Colorectal cancer
happens when cells that are not normal grow in your
colon or rectum. These cells grow together and form tumors.
This
cancer is also called colon cancer or rectal cancer. It is the third most
common cancer in the United States. And it occurs most often in people older
than 50.
When it is found early, it is easily treated and often
cured. But because it usually is not found early, it is the second leading
cause of cancer deaths in the United States.1
Screening tests can prevent this cancer, but fewer than half of people older
than 50 are screened. According to the American Cancer Society, if everyone
were tested, tens of thousands of lives could be saved each year.
What causes colorectal cancer?
Most cases begin as
polyps, which are small growths inside the colon or
rectum.
Colon polyps are very common, and most of them do not
turn into cancer. But doctors cannot tell ahead of time which polyps will turn
into cancer. This is why people older than 50 need regular tests to find out if
they have any polyps and then have them removed. And some people who are
younger than 50 need regular tests if their medical history puts them at
increased risk for colorectal cancer.
What are the symptoms?
Colorectal cancer usually
does not cause symptoms until after it has begun to spread. See your doctor if
you have any of these symptoms:
Pain in your belly
Blood in your
stool or very dark stools
A change in your bowel habits, such as
more frequent stools or a feeling that your bowels are not emptying
completely
How is colorectal cancer diagnosed?
If your doctor
thinks that you may have this cancer, you will need a test, called a
colonoscopy, that lets the doctor see the inside of
your entire colon and rectum. During this test, your doctor will remove polyps
or take tissue samples from any areas that don't look normal. The tissue will
be looked at under a microscope to see if it contains cancer.
Sometimes other tests, such as a
barium enema or a
sigmoidoscopy, are used to diagnose colorectal
cancer.
How is it treated?
Surgery is almost always used
to treat colon and rectal cancer. The cancer is easily removed and often cured
when it is found early.
If the cancer has spread into the wall of
the colon or farther, you may also need
radiation or
chemotherapy. These treatments have side effects, but
most people can manage the side effects with medicines or home care.
Learning that you have cancer can be upsetting. It may help to talk with
your doctor or with other people who have had cancer. Your local American
Cancer Society chapter can help you find a support group.
How can you screen for colorectal cancer?
Screening tests can prevent many cases of colon and rectal cancer. They
look for a certain disease or condition before any symptoms appear. Regular
screening is advised for most people age 50 and older. If you have a family
history of this cancer, you may need to begin screening earlier than
that.
These are the most common screening tests:
Stool tests that check for signs of cancer:
Fecal occult blood test (FOBT).
Fecal
immunochemical test (FIT).
Stool DNA test (sDNA).
Barium enema. A liquid with barium is put into
your rectum and colon. The white liquid outlines the inside of the colon so
that it can be more clearly seen on an X-ray.
Sigmoidoscopy. A
doctor puts a flexible viewing tube into your rectum and into the first part of
your colon. This lets the doctor see the lower portion of the intestine, which
is where most colon cancers grow. Doctors can remove polyps during this test
also.
Colonoscopy. A doctor puts a long, flexible viewing tube
into your rectum and colon. The tube is usually linked to a video monitor
similar to a TV screen. With this test, the doctor can see the entire large
intestine.
Computed tomographic colonography (CTC). This test is
also called a virtual colonoscopy. A computer and X-rays make a detailed
picture of the colon to help the doctor look for polyps.
The exact cause of
colorectal cancer is not known. Most cases begin as
small growths, or polyps, inside the colon or rectum.
Colon polyps are very common. Very few of them turn into cancer. If they are
found early, usually through routine screening tests, they can be removed
before they turn into cancer.
Symptoms
Colorectal cancer in its early stages usually doesn't
cause any symptoms. Symptoms occur later, when the cancer may be more difficult
to treat. The most common symptoms include:
Pain in the belly.
Blood in your
stool or very dark stools.
A change in your bowel habits (such as
more frequent stools or a feeling that your bowels are not emptying
completely).
Fatigue.
In rare cases, unexplained weight
loss.
Colon cancer may cause no symptoms. When there are
symptoms, they may depend on where in the colon the cancer is.2
The
cecum and ascending colon, the first and second parts of the colon, are on the
right side of your abdomen. Cancer in this area may bleed, causing blood in the
stool and symptoms of
anemia, including fatigue and weakness. The amount of
blood may be small and so well mixed with stool that your stool may look
normal. Sometimes cancer in this area does not cause many
symptoms.
The
transverse colon, the third part, goes across your
body from right to left. Cancer here may cause abdominal
cramps.
The
descending colon, the fourth part, and the S-shaped
sigmoid colon, the fifth part, are on the left side of your abdomen and join the
rectum. Cancer here may cause narrower stools and bright red blood in the
stool. Sometimes this blood is mistakenly thought to come from
hemorrhoids.
Having these symptoms does not mean you have cancer. A
number of other medical problems could cause similar symptoms,
including:
Irritable bowel syndrome, a common digestive problem that causes periods of stomach
pain, cramping or bloating, and diarrhea or constipation.
Other
growths (polyps) in the large intestine that are not
cancer.
Diverticulitis, a condition in which
pouches form in the wall of the colon and become painful, swollen, or
infected.
Infections that cause diarrhea, such as
salmonella.
Cancer is the growth of
abnormal cells in the body. These extra cells grow together and form masses,
called tumors. In
colorectal cancer, these growths usually start as
polyps in the
large intestine (colon or rectum).
Colon polyps are quite common and most do not cause
problems. But if they are not detected and removed, some of them can turn into
cancer.
Cancers in the colon or rectum usually grow very slowly.
It takes most of them years to become large enough to cause symptoms. If the
cancer is allowed to grow, it eventually will invade and destroy nearby tissues
and then spread farther. Colorectal cancer spreads first to nearby
lymph nodes. From there it may spread to other parts
of the body, usually the liver. It may also spread to the lungs, and less
often, to the bones and the brain.
The long-term outcome, or
prognosis, for colorectal cancer depends on how much the cancer has grown and
spread. Experts talk about prognosis in terms of "5-year survival rates." The
5-year survival rate means the percentage of people who are still alive 5 years
or longer after their cancer was discovered. It is important to remember that
these are only averages. Everyone's case is different, and these numbers do not
necessarily show what will happen to you. The estimated 5-year survival rate
for colorectal cancer is:1
90% or more if cancer is found early and
treated before it has spread.
67% if the cancer has spread to
nearby organs and lymph nodes.
10% if the cancer has spread to the
liver, lungs, or bones.
What Increases Your Risk
Colorectal cancer occurrence rates are highest among blacks; intermediate among
whites, Asians, and Pacific Islanders; and lowest among American Indians,
Alaskan Natives, and Hispanics.1
A risk
factor is anything that increases your chance of getting a disease such as
cancer. Risk factors for getting colorectal cancer include:
Your age
Everyone who is older than 50 has a risk
of getting colorectal cancer and the older you are, the greater the risk. Most
cases of colorectal cancer are diagnosed in people older than 50. Most people
who get colorectal cancer have no other risk factors besides being older than
50.
Your family's medical history
You
are more likely to get colorectal cancer if one of your parents, brothers,
sisters, or children has had the disease. Your risk depends on how old your
family member was when he or she was diagnosed and on how many members of your
family have had the disease.1
If you have
a strong family history of colorectal cancer, you may want to have a blood test
to look for changed genes. Genetic mutations are more common in certain ethnic
groups, such as Ashkenazi Jews (Jews whose ancestors were from Eastern
Europe).
You have a strong family history if all of the following
are true:
You have at least three relatives who have had
colon cancer, and at least one of them is a parent, brother, or
sister.
Those relatives are spread over two generations in a row
(for example, a grandparent and a parent).
Your
chances of getting colorectal cancer may be higher if your diet is high in
calories, protein, and fat-especially animal fat-and if your diet is low in
calcium.
Whether you smoke
Studies show that smokers have a greater chance of getting colorectal
cancer.2
How much you exercise
If you are not physically active, you have a
greater chance of getting colorectal cancer.
How much you weigh
If you are very overweight, your chances of
getting colorectal cancer are higher. Having extra fat in the waist area is a
greater risk than having extra fat in the hips or thighs.
How much alcohol you drink
People who drink more
than 2 alcoholic drinks a day-and especially those who drink more than 3 drinks
a day-have a slightly higher risk for colorectal cancer.5
When To Call a Doctor
Call your doctor if you have any
symptoms of
colorectal cancer, such as:
A change in bowel habits.
Bleeding
from your rectum, including bright red or dark blood in your stools or stools
that look black.
Constant or frequent diarrhea, constipation, or a
feeling that your bowel doesn't empty completely.
Stools that are
narrow (may be as narrow as a pencil).
Because colorectal cancer often does not cause any
symptoms, talk with your doctor about
screening tests. Screening helps doctors find a
certain disease or condition before any symptoms appear. Some screening tests
for colorectal cancer can find and remove small precancerous growths in the
colon and rectum called
adenomatous polyps. If these are found and removed
early, they cannot turn into cancer.
Watchful Waiting
Watchful waiting refers to a period of time in
which your doctor is checking you regularly but not treating you. It is also
called observation or surveillance. Watchful waiting is not a reasonable option
when you have symptoms of colorectal cancer.
Who To See
Health professionals who can evaluate your symptoms of
colorectal cancer include:
If your doctor thinks you may have
colorectal cancer, he or she will ask you questions
about your
medical history and give you a physical exam. Other
tests may include:
A
colonoscopy, a test in which your doctor uses a
lighted scope to view the inside of your entire colon. A colonoscopy may be
done to look into symptoms such as unexplained bleeding from the rectum,
constant diarrhea or constipation, blood in the stool, or pain in the lower
abdomen. A colonoscopy is recommended when another screening test shows you may
have colorectal cancer.6
A
digital rectal examination, in which your doctor puts
a gloved finger into your rectum. This exam is done to look into symptoms such
as rectal bleeding or blood in the stool, abdominal or pelvic pain, a change in
bowel habits, or urinary problems in men.
Fecal occult blood test (FOBT), or fecal immunochemical test (FIT), in which your stool is
tested with a special solution to see if it contains blood. Or a stool DNA test
(sDNA) may be used to check for signs of cancer.
A
sigmoidoscopy, a test in which your doctor uses a
lighted scope to view the lower part of your intestine. A sigmoidoscopy may be
done to look into symptoms such as unexplained bleeding from the rectum,
constant diarrhea or constipation, blood in the stool, or pain in the lower
abdomen. Doctors can also remove polyps during this test.
A
barium enema, in which a whitish liquid with barium is
inserted through your rectum into your intestine. The barium outlines the
inside of the colon so that it can be seen on an X-ray.
Computed
tomographic colonography (CTC), also known as
virtual colonoscopy. This test uses X-rays and a
computer to make a detailed picture of the colon to help the doctor look for
polyps. It may be used as a screening test for people who do not have an
increased risk for colon cancer or in people who cannot have a
colonoscopy.
A
biopsy, in which a sample of tissue is taken from the
inside of your intestine and examined under a microscope. A doctor called a
pathologist can look at the tissue sample and see if
it contains cancer.
A
complete blood count, which is a blood test. It is
used to look into symptoms such as fatigue, weakness, anemia, bruising, or
weight loss.
For people who have an increased risk for colorectal
cancer, regular
colonoscopy is the recommended screening test because
it allows your doctor to remove polyps (polypectomy) and take tissue samples at
the same time.
When you are diagnosed with colorectal cancer,
your doctor may order other tests to determine whether the cancer has spread.
These tests include:
A
CT scan to see if the cancer has spread to your liver,
lungs, or abdomen.
A
chest X-ray to see if the cancer has spread to your
lungs.
An
MRI or
PET scan to see if the cancer has spread into your
chest or organs in the abdomen or pelvis.
An
ultrasound to find the cause of abdominal pain or
increased abdominal girth or to see if the cancer has spread to your
liver.
Colorectal cancer is very treatable and can
usually be cured when it is caught early. Most people who get colorectal cancer
are older than 50 and have no other risk factors besides their age. See the
What Increases Your Risk section of this topic for more information.
Research shows that
routine screening greatly reduces deaths from
colorectal cancer.6 Screening tests look for a certain
disease or condition before any symptoms appear. Screening methods include:
Stool tests, such as the
fecal occult blood test (FOBT), the fecal
immunochemical test (FIT), and the stool DNA test (sDNA).
Talk to your doctor about which test is right for you. If
you have a higher risk for colorectal cancer, you will need to begin screening
at age 40 or younger and be tested more often.
If you have a very
strong family history of colon cancer, you may want to talk to your doctor or a
genetic counselor about having a blood test to look
for changed genes.
Genetic testing can tell you whether you carry a
changed, or mutated, gene that can cause colon cancer. Having certain genes
greatly increases your risk of colon cancer. But most cases of colon cancer are
not caused by changed genes.
The first step in treating
colorectal cancer is usually an operation to remove
the tumor. Sometimes a simple operation can be done during a colonoscopy or
sigmoidoscopy to remove small polyps and a small amount of tissue surrounding
them. But in most cases a major operation, in which the cancer and part of the
colon or rectum around it are removed, is needed. If cancer has spread to
another part of your body, such as the liver, you may need more far-reaching
surgery.
After the cancer has been examined under a microscope, it
will be staged. Staging is a way for your doctor to tell how far, if at all,
your cancer has spread. It also helps your doctor decide what your treatment
should be.
There are several different types of
staging systems, so it's important to ask your doctor
to explain carefully what stage your cancer is in and what that means.
In general, the most common staging system describes colorectal cancer
this way:
Stage I: Your cancer has not spread beyond the
inside of your colon or rectum.
Stage II: Your cancer has spread
into the muscle layer of your colon or rectum.
Stage III: Your
cancer has spread to one or more lymph nodes in the area.
Stage IV:
Your cancer has spread to other parts of your body, such as the liver, lung, or
bones.
Cancers that have not spread beyond the colon or rectum may
require only surgery. If the cancer has spread, you may need
radiation therapy,
chemotherapy, or both.
Initial treatment
You and your doctor will work
together to decide what your treatment should be. You will consider your own
preferences and your general health, but the
stage of your cancer is the most important tool for
choosing your treatment.
Surgery is almost
always used to remove
colorectal cancer. If the cancer is found early, you
may need only a simple procedure, called a polypectomy, in which a doctor
removes small polyps found in the colon or rectum during a
colonoscopy or
sigmoidoscopy.
For a larger cancer, more
extensive surgery is needed to remove the cancer and part of the colon or
rectum around it. This is called a
bowel resection. During this operation, your doctor
will also remove some of your lymph nodes for testing. The healthy ends of the
colon or rectum are then sewn back together.
Sometimes it isn't
possible to rejoin the ends, and a
colostomy is needed. This creates an opening on the
outside of your abdomen where waste can pass through into a colostomy bag. The
colostomy may be temporary until your colon heals, or it may be permanent if
the entire lower colon or rectum was removed. Very few people who have
colorectal cancer need a permanent colostomy.
Radiation therapy, which uses X-rays to destroy cancer cells,
is standard treatment for some types of cancer in the rectum. Radiation therapy
is often combined with surgery or chemotherapy. Compared to surgery alone,
radiation therapy given before surgery for rectal cancer may reduce the risk
that the cancer will return and may help you live longer.7
Chemotherapy uses
drugs-given either as pills or through a needle-to destroy cancer cells
throughout the body. Chemotherapy is used for some stages of colon
cancer.
Your doctor may prescribe
medicines to control nausea and vomiting caused by
chemotherapy. There are also things you can do at home to manage these and
other side effects. See the Home Treatment section of this topic for more
information.
For more information about specific treatments, see
the following topics:
If you have just been told you have colorectal cancer, you may have many
different feelings. Most people feel some denial, anger, and grief. Others have
few emotions. There is no normal or right way to react.
There are
many things you can do to help with your
emotional reaction to colorectal cancer. You may find
that talking with family and friends helps. Some people find that spending time
alone is what they need.
If your feelings get in the way of your
ability to make decisions, it is important to talk with your doctor. Your
cancer treatment center may offer psychological services. Your local American
Cancer Society chapter can help you find a support group. Talking with other
people who have had similar feelings can be very helpful.
Physical exams. How often you have
these depends on your general health and the type of colorectal cancer you
have. In general, you will see your doctor several times a year for 3 to 5
years and then return to once-a-year checkups.
Colonoscopy, to inspect the inner surface of your
colon and rectum for new problems
Carcinoembryonic antigen (CEA) and other blood tests, to check the success of your
treatment and find out whether the cancer has returned.
CT scan,
PET scan, or
MRI, to see if the cancer has spread to other
organs
Treatment if the condition gets worse
Colorectal cancer comes back after surgery in about half of people who have surgery
to remove the cancer.7 The cancer may be more likely
to come back after surgery if it was not discovered in an early stage. Cancer
that has spread or comes back is harder to treat. A cure is less likely, but
treatment can help you feel better and live longer. For more information, see
the topic
Colorectal Cancer, Metastatic and Recurrent.
What To Think About
After you have had colorectal
cancer, your chances of having it again go up. It's important to continue to
see your doctor and be tested regularly to help find any returning cancer or
new polyps early.
Clinical trials are designed to find
better ways to treat people with cancer and are based on the most current
information. Some people who meet the criteria for participation choose to
enroll in such clinical trials.
Prevention
Some screening tests can prevent
colorectal cancer. Screening tests look for a certain
disease or condition before any symptoms appear. Regular screening is
recommended beginning at age 50 for people with an average risk for colorectal
cancer. For people with an increased risk for colorectal cancer, earlier
screening is recommended.
Fewer than half of people who are older
than 50 are screened for colorectal cancer. According to the American Cancer
Society, if everyone were tested, tens of thousands of lives could be saved
each year.
The following guidelines are for people who
do not have an increased risk for colorectal
cancer.
Colorectal screening guidelines
Test
Frequency
Stool
test,* such as the
fecal occult blood test (FOBT), the fecal
immunochemical test (FIT), or the stool DNA test (sDNA)
Every year*
The frequency of the sDNA test has not yet been set.
*One group recommends
combining a stool test every 3 years with a sigmoidoscopy every 5
years.
Experts have not yet set guidelines for how often a person
should have the stool DNA test (sDNA) or computed tomographic colonography
(CTC).8
You will need to begin routine
screening earlier than age 50 and have it more often if you have a
higher risk for colorectal cancer.
Virtual colonoscopy (also called computed tomographic colonography or CT
colonography) uses X-rays and a computer to take pictures of the inside of your
large intestine. It may be used as a screening test for people who do not have
an increased risk for colon cancer or for people who cannot have a colonoscopy.
Here are other things you can do to help prevent colorectal
cancer:
Watch your weight. In
trials, people who were overweight got colorectal cancer more often than those
who were not. And people whose extra fat was in the waist area got it more
often than people whose extra fat was in the hips or thighs. For more
information, see the topic
Weight Management.
Eat well.Eat a variety of healthy foods,
especially fruits and vegetables. Eating more vegetables, fruits, legumes,
fish, poultry, and whole grains helps prevent cancer. Limit your consumption of
animal fat. Talk to your doctor about taking a
calcium supplement daily. For more information, see
the topic
Healthy Eating.
Limit drinking.People who drink more than 2 alcoholic drinks a day-and
especially those who drink more than 3 drinks a day-have a slightly higher risk
for colorectal cancer.5
Get active.Keep up a physically active lifestyle. Being fit
also leads to an improved sense of well-being, improved appearance, and
increased stamina and strength. For more information, see the topic
Fitness.
Do not smoke. Smokers have a higher rate of cancer than nonsmokers.2 For more information, see the topic
Quitting Smoking.
Researchers continue to investigate ways to use drugs to
prevent cancer. Drugs being studied include
hormones used to treat symptoms of menopause, a
mineral called selenium, and vitamin E.
What to think about
If you have a strong family history of colon
cancer, you may want to talk to your doctor or a genetic counselor about having
a blood test to look for changed genes.
Genetic testing can tell you whether you carry a
changed, or mutated, gene that can cause colon cancer. Having certain genes
greatly increases your risk of colon cancer.
You have a strong
family history if each of the following is true:
You have at least three relatives who have had
colon cancer, and at least one of them is a parent, brother, or
sister.
Those relatives are spread over two generations in a row
(for example, a parent and a grandparent).
One of those relatives
got cancer before age 50.
Home Treatment
You can do things at home to help manage
the side effects of
colorectal cancer or its treatment. Be sure to follow
your doctor's advice on any drugs you are taking. Healthy habits such as eating
a balanced diet and getting enough sleep and exercise may help control your
symptoms.
Home treatment for diarrhea includes
resting your stomach by not eating for several hours or until you feel better
and watching for signs of dehydration. Check with your doctor before using any
drugs for your diarrhea.
Home treatment for constipation includes gentle exercise, drinking plenty of fluids, and
eating lots of fruits, vegetables, and foods that contain fiber. Check with
your doctor before using a laxative.
Home treatment for fatigue includes getting extra rest while you are having
chemotherapy or radiation therapy. Let your symptoms be your guide. You may be
able to stick to your usual routine and just get some extra sleep. Fatigue is
often worse at the end of treatment or just after treatment is completed.
Home treatment for sleep problems includes going to
bed at the same time every night, exercising during the day, and avoiding
caffeine late in the day.
Home treatment for pain can range from
hot packs or cold packs to relaxation or aromatherapy and can improve your
physical and mental well-being. Not all forms of cancer and cancer treatment
cause pain. Talk to your doctor before using any home treatment for
pain.
Drink cold liquids, such as water or iced
tea, or eat flavored ice treats or frozen juices.
Eat foods that
are easy to swallow, such as gelatin, ice cream, or custard.
Drink
from a straw.
Rinse your mouth several times a day with a warm
saltwater rinse. Mix 1 tsp (5 g) of salt with 8 fl oz (0.2 L) of warm
water.
Managing your emotions
Learning that you have colorectal cancer and being treated for it can be
very stressful.
You may be able to
reduce your stress by talking to others. Consider
meeting with a counselor or joining a support group of others who have
colorectal cancer. Your doctor may also be able to help you find other sources
of support and information. Learning relaxation techniques, such as yoga or
visualization exercises, may also help you reduce your stress.
Your feelings about your body may change after treatment.
Dealing with your body image may involve talking
openly about your worries with your partner and discussing your feelings with a
doctor.
Medications
Chemotherapy is the use of drugs to control
the cancer's growth or relieve symptoms. Often the drugs are given through a
needle in your vein, and your blood vessels carry the drugs through your body.
Sometimes the drugs are available as pills you can swallow. Sometimes they are
given through a shot, or injection.
Several drugs are used to
treat
colorectal cancer. There are also several drugs
available for treating side effects.
Medication Choices
A combination of drugs often works better than a single
drug in treating colorectal cancer. The most commonly used drugs are:
Hair loss, a side effect common with some types of
chemotherapy, is usually not a side effect of these drugs.
Treating the side effects
Your doctor may
prescribe medicines that can help relieve side effects of chemotherapy. These
side effects can include mouth sores, diarrhea, nausea, and vomiting. Your
doctor may prescribe
medicines to control nausea and vomiting. These drugs
may include:
Serotonin antagonists, such as
ondansetron (Zofran), granisetron (Kytril), or dolasetron (Anzemet). These
drugs more effectively prevent nausea and vomiting caused by chemotherapy when
they are combined with
corticosteroids, such as
dexamethasone.
Aprepitant (Emend), which is used in
combination with ondansetron and dexamethasone as part of a 3-day
program.
Antiemetics, such as promethazine and
prochlorperazine.
There also are things you can do at home to manage side
effects. See the Home Treatment section for more information.
What To Think About
Chemotherapy
and
radiation may be combined to treat some types of
colorectal cancer. Radiation or chemotherapy given before or after surgery can
destroy microscopic areas of cancer to increase the chances of a cure. In some
studies, people who had surgery and then were given the chemotherapy drugs
fluorouracil (5-FU) and leucovorin lived longer.9
Clinical trials are designed to find
better ways to treat people with cancer and are based on the most current
information. Some people who meet the criteria for participation choose to
enroll in such clinical trials.
Surgery
Surgery to remove cancer is almost always the
main treatment for
colorectal cancer. The type of surgery depends on the
size and location of your cancer.
Side effects are common after
surgery. You may be able to reduce the severity of your side effects at home.
For more information, see the Home Treatment section of this topic.
Surgery Choices
Local excision. When colorectal cancer is
discovered in its very early stages, it can be removed during a
sigmoidoscopy or
colonoscopy. The surgeon cuts out not just the polyp,
but also a small amount of tissue around it. The surgeon does not need to cut
into the abdomen.
Bowel resection. This operation
involves cutting out the cancer as well as the sections of the colon or rectum
that are next to it. Then the two healthy ends of the colon or rectum are sewn
back together. The surgery can be done in two ways:
Open resection. The surgeon makes a long
incision in the abdomen, completes the bowel resection, and closes the
incision. Open resection is the best option for cancer of the rectum.10
Laparoscopic surgery. Instead of
needing a large incision in the abdomen, laparoscopic surgery requires only 3
to 6 small incisions. The surgeon inserts a camera, or laparoscope, and other
operating instruments through these incisions to perform the operation. Because
the incisions are smaller, there usually is less pain and recovery is faster.
In some cases, the surgeon may make 1 or 2 of the incisions a little bigger
during surgery in order to complete the procedure, but the opening is still far
smaller than in an open resection. Open resection is best for cancer of the
rectum, but for other colon cancers, laparoscopic surgery is equally
effective.10 But laparoscopic surgery cannot always be
done, such as when the cancer has spread to areas outside the colon.
What To Think About
Polypectomy or local excision is
used when the cancer has been caught in its early stages. Bowel resection is
used when the cancer is larger. Sometimes after this major operation, the two
ends of the colon or rectum cannot be sewn back together. When this happens, a
colostomy is performed. Most people do not need a
colostomy.
Colorectal cancer comes back after surgery in about half
of people who have surgery to remove the cancer.7 The
cancer may be more likely to come back after surgery if it was not discovered
in an early stage. Even if your doctor thinks that all the cancer has been
removed during surgery,
radiation therapy or
chemotherapy may be recommended to destroy any
remaining microscopic areas of cancer.
Clinical trials are
designed to find better ways to treat people with cancer and are based on the
most current information. Some people who meet the criteria for participation
choose to enroll in such clinical trials.
Other Treatment
Radiation therapy uses X-rays to destroy
colorectal cancer cells and shrink tumors. It is often
used to treat rectal cancer, usually combined with surgery. It is used less
often to treat colon cancer. It may also be combined with
chemotherapy.
Other Treatment Choices
Radiation may be given:
Externally, using a machine outside the body
that points a beam of radiation at the tumor.
Internally, by placing tiny radioactive "seeds" next to or into
the cancer.
Compared to surgery alone, radiation given before surgery
may reduce the risk that rectal cancer will return and may help you live
longer.7
What To Think About
Clinical trials are
designed to find better ways to treat people with cancer and are based on the
most current information. Some people who meet the criteria for participation
choose to enroll in such clinical trials.
Other Places To Get Help
Organizations
American College of
Gastroenterology
P.O. Box 342260
Bethesda, MD 20827-2260
Phone:
(301) 263-9000
Web Address:
www.acg.gi.org
The American College of Gastroenterology is an organization of
digestive disease specialists. The Web site contains information about common
gastrointestinal problems.
American Cancer Society
Phone:
1-800-ACS-2345 (1-800-227-2345)
TDD:
1-866-228-4327 (toll-free)
Web Address:
www.cancer.org
The American Cancer Society conducts educational programs and
offers many services to people with cancer and to their families. Staff at the
toll-free numbers have information about services and activities in local areas
and can provide referrals to local ACS divisions.
Cancer.Net
Phone:
1-888-651-3036 (571) 483-1300
Fax:
(571) 366-9530
E-mail:
foundation@asco.org
Web Address:
www.cancer.net
Cancer.Net is the information Web site of the American
Society of Clinical Oncology (ASCO) for people living with cancer and for those
who care for them. ASCO is the world's leading professional organization
representing physicians of all oncology subspecialties. Cancer.Net provides
current oncologist-approved information on living with cancer.
National Cancer Institute (NCI)
NCI Publications Office
6116 Executive Boulevard
Suite 3036A
Bethesda, MD 20892-8322
Phone:
1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday
TDD:
1-800-332-8615
E-mail:
cancergovstaff@mail.nih.gov
Web Address:
www.cancer.gov (or
https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help
online)
The National Cancer Institute (NCI) is a U.S. government agency
that provides up-to-date information about the prevention, detection, and
treatment of cancer. NCI also offers supportive care to people with cancer and
to their families. NCI information is also available to doctors, nurses, and
other health professionals. NCI provides the latest information about clinical
trials. The Cancer Information Service, a service of NCI, has trained staff
members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
American Cancer Society (2005). Colorectal Cancer Facts and Figures: Special Edition 2005, pp.
1-20. Available online:
http://www.cancer.org/docroot/STT/content/STT_1x_Colorectal_Cancer_Facts_and_Figures_-_Special_Edition_2005.asp.
Levin B (2006). Colorectal cancer. In DC Dale, DD
Federman, eds., ACP Medicine, section 12, chap. 5. New
York: WebMD.
Elwing JE, et al. (2006). Type 2 diabetes mellitus: The impact on colorectal adenoma risk in women. American Journal of Gastroenterology, 101(8): 1866-1871.
Limburg PJ, et al. (2006). Clinically confirmed type 2 diabetes mellitus and colorectal cancer risk: A population-based, retrospective cohort study. American Journal of Gastroenterology, 101(8): 1872-1879.
Cho E, et al. (2004). Alcohol intake and colorectal
cancer: A pooled analysis of 8 cohort studies. Annals of Internal Medicine, 140(8): 603-614.
Winawer S, et al. (2003).
Colorectal cancer screening and surveillance: Clinical guidelines and
rationale-Update based on new evidence. Gastroenterology, 124(2): 544-560.
Lewis C (2007). Colorectal cancer screening, search
date November 2006. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Levin B, et al. (2008). Screening and surveillance for
the early detection of colorectal cancer and adenomatous polyps, 2008: A joint
guideline from the American Cancer Society, the U.S. Multi-Society Task Force
on Colorectal Cancer, and the American College of Radiology. CA: A Cancer Journal for Clinicians, 58(3):
130-160.
Meyerhardt JA, Mayer RJ (2005). Systemic therapy for
colorectal cancer. New England Journal of Medicine,
352(5): 476-486.
Guillou PJ, et al. (2005). Short-term endpoints of
conventional versus laparoscopic-assisted surgery in patients with colorectal
cancer (MRC CLASICC trial): Multicentre, randomised controlled trial. Lancet,
365(9472): 1718-1726.
Other Works Consulted
American Cancer Society (2008). Cancer Facts and Figures 2008. Atlanta: American Cancer Society. Available
online:
http://www.cancer.org/docroot/STT/content/STT_1x_Cancer_Facts_and_Figures_2008.asp.
Schroy PC (2006). Screening and surveillance
guidelines for individuals at increased risk section of Neoplastic diseases of
the small and large bowel. In MM Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 890-910. Philadelphia: Saunders
Elsevier.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
American Cancer Society (2005). Colorectal Cancer Facts and Figures: Special Edition 2005, pp.
1-20. Available online:
http://www.cancer.org/docroot/STT/content/STT_1x_Colorectal_Cancer_Facts_and_Figures_-_Special_Edition_2005.asp.
Levin B (2006). Colorectal cancer. In DC Dale, DD
Federman, eds., ACP Medicine, section 12, chap. 5. New
York: WebMD.
Elwing JE, et al. (2006). Type 2 diabetes mellitus: The impact on colorectal adenoma risk in women. American Journal of Gastroenterology, 101(8): 1866-1871.
Limburg PJ, et al. (2006). Clinically confirmed type 2 diabetes mellitus and colorectal cancer risk: A population-based, retrospective cohort study. American Journal of Gastroenterology, 101(8): 1872-1879.
Cho E, et al. (2004). Alcohol intake and colorectal
cancer: A pooled analysis of 8 cohort studies. Annals of Internal Medicine, 140(8): 603-614.
Winawer S, et al. (2003).
Colorectal cancer screening and surveillance: Clinical guidelines and
rationale-Update based on new evidence. Gastroenterology, 124(2): 544-560.
Lewis C (2007). Colorectal cancer screening, search
date November 2006. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Levin B, et al. (2008). Screening and surveillance for
the early detection of colorectal cancer and adenomatous polyps, 2008: A joint
guideline from the American Cancer Society, the U.S. Multi-Society Task Force
on Colorectal Cancer, and the American College of Radiology. CA: A Cancer Journal for Clinicians, 58(3):
130-160.
Meyerhardt JA, Mayer RJ (2005). Systemic therapy for
colorectal cancer. New England Journal of Medicine,
352(5): 476-486.
Guillou PJ, et al. (2005). Short-term endpoints of
conventional versus laparoscopic-assisted surgery in patients with colorectal
cancer (MRC CLASICC trial): Multicentre, randomised controlled trial. Lancet,
365(9472): 1718-1726.
