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Colorectal Cancer

What Is Cancer?
The body is made up of many kinds of cells. Normally, the body makes new cells in an orderly way and only when they are needed. If new cells are made when they are not needed, a large group of cells (tissue) forms. This extra tissue, called a growth or tumor, can be benign or malignant.

Benign tumors are not cancer. They do not grow into nearby tissue or spread to other parts of the body. Benign tumors can be removed and usually are not life threatening. In some instances, benign tumors can turn into cancer.

Malignant tumors are cancer. These cells can creep into nearby tissue and damage other organs. Sometimes cells from the tumor may break off and travel through the bloodstream or the lymph system and start tumors in other parts of the body.

What is Colorectal Cancer?
The colon and rectum form a long, muscular tube called the large intestine or large bowel. The colon is the upper 5 to 6 feet of the large bowel and the rectum is the last 6 to 8 inches. The large bowel, along with the esophagus, stomach, and the small bowel, are part of the body’s digestive system. The digestive system removes minerals, proteins and vitamins from the food you eat and stores the waste until it passes out of the body.

Tumors can begin anywhere in the colon or rectum. Sometimes a benign growth, called a polyp, may start to grow on the wall of the colon or rectum. Polyps in the colon or rectum should be removed because they can become cancerous. These can be easily removed in a doctor’s office during an examination using a lighted flexible tube. If not removed, these cancer cells can spread outside of the colon or rectum to the nearby lymph nodes. These cells can also spread to other parts of the body such as the liver and lungs. People who have had one polyp are more likely to develop others, so it is very important they have regular check-ups to prevent the start of cancer.

Colorectal cancer is the third most common cancer in both men and women. In 2002, there will be an estimated 152,200 new cases of colorectal cancer and about 57,100 people will die from the disease. Like most health problems, colorectal cancer responds best to treatment when it is diagnosed and treated as early as possible, especially before it has a chance to spread outside of the colon.

Risk Factors
Studies have found that certain things may increase a person’s risk of getting colorectal cancer. These include being over 50 years of age; having a history of polyps in the colon, ulcerative colitis, or Crohn’s disease; and having a family history of colon cancer or familial polyposis syndrome. Studies have shown diet, especially a diet high in red meat and low in fiber, may also contribute to the development of colon cancer. Other risk factors include daily drinking of alcoholic beverages, and an inactive way of life.

Prevention Tips
There are steps you can take to help prevent colorectal cancer.

• Eat less red meat.
  Scientists have shown that people who eat less than 1 serving (4 ounces) of red meat a day have a lower risk of colon cancer. Red meat includes pork, beef, lamb and veal.
• Increase fiber in your diet, especially the fiber found in vegetables.
  Studies suggest that diets high in fiber (3 servings/day), especially from vegetables, can protect against colon and rectal cancer.
• Take a multivitamin with folate every day.
  People who take a multivitamin with folate every day have a lower risk of colon cancer. Folate is one of the B vitamins, which helps keeps cells in the colon from becoming cancerous.
• Increase your activity level.
  Research has linked an inactive lifestyle with an increased risk of colon and rectal cancer. A person is considered physically active if they exercise for at least 30 minutes a day.
• Limit your alcohol intake.
  People who drink more than one alcoholic beverage a day tend to develop colorectal cancer more often than those who do not drink alcohol.
• Have regular screening examinations.
  Screening exams can find and remove precancerous polyps before they turn into cancer. Follow your doctor’s advice about having tests for colon cancer.
• Birth control pills
  Women who take birth control pills for at least 5 years have a lower risk of colon cancer. However, birth control pills can raise the risk of breast cancer, heart attacks and stroke. Talk with your doctor about whether you should take birth control pills.

Screening Tests
You can take an active role in the prevention and early detection of colon and rectal cancer by getting tested regularly after the age of 50. Talk to your doctor about which test you should have.

The three recommended screening tests are:

Fecal Occult Blood Test–every year. You can do this test at home, using a special kit from your doctor. It tests sample of your bowel movement for blood that may not be seen by the naked eye. Blood can be a sign of cancer or polyps.

Sigmoidoscopy–every five years. A doctor inserts a long, lighted, flexible tube into the rectum and part of the colon to check for polyps and cancer.

Colonscopy–every 10 years. This exam also uses a long, lighted, flexible tube, but it is able to check the entire colon for polyps and cancer, rather than just the lower part of the colon.

Persons who are having symptoms or are at high risk for developing colorectal cancer may need testing more often or before the age of 50. Your doctor can advise you which screening tests you need to have and how often you need to have them done.

Symptoms to Watch For
Colorectal cancer can cause a wide range of symptoms. Warning signs to watch for include:

• A change in usual bowel habits, (constipation, diarrhea or both)
• Stools that are more narrow than usual
• Blood in or on the bowel movement (stool), or in the toilet after having a bowel movement
• Lower abdominal discomfort, such as bloating, fullness and/or cramps
• Frequent painful or cramping gas
• A feeling that the bowel does not empty completely
• Weight loss with no known reason
• Unusual tiredness

These same symptoms may be caused by problems other than cancer. Only your doctor can determine the cause. If you have any of these symptoms you should see your doctor.

Treatment of Colorectal Cancer
If you are diagnosed with colon or rectal cancer, you will need more tests to find out if the cancer has spread to other parts of the body. This is called staging the disease. Your doctor needs to know the stage of the disease in order to plan the treatment best for you.

The treatments used for colorectal cancer include surgery, radiation and chemotherapy. Clinical trials are under way using biological therapies in the treatment of colorectal cancer also.

Surgery is the most common treatment for colon and rectal cancer. The type of operation depends on the location and the size of the tumor. Most patients have a partial colectomy, where the surgeon takes out the part of the colon or rectum that contains the cancer and a small amount of healthy tissue around it. Surgery is often the only treatment needed for early stage colorectal cancer. Colostomy (an operation that makes an opening in the bowel on to the skin for bowel movements to be eliminated from the body) is a much-feared surgery for colon cancer. But, it is in fact, only needed in 15% of colorectal cancer patients.

Chemotherapy uses special medicine to kill cancer cells. Chemotherapy goes all through the body killing cancer cells. Chemotherapy is sometimes given after surgery to try to prevent the disease from spreading.

Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing. Radiation therapy is a therapy that only affects the cancer cells in the treated area. It might be used before or after surgery.

Biological therapy tries to get your own body to fight the disease. It uses materials made by your own body or made in a laboratory to make your body’s own immune system fight the cancer. Sometimes biological therapy will be combined with chemotherapy.

Chemoprevention Trials
Several clinical trials (research) are currently being done in the United States to test ways of preventing the development of or recurrence of colorectal cancer. These studies are researching how aspirin and other substances might help prevent colorectal cancer.

The Cancer Information Service
The University of Iowa Cancer Information Service is located at 200 Hawkins Drive, Room 4802 JPP, Iowa City, Iowa 52242, and can be reached through its nationwide toll-free number, 1-800-237-1225, or visit them on the web at: http://www.uihealthcare.com/depts/cancercenter/patients/cis.html

Last Reviewed 2005

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Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.