Colorectal Cancer

Colorectal Cancer

WHAT IS COLORECTAL CANCER?

Colorectal cancer starts in the colon or rectum, the two organs that make up the large intestine. It is the third most common cancer in both men and women in the United States, with more than 135,000 new cases diagnosed per year.

Deaths from colorectal cancer have steadily decreased in the last few decades. This is thanks to early diagnosis with screening programs, improved surgical techniques and more effective medical therapies.

At Loma Linda University Health, we offer leading-edge treatments for colorectal cancer. In addition, our specialists treat more digestive disease patients than any other medical center in the region.

WHAT ARE THE SYMPTOMS OF COLORECTAL CANCER?

In the early stages of colorectal cancer, symptoms may be minimal or absent. In general, symptoms are different based on the location of the tumor within the large intestine.

Right colon cancer symptoms:

• Anemia or low red blood cell count
• Fatigue and weakness
• Shortness of breath
• Dark colored or tarry stools (black or dark red stool)

Left colon and rectal cancer symptoms:

• Blood in the stool
• A change in stool consistency (such as constipation alternating with diarrhea
• mucus in the stool)
• Changes in stool caliber (stools may become narrower when a tumor causes narrowing of the color)
• A change in urgency, frequency, or a persistent feeling of incomplete evacuation of stool

In its advanced stages, symptoms of colorectal cancer may include:

• Nausea
• Vomiting
• Appetite loss
• Uncontrolled weight loss
• Deterioration of physical condition

WHAT CAUSES COLORECTAL CANCER?

The cause of colorectal cancer isn't currently known. Some risk factors have been identified, including:

Age - The risk of developing a colon or rectum tumor increases considerably after age 50. In about 9 out of 10 cases, the diagnosis of colorectal cancer occurs after this age.

Family history - Approximately 20-25% of individuals who develop colorectal cancer have a family history of colorectal cancer.

Inherited family gene mutations - About 5-10% of people developing colon cancer have inherited genetic defects that cause the disease.

Ulcerative colitis and Crohn's disease - Inflammatory bowel diseases cause chronic inflammation in the intestines which increases the risk of developing colorectal cancer.

Type 2 diabetes - People with type 2 diabetes are at greater risk of developing colon cancer.

Diet - A diet high in animal fat and red meat can increase the risk of colorectal cancer. On the contrary, diets rich in vegetables, fruits and whole grains seem to be protective against colorectal cancer.

Obesity - A relationship between excessive body weight and the incidence of colorectal cancer has been noted. Obesity increases the risk for both men and women, but the link seems to be even stronger for the male.

Physical activity - The lack of regular physical activity is related to a greater chance of developing colorectal cancer. Increasing your activity can help reduce your risk. Physically active individuals have a substantial risk reduction (approximately 20%) comparing to sedentary people.

Smoking and alcohol - Smoking and excessive alcohol consumption have been linked to an increased risk of developing colorectal cancer.

HOW IS COLORECTAL CANCER DIAGNOSED?

Prevention of colorectal cancer is often possible using a variety of diagnostic tests. These tests identify precancerous lesions (known as polyps) that can be removed before they become cancerous.

Diagnostic tests include:

Fecal tests - The fecal occult blood test (FOBT) is used to detect occult blood or byproducts of degraded blood (blood that cannot be seen with the naked eye) in the stools.

Sigmoidoscopy - The physician puts a flexible tube in the rectum (sigmoidoscope) and advances it up into the lower third of the large intestine. The tube has a camera attached to it, so the physician can look inside the colon from the rectum to the sigmoid colon.  

Colonoscopy - The physician puts a flexible tube in the rectum (colonoscope) and advances it up into the entire length of your colon. The tube has a camera attached to it, so the physician can look inside the colon (large intestine) for any abnormalities.  

HOW IS COLORECTAL CANCER TREATED?

Colorectal cancer treatments include:

Surgery - Open, laparoscopic and robotic surgery can all treat colorectal cancer. Most people are cured after surgery, but for some the cancer can come back. Laparoscopic surgery consists of operating on the area through small incisions in the abdominal wall. Robotic surgery replicates the surgeon’s hand motion performed at the console with high precision and control in the operative field.

Chemotherapy - Chemotherapy uses medications to stop the spread or growth of cancer. It does this by killing or preventing the replication (division) of cancer cells. It can be taken orally or by injection into a vein.

Radiation therapy - Radiation can come from a source outside the body (external-beam radiation therapy) or from radioactive material placed directly near cancer cells (brachytherapy). For rectal cancer, external-beam radiation is the most common form of radiation therapy. It is often used in combination with chemotherapy prior to surgery to reduce the risk of relapse of the disease.

Biologic Therapy - The three types of biologic therapies are 1) Angiogenesis inhibitors, which are used to counteract the growth of new blood vessels, stimulated by tumors to grow. 2) Epidermal growth factor receptor (EGFR) inhibitors, which target a protein that stimulates growth and proliferation of cancer cells. 3) Immunotherapeutic drugs, which stimulate the immune system of the patient to attack and kill the cancer cells.

At Loma Linda University Health, our Cancer Center is where world-renowned experts provide patient-focused, technologically advanced treatments for colon and rectal cancer. Here, innovative therapies such as robotic surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are routinely used alongside other support services. Our commitment is to deliver the best cancer care while understanding and supporting the complexity of each patients’ needs. We provide a comprehensive, individualized treatment plan that is constantly aimed at curing the disease and maintaining patients’ quality of life.

WHAT ARE THE COMPLICATIONS OF COLORECTAL CANCER?

Early complications of colorectal cancer include bleeding and post-operative infection. Long-term complications of colorectal cancer include:

• Frequent bowel movements 
• Constipation 
• Fecal incontinence (stool and/or gases) 
• Urinary retention
• Sexual dysfunction

WHO IS AT RISK FOR COLORECTAL CANCER?

Those who are most at risk of developing colorectal cancer are men and women age 50 or older, those who have a history of colorectal cancer in their family, and those who suffer from inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease. In addition, people with excessive body weight (obesity) and with non-insulin-dependent type 2 diabetes are also at a greater risk of developing colon cancer. Lifestyle risk factors include: lack of regular physical activity, smoking, excessive alcohol consumption and a diet high in red meat and low in vegetables

NEXT STEPS

• Schedule a screening. The American Cancer Society recommends that colon and rectal cancer screenings begin at age 45. Even if you are not experiencing any symptoms, it is highly recommended that you schedule a screening if you are in the target age range for colorectal cancer.
• Make healthy choices. Lifestyle plays a major role in the prevention of colorectal cancer. If you are at risk because of any of the lifestyle factors listed here, take steps to change those habits immediately.
• Seek medical intervention. If you are experiencing symptoms that resemble colorectal cancer, it is imperative that you seek a medical evaluation. To request an evaluation at Loma Linda University Health, contact your provider or schedule the appointment through MyChart.