cancer, it is helpful to understand what parts of the body are afflicted and how they work.

The colon

The colon is an approximately 5- to six-foot long tube that connects the small intestine to the rectum. The colon — which, along with the rectum, is called the big intestine — moves and processes digesting food across your body and down towards the rectum, where it exits the trunk equally stool. At that place are several parts of the colon, including:

Ascending colon: This section is where undigested food begins its journey through the colon. Undigested food moves upward through this section, where fluid is reabsorbed more efficiently.
Transverse colon: Moving across the body, the transverse colon takes the food from 1 side of the body to the other (right to left).
Descending colon: Once the nutrient has travelled across the top through the transverse colon, it makes its way downwards through the descending colon—typically on the left side.
Sigmoid colon: The last department of the colon, this portion is shaped like an "Southward" and it is the last stop before the rectum.

Illustration of the colon | Cleveland Clinic

The rectum

The rectum is a 5- to half-dozen-inch chamber that connects the colon to the anus. It is the job of the rectum to act as a storage unit of measurement and hold the stool until defecation (evacuation) occurs.

Symptoms and Causes

How does colorectal cancer develop?

All of the torso'south cells normally grow, split, and then die in order to go on the body healthy and functioning properly. Sometimes this procedure gets out of control. Cells go along growing and dividing even when they are supposed to die. When the cells lining the colon and rectum multiply uncontrolled, colorectal cancer may ultimately develop.

Fortunately, most colorectal cancers begin equally small-scale precancerous (adenomatous or serrated) polyps. These polyps usually grow slowly and practice not cause symptoms until they go large or cancerous. This allows the opportunity for detection and removal at this pre-cancerous polyp phase before the development of cancer.

What if I have polyps?

There are a variety of colorectal polyps, but cancer is idea to arise mainly from adenomas and sessile serrated lesions, which are precancerous polyps. If a polyp is found during a colonoscopy it is unremarkably removed, if possible. Polyps removed during colonoscopies are then examined by a pathologist and evaluated to determine if they comprise cancerous or precancerous cells. Based on the number, size, and type of precancerous polyps plant during colonoscopy, your healthcare provider will recommend a futurity colonoscopy for monitoring (surveillance).

What are the signs and symptoms of colorectal cancer?

Unfortunately, some colorectal cancers might exist present without any signs or symptoms. For this reason, information technology is very important to take regular colorectal screenings (examinations) to discover problems early. The best screening evaluation is a colonoscopy. Other screening options include fecal occult blood tests, fecal DNA tests, flexible sigmoidoscopy, barium enema, and CT colonography (virtual colonoscopy). The historic period at which such screening tests begin depends upon your risk factors, especially a family history of colon and rectal cancers.

Even if you do not accept a family history of colorectal cancer or polyps, tell your dr. if you have whatever of the signs that could indicate a colorectal cancer, no affair what your age. Mutual signs of colorectal cancer include the following:

Change in bowel habits: Constipation, diarrhea, narrowing of stools, incomplete evacuation, and bowel incontinence — although usually symptoms of other, less serious problems — can likewise exist symptoms of colorectal cancer.
Blood on or in the stool: By far the most noticeable of all the signs, claret on or in the stool can be associated with colorectal cancer. However, it does not necessarily indicate cancer, since numerous other problems can cause bleeding in the digestive tract, including hemorrhoids, anal tears (fissures), ulcerative colitis, and Crohn's disease, to name only a few. In addition, iron and some foods, such as beets, tin can give the stool a black or red appearance, falsely indicating blood in the stool. However, if you notice blood in or on your stool, see your doctor to rule out a serious condition and to ensure that proper handling is received.
Unexplained anemia: Anemia is a shortage of red blood cells— the cells that carry oxygen throughout the torso. If y'all are anemic, yous may experience shortness of breath. Yous may too feel tired and sluggish, then much so that rest does non make you feel better.
Intestinal or pelvic pain or bloating
Unexplained weight loss
Vomiting

If you lot feel whatever of these signs or symptoms, it is of import to see your md for evaluation. For a patient with colorectal cancer, early diagnosis and treatment tin be life-saving.

Diagnosis and Tests

When should screening for colorectal cancer begin?

The American Cancer Guild recommends that people at average risk of colorectal cancer start regular screening at age 45. Other experts recommend regular screening in average risk individuals to first no later on than at age 50. Still, if y'all have a personal or a family history of colorectal polyps or cancer, or inflammatory bowel disease, screening may need to brainstorm before historic period 45. Men and women should undergo screening since colorectal polyps and cancer affect both genders. Ask your healthcare provider what historic period is best to start your screening based on your personal risk factors.

What if I have a family history of colorectal cancer?

Your doctor may recommend before screening for colorectal cancer if you have a family history of the condition. To make up one's mind the appropriate age to first screening, your md will discuss all of your risk factors with y'all. These risk factors tin include a family or personal history of polyps, a history of cancer in the abdomen, and a history of inflammatory bowel illness.

Some studies have found that having a showtime-degree relative with colorectal cancer puts yous at a risk that is 2-3 times higher than someone without a first-degree relative with colorectal cancer. A first-degree relative is defined every bit your mother, your begetter, your brother or sister, and your child. Your risk can also be higher if yous have other people in your family with colorectal cancer, fifty-fifty if they are not first-caste relatives. They could be grandparents, aunts, uncles, cousins, nieces and nephews, even grandchildren.

The age at which whatever relative is diagnosed is also important. The risk to you is more significant when the relative is diagnosed before age 45.

About 75% of people who practice go colorectal cancer do not get it because of genetics. Almost ten% to 30% exercise have a family history of the affliction.

If you do accept relatives that have been diagnosed with colorectal cancer, your healthcare provider may also recommend genetic testing and/or genetic counseling. Certain DNA mutations are inherited and are linked to colorectal cancers. Genetic testing may provide the information needed to know if you are at a college take a chance, so that you lot can have the correct screening at the correct time and peradventure terminate cancer before it develops or at a very early phase.

What is involved in screening for colorectal cancer?

Several tests are used to screen for colorectal cancer. Although colonoscopy is virtually recommended, other options are bachelor. These are the near common screening tests:

Fecal immunochemical test (FIT): This test looks for blood in the stool that is not hands seen visually. This test can be done at domicile past collecting stool in tubes. The nerveless stool will be tested at a lab for any claret.
Guaiac-based fecal occult blood test (gFOBT): Similar to the FIT test, the guaiac-based fecal occult blood test also looks for hidden claret in the stool. The specimen (stool) for this test is also collected at home and sent to a lab. In this test, a chemical reaction is used to screen for any subconscious blood. Withal, the gFOBT is unable to make up one's mind where in the digestive tract the blood is coming from. Additional testing will exist needed to determine the exact location of the blood.
Fecal Dna examination: The fecal Dna test works by detecting genetic mutations and blood products in the stool. Genetic material, called Dna, is present in every cell of the torso, including the cells lining the colon. Normal colon cells and their genetic material are passed with the stool every twenty-four hours. When a colorectal cancer or a large polyp develops, abnormalities (or mutations) occur in the genetic material of the cells. Some mutations nowadays in the polyp or cancer can be detected by laboratory assay of the stool.
Flexible sigmoidoscopy: A flexible sigmoidoscopy uses a device called a sigmoidoscope to run across within the rectum and lower colon. Unlike the tool used during a colonoscopy, this device is not as long, limiting how much of the colon can be seen. During this procedure, the sigmoidoscope is inserted into the anus and up through the rectum and sigmoid colon (s-shaped part). Gas is pumped in during the procedure to allow the caregiver the best possible view. This is a brief outpatient procedure, often performed without sedation. The bowel must be empty for this procedure—typically done with the help of a laxative and or enema beforethe test. Small polyps found during the procedure can be removed and tested for cancer. If these tests come up back positive, a colonoscopy will exist done.
Colonoscopy: Colonoscopy is the best process to check for colorectal polyps and cancer. Colonoscopy is an outpatient procedure in which a physician uses a long, flexible scope (called a colonoscope) to view the rectum and unabridged colon. During the procedure, polyps can be removed and tested for signs of cancer. The bowel must be cleaned-out—done with the help of a laxative ("bowel training")—before the procedure begins. The patient is usually given a sedative for this procedure and will need help getting home afterwards as the sedative wears off. A colonoscopy is considered a safety procedure with few risks.
Double contrast barium enema: This is an X-ray exam of the colon and rectum in which barium is given every bit an enema (through the rectum). Air is then blown into the rectum to expand the colon, producing an outline of the colon on an 10-ray. Barium enema is not the nigh accurate method and should not exist the procedure of pick for colorectal cancer screening. It as well requires a bowel preparation.
CT colonography (virtual colonoscopy): In this procedure, also known equally CT colonoscopy or virtual colonoscopy, a CT browse (imaging created with the use of 10-rays) of the abdomen and pelvis is performed after drinking a dissimilarity dye and inflating contrast and air into the rectum. No sedation is needed for this test. Similar colonoscopy and barium enema, the colon must exist cleaned out before the examination. In the case that a polyp is institute, then a colonoscopy must be performed.

How is colorectal cancer diagnosed?

Colorectal cancer can be diagnosed by a diverseness of tests. This condition can be diagnosed after you show symptoms or if your caregiver finds something during a screening exam that is not normal.

During the diagnosis process, your doctor may do the following tests:

Blood tests (Complete blood count, tumor markers and liver enzymes)
Imaging tests (Ten-rays, CT scan, MRI scan, PET scan, ultrasound, angiography)
Biopsy
Diagnostic colonoscopy (washed after y'all show symptoms, not as a routine screening exam)
Proctoscopy

Routine screening tests are washed earlier you show whatever symptoms. These tests are detailed above.

Direction and Treatment

How is colorectal cancer treated?

Colorectal cancer is treated based on the stage of cancer. Staging identifies the severity of the cancer. Treatment options can include the use of surgery, chemotherapy and radiation.

What are the stages of colorectal cancer?

Colorectal cancer is described clinically by the stages at which information technology is discovered. The various stages of a colorectal cancer are determined past the depth of invasion through the wall of the intestine; the involvement of the lymph nodes (the drainage nodules); and the spread to other organs (metastases). Listed below is a clarification of the stages of colorectal cancer and the treatment for each stage. In most cases, handling requires surgical removal (resection) of the affected part of the intestine. For some tumors, chemotherapy or — for rectal cancers — radiations are added to manage the disease.

Stage 0: For lesions that are stage 0 — likewise known equally carcinoma in situ — the illness remains within the lining of the colon or rectum. Lesions are in the pre-cancerous phase and are not cancers. Therefore, removal of the lesion, either by polypectomy via colonoscopy or by surgery if the lesion is too large, may be all that is required for treatment.

Stage I: Stage I colorectal cancers have grown into the wall of the intestine but have not spread beyond its muscular coat or into close lymph nodes. The standard handling of a stage I colon cancer is commonly a colon resection alone, in which the affected part of the colon and its lymph nodes are removed. The type of surgery used to treat a rectal cancer is dependent upon its location, simply includes a low anterior resection or an abdominoperineal resection.

Stage II: Phase II is divided into 3 smaller stages. In the outset stage, IIA, the cancer has spread through the wall of the colon. In phase IIB, colorectal cancer has penetrated beyond the muscular layers of the large intestine. By stage IIC the cancer has even spread into next tissue. Yet, in all stage II lesions, the cancer has non yet reached the lymph nodes. Commonly the only handling for this phase of colon cancer is a surgical resection (removal), although chemotherapy later surgery may exist added. For a stage Ii rectal cancer, a surgical resection is sometimes preceded or followed past chemotherapy and/or radiation.

Phase Iii: A stage III colorectal cancer is considered an advanced stage of cancer as the disease has spread to the lymph nodes. Once again, there are three smaller stages of phase Iii colorectal cancer. Stage IIIA is characterized by cancer that has moved across the colon wall and spread to one to iii lymph nodes or a very early lesion in the colon wall that has spread to four to six lymph nodes. In the second phase, IIIB, more lymph nodes are affected or there is a more advanced lesion in the colon wall with one to iii lymph nodes affected. The cancer as well impacts the organs in the abdomen in this stage. In phase IIIC, the cancer continues to spread to nearby lymph nodes and impacts more side by side tissue of organs in the abdomen. For a colon cancer, surgery is usually done first, followed by chemotherapy. Chemotherapy and radiation may precede or follow surgery for a stage III rectal cancer.

Stage IV: For patients with stage IV colorectal cancer, the disease has spread (metastasized) to afar organs such as the liver, lungs or ovaries. This stage is also divided into three stages. Phase IVA is characterized by cancer that has spread to an organ and lymph nodes that are farther from the colon. In stage IVB the cancer has moved to more than ane distant organ and more than lymph nodes. Stage IVC cancer has impacted not only the distant organs and lymph nodes, but as well the tissue of the belly. When the cancer has reached this stage, surgery is mostly used for relieving or preventing complications every bit opposed to curing the patient of the affliction. Occasionally the cancer's spread is restricted enough to where it can all be removed by surgery. In the example of minimal disease in the liver, the tumor may exist treated with radiofrequency ablation (destruction with rut), cryotherapy (devastation by freezing), or intra-arterial chemotherapy. For stage IV cancer that cannot be surgically removed, chemotherapy, radiation therapy, or both may exist used to salvage, filibuster, or forestall symptoms.

What is chemotherapy?

Chemotherapy refers to drugs that kill cancer cells. Chemotherapy drugs can exist given intravenously (into a vein) via an injection or a pump, or orally (by oral cavity) as a pill. Each drug works against a specific cancer and is delivered in specific doses and schedules. Chemotherapy may be recommended for avant-garde colorectal cancers, in which the cancer cells take spread to the lymph nodes (drainage nodules) or to other organs.

Chemotherapy is used in the following ways:

Primary chemotherapy is used when the colorectal cancer has already metastasized (spread) to other organs, like the liver or lungs. In this situation, since surgery usually cannot eliminate the cancer, chemotherapy can possibly shrink the tumor nodules, relieve symptoms and prolong life.
Neo-adjuvant chemotherapy is given before surgery for sure rectal cancers in order to shrink the tumor and allow the surgeon to ameliorate remove information technology. In this situation, the patient usually receives radiation along with the chemotherapy.
When advisable, adjuvant chemotherapy is given subsequently the colorectal cancer is removed with surgery. The surgery may not eliminate all of the cancer cells, and some may remain in the lymph nodes or other organs. The adjuvant chemotherapy is used to kill whatever of these remaining cancer cells.

Your doc volition talk with yous virtually the best treatment for your condition.

What chemotherapy agents are used to treat colorectal cancer?

v-Fluorouracil, or 5-FU (Adrucil®), has been the first-line chemotherapy drug, along with the vitamin leucovorin, for advanced colorectal cancers for many years. five-FU is often given intravenously but is also available in an oral grade as capecitabine (Xeloda®).

Two other intravenous (directly into the vein) chemotherapy drugs — irinotecan (Camptosar®) and oxaliplatin (Eloxatin®) — as well are used for the treatment of advanced colorectal cancers. Oxaliplatin is given, along with 5-FU and leucovorin, for avant-garde colorectal cancers, while irinotecan is used alone or in combination with 5-FU/leucovorin for patients with metastatic colorectal cancer (cancer that has spread).

Newer treatments for metastatic colorectal cancer include monoclonal antibodies and immunotherapy.

Monoclonal antibodies are created in a lab to find and destroy a particular target – in this case, colorectal cancer cells. Because of their precision, the thought is that treating a tumor with a monoclonal antibody will be more specific than chemotherapy drugs, and therefore have fewer side effects.

Some monoclonal antibody medications prevent tumors from growing the blood vessels needed for their survival, such every bit vascular endothelial growth factor (VEGF), a substance released by tumors to stimulate the growth of new blood vessels. Interfering with the blood supply to a tumor might deadening its growth. Others slow cancer growth by targeting the epidermal growth cistron receptor (EGFR), a protein found on the surface of about 60 to fourscore percent of colon cancer cells. They are often used along with or after other chemotherapy agents for metastatic colorectal cancer that does non respond to other treatments.

What is immunotherapy?

Immunotherapy is a newer type of treatment for colorectal cancer. The goal of immunotherapy is to boost a patient'southward allowed reaction to the cancer cells to assist them fight the illness more effectively. At that place are two types of immunotherapy: active and passive.

Active immunotherapy is intended to stimulate the patient'south allowed organisation. The patient'south antibodies (immune system cells) are made to recognize an abnormal component in the cancer cells then to selectively impale those cells. A vaccine is an example of an active immunotherapy. Active immunotherapy and vaccines against colorectal cancer are still nether investigation.
Passive immunotherapy products are manufactured in a laboratory to imitate the trunk's antibodies. Passive immunotherapeutic medications do not stimulate the patients' immune organization to fight the affliction. Rather, these human being-made antibodies target specific components on the colorectal cancer cells in lodge to forestall the cancer cells from escaping the body'southward natural immune response.

What are the side furnishings of chemotherapy and immunotherapies?

Traditional chemotherapy

The side effects of traditional chemotherapy depend upon the drug, its dosage, how long the treatment lasts and the patient. Because traditional chemotherapy drugs target rapidly dividing cancer cells, they too kill other rapidly dividing salubrious cells in the lining of the mouth and the gastrointestinal tract, the hair follicles, and the bone marrow. The side effects of chemotherapy come up from damage to these normal cells. (Although hair loss is not common to most chemotherapy treatments for colorectal cancer, some people may feel hair thinning.)

The side effects of traditional chemotherapy can include:

Nausea.
Vomiting.
Loss of ambition.
Hair loss.
Mouth sores.
Rashes.
Diarrhea.

Since chemotherapy affects the os marrow, there may as well be a greater risk of infection (because of low white claret prison cell counts), bleeding or bruising from minor injuries (because of low blood platelet counts), and anemia-related fatigue (because of low reddish blood jail cell counts).

Although it may take some time, most side furnishings related to chemotherapy will go abroad when the chemotherapy is stopped.

Monoclonal antibodies

The side effects of monoclonal antibodies depend on the drug. Many of these side effects are like to those of traditional chemotherapy medications.

Inquire your doctor about the side effects of whatsoever medications earlier you start to take them. If you are having any side effects, tell your doc. In many cases, they can exist treated or prevented with medications or a change in nutrition.

Prevention

Who is at adventure for colorectal cancer?

Every 1 of u.s.a. is at take chances for colorectal cancer. Although the exact crusade for the development of precancerous colon polyps that lead to colorectal cancer is not known, there are some factors that increase a person'southward risk of developing colorectal polyps and cancer. These hazard factors include:

Age: The risk of developing colorectal polyps and cancer increases as we age. Colorectal cancer is more common in people over the age of 50, all the same, younger adults can as well develop colorectal cancer.
Other medical conditions: Medical conditions (type 2 diabetes, previous history of cancer, history of inflammatory bowel illness) and inherited conditions (Lynch syndrome, familial adenomatous polyposis) can increase your chances of developing colorectal cancer.
Lifestyle factors: Y'all may be at increased chance for developing colorectal cancer if you drink alcohol, use tobacco, don't become enough exercise, and/or if y'all are overweight. Smoking increases the risk of precancerous polyps and colorectal cancer. A diet loftier in fatty and calories and low in fiber, fruits and vegetables has been linked to a greater gamble of developing colorectal cancer. Many lifestyle factors that increase the risk of colorectal cancer tin can be modified to lessen that risk.

What conditions are associated with colorectal cancer?

Polyps: In that location are a variety of polyps that can form on the inner wall of the colon or rectum. Precancerous polyps can plow into colorectal cancer. People with numerous polyps—including adenomas, serrated polyps or other types of polyps—ofttimes have a genetic predisposition to polyposis and colorectal cancer. These individuals should exist managed differently than people with simply one to two colorectal polyps.
Inflammatory bowel disease: Ulcerative colitis and Crohn'south colitis are conditions in which the lining of the colon becomes inflamed. People with these conditions, when present for more than 7 years and affecting a large portion of the colon, are at greater risk for developing colorectal cancer.
Personal history: A person who already has had colorectal adenomas or cancer may develop the disease a second time. Also, a history of inflammatory bowel disease can increase the risk of developing colorectal cancer.
Family history: Sometimes colon cancer "runs in" families. This type of moderately increased cancer adventure can be called a "familial colon cancer." When a person has a hereditary cancer susceptibility, he or she has inherited a copy of a cancer susceptibility gene with a mutation. Individuals who inherit a mutation in a cancer susceptibility gene have a much greater chance for developing cancer. However, not anybody with a cancer susceptibility gene mutation will develop cancer. Genetic testing is available for these colorectal cancer syndromes.

Does having these gamble factors mean that I will develop colorectal cancer?

Having 1 or more of these gamble factors does not guarantee that you will develop colorectal cancer. However, you should talk about these run a risk factors with your medico. He or she may exist able to advise ways to reduce your chances of developing colorectal cancer.

Outlook / Prognosis

What is the prognosis for people with colorectal cancer?

Every person is dissimilar and responds differently to handling. However, with prompt and advisable treatment, the outlook for a person with colorectal cancer is hopeful. The survival charge per unit for people with colorectal cancer depends on the stage of the cancer at the time of diagnosis and the individual'southward response to treatment. In addition, many new discoveries have the potential for improving the treatment of colorectal cancer, likewise every bit the prognosis.

Several factors make up one's mind how well a person volition do after handling for colorectal cancer. They include:

Stage of the cancer: This is the nearly critical factor. The stage of your cancer when diagnosed helps determine the severity of the condition. Lower staged conditions (stages 0, I, II) are characterized by cancers that have not spread to other organs in the torso or lymph nodes. The survival rate goes down with higher staged cancers. Talk to your healthcare provider about the different stages of colorectal cancer for more than information.
The number of lymph nodes involved: The lymph organisation is a circulatory system that includes an extensive network of lymph vessels and lymph nodes. The lymphatic system helps coordinate the immune system's function to protect the body from foreign substances. The more lymph glands that were affected past the cancer, the more than likely your cancer will recur. Chemotherapy is unremarkably needed in cases where lymph nodes are involved.
If the cancer has spread to other organs: If the colorectal cancer is advanced, it may spread to other organs, such as the liver or lungs. In this example, additional chemotherapy or radiation may be needed to help delay the farther spread of the cancer.
Quality of the surgery: Having the right surgery performed by an adept surgeon who was trained in colorectal surgery.This is specially of import for rectal cancers, where surgery is more complicated.

Many people who take had colorectal cancer live normal lives. The treatments available today offer good outcomes, but you may require several treatments or a combination of treatments (surgery, chemotherapy, radiation) to have the best chance of fugitive a recurrence of the cancer. Retrieve to tell your doctor almost whatever changes in your health. This will help him or her decide if you need whatever additional screening tests or treatment.

Resources

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Source: https://my.clevelandclinic.org/health/diseases/14501-colorectal-colon-cancer