Colon and rectal cancers are often grouped since they share several features. Colorectal cancer usually originates from a polyp inside the colon or rectum. Some benign polyps can change over the years and become cancerous.
Adenocarcinoma is the most prevalent type of colorectal cancer.
The most prevalent sign of colorectal cancer is blood in the stool that causes it to change color. Symptoms may include changes in bowel habits, persistent gas pains, bloating, fullness, or abdominal cramps.
To diagnose colorectal cancer, patients usually undergo a series of tests and procedures, for example:
- Clinical rectal exam- a doctor or nurse inserts a lubricated, gloved finger into the rectum to feel for lumps or any abnormalities.
- Barium enema- a colon X-ray exam that can detect changes or abnormalities in the colon. A specialist injects barium containing liquid into the rectum. The barium coats the lower GI tract and allows a relatively clear outline.
- Sigmoidoscopy or Colonoscopy- a specialist passes a slim device with a light and a lens through the rectum and sigmoid colon. It allows examining them for any sign of disease. If needed, the doctor can use the scope to remove polyps or abnormal tissue. The procedures can be used to take a tissue sample (a biopsy) for further examination by a pathologist.
- Virtual colonoscopy – the noninvasive procedure allows the specialists to see polyps and any abnormalities on the inside surface of the colon. It involves taking a series of X-rays of the colon that the computer then processes to generate detailed 3-D images.
- Blood tests such as a full blood count, liver functions and a tumor marker (CEA)
A colorectal tumor can spread locally, regionally to nearby lymph nodes, and systemically to other organs. Common spreading might occur to the liver and also to the peritoneum, lungs, or distant lymph nodes. To learn whether cancer has spread, the doctor might recommend imaging tests. They may include CT, MRI, chest X-ray, or a PET CT scan.
Most patients diagnosed with colorectal cancer will need to undergo surgery (local excision or resection of the colon). Some might need to receive chemotherapy or radiation therapy after surgery. Some patients can benefit from targeted therapy according to particular factors in the patient’s tumor. For some patients with advanced or metastatic colorectal cancer, and with a specific cancer mutation, there is also the option of immunotherapy.
Early Detection Of Colorectal Cancer
Most colorectal cancers are random, but in a significant number of cases there is a family history of the disease. Up to 10% of colon cancer patients have a family history at the time of diagnosis, with at least one relative being first-degree. Early detection and diagnosis of colorectal cancer reduces the risk of mortality from this disease. When there is a family history, a number of factors are important which influence the method of the follow-up and the age at which genomic tests and monitoring begin. These factors include: the number of colon cancer patients in the family, the youngest age of cancer detection, additional cancers and the appearance of polyps in other family members.
It is known that about 50% of the relatives of a colon cancer patient are not aware of the increased risk of developing the disease, and only 45% of them have undergone a colonoscopy. Patients’ wish to conceal or not to share their newly diagnosed cancer with their close relatives, is a common problem in various communities. Many times, a patient diagnosed with colorectal cancer is concerned about being labeled as ”cancer patient” or ”seriously ill” and does not want others to know about his illness. It is possible to identify a number of obstacles regarding the patient and their relatives, some of those barriers are detailed below:
The patient’s barriers:
- There is little understanding on the part of the patient regarding the need for early detection tests and follow-up of relatives. Usually the patient is not aware that there is an increased risk of developing cancer in relatives, especially if they do not have symptoms and if they are young.
- Lack of recommendations and medical explanations by the attending physician (gastroenterologist or oncologist).
The barriers of relatives:
- Lack of awareness about the increased personal risk and the need for early detection checkups, including early-age colonoscopy.
- Lack of medical recommendations.
- Fear of an invasive procedure (colonoscopy) that requires uncomfortable preparation and has a risk of possible complications, especially when there are no symptoms.
Can Diet Reduce The Risk Of Recurrence Of Stage III Colon Cancer?
One of the things that greatly interests patients is what can they do in order to reduce their risk of recurring cancer. Earlier studies have shown that patients recovering from colon cancer that had a healthy lifestyle, keeping physically active, maintaining a proper weight, and controlling their nutrition, have a better prognosis than those with less healthy habits. Scientists thought that it was possible that this fact derived, amongst other things, from the lower levels of insulin, which are caused as a result of the healthy behavior. Diets with a higher level of simple carbs (such as white flours – bread, pasta, rice), white sugar and fat, which are characteristic in Western diets, tend to create higher levels of insulin. Mediterranean-style diets, rich in vegetables, fruits, legumes, healthy fats, and proteins, are related to lower levels of insulin.
Does The Side Of The Tumor Impact The Treatment Response And Efficacy In Metastatic Colon Cancer?
The question arose of whether the location of the primary tumor in colon cancer is significant or changes the treatment results for metastatic patients. The side of the tumor is defined as left-side tumors when it is situated in the spleen area, the descending colon, the sigmoid colon, and the rectum, while right-side tumors are in the area of the appendix, the cecum, the ascending colon, and the transverse colon. Right-side, metastatic primary tumors of the colon are impacted by combined chemotherapy treatment in a different manner than left-side primary tumors of the colon.
Is There A Relationship Between BRCA1/2 Mutations And Colon Cancer?
Mutations in BRCA1 / 2 genes have recently been associated with an increased risk of colon cancer. The researchers defined the largest group of BRCA1 / 2 mutation carriers with colon cancer. They looked at 32 patients with low gastrointestinal cancer exhibiting the presence of BRCA1 / 2 mutations in genetic testing. The data were collected in 2 large academic hospitals in Israel. 91% of the patients were of Ashkenazi origin, 78% were women and 62.5% were carriers of genetic mutations BRCA1. A high percentage of colorectal tumors (34.5%) had mucinous histology and were found in an uncharacteristic location- in the left colon. Two patients had anal cancer with exceptional histology and another patient suffering from small intestine cancer. Gene expression analysis showed significant correlation between gene signatures of left colorectal cancer and known breast cancer. The results suggest that Ashkenazi’s carrying BRCA1 / 2 mutations with colorectal cancer may have unique characteristics with a high rate left side cancer, and possibly an anal carcinoma. This report suggests that in the future, it will be possible to affect the properties of defective genes and repair DNA on tumors in the colon.
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