General Information
Prevention
Stages of Colon Cancer
Flexible Sigmoidoscopy
Treatment Option Overview
Understanding Your Colonstomy
Colonstomy- What's right for me?
Colon Cleansers

General Information:

Colon cancer is a disease in which malignant (cancer) cells form in the tissues of the colon.

The colon is part of the body’s digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The first 6 feet of the large intestine are called the large bowel or colon. The last 6 inches are the rectum and the anal canal. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).

Anatomy of the lower digestive system, showing the colon and other organs.

Age and health history can affect the risk of developing colon cancer.

Risk factors include the following:

• Age 50 or older.
  

• A family history of cancer of the colon or rectum.
  

• A personal history of cancer of the colon, rectum, ovary, endometrium, or breast.
  

• A history of polyps in the colon.

  Polyps in the colon. Some polyps have a stalk and others do not. Inset shows a photo of a polyp with a stalk.

• A history of ulcerative colitis (ulcers in the lining of the large intestine) or Crohn's disease.

• Certain hereditary conditions, such as familial adenomatous polyposis and hereditary nonpolyposis colon cancer (HNPCC; Lynch Syndrome).

Possible signs of colon cancer include a change in bowel habits or blood in the stool.

These and other symptoms may be caused by colon cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

• A change in bowel habits.

• Blood (either bright red or very dark) in the stool.

• Diarrhea, constipation, or feeling that the bowel does not empty completely.

• Stools that are narrower than usual.

• General abdominal discomfort (frequent gas pains, bloating, fullness, or cramps).

• Weight loss with no known reason.

• Constant tiredness.

• Vomiting.

Tests that examine the rectum, rectal tissue, and blood are used to detect (find) and diagnose colon cancer.

The following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

• Fecal occult blood test: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.

  Fecal Occult Blood Test (FOBT) kit to check for blood in stool.

• Digital rectal exam: An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.

• Barium enema: A series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.

  Barium enema procedure. The patient lies on an x-ray table. Barium liquid is put into the rectum and flows through the colon. X-rays are taken to look for abnormal areas.

• Sigmoidoscopy: A procedure to look inside the rectum and sigmoid (lower) colon for polyps, abnormal areas, or cancer. A sigmoidoscope (a thin, lighted tube) is inserted through the rectum into the sigmoid colon. Polyps or tissue samples may be taken for biopsy.

  Sigmoidoscopy. A thin, lighted tube is inserted through the anus and rectum and into the lower part of the colon to look for abnormal areas.

• Colonoscopy: A procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope (a thin, lighted tube) is inserted through the rectum into the colon. Polyps or tissue samples may be taken for biopsy.

  Colonoscopy. A thin, lighted tube is inserted through the anus and rectum and into the colon to look for abnormal areas.

• Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.

• Virtual colonoscopy: A procedure that uses a series of x-rays called computed tomography to make a series of pictures of the colon. A computer puts the pictures together to create detailed images that may show polyps and anything else that seems unusual on the inside surface of the colon. This test is also called colonography or CT colonography.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the following:

• The stage of the cancer (whether the cancer is in the inner lining of the colon only, involves the whole colon, or has spread to other places in the body).

• Whether the cancer has blocked or created a hole in the colon.

• The blood levels of carcinoembryonic antigen (CEA; a substance in the blood that may be increased when cancer is present) before treatment begins.

• Whether the cancer has recurred.

• The patient’s general health.

Treatment options depend on the following:

• The stage of the cancer.

• Whether the cancer has recurred.

• The patient’s general health

Prevention

Not along ago, many people thought that there was little that they could do to protect themselves against cancer.

Recently, however, scientists have taken a closer look at cancer. They've learned more about how the disease develops and what biological and environmental factors increase cancer risk.

We now have better weapons for fighting the disease: more options for diagnosis and treatment, improved therapies and new technologies for early detection.

We also now know that people can take steps to protect themselves against cancer.

All people can lower their overall cancer risk by being active and eating a diet rich in fruits and vegetables. 

High consumption of red and processed meat over a long period of time is associated with an increased risk for a certain type of colon cancer, according to a study in the January 12 issue of the Journal of the American Medical Association.

But, in addition to regular exercise and healthy eating, there are other ways that you could protect yourself against cancer, based on your age, gender and family history of the disease.

Research suggests that up to 35 percent of cancers are related to poor diet. By modifying what you eat and being active, you can reduce your risk of cancer and other health problems.

Exercise

• Once you have made the decision to exercise, choose an activity that suits your personality – if you like the company of other people, choose an activity like a dance class or a team sport. If you prefer solitary activity, then walking or using equipment in a gym may be better for you.

• Get help: ask for assistance from someone with an understanding of your selected activity – a trainer at your gym, the aerobic instructor – to help you prevent injury and to get the most from your workout. 

• Remember that even moderate exercise has health benefits. Moderate exercise is defined as activity that burns 150 calories of energy a day or 1000 a week. Try walking, yard work or recreational games like tennis or basketball.

• Work toward 30 minutes of physical activity between three to five days a week.

• Set realistic goals for yourself based on your fitness level.

• Go slow and steady so you don’t become disappointed by setbacks.

• Keep to a regular schedule – you will establish a routine and be more likely to stick to it. If you don’t stick to your schedule, don’t worry. Just pick up again where you left off and start again.

• Always check with a physician when you begin a new exercise program, especially if you have been sedentary.

Medical Disclaimer

The information presented on the Susan Cohan Kasdas Colon Cancer web site is solely intended to provide you with information that will help educate you on the importance of diet, exercise and regular cancer screening in maintaining a healthy lifestyle. Adopting these habits is an individual choice and one that should only be made after consultation with your health care professional. No information provided on this Web site or otherwise offered by CRPF is intended to replace or in any way modify the advice of your health care professional.

Stages of Colon Cancer

After colon cancer has been diagnosed, tests are done to find out if cancer cells have spread within the colon or to other parts of the body.

The process used to find out if cancer has spread within the colon or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

• Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.

• Complete blood count: A procedure in which a sample of blood is drawn and checked for the following:

• The number of red blood cells, white blood cells, and platelets.

• The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.

• The portion of the sample made up of red blood cells.

• Carcinoembryonic antigen (CEA) assay: A test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of colon cancer or other conditions.

• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the colon. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

• Surgery: A procedure to remove the tumor and see how far it has spread through the colon.
  
  
  The following stages are used for colon cancer:

Stage 0 (Carcinoma in Situ)
In stage 0, the cancer is found in the innermost lining of the colon only. Stage 0 cancer is also called carcinoma in situ.

Stage I
In stage I, the cancer has spread beyond the innermost tissue layer of the colon wall to the middle layers. Stage I colon cancer is sometimes called Dukes’ A colon cancer.

Stage II
Stage II colon cancer is divided into stage IIA and stage IIB.

Stage IIA: Cancer has spread beyond the middle tissue layers of the colon wall or has spread to nearby tissues around the colon or rectum.

Stage IIB: Cancer has spread beyond the colon wall into nearby organs and/or through the peritoneum.

Stage II colon cancer is sometimes called Dukes' B colon cancer.

Stage III
Stage III colon cancer is divided into stage IIIA, stage IIIB, and stage IIIC.

Stage IIIA: Cancer has spread from the innermost tissue layer of the colon wall to the middle layers and has spread to as many as 3 lymph nodes.

Stage IIIB: Cancer has spread to as many as 3 nearby lymph nodes and has spread:

*beyond the middle tissue layers of the colon wall; or

*to nearby tissues around the colon or rectum; or

*beyond the colon wall into nearby organs and/or through the peritoneum.

Stage IIIC: Cancer has spread to 4 or more nearby lymph nodes and has spread:

*to or beyond the middle tissue layers of the colon wall; or

*to nearby tissues around the colon or rectum; or

* to nearby organs and/or through the peritoneum.

Stage III colon cancer is sometimes called Dukes' C colon cancer.

Stage IV
In stage IV, cancer may have spread to nearby lymph nodes and has spread to other parts of the body, such as the liver or lungs. Stage IV colon cancer is sometimes called Dukes’ D colon cancer.

Flexible Sigmoidoscopy

The digestive system

Flexible sigmoidoscopy (SIG-moy-DAH-skuh-pee) enables the physician to look at the inside of the large intestine from the rectum through the last part of the colon, called the sigmoid or descending colon. Physicians may use the procedure to find the cause of diarrhea, abdominal pain, or constipation. They also use it to look for early signs of cancer in the descending colon and rectum. With flexible sigmoidoscopy, the physician can see bleeding, inflammation, abnormal growths, and ulcers in the descending colon and rectum. Flexible sigmoidoscopy is not sufficient to detect polyps or cancer in the ascending or transverse colon (two-thirds of the colon). For the procedure, you will lie on your left side on the examining table. The physician will insert a short, flexible, lighted tube into your rectum and slowly guide it into your colon. The tube is called a sigmoidoscope (sig-MOY-duh-skope). The scope transmits an image of the inside of the rectum and colon, so the physician can carefully examine the lining of these organs. The scope also blows air into these organs, which inflates them and helps the physician see better. If anything unusual is in your rectum or colon, like a polyp or inflamed tissue, the physician can remove a piece of it using instruments inserted into the scope. The physician will send that piece of tissue (biopsy) to the lab for testing. Bleeding and puncture of the colon are possible complications of sigmoidoscopy. However, such complications are uncommon. Flexible sigmoidoscopy takes 10 to 20 minutes. During the procedure, you might feel pressure and slight cramping in your lower abdomen. You will feel better afterward when the air leaves your colon. Preparation The colon and rectum must be completely empty for flexible sigmoidoscopy to be thorough and safe, so the physician will probably tell you to drink only clear liquids for 12 to 24 hours beforehand. A liquid diet means fat-free bouillon or broth, gelatin, strained fruit juice, water, plain coffee, plain tea, or diet soda. The night before or right before the procedure, you may also be given an enema, which is a liquid solution that washes out the intestines. Your physician may give you other special instructions

Treatment Option Overview

There are different types of treatment for patients with colon cancer.

Different types of treatment are available for patients with colon cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the “standard” treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used. These include the following:

Surgery

Surgery (removing the cancer in an operation) is the most common treatment for all stages of colon cancer. A doctor may remove the cancer using one of the following types of surgery:

• Local excision: If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall. Instead, the doctor may put a tube through the rectum into the colon and cut the cancer out. This is called a local excision. If the cancer is found in a polyp (a small bulging piece of tissue), the operation is called a polypectomy.

• Resection: If the cancer is larger, the doctor will perform a partial colectomy (removing the cancer and a small amount of healthy tissue around it). The doctor may then perform an anastomosis (sewing the healthy parts of the colon together). The doctor will also usually remove lymph nodes near the colon and examine them under a microscope to see whether they contain cancer.

  Colon cancer surgery with anastomosis. Part of the colon containing the cancer and nearby healthy tissue is removed, and then the cut ends of the colon are joined.

• Resection and colostomy: If the doctor is not able to sew the 2 ends of the colon back together, a stoma (an opening) is made on the outside of the body for waste to pass through. This procedure is called a colostomy. Sometimes the colostomy is needed only until the lower colon has healed, and then it can be reversed. If the doctor needs to remove the entire lower colon, however, the colostomy may be permanent.

  Colon cancer surgery with colostomy. Part of the colon containing the cancer and nearby healthy tissue is removed, a stoma is created, and a colostomy bag is attached to the stoma.

• Radiofrequency ablation: The use of a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in the hospital with general anesthesia.

• Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy.

Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas.

Chemoembolization of the hepatic artery may be used to treat cancer that has spread to the liver. This involves blocking the hepatic artery (the main artery that supplies blood to the liver) and injecting anticancer drugs between the blockage and the liver. The liver’s arteries then deliver the drugs throughout the liver. Only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on what is used to block the artery. The liver continues to receive some blood from the hepatic portal vein, which carries blood from the stomach and intestine.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Other types of treatment are being tested in clinical trials. These include the following:

Biologic therapy

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Follow-up exams may help find recurrent colon cancer earlier.

After treatment, a blood test to measure carcinoembryonic antigen (CEA; a substance in the blood that may be increased when colon cancer is present) may be done along with other tests to see if the cancer has come back.

Colon Cleansing

Colon Cleansing is a topic that is second only to colon cancer on a list of frequently searched Google terms related to the colon.  The rationale for colon cleansing is the belief that toxins build up in the stool, sits in our bodies and leads to disease.  Many people believe that if we clean out the colon with different products – from enemas to oral preparations – we will decrease the amount of these toxins in our body.

At this time the Foundation has no supporting objective evidence, clinical trials, or any validated scientific information supporting the value of colon cleaners.  In fact, many leading experts agree that colon cleansers can do more harm than good to the colon. 

What many people do not know is that the colon lining, called the mucosa, gets its nourishment from bacterial products that exist in the stool.  In addition, colon cleansing leads to sloughing of the colonic mucosa which can lead to inflammation and subsequent colonic diseases.

All of this can be very confusing when searching for information about colon cleansers, or colon cleansing.  Since there are so many companies advertising their brand of colon cleansers and absolutely no medical or governmental institutions policing these companies please be careful.  As with any advertised product on the internet or in your local store it is recommended to consult with your primary care physician, or a Gastroenterologist or Colorectal surgeon.

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