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Colon cancer

Definition

Colon, or colorectal, cancer is cancer that starts in the large intestine (colon) or the rectum (end of the colon).

Other types of cancer can affect the colon, such as lymphoma, carcinoid tumors, melanoma, and sarcomas. These are rare. In this article, use of the term "colon cancer" refers to colon carcinoma only.

Alternative Names

Colorectal cancer; Cancer - colon; Rectal cancer; Cancer - rectum; Adenocarcinoma - colon; Colon - adenocarcinoma

Causes, incidence, and risk factors

According to the American Cancer Society, colorectal cancer is one of the leading causes of cancer-related deaths in the United States. However, early diagnosis can often lead to a complete cure.

Almost all colon cancer starts in glands in the lining of the colon and rectum. When doctors talk about colorectal cancer, this is usually what they are talking about.

There is no single cause of colon cancer. Nearly all colon cancers begin as noncancerous (benign) polyps, which slowly develop into cancer.

You have a higher risk for colon cancer if you:

  • Are older than 60
  • Are African American of eastern European descent
  • Eat a diet high in red or processed meats
  • Have cancer elsewhere in the body
  • Have colorectal polyps
  • Have inflammatory bowel disease (Crohn's disease or ulcerative colitis)
  • Have a family history of colon cancer
  • Have a personal history of breast cancer

Certain genetic syndromes also increase the risk of developing colon cancer. Two of the most common are:

  • Familial adenomatous polyposis (FAP)
  • Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome

What you eat may play a role in your risk of colon cancer. Colon cancer may be associated with a high-fat, low-fiber diet and red meat. However, some studies have found that the risk does not drop if you switch to a high-fiber diet, so this link is not yet clear.

Smoking cigarettes and drinking alcohol are other risk factors for colorectal cancer.

Symptoms

Many cases of colon cancer have no symptoms. The following symptoms, however, may indicate colon cancer:

Signs and tests

With proper screening, colon cancer can be detected before symptoms develop, when it is most curable.

Your doctor will perform a physical exam and press on your belly area. The physical exam rarely shows any problems, although the doctor may feel a lump (mass) in the abdomen. A rectal exam may reveal a mass in patients with rectal cancer, but not colon cancer.

A fecal occult blood test (FOBT) may detect small amounts of blood in the stool, which could suggest colon cancer. However, this test is often negative in patients with colon cancer. For this reason, a FOBT must be done along with colonoscopy or sigmoidoscopy. It is also important to note that a positive FOBT doesn't necessarily mean you have cancer.

Imaging tests to screen for and potentially diagnose colorectal cancer include:

Note: Only colonoscopy can see the entire colon, and this is the best screening test for colon cancer.

Blood tests that may be done include:

If your doctor learns that you do have colorectal cancer, more tests will be done to see if the cancer has spread. This is called staging. CT or MRI scans of the abdomen, pelvic area, chest, or brain may be used to stage the cancer. Sometimes, PET scans are also used.

Stages of colon cancer are:

  • Stage 0: Very early cancer on the innermost layer of the intestine
  • Stage I: Cancer is in the inner layers of the colon
  • Stage II: Cancer has spread through the muscle wall of the colon
  • Stage III: Cancer has spread to the lymph nodes
  • Stage IV: Cancer has spread to other organs

Blood tests to detect tumor markers, including carcinoembryonic antigen (CEA) and CA 19-9, may help your physician follow you during and after treatment.

Treatment

Treatment depends on many things, including the stage of the cancer. In general, treatments may include:

SURGERY

Stage 0 colon cancer may be treated by removing the cancer cells, often during a colonoscopy. For stages I, II, and III cancer, more extensive surgery is needed to remove the part of the colon that is cancerous. (See: Colon resection)

CHEMOTHERAPY

Almost all patients with stage III colon cancer should receive chemotherapy after surgery for approximately 6 - 8 months. This is called adjuvant chemotherapy. The chemotherapy drug 5-fluorouracil has been shown to increase the chance of a cure in certain patients.

Chemotherapy is also used to improve symptoms and prolong survival in patients with stage IV colon cancer.

  • Irinotecan, oxaliplatin, capecitabine, and 5-fluorouracil are the three most commonly used drugs.
  • Monoclonal antibodies, including cetuximab (Erbitux), panitumumab (Vectibix), bevacizumab (Avastin), and other drugs have been used alone or in combination with chemotherapy.

You may receive just one type, or a combination of these drugs. There is some debate as to whether patients with stage II colon cancer should receive chemotherapy after surgery. You should discuss this with your oncologist.

RADIATION

Although radiation therapy is occasionally used in patients with colon cancer, it is usually used in combination with chemotherapy for patients with stage III rectal cancer.

For patients with stage IV disease that has spread to the liver, various treatments directed specifically at the liver can be used. This may include:

  • Burning the cancer (ablation)
  • Delivering chemotherapy or radiation directly into the liver
  • Freezing the cancer (cryotherapy)
  • Surgery

Support Groups

For additional resources and information, see: Colon cancer support groups.

Expectations (prognosis)

Colon cancer is, in many cases, a treatable disease if it is caught early.

How well you do depends on many things, especially the stage of the cancer. In general, when treated at an early stage, many patients survive at least 5 years after their diagnosis. (This is called the 5-year survival rate.)

If the colon cancer does not come back (recur) within 5 years, it is considered cured. Stage I, II, and III cancers are considered potentially curable. In most cases, stage IV cancer is not considered curable, although there are exceptions.

Complications

  • Blockage of the colon
  • Cancer returning in the colon
  • Cancer spreading to other organs or tissues (metastasis)
  • Development of a second primary colorectal cancer

Calling your health care provider

Call your health care provider if you have:

  • Black, tar-like stools
  • Blood during a bowel movement
  • Change in bowel habits
  • Unexplained weight loss

Prevention

The death rate for colon cancer has dropped in the last 15 years. This may be due to increased awareness and screening by colonoscopy.

Colon cancer can almost always be caught by colonoscopy in its earliest and most curable stages. Almost all men and women age 50 and older should have a colon cancer screening. Patients at risk may need earlier screening.

Colon cancer screening can often find polyps before they become cancerous. Removing these polyps may prevent colon cancer.

For information, see:

Changing your diet and lifestyle is important. Some evidence suggests that low-fat and high-fiber diets may reduce your risk of colon cancer.

Some studies have reported that NSAIDs (aspirin, ibuprofen, naproxen, celecoxib) may help reduce the risk of colorectal cancer. However, these medicines can increase your risk for bleeding and heart problems. Most expert organizations do not recommend that most people take these medicines to prevent colon cancer. Talk to your health care provider about this issue.

References

Burt RW, Barthel JS, Dunn KB, et al. NCCN clinical practice guidelines in oncology. Colorectal cancer screening. J Natl Compr Canc Netw. 2010;8:8-61.

Cunningham D, Atkin W, Lenz HJ, Lynch HT, Minsky B, Nordlinger B, et al. Colorectal cancer. Lancet. 2010;375:1030-1047.

Smith RA, Cokkinides V, Brooks D, Saslow D, Brawley OW. Cancer screening in the United States, 2010: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2010;60:99-119.


Review Date: 2/7/2012
Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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