In 2018, the American Cancer Society stated that they estimate the number of colorectal cancer cases to increase to over 97,000 new cases of colon cancer, and over 43,000 cases of rectal cancer diagnosed in one year (ACS). The overall risk for men in their lifetime for this type of cancer is 1 in 22 people or roughly 4.5%. For women, the risk is 1 in 24 people, or 4.1% (ACS). While the overall numbers of newly diagnosed patients seem high, the numbers have actually been on a steady decline over the past few decades due to early diagnosis and treatment. This year, however, 50,000 people will succumb to this cancer alone.
Colorectal cancer is a cancer that forms in the colon or rectum. This type of cancer can also be referred to as rectal cancer, or colon cancer, depending on your physician and location of the originating cancer. Most colorectal cancers begin as polyps on the lining of the colon and rectum. Growths in this area are called polyps. These are checked for and often removed during the colonoscopy procedure and another pre-cancer testing. There are two main types of polyps: adenomatous polyps and hyperplastic polyps. Adenomas are often referred to as a pre-cancerous condition because they can turn into cancer. Hyperplastic polyps are very common, and rarely are cancerous.
Understanding colorectal cancer can be difficult, as there are many facets and layers. This type of cancer spreads through the body quickly after it grows and develops in the layers of the tissue lining the colon and rectum. Once these polyps are large enough, the cells they developed can break off and travel through the body disguised as blood vessels and lymph cells and implant themselves elsewhere in the body. The stage of cancer depends on this growth and if the cells have spread to other places in the body.
There are certain risks for colorectal cancer that can be changed, and some that cannot. Things that you can change to lessen your risk or risk of recurrence are smoking cessation, ceasing alcohol consumption, maintaining a healthy diet including physical activity, and working to maintain a healthy body weight. Other things that have been proven to increase risk, but no affirmed studies have been done are age, history with polyps or other colon or rectal cancers, having an inherited condition, IBS (irritable bowel syndrome), your ethnic background, or having type 2 diabetes. There are other unstudied risk factors like overworking and being overly stressed. If you feel you are experiencing other factors, be sure to speak with your doctor.
Screening and Prevention
The American Cancer Society recommends colorectal screening begins at age 45 and continue regularly through age 75 if otherwise healthy. After age 75, these screenings can be done as needed, or determined by other quality of life standards and outcomes. There are two main tests done to screen for these cancers and they are stool-based tests and visual exams of the colon and rectum. The stool-based tests available are:
- Highly sensitive fecal immunochemical test (FIT) which is done every year.
- Highly sensitive guaiac-based fecal occult blood test (gFOBT) which is done every year.
- A multi-targeted stool DNA test (MT-sDNA) which is recommended to be done every 3 years.
The visual exams are commonly done as a part of our routine medical care, and are:
- Colonoscopy is done every 10 years.
- CT colonography, which is a virtual colonoscopy, to be done every 5 years.
- Flexible sigmoidoscopy is done every 5 years.
Signs & Symptoms
The obvious signs for colorectal cancer might not show themselves right away. In some cases, the only way diagnosis occurs is during the routine colonoscopy. If other signs are present, you might experience one or more of the following:
- unintended weight loss
- weakness and fatigue
- abdominal cramping; may be severe
- belly pain
- rectal bleeding with bright red blood
- the constant urge to defecate that does not lessen after a movement
- a constant or sudden change in bowel habits; diarrhea, constipation, narrowing of the stool itself, or heavy feelings that last more than three days
There are many reasons there could be blood in your stool other than colorectal cancer. Some of those other reasons are infection, hemorrhoids, or irritable bowel syndrome. If you notice blood in your stool for more than a few days, please contact your doctor to find a course of action to ease your ailments.
There are many different doctors and specialists that you might see if you have colorectal cancer. This is because this cancer effects the gastrointestinal system, waste system, and a myriad of organs and organ systems in between. These are the types of doctors you might see for treatment:
- Physician’s Assistants (PAs)
- Nurse Practitioners (NPs)
- Surgical Oncologist
- Colorectal Surgeon
- Radiation Oncologist
- Medical Oncologist
Local therapies and treatments are those that treat only the tumor or cancerous growths. They are most often used in early-stage cancer treatments and certain other situations. These include surgery, ablation and immobilization, and radiation.
- Surgery is the main treatment for early-stage colorectal cancer. Most commonly, surgery is done by excising polyps and growths, or by doing a more invasive colectomy, which is the partial or complete removal of the colon. Total colectomies are not common.
- Ablation is a process to remove small growths that have spread away from the original cancer location. There are different methods used in ablation, but the process is done to kill specific cells. Ablation can be done with ethanol, cryosurgery, microwave ablation or radiofrequency ablation. Embolization is done to block the blood flow into the cancerous growths and tumors, thusly cutting off their life-line. This process is helpful with larger tumors that ablation cannot remove.
- Radiation therapies use high-energy rays to destroy cells. This treatment may be used if your cancer is located more in the rectum than the colon. For those cancers responding to radiation, often chemotherapy is done as well as part of the regimen.
Systemic treatments are those that treat the whole body along with the tumor and cancerous growths. These medications are given by mouth or through the blood. These medications are chemotherapy, targeted therapy, and immunotherapy.
- Chemotherapy is often given for anyone with colorectal cancer. There are many ways to receive chemotherapy from pill form to an IV drip, and there are many different types of chemotherapy drugs.
- Targeted therapy drugs are often used when chemotherapy does not or will not work. They have less side effects and can work alongside chemotherapy when needed. These targeted therapy drugs are used to block the flow of nutrients and blood flowing into the tumor. These drugs are given via IV every few weeks, or as determined by your care team.
- Immunotherapy drugs are designed to help your body reignite your immune system to recognize the cancer cells as the enemy, as they are. If you are dealing with these types of medications, you might hear names like checkpoint inhibitors, pd-1 inhibitors, or ctla-4 inhibitors; which are the drugs that will help your immune system fight back.
It is important to talk about all of your treatment options with your doctors and specialists at the time of diagnosis. If time allows in your own diagnosis and plan, consider seeking alternative or second opinions to ensure you are getting the best course of care possible. As with any cancer, if you have specific questions regarding your own case or care, do not hesitate to contact your doctor immediately.
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