Colon and Rectal Cancer

________________________________________________________________________

KEY POINTS

• Colon or rectal cancer is the growth of abnormal cells in your large intestine.
• Treatment may include surgery to remove the tumor and part of your intestine, chemotherapy, or radiation. Often, more than 1 treatment is used.
• After successful treatment, you will need to have regular follow-up visits with your healthcare provider.

________________________________________________________________________

What is colon or rectal cancer?

Colon or rectal cancer is the growth of abnormal cells in your large intestine, which is also called the large bowel. The colon is the last 5 feet of the bowel. The rectum is the last few inches of the large bowel inside the anus, where your bowel movements come out. Colon cancer is one of the most common types of cancer. Another name for this type of cancer is colorectal cancer.

The sooner cancer is found and treated, the better your chances for recovery. However, even advanced cancer can usually be treated. Treatment may slow or temporarily stop the growth of the cancer and ease symptoms. Ask your healthcare provider what you can expect with the type of cancer that you have.

What is the cause?

Most colorectal cancers start from a growth of extra tissue, called a polyp, on the inside wall of the bowel. Polyps are very common. About half of all people will eventually have a polyp in their large bowel. Less than 1 in 10 polyps turn into cancer. Colorectal cancer grows very slowly, over 10 to 15 years. Colon or rectal cancer usually occurs after age 50, but it can happen at any age.

You may have a greater risk of developing colon cancer if you:

• Have had colorectal cancer before
• Have polyps, or a bowel disease such as ulcerative colitis or Crohn’s disease
• Have a parent, brother, sister, or child who has had colon cancer or colon polyps
• Have had uterine, ovarian, or breast cancer
• Eat a high-fat and low-fiber diet
• Smoke cigarettes

What are the symptoms?

At first there are no symptoms. When symptoms do occur, they may include:

• Blood in your bowel movements
• A change in your bowel movements, such as diarrhea, constipation, or bowel movements that are narrower than usual
• Feeling like your bowels do not empty completely, gas pains or cramps, or a sense of fullness in your belly
• Feeling tired all the time
• Weight loss

What is metastasis?

The spread of cancer cells from one part of the body to other parts is called metastasis. What causes cancer to spread is not known. Cancer cells can:

• Grow into the area around the tumor
• Travel to other parts of the body through the bloodstream or the lymph system. The lymph system is part of your body's system for fighting infection. The lymph system consists of lymph nodes that store blood cells (lymphocytes) to fight infection and vessels that carry fluid, nutrients, and wastes between your body and your bloodstream.

New tumors then grow in these other areas.

When colorectal cancer spreads, it most often affects the lungs and liver. Sometimes your first symptoms of cancer are in the part of the body where the cancer has spread. The symptoms of colon cancer that has spread to another part of your body depend on where the tumors are. For example:

• If the cancer has spread to the lungs, you may have a cough or trouble breathing.
• If the cancer has spread to the liver, you may have yellowish skin, pain, or swelling in your belly.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Small samples of your bowel movements will be tested for blood. The test can find blood that you cannot see on your bowel movements. If you have blood in your bowel movements, you may need other tests such as:

• Colonoscopy, which uses a flexible, lighted tube, put through your rectum to look at the inside of your colon. A similar test called a sigmoidoscopy looks at just the lower one-third of your colon.
• Biopsy of the polyp or growth, which may be done during a colonoscopy to take a small sample of tissue for testing
• Barium enema, which means that a chalky liquid that shows up on X-rays is put into your colon through your rectum to see if you have polyps or cancer

You may need more lab tests and scans to check if the cancer has spread to other parts of your body.

How is it treated?

You and your healthcare provider will discuss possible treatments. You may also talk with a surgeon and a cancer specialist. Some things to think about when making treatment decisions are:

• Your age
• Your overall health
• The stage of the cancer (how advanced the cancer is)
• Whether the cancer has spread to other parts of your body

The usual treatment is surgery to remove all or part of the colon or rectum that has cancer.

If a large part of your colon or rectum is removed, you may need a colostomy. A colostomy is an opening through the skin in your belly that connects to the healthy end of your colon. After this procedure, bowel movements will empty through the opening and collect in a disposable bag outside your body You will have to empty or change the bag several times a day. Most people who have a colostomy only need it while they heal after surgery. About 1 in 8 people with rectal cancer will need a permanent colostomy.

Other possible treatments are:

• Chemotherapy (anticancer drugs), which uses medicine to kill cancer cells
• Radiation therapy, which uses high-energy X-rays to kill cancer cells and shrink rectal tumors

Often, more than 1 type of treatment is used. After treatment, you will need to have regular follow-up visits with your healthcare provider.

Your treatment may also include:

• Preventing infections
• Controlling pain or other symptoms you may have
• Preventing and controlling the side effects from treatments
• Helping you manage your life with cancer

Ask your healthcare provider about clinical trials that might be available to you. Clinical trials are research studies to find effective cancer treatments. It’s always your choice whether you take part in one or not.

How can I take care of myself?

If you have been diagnosed with colorectal cancer:

• Talk about your cancer and treatment options with your healthcare provider. Make sure you understand your choices.
• Follow the full course of treatment prescribed by your healthcare provider.
• Ask your healthcare provider:
  • How and when you will get your test results
  • How long it will take to recover
  • If there are activities you should avoid and when you can return to your normal activities
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them
• Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

Other things that may help include:

• Eat a healthy diet and get regular exercise as recommended by your healthcare provider.
• Get plenty of rest.
• Try to reduce stress and take time for activities that you enjoy. It may help to talk with a counselor about your illness.
• Talk with your family and your healthcare providers about your concerns. Ask your healthcare provider any questions you have about the disease, treatments, side effects of the treatments, sexual activity, support groups, and anything else that concerns you.
• If you smoke, try to quit.
• Ask your provider if you need to avoid drinking alcohol. It may interfere with medicines you are taking. Alcohol can also make it harder for white blood cells to fight infections.
• Tell your provider if your treatment causes discomfort. Usually there are ways to help you feel more comfortable.

If you have a colostomy:

• Learn how to take care of your colostomy.
• Learn which foods you should avoid because they cause too much gas or make it hard for you to control your bowels.
• Give yourself time to get used to the changes in your body. You may need to change how you dress to allow room for the colostomy and bag.
• Seek sexual counseling for yourself and your partner if you feel you need it.
• You may feel anger, frustration, grief, and embarrassment about the cancer and colostomy. Talk about your feelings. Let members of your care team know what you are thinking.

What are the best ways to find colorectal cancer early?

If you are not at high risk for colorectal cancer but are 50 to 75 years old, there are several ways to check for cancer:

• Have your bowel movements checked for blood once a year.
• Have a sigmoidoscopy exam every 5 years.
• Have a colonoscopy every 10 years.

A barium enema may be done every 5 years instead of a colonoscopy or sigmoidoscopy. Your healthcare provider may recommend this test instead of a colonoscopy if you have certain conditions, such as a colon that is very twisted. (The twists make it hard to pass the scope through the colon.)

If you have a higher than normal risk for colorectal cancer, ask your healthcare provider when and how often you should be tested for colorectal cancer. You may need to start testing before you are 50.

For more information, contact:

• American Cancer Society, Inc.
  800-227-2345
  http://www.cancer.org
• National Cancer Institute
  800-422-6237 (TTY: 800-332-8615)
  https://www.cancer.gov/