Colon Cancer Support Group

Colorectal cancer, also called colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix. It is the third most common form of cancer and the second leading cause of death among cancers in the Western world. Many colorectal cancers are thought to arise from adenomatous polyps in the colon. These mushroom-like growths are usually benign, but some may develop into cancer over time. The majority of the time, the diagnosis of localized colon cancer is through colonoscopy. Therapy is usually through surgery, which in many cases is followed by chemotherapy.

The lifetime risk of developing colon cancer in the United States is about 7%. Certain factors increase a person's risk of developing the disease. These include:

Age. The risk of developing colorectal cancer increases with age. Most cases occur in the 60s and 70s, while cases before age 50 are uncommon unless a family history of early colon cancer is present.

Polyps of the colon, particularly adenomatous polyps, are a risk factor for colon cancer. The removal of colon polyps at the time of colonoscopy reduces the subsequent risk of colon cancer.

History of cancer. Individuals who have previously been diagnosed and treated for colon cancer are at risk for developing colon cancer in the future. Women who have had cancer of the ovary, uterus, or breast are at higher risk of developing colorectal cancer.

Heredity:
Family history of colon cancer, especially in a close relative before the age of 55 or multiple relatives.
Familial adenomatous polyposis (FAP) carries a near 100% risk of developing colorectal cancer by the age of 40 if untreated.
Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome

Long-standing ulcerative colitis or Crohn's disease of the colon, approximately 30% after 25 years if the entire colon is involved

Smoking. Smokers are more likely to die of colorectal cancer than non-smokers. An ACS study found that "Women who smoked were more than 40% more likely to die from colorectal cancer than women who never had smoked. Male smokers had more than a 30% increase in risk of dying from the disease compared to men who never had smoked."

Diet. Studies show that a diet high in red meat (Chao et al 2005) and low in fresh fruit, vegetables, poultry and fish increases the risk of colorectal cancer. However, other studies have cast doubt on the claim that diets high in fiber decrease the risk of colorectal cancer. The nature of the relationship between dietary fiber and risk of colorectal cancer remains controversial.

Physical inactivity. People who are physically active are at lower risk of developing colorectal cancer.

Virus. Exposure to some viruses (such as particular strains of human papilloma virus) may be associated with colorectal cancer.

Alcohol. "Heavy alcohol use may also increase the risk of colorectal cancer"

Primary sclerosing cholangitis offers a risk independent to ulcerative colitis

The treatment depends on the staging of the cancer. When colorectal cancer is caught at early stages (with little spread) it can be curable. However when it is detected at later stages (when distant metastases are present) it is less likely to be curable.

Surgery remains the primary treatment while chemotherapy and/or radiotherapy may be recommended depending on the individual patient's staging and other medical factors. Surgeries can be categorised into curative, palliative, bypasss, fecal diversion or open-and-close.

Curative Surgical treatment can be offered if the tumor is localized.

Very early cancer that develops within a polyp can often be cured by removing the polyp (i.e. polypectomy) at the time of colonoscopy.

In colon cancer, a more advanced tumor typically require surgical removal of the section of colon containing the tumor with sufficient margins and radical en-bloc resection of mesentery and lymph nodes to reduce local recurrence (i.e. colectomy); if possible, the remaining parts of colon are anastomosed together to create a functioning colon. In cases when anastomosis is not possible, a stoma (artificial orifice) is created.

Curative surgery on rectal cancer include total mesorectal excision (anterior resection) or abdominoperineal excision.

In case of multiple mestatasis, palliative resection of the primary tumour is still offered in order to reduce further morbidity caused by tumor bleeding, invasion and its catabolic effect. Surgical removal of isolated liver metastases is, however, common; improved chemotherapy has increased the number of patients who are offered surgical removal of isolated liver metastases.

If the tumor invaded into adjacent vital structures which makes excision technically difficult, the surgeons may prefer to bypass the tumor (ileotransverse bypass) or to do a proximal fecal diversion through a stoma.

The worst case would be an open-and-close surgery, when surgeons find the tumor unresectable and the small bowel involved; any more procedures would do more harm then good to the patient.

Laparoscopic-assisted colectomy is a minimally-invasive technique that can reduce the size of the incision, minimize the risk of infection and reduce post-operative pain.

Chemotherapy is used to reduce the likelihood of metastasis developing, shrink tumor size, or slow tumor growth. Chemotherapy is often applied after surgery (adjuvant), before surgery (neo-adjuvant), or as the primary therapy if surgery is not indicated (palliative). The treatments listed here have been shown in clinical trials to improve survival and/or reduce mortality and have been approved for use by the US Food and Drug Administration.

Radiotherapy is not used routinely in colorectal cancer, as it could lead to radiation enteritis, and is difficult to target specific portions of the colon. Sometimes chemotherapy agents are used to increase the effectiveness of radiation by sensitizing tumor cells if present.

Cancer diagnosis very often results in an enormous change in the patient's psychological wellbeing. Various support resources are available from hospitals and other agencies which provide counseling, social service support, cancer support groups, and other services. These services help to mitigate some of the difficulties of integrating a patient's medical complications into other parts of their life.