COLON CANCER AND RECTAL CANCER - Screening, Symptoms, Diagnosis & Treatment
Introduction
What is colorectal cancer?
Who is at risk?
What are screening tests, and why are they
so important?
What tests are used to screen people for
colorectal cancer?
Do insurance companies pay for colorectal
cancer screening?
Does colorectal cancer cause symptoms?
How is colorectal cancer diagnosed?
How is colorectal cancer treated?
Do patients with colorectal cancer participate
in clinical trials (research studies)?
Colorectal Cancer Screening Guidelines
Video References
Introduction: Do Hemorrhoids Cause Colon & Rectal Cancer?
People assume they have "piles" or hemorrhoids whenever there is any symptom in the rectal area. This is a misconception. Hemorrhoids do not a cause colorectal cancer. A study done at the Hemorrhoid Care Medical Clinic in 1988, showed that approximately 90% of colon and rectal cancer patients initially thought that they had hemorrhoids, and presented with symptoms of rectal itching and rectal bleeding. So a belief that one has hemorrhoids, could be considered a colorectal cancer warning sign.
Other warning signs of colon and rectal cancer are:
- Excess Gas
- Constipation
- Blood in Stools
- Change in Bowel Habits
- Persistent Abdominal Discomfort
- Change in Shape of Color of Stools
- Sensation of Incomplete Evacuation
- Feelings of Tiredness or Exhaustion
Cancer of the colon and rectum is
the second most common cause of cancer death in the U.S.A.
today. 1 out of every 17 Americans will get colorectal cancer
at some point in their life. Early diagnosis is the key to
achieving survival. With better diagnostic modalities and
more aggressive approaches, we can improve the present rate
of survival from 62% to 81%, which means an additional 56,000
patients will live each year.
According to the American Cancer Society
(ACS), 90% of all colorectal cancer cases and deaths are thought
to be preventable, based on existing approaches to prevention
and early detection. Screening tests that detect occult blood
in the stool or identify adenomatous polyps can prevent the
occurrence of colorectal cancers by allowing the detection
and removal of pre-cancerous lesions before they undergo malignant
transformation.
Approximately the five-year survival
rate for colon cancer is 90% when it is diagnosed at an early,
localized stage. However, only 37% of diagnoses are made in
the early stage. As a result, colon cancer is the second deadliest
cancer in the US.
Get the
test. Get the polyp. Get the cure.
Colon cancer almost always starts
with a colon polyp, developing
with no symptoms. Finding and removing polyps through early
detection testing before they become cancerous can stop colon
cancer before it even starts. In fact, if all Americans 50
years of age or older had regular tests, annual deaths from
colon cancer could be cut in half.
The death rate from colorectal cancer
has been going down for the past 20 years. This may be because
there are fewer cases, because more of the cases are found
early, and also because treatments have improved.
That is why for most proctologists
and gastrointestinal specialists, the diagnosis and treatment
of colorectal cancer is a priority concern.
Questions and Answers About
Screening,
Early Detection, and Treatment for Colorectal Cancer
What
is colorectal cancer?
Cancer that begins in the colon is called colon cancer, and
cancer that begins in the rectum is called rectal cancer.
Cancers affecting either of these organs may also be called
colorectal cancer.
The colon and rectum are parts of
the body's digestive system, which removes nutrients from
food and stores waste until it passes out of the body. Together,
the colon and rectum form a long, muscular tube called the
large intestine (also called the large bowel). The colon is
the first 6 feet of the large intestine, and the rectum is
the last 8 to 10 inches.
Colon,
rectum, and other parts of digestive system
Colorectal cancer is a disease in
which cells in the colon or rectum become abnormal and divide
without control or order, forming a mass called a tumor. Tumors
can be either benign or malignant.
Benign tumors are not cancer.
They often can be removed and, in most cases, they do not
come back. Cells in benign tumors do not spread to other parts
of the body. Most important, benign tumors are rarely a threat
to life.
Malignant tumors are cancer.
Cells in malignant tumors are abnormal and divide without
control or order. These cancer cells can invade and destroy
the tissue around them. Cancer cells can also break away from
a malignant tumor. They may enter the bloodstream or lymphatic
system (the tissues and organs that produce and store cells
that fight infection and disease). This process, called metastasis,
is how cancer spreads from the original (primary) tumor to
form new (secondary) tumors in other parts of the body.
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Who
is at risk?
The exact causes of colorectal cancer are not known. However,
studies show that certain factors increase a person's chance
of developing colorectal cancer:
Age. Colorectal cancer is more
likely to occur as people get older. Most people who develop
colorectal cancer are over the age of 50. However, the disease
can occur at any age.
Diet. The development of colorectal
cancer seems to be associated with a diet that is high in
fat and calories and low in foods with fiber, such as whole
grains, fruits, and vegetables. Eating a high
fiber diet helps to prevent colorectal cancer. Patients
that follow Researchers are exploring how these and other
dietary components play a role in the development of colorectal
cancer.
Polyps. Polyps
are benign growths (not cancer) on the inner wall of the colon
or rectum. They are relatively common in people over age 50.
Because most colorectal cancers develop in polyps, detecting
and removing these growths may be a way to prevent colorectal
cancer. Familial polyposis is a rare, inherited condition
in which hundreds of polyps develop in the colon and rectum.
Unless this condition is treated, a person who has it is extremely
likely to develop colorectal cancer.
Personal history. A person
who has already had colorectal cancer may develop colorectal
cancer a second time. Also, research studies show that women
with a history of ovarian, uterine, or breast cancer have
a somewhat increased chance of developing colorectal cancer.
Family history. Close relatives
(parents, siblings, or children) of a person who has had colorectal
cancer are somewhat more likely to develop this type of cancer
themselves, especially if the relative developed the cancer
at a young age. If many family members have had colorectal
cancer, the chances increase even more.
Ulcerative colitis. Ulcerative
colitis is a condition in which the lining of the colon
becomes inflamed. People who have ulcerative colitis are more
likely to develop colorectal cancer.
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What are screening tests, and why are they so important?
Screening tests are examinations that check for health problems
before they cause symptoms. Screening tests are important
because finding health problems at an early stage often means
that treatment will be more successful.
Colorectal cancer screening tests
are used to detect cancer, polyps that may eventually become
cancerous, or other abnormal conditions.
Most people who undergo colorectal
screening do not have any colorectal abnormality. For those
who do, diagnosis and treatment can occur promptly.
What
tests are used to screen people for colorectal cancer?
People who have any risk factors for colorectal cancer should
ask their doctor when to begin screening for colorectal cancer,
what tests to have, and how often to schedule appointments.
Doctors may suggest one or more of the tests listed below
as a part of regular checkups.
A fecal occult blood test (FOBT)
is a test for hidden blood in the stool. This test has
been proven to reduce the death rate of colorectal cancer.
A sigmoidoscopy
is an examination of the rectum and lower colon with a lighted
instrument.
A colonoscopy
is an examination of the rectum and entire colon with a lighted
instrument.
A double contrast barium enema
is a series of x-rays of the colon and rectum. The x-rays
are taken after the patient is given an enema with a white,
chalky solution that contains barium to outline the colon
and rectum on the x-rays.
A digital rectal exam (DRE)
is a test in which the doctor inserts a lubricated, gloved
finger into the rectum to feel for abnormal areas.
Virtual Colonoscopy is an imaging study of the colon and rectum performed with computed tomography (CT), sometimes called a CAT scan, or with magnetic resonance imaging (MRI).
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Do
insurance companies pay for colorectal cancer screening?
People should check with their health insurance provider to
determine their colorectal cancer screening benefits. People
who are age 50 or older and are covered by Medicare are eligible
for colorectal cancer screening benefits. Additional information
is available on the Medicare Web site at http://www.medicare.gov/health/overview.asp
on the Internet.
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Does
colorectal cancer cause symptoms?
Common symptoms of colorectal cancer include the following:
- Change in bowel habits
- Diarrhea, constipation, or feeling
that the bowel does not empty completely
- Blood in the stool (either bright
red or very dark in color)
- Stools that are narrower than usual
- General abdominal discomfort (frequent
gas pains, bloating, fullness, and/or cramps)
- Weight loss with no known reason
- Constant tiredness
- Vomiting
These symptoms can be caused by cancer
or by a number of other conditions. It is important to check
with a doctor.
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How
is colorectal cancer diagnosed?
To find the cause of symptoms, the doctor evaluates one's
personal and family medical history. The doctor also performs
a physical exam and may order one or more diagnostic tests.
These may include a blood test called a CEA assay to measure
a protein called carcinoembryonic antigen that is sometimes
higher in patients with colorectal cancer. The
doctor may also order x-rays of the gastrointestinal tract
, sigmoidoscopy , or colonoscopy. If abnormal tissue is found
during these tests, a biopsy (the removal of tissue for examination
under a microscope by a pathologist) is performed to determine
if a person has cancer.
If the diagnosis is cancer, the doctor
will want to learn the stage (or extent) of disease. Staging
is a careful attempt to find out whether the cancer has spread
and, if so, to what parts of the body. Knowing the stage of
the disease helps the doctor plan treatment. Additional tests
may be performed to help determine the stage.
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How
is colorectal cancer treated?
Treatment for colorectal cancer depends on a number of factors,
including the general health of the patient and the size,
location, and extent of the tumor. Many different treatments
and combinations of treatments are used to treat colorectal
cancer.
Surgery to remove the cancer
is the most common treatment for colorectal cancer. The type
of surgery that a doctor performs depends mainly on where
the cancer is found.
Chemotherapy is the use of
anticancer drugs to kill cancer cells. The anticancer drugs
circulate in the bloodstream and affect cancer cells throughout
the body.
Radiation therapy, also called
radiotherapy, involves the use of high-energy x-rays to kill
cancer cells. Radiation therapy affects the cancer cells only
in the treated area.
Biological therapy, also called
immunotherapy, uses the body's immune system, either directly
or indirectly, to fight cancer. The immune system recognizes
cancer cells in the body and works to eliminate them. Biological
therapies are designed to repair, stimulate, or enhance the
immune system's natural anticancer function.
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Do
patients with colorectal cancer participate in clinical trials
(research studies)?
Yes, patients with all stages of colorectal cancer can take
part in clinical trials (research studies). Clinical trials
to evaluate new ways to treat cancer are an appropriate treatment
option for many patients with this disease. Through research,
doctors learn new ways to treat cancer that may be more effective
than the standard therapy. Research has led to significant
advances in the treatment of colorectal cancer. Information
about ongoing clinical trials is available from the Cancer
Information Service (see below), or from the National Cancer
Institute's cancerTrials™ Web site at http://cancertrials.nci.nih.gov
on the Internet.
Cancer Information Service
Toll-free: 1-800-4-CANCER (1-800-422-6237)
TTY (for deaf and hard of hearing callers): 1-800-332-8615
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Colorectal Cancer Screening Guidelines
Medicare Guide to Preventative Services – April 2007
Colorectal Cancer Screening Tests
• Fecal Occult Blood (FOBT)
• Flexible Sigmoidoscopy
• Colonoscopy
• Barium Enema
Unless the words “High Risk” are specified, all of the following guidelines are for patients who are at a normal risk for developing colorectal cancer:
High Risk Factors
• A sibling, parent, or child had an adenomatous polyp or colon cancer
• Family history of adenomatous polyposis or hereditary colorectal cancer
• A personal history of adenomatous polyps, colorectal cancer, or Inflammatory Bowel Disease (IBD)
A patient is at “high risk” if he has any of these above risk factors.
After age 50, all annual time periods listed below are given a 30 day grace period; whereby the physician may commence Colorectal Cancer Screening up to 30 days earlier than specified:
Medicare Covered Fecal Occult Blood (FOBT)
• Annually if ≥ age 50
Medicare Covered Flexible Sigmoidoscopy
• Beginning age 50, then once every 4 years
Medicare Covered Colonoscopy
• Once every 2 years for a patient with high risk factors (without regard to age)
• Beginning age 50, then once every 10 years
• Must be at least 4 years after a Flexible Sigmoidoscopy.
Medicare Covered Barium Enema
• As an alternative to Colonoscopy of Flexible Sigmoidoscopy
• Once every 2 years for a patient with high risk factors (without regard to age)
• Beginning age 50, then once every 4 years
• Preferably a double contrast Barium Enema
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American College of Gastroenterology (ACG) Guidelines - March 2009:
1) The starting age is lowered to 45 years for African Americans. Perhaps also at age 45 years, for patients who are obese or who have an "extreme smoking history."
2) It is reasonable to consider screening at an age earlier than 50 years (i.e. 45 years) in patients with characteristics known to promote colorectal cancer, including a history of smoking and obesity (defined as a BMI >30). However, there is no formal recommendation for earlier screening in these subgroups of patients at this time.
3) If the colorectal cancer or advanced adenoma in the first-degree family member is diagnosed at younger than 60 years, or if there are 2 first-degree relatives with colorectal cancer or advanced adenoma, screening colonoscopy should begin at age 40 years, or 10 years younger than the age at diagnosis of the youngest affected relative. Colonoscopy should be repeated at 5-year intervals for these patients.
4) Patients with familial adenomatous polyposis should undergo annual flexible sigmoidoscopy or colonoscopy until colectomy is performed.
5) Another preferred screening test is annual Fecal Immunochemical Test (FIT). A previous study found that FIT was superior to older guaiac-based fecal occult blood tests to detect both advanced adenomas and colorectal cancer in adults being screened for colorectal cancer; and because fecal DNA testing is too expensive.
6) Alternative and less-preferred screening tests for colorectal cancer include flexible sigmoidoscopy every 5 years, or computed tomographic colonography every 5 years. Double-contrast barium enema testing is no longer part of the screening recommendations for colorectal cancer. Its use has declined dramatically, and computed tomographic colonography is more effective in diagnosing polyps.
7) In the current recommendations from the ACG, colonoscopy is the test of choice to screen for colorectal cancer. Annual screening with FIT is the first alternative to colonoscopy screening, followed by flexible sigmoidoscopy and computed tomographic colonography. Double-contrast barium enema to screen for colorectal cancer is no longer recommended.
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Video
References
1. Video: Colon
Cancer Tutorial - The National Library of Medicine
= http://www.nlm.nih.gov/medlineplus/tutorials/coloncancer/htm/index.htm
2. Video: Colon
Cancer Surgery Tutorial - The National Library of Medicine
http://www.nlm.nih.gov/medlineplus/tutorials/coloncancersurgery/htm/index.htm
3) Video: Radiation
Therapy Tutorial - The National Library of Medicine
http://www.nlm.nih.gov/medlineplus/tutorials/radiationtherapyintroduction/htm/index.htm
4) Video: Chemotherapy
Tutorial - The National Library of Medicine
http://www.nlm.nih.gov/medlineplus/tutorials/chemotherapyintroduction/htm/index.htm
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