Colorectal Cancer

The colorectal area is the third most common site of new cancer cases in the United States, and colorectal cancer is the third leading cause of cancer deaths in both men and women. One of every 20 people will develop colorectal cancer. In most cases colorectal cancer strikes men and women over age 50. However Colorectal cancer can occur at any age, and no one is too young to develop colorectal cancer.

If the cancer is found and treated early before it spreads to lymph nodes or other organs, the survival rate is higher. However, less than 40% of colorectal cancers are discovered at an early stage.

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Colorectal cancer is the abnornal growth of certain cells in the lower digestive tract. Colon cancer forms in the large intestine, a muscular tube about 6 feet long that is part of the body’s digestive system. Rectal cancer develops in the rectum, the last 8 to 10 inches of the large intestine.

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Cancer affects your cells, the basic units of life. Healthy cells grow and divide in an orderly way to keep your body functioning normally. But sometimes this growth gets out of control — cells continue dividing even when new cells aren't needed. In the colon and rectum, this exaggerated growth may cause pre-cancerous polyps (adenomas, or adenomatous polyps) to form in the lining of your intestine. Over a long period of time — spanning up to several years — some of these polyps may become cancerous. In later stages of the disease, cancerous polyps may penetrate the colon walls and spread (metastasize) to nearby lymph nodes or other organs.

Polyps can occur anywhere in your large intestine, the muscular tube that forms the last part of your gastrointestinal (GI) tract. The colon comprises the upper 4 to 6 feet of your large intestine, and the rectum makes up the lower 8 to 10 inches. Your colon absorbs water, salt and other minerals from food and stores waste until it's eliminated from your body.

Polyps are either mushroom-shaped or flat and may be large or small. There are also several different types of colon polyps. Among the most common are:

• Adenomas. These polyps have the potential to become cancerous and are usually removed during screening tests such as flexible sigmoidoscopy or colonoscopy.
• Hyperplastic polyps. Often less than 1/4 inch in diameter, these polyps are rarely, if ever, a risk factor for colorectal cancer.
• Inflammatory polyps. These polyps may follow a bout of ulcerative colitis. Although the polyps themselves aren't a significant risk, having ulcerative colitis increases your overall risk of colon cancer.

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Like many people with colorectal cancer, you may have no symptoms in the early stages of the disease. When symptoms appear, they'll likely vary, depending on the cancer's size and location in your large intestine. In some cases, your symptoms may result from a condition other than cancer, such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) , and sometimes diverticulosis or diverticulitis. Like colorectal cancer, these conditions are treatable.

See your doctor if any of the following signs and symptoms persist for more than a couple of weeks:

• A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
• Narrow, pencil-thin stools
• Rectal bleeding or blood in your stool on more than one occasion
• Persistent abdominal discomfort, such as cramps, gas or pain
• A feeling that your bowel doesn't empty completely
• Unexplained weight loss

Blood in your stool may be a sign of cancer, but it can also indicate other conditions. Bright red blood you notice on bathroom tissue may come from hemorrhoids or minor tears (fissures) in your anus, for example.

Normally, hemorrhoids don't bleed consistently over a period of weeks. If your bleeding is prolonged, talk to your doctor.

In addition, certain foods, such as beets or red licorice, can turn your stools red. Iron supplements and some anti-diarrheal medications may make stools black. Still, it's best to have any sign of blood or change in your stools checked promptly by your doctor.

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Colorectal cancer can occur at any age, and no one is too young to develop colorectal cancer. However, about 90 percent of people with the disease are older than 50. Factors other than age that place you at a higher risk include:

• Inflammatory intestinal conditions. Long-standing inflammatory diseases of the colon, such as ulcerative colitis and Crohn's disease, can increase your risk.
• Family history. You're more likely to develop colorectal cancer if you have a parent, sibling or child with the disease. If many family members have colon or rectal cancer, your risk is even greater. In some cases, this connection isn't hereditary or genetic. Instead, cancers within the same family may result from shared exposure to an environmental carcinogen or from diet or lifestyle factors.
  • Familial adenomatous polyposis (FAP) is a rare hereditary disorder that causes you to develop hundreds of polyps in the lining of your colon and rectum, beginning in your teenage years. If these go untreated, you'll likely develop colon cancer by age 40. In most cases, genetic testing can help determine if you're at risk of FAP.
  • FAP also causes polyps to develop not only throughout your colon but also, in most cases, eventually in your upper intestine or duodenum. You may also develop noncancerous tumors in other parts of your body, including your skin (sebaceous cysts and lipomas), bone (osteomas) and abdomen (desmoid tumors).
  • Hereditary nonpolyposis colorectal cancer (HNPCC) is another hereditary disorder that can put you at high risk of developing colon or rectal cancer. Unlike FAP, however, you may have relatively few polyps.
  • If you're Jewish and of Eastern European descent, you may have an inherited tendency to develop colorectal cancer. This is particularly true of Ashkenazi Jews.
• Diet. Colorectal cancer may be associated with a diet low in fiber and high in fat, red meat diet and calories. Research is still occurring in this area. However, high-fiber, low-fat diets have additional health benefits apart from a potential connection to colorectal cancer prevention.
• A sedentary lifestyle. If you're inactive, you're more likely to develop colon cancer, although not rectal cancer. This may be because when you're inactive, waste stays in your colon longer. Getting regular physical activity may reduce your risk of colon cancer.

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According to the American Cancer Society up to 90% of Colorectal Cancer cases are thought to be preventable. The most encouraging news about colorectal cancer is that you can reduce your risk by having regular screenings. You can also protect yourself by making a few simple changes in your diet and lifestyle. The following suggestions may help save your life:

• Eat plenty of fruits and vegetables. Fruits and vegetables contain vitamins, minerals, fiber and antioxidants, which may protect you from cancer. Try to eat five or more servings of fruits and vegetables every day. Look for deep green and dark yellow or orange fruits and vegetables, such as Swiss chard, bok choy, spinach, cantaloupe, mango, acorn or butternut squash, and sweet potatoes, as well as vegetables from the cabbage family, including broccoli, brussels sprouts and cauliflower. Lycopene, a nutrient found in tomatoes, may provide some minimal protection against cancer, but studies show that lycopene is helpful only if consumed as part of the whole fruit, and is unlikely to be beneficial when taken as a supplement. Also try to include legumes — including peas and beans — and soy foods, such as tofu or soy milk, in your diet.
• Limit fat, especially saturated fat. People who eat high-fat diets may have a higher rate of colorectal cancer. Be especially careful to limit saturated fats from animal sources such as red meat. Other foods that contain saturated fat include milk, cheese, ice cream, and coconut and palm oils. Try to restrict your total fat intake to less than 30 percent of your daily calories, with no more than 10 percent coming from saturated fats.
• Get recommended amounts of calcium and folic acid. Calcium and the B vitamin, folic acid, may help reduce your risk of colorectal cancer. Good food sources of calcium include skim or low-fat milk and other dairy products, broccoli, kale and canned salmon with the bones. Folate is the natural form of the B vitamin. It's found in certain foods naturally, including dark leafy greens such as spinach, and in pinto, kidney and navy beans, and some nuts and seeds. Folic acid is the synthetic form of the vitamin, and it's used in fortified breads, cereals, and supplements. Most multiple vitamins also contain both calcium and folic acid. Eating foods rich in calcium and folic acid can have added benefits for women. If you are pregnant, or think you may become pregnant, getting enough folic acid in your diet reduces the risk of certain birth defects. Calcium also provides many benefits, including helping to prevent osteoporosis.
• Limit alcohol consumption. Consuming moderate to heavy amounts of alcohol — more than one drink a day for women and two for men — may increase your risk of colon cancer. This is particularly true if you have a close relative, such as a parent, child or sibling, with the disease. A drink is a 4- to 5-ounce glass of wine, a 12-ounce can of beer, or a 1.5-ounce shot of 80-proof liquor. Curbing alcohol consumption can reduce your risk, even if colon cancer runs in your family.
• Stop smoking. Smoking can increase your risk of many different cancers. Talk to your doctor about ways to quit that may work for you.
• Stay physically active and maintain a healthy body weight. Controlling your weight alone can reduce your risk of colorectal cancer. And staying physically active may cut your colon cancer risk in half. Exercise stimulates movement through your bowel and reduces the time your colon is exposed to harmful substances (carcinogens) that may cause cancer. Try to get at least 30 minutes of exercise on most days. If you've been inactive, start slowly and build up gradually to 30 minutes. Also, talk to your doctor before starting any exercise program.
• Consider hormone replacement therapy. If you're a woman past menopause, hormone replacement therapy (HRT) may reduce your risk of colorectal cancer. Women who use HRT have a somewhat lower risk of colorectal cancer than women who don't use HRT. But not all effects of HRT are positive. Taking HRT as a combination therapy — estrogen plus progestin — can result in serious side effects and health risks. Work with your doctor to discuss the options and decide what's best for you.

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Treatment for colorectal cancer depends upon the stage of the cancer, the location and size of the tumor, and whether it is colon cancer or rectal cancer. Your general health is another determining factor in treatment choices.

Treatments of colorectal cancer include:

• Surgery to remove the cancer
• Radiation therapy to destroy cancer cells
• Chemotherapy to destroy cancer cells

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Survival rates for people with colorectal cancer vary, but this will give you a general idea of the five-year survival rates for colorectal cancer patients.

The five-year survival rate represents the percentage of patients alive five years after their initial diagnosis.

The information below is from colorectal cancer patients in the United States.

Five-Year Survival Rates:

• Duke's A / Stage 1 Colorectal Cancer: 96%
• Duke's B / Stage 2 Coloretal Cancer: 87%
• Duke's C / Stage 3 Colorectal Cancer: 55%
• Stage 4 Colorectal Cancer: 5%

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* Text Resources: The Mayo Clinic Staff