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What is colon cancer?
Colon cancer is a type of cancer that begins in the large intestine (colon). The colon is the final part of the digestive tract. Colon cancer typically affects older adults, though it can happen at any age. It usually begins as small, noncancerous (benign) clumps of cells called polyps that form on the inside of the colon. Over time some of these polyps can become colon cancers. Colon cancer is sometimes called colorectal cancer, which is a term that combines colon cancer and rectal cancer, which begins in the rectum.
Signs and symptoms of colon cancer include:
A persistent 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
Doctors aren't certain what cause most colon cancers.
In general, colon cancer begins when healthy cells in the colon develop changes (mutations) in their DNA. A cell's DNA contains a set of instructions that tell a cell what to do.
Healthy cells grow and divide in an orderly way to keep your body functioning normally. But when a cell's DNA is damaged and becomes cancerous, cells continue to divide — even when new cells aren't needed. As the cells accumulate, they form a tumor.
With time, the cancer cells can grow to invade and destroy normal tissue nearby. And cancerous cells can travel to other parts of the body to form deposits there (metastasis).
Factors that may increase your risk of colon cancer include:
Older age. Colon cancer can be diagnosed at any age, but a majority of people with colon cancer are older than 50. The rates of colon cancer in people younger than 50 have been increasing, but doctors aren't sure why.
African-American race. African-Americans have a greater risk of colon cancer than do people of other races.
A personal history of colorectal cancer or polyps. If you've already had colon cancer or noncancerous colon polyps, you have a greater risk of colon cancer in the future.
Inflammatory intestinal conditions. Chronic inflammatory diseases of the colon, such as ulcerative colitis and Crohn's disease can increase your risk of colon cancer.
Inherited syndromes that increase colon cancer risk. Some gene mutations passed through generations of your family can increase your risk of colon cancer significantly. Only a small percentage of colon cancers are linked to inherited genes
Family history of colon cancer. You're more likely to develop colon cancer if you have a blood relative who has had 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 typical Western diet, which is 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 and processed meat.
A sedentary lifestyle. People who are inactive are more likely to develop colon cancer. Getting regular physical activity may reduce your risk of colon cancer.
Diabetes. People with diabetes or insulin resistance have an increased risk of colon cancer.
Obesity. People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight.
Smoking. People who smoke may have an increased risk of colon cancer.
Alcohol. Heavy use of alcohol increases your risk of colon cancer.
Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat previous cancers increases the risk of colon cancer.
Doctors recommend certain screening tests for healthy people with no signs or symptoms in order to look for signs of colon cancer or noncancerous colon polyps. Finding colon cancer at its earliest stage provides the greatest chance for a cure. Screening has been shown to reduce your risk of dying of colon cancer.
Several screening options exist — each with its own benefits and drawbacks. If a colonoscopy is used for screening, polyps can be removed during the procedure before they turn into cancer.
Diagnosing colon cancer
If your signs and symptoms indicate that you could have colon cancer, your doctor may recommend one or more tests and procedures, including:
Using a scope to examine the inside of your colon (colonoscopy). Colonoscopy uses a long, flexible and slender tube attached to a video camera and monitor to view your entire colon and rectum.
Blood tests. No blood test can tell you if you have colon cancer. But your doctor may test your blood for clues about your overall health, such as kidney and liver function tests.
Your doctor may also test your blood for a chemical sometimes produced by colon cancers (carcinoembryonic antigen, or CEA). Tracked over time, the level of CEA in your blood may help your doctor understand your prognosis and whether your cancer is responding to treatment.
Treatment for colon cancer usually involves surgery to remove the cancer. Other treatments, such as radiation therapy and chemotherapy, might also be recommended.
Surgery for early-stage colon cancer
If your colon cancer is very small, your doctor may recommend a minimally invasive approach to surgery, such as:
Removing polyps during a colonoscopy (polypectomy). If your cancer is small, localized, completely contained within a polyp and in a very early stage, your doctor may be able to remove it completely during a colonoscopy.
Endoscopic mucosal resection. Larger polyps might be removed during colonoscopy using special tools to remove the polyp and a small amount of the inner lining of the colon in a procedure called an endoscopic mucosal resection.
Minimally invasive surgery (laparoscopic surgery). Polyps that can't be removed during a colonoscopy may be removed using laparoscopic surgery. In this procedure, your surgeon performs the operation through several small incisions in your abdominal wall, inserting instruments with attached cameras that display your colon on a video monitor. The surgeon may also take samples from lymph nodes in the area where the cancer is located.
Surgery to create a way for waste to leave your body. When it's not possible to reconnect the healthy portions of your colon or rectum, you may need an ostomy. This involves creating an opening in the wall of your abdomen from a portion of the remaining bowel for the elimination of stool into a bag that fits securely over the opening.
Partial colectomy. During this procedure, the surgeon removes the part of your colon that contains the cancer, along with a margin of normal tissue on either side of the cancer. Your surgeon is often able to reconnect the healthy portions of your colon or rectum. This procedure can commonly be done by a minimally invasive approach (laparoscopy). Sometimes the ostomy is only temporary, allowing your colon or rectum time to heal after surgery. In some cases, however, the colostomy may be permanent.
Lymph node removal. Nearby lymph nodes are usually also removed during colon cancer surgery and tested for cancer.
Surgery for advanced cancer
If your cancer is very advanced or your overall health very poor, your surgeon may recommend an operation to relieve a blockage of your colon or other conditions in order to improve your symptoms. This surgery isn't done to cure cancer, but instead to relieve signs and symptoms, such as a blockage, bleeding or pain.
In specific cases where the cancer has spread only to the liver or lung but your overall health is otherwise good, your doctor may recommend surgery or other localized treatments to remove the cancer. Chemotherapy may be used before or after this type of procedure. This approach provides a chance to be free of cancer over the long term.
Chemotherapy uses drugs to destroy cancer cells. Chemotherapy for colon cancer is usually given after surgery if the cancer is larger or has spread to the lymph nodes. In this way, chemotherapy may kill any cancer cells that remain in the body and help reduce the risk of cancer recurrence.
Chemotherapy might also be used before an operation to shrink a large cancer so that it's easier to remove with surgery.
Radiation therapy uses powerful energy sources, such as X-rays and protons, to kill cancer cells. It might be used to shrink a large cancer before an operation so that it can be removed more easily.
When surgery isn't an option, radiation therapy might be used to relieve symptoms, such as pain. Sometimes radiation is combined with chemotherapy.
Targeted drug therapy
Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.
Targeted drugs are usually combined with chemotherapy. Targeted drugs are typically reserved for people with advanced colon cancer.
Immunotherapy is a drug treatment that uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells from recognizing the cancer cells. Immunotherapy works by interfering with that process.
Supportive (palliative) care
Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care is provided by a team of doctors, nurses and other specially trained professionals that work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care.
Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.
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Recurrent colorectal cancer usually comes back after being gone for at least a year. When it's just an advanced version of the original cancer, it may show up in a few months. In that situation, the cancer often returns because the first round of treatment didn't get rid of all the cancer cells.
These usually consist of soft, moist foods such as soup, gelatin, pudding, and yogurt. Avoid gummy foods such as bread and tough meats, as well as spicy, fried, or gas-producing foods. To prevent swallowing air, which produces excess gas, avoid drinking through a straw and don't chew gum or tobacco.
Cancer of the colon is a highly treatable and often curable disease when localized to the bowel. Surgery is the primary form of treatment and results in cure in approximately 50% of the patients. Recurrence following surgery is a major problem and is often the ultimate cause of death.
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