This topic will tell you
about the initial testing, diagnosis, and treatment of colorectal
cancer. If you want to learn about colorectal cancer that has
come back or has spread, see the topic
Colorectal Cancer, Metastatic or Recurrent.
What is colorectal cancer?
Colorectal cancer
happens when cells that are not normal grow in your
colon or rectum. These cells grow together and form polyps. Over time, some polyps can turn into cancer.
This
cancer is also called colon cancer or rectal cancer, depending on where the cancer is. It is the third most
common cancer in the United States. And it occurs most often in people older
than 50.
As with other cancers, treatment for colorectal cancer works best when the cancer is found early. Screening tests can detect or prevent this cancer, but only about half of people older
than 50 are screened. According to the American Cancer Society, if everyone
were tested, tens of thousands of lives could be saved each year.
What causes colorectal cancer?
Most cases begin as
polyps, which are small growths inside the colon or
rectum.
Colon polyps are very common. Some polyps can turn into cancer. But doctors cannot tell ahead of time which polyps will turn
into cancer. This is why people age 50 and older need regular tests to find out if
they have any polyps and then have them removed. And some people who are
younger than 50 need regular tests if their medical history puts them at
increased risk for colorectal cancer.
What are the symptoms?
Colorectal cancer usually
does not cause symptoms until after it has begun to spread. See your doctor if
you have any of these symptoms:
Pain in your belly
Blood in your
stool or very dark stools
A change in your bowel habits, such as
more frequent stools or a feeling that your bowels are not emptying
completely
How is colorectal cancer diagnosed?
If your doctor
thinks that you may have this cancer, you will need a test, called a
colonoscopy (say "koh-luh-NAW-skuh-pee"), that lets the doctor see the inside of
your entire colon and rectum. During this test, your doctor will remove polyps
or take tissue samples from any areas that don't look normal. The tissue will
be looked at under a microscope to see if it contains cancer.
Sometimes another test, such as a
sigmoidoscopy (say "sig-moy-DAW-skuh-pee"), is used to diagnose colorectal
cancer.
Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org.
How can you screen for colorectal cancer?
Screening tests can find or prevent many cases of colon and rectal cancer. They
look for a certain disease or condition before any symptoms appear. Experts
recommend routine colon cancer testing for everyone age 50 and older who has a
normal risk for colon cancer. Your doctor may recommend earlier or more frequent testing if you have a higher risk for colorectal cancer. Talk to your doctor about when you should be tested.
These are the most common screening tests:
Stool tests that check for signs of cancer:
Fecal occult blood test (FOBT)
Fecal
immunochemical test (FIT)
Stool DNA test (sDNA)
Sigmoidoscopy. A doctor puts a flexible viewing tube into your
rectum and into the first part of your colon. This lets the doctor see the
lower portion of the intestine, which is where most colon cancers grow. Doctors
can remove polyps during this test also.
Colonoscopy. A doctor
puts a long, flexible viewing tube into your rectum and colon. The tube is
usually linked to a video monitor similar to a TV screen. With this test, the
doctor can see the entire large intestine.
Computed tomographic
colonography (CTC). This test is also called a virtual colonoscopy. A computer
and X-rays make a detailed picture of the colon to help the doctor look for
polyps.
The exact cause of
colorectal cancer is not known. Most cases begin as
small growths, or polyps, inside the colon or rectum.
Colon polyps are very common. If they are
found early, usually through routine screening tests, they can be removed
before they turn into cancer.
Symptoms
Colorectal cancer in its early stages usually doesn't
cause any symptoms. Symptoms occur later, when the cancer may be more difficult
to treat. The most common symptoms include:
Pain in the belly.
Blood in your
stool or very dark stools.
A change in your bowel habits (such as
more frequent stools or a feeling that your bowels are not emptying
completely).
Constant
tiredness (fatigue).
In rare cases, unexplained weight
loss.
Colon cancer may not cause symptoms you notice in the early stages. When there are
symptoms, they may depend on where the cancer is in your colon.
The
cecum and ascending colon, the first and second parts of the colon, are on the
right side of your abdomen. Cancer in this area may bleed, causing blood in the
stool and symptoms of
anemia, including fatigue and weakness. The amount of
blood may be small and so well mixed with stool that your stool may look
normal. Sometimes cancer in this area does not cause many
symptoms.
The
transverse colon, the third part, goes across your
body from right to left. Cancer here may cause abdominal
cramps.
The
descending colon, the fourth part, and the S-shaped
sigmoid colon, the fifth part, are on the left side of your abdomen and join the
rectum. Cancer here may cause narrower stools and bright red blood in the
stool. Sometimes this blood is mistakenly thought to come from
hemorrhoids.
Having these symptoms does not mean you have cancer. A
number of other medical problems could cause similar symptoms,
including:
Irritable bowel syndrome, a common digestive problem that causes periods of stomach
pain, cramping or bloating, and diarrhea or constipation.
Other
growths (polyps) in the large intestine that are not
cancer.
Diverticulitis, a condition in which
pouches form in the wall of the colon and become painful, swollen, or
infected.
Infections that cause diarrhea, such as
salmonella.
Cancer is the growth of
abnormal cells in the body. These extra cells grow together and form masses,
called tumors. In
colorectal cancer, these growths usually start as
polyps in the
large intestine (colon or rectum).
Colon polyps are quite common. But if they are not detected and removed, the polyps may turn into
cancer.
Cancers in the colon or rectum usually grow very slowly.
It takes most of them years to become large enough to cause symptoms. If the
cancer is allowed to grow, it eventually will invade and destroy nearby tissues
and then spread farther. Colorectal cancer spreads first to nearby
lymph nodes. From there it may spread to other parts
of the body, usually the liver. It may also spread to the lungs, and less
often, to other organs in the body.
The long-term outcome, or
prognosis, for colorectal cancer depends on how much the cancer has grown and
spread. Experts talk about prognosis in terms of "5-year survival rates." The
5-year survival rate means the percentage of people who are still alive 5 years
or longer after their cancer was discovered. It is important to remember that
these are only averages. Everyone's case is different. And these numbers do not
necessarily show what will happen to you. The estimated 5-year survival rate
for colorectal cancer is:1
90% or more if cancer is found early and
treated before it has spread. This means that 90 or more out of 100 people will still be alive in 5 years if the cancer is found early and treated before it has spread.
69% if the cancer has spread to
nearby organs and lymph nodes. This means that 69 out of 100 people will still be alive in 5 years if the cancer has spread to
nearby organs and lymph nodes.
12% if the cancer has spread to the
liver, lungs, or bones. This means that 12 out of 100 people will still be alive in 5 years if the cancer has spread to the
liver, lungs, or other organs in the body.
These numbers are taken from reports that were done at least 5 years ago, before newer treatments were available. So the actual chances of your survival are likely to be higher than these numbers.
What Increases Your Risk
A risk factor for colorectal cancer is something that increases your chance of getting this cancer. Having one or more of these risk factors can make it more likely that you will get colorectal cancer. But it doesn't mean that you will definitely get it. And many people who get colorectal cancer don't have any of these risk factors.
Risks you can't change
Your age
Everyone who is older than 50 has a risk
of getting colorectal cancer. And the older you are, the greater the risk. Most
cases of colorectal cancer are diagnosed in people older than 50. Most people
who get colorectal cancer have no other risk factors besides being older than
50.
Your race and ethnicity
African Americans are at greater risk of getting colorectal cancer (and dying from it) than non-Hispanic whites. And non-Hispanic white people have a higher risk than other major racial or ethnic groups, such as Hispanics, Asians, and Pacific Islanders.2
Ashkenazi Jews (Jewish people whose ancestors came from Eastern Europe) who have inherited certain genes are also at a higher risk for getting colorectal cancer.3
Your family's medical history
You
are more likely to get colorectal cancer if one of your parents, brothers,
sisters, or children has had the disease. This is considered a strong family history. Your risk depends on how old your
family member was when he or she was diagnosed and on how many members of your
family have had the disease.
You have a very strong family history if all of the following
are true:
You have at least three relatives who have had
colon cancer, endometrial cancer, or another HNPCC-related cancer, and at least one of the relatives is a parent, brother, or sister.
Those relatives are spread over two generations in a row
(for example, a grandparent and a parent).
One of those relatives
had cancer before age 50.
If you have a very strong family history of colorectal and related cancers, you may want to have genetic testing. Related cancers include ovarian cancer, stomach cancer, liver cancer, or cancer of the small bowel, among others. Genetic testing is done with a blood test that looks for changed genes (mutations).
The most common gene changes occur in two conditions:
familial adenomatous polyposis (FAP) and
Lynch syndrome, also called hereditary nonpolyposis colon cancer (HNPCC). Many
people with these changed genes will develop colorectal cancer if they are not
carefully watched.
Genetic testing can tell you whether you carry a
changed, or mutated, gene that can cause FAP or HNPCC.
Your medical history
Your
chances of getting colorectal cancer are higher if you have had:
Call your doctor if you have any
symptoms of
colorectal cancer, such as:
A change in bowel habits.
Bleeding
from your rectum, including bright red or dark blood in your stools or stools
that look black.
Constant or frequent diarrhea, constipation, or a
feeling that your bowel doesn't empty completely.
Stools that are
narrow (may be as narrow as a pencil).
Abdominal (belly) pain or problems
with gas or bloating.
Unexplained weight loss.
Constant
tiredness (fatigue).
Because colorectal cancer often does not cause any
symptoms, talk with your doctor about
screening tests. Screening helps doctors find a
certain disease or condition before any symptoms appear. Some screening tests
for colorectal cancer can find and remove small precancerous growths in the
colon and rectum called
adenomatous polyps. If these are found and removed
early, they cannot turn into cancer.
Who to see
Health professionals who can evaluate your symptoms of
colorectal cancer include:
If your doctor thinks you may have colorectal cancer, he
or she may advise you to see a
general surgeon or a
colorectal surgeon. Colorectal cancer is treated
by surgeons,
medical oncologists, and
radiation oncologists.
If your doctor thinks you may have
colorectal cancer, he or she will ask you questions
about your
medical history and give you a physical exam. Other
tests may include:
A
colonoscopy, a test in which your doctor uses a
lighted scope to view the inside of your entire colon. A colonoscopy may be
done to look into symptoms such as unexplained bleeding from the rectum,
constant diarrhea or constipation, blood in the stool, or pain in the lower
abdomen. A colonoscopy is recommended when another screening test shows you may
have colorectal cancer.4
A
sigmoidoscopy, a test in which your doctor uses a
lighted scope to view the lower part of your intestine. A sigmoidoscopy may be
done to look into symptoms such as unexplained bleeding from the rectum,
constant diarrhea or constipation, blood in the stool, or pain in the lower
abdomen. Doctors can also remove polyps during this test.
A
barium enema, in which a whitish liquid with barium is
inserted through your rectum into your intestine. The barium outlines the
inside of the colon so that it can be seen on an X-ray.
A
biopsy, in which a sample of tissue is taken from the
inside of your intestine and examined under a microscope. A doctor called a
pathologist can look at the tissue sample and see if
it contains cancer.
A
complete blood count, which is a blood test. It is
used to look into symptoms such as fatigue, weakness, anemia, bruising, or
weight loss.
For people who have an increased risk for colorectal
cancer, regular
colonoscopy is the recommended screening test. It allows your doctor to remove polyps (polypectomy) and take tissue samples at
the same time.
When you are diagnosed with colorectal cancer,
your doctor may order other tests to find out whether the cancer has spread.
These tests include:
A
CT scan to see if the cancer has spread to your liver,
lungs, or abdomen.
A
chest X-ray to see if the cancer has spread to your
lungs.
An
MRI or
PET scan to see if the cancer has spread into your
chest or organs in the abdomen or pelvis.
An
ultrasound to find the cause of belly pain or
increased belly girth or to see if the cancer has spread to your
liver. An endoscopic ultrasound is used to see how far rectal cancer may have spread.
Colorectal cancer has a much better chance of being successfully treated when it is found early. Most people who get colorectal cancer
are older than 50 and have no other risk factors besides their age.
Routine screening can reduce deaths from colorectal cancer. Some screening tests find and remove polyps before they can turn into cancer. Other screening tests look for early signs of cancer, because that is when treatment works better. Screening methods include:
Stool tests, such as the
fecal occult blood test (FOBT), the fecal
immunochemical test (FIT), and the stool DNA test (sDNA).
Stool tests look for signs of cancer. If used as recommended, these tests may find cancer early, when treatment works better. Sigmoidoscopy and colonoscopy are tests that find and remove polyps to stop them from turning into cancer. Virtual colonoscopy finds polyps. With stool tests and virtual colonoscopy, if there are abnormal findings, you will need to have a colonoscopy to remove any polyps.
Talk to your doctor about which test is right for you.
People with a higher risk for colorectal cancer, such as African Americans and
people with a strong family history of colon cancer, may need to begin routine
testing before age 50 and have it more often.
If you have a very
strong family history of colon cancer, you may want to talk to your doctor or a
genetic counselor about having a blood test to look
for changed genes.
Genetic testing can tell you whether you carry a
changed, or mutated, gene that can cause colon cancer. Having certain genes
greatly increases your risk of colon cancer. But most cases of colon cancer are
not caused by changed genes.
The first step in treating
colorectal cancer is usually an operation to remove
the tumor. Sometimes a simple operation can be done during a colonoscopy or
sigmoidoscopy to remove small polyps and a small amount of tissue surrounding
them. But in most cases a major operation, in which the cancer and part of the
colon or rectum around it are removed, is needed. If cancer has spread to
another part of your body, such as the liver, you may need more far-reaching
surgery.
After the cancer has been examined under a microscope, it
will be staged. Staging is a way for your doctor to tell how far, if at all,
your cancer has spread. It also helps your doctor decide what your treatment
should be.
There are several different types of
staging systems, so it's important to ask your doctor
to explain carefully what stage your cancer is in and what that means.
Cancers that have not spread beyond the colon or rectum may
require only surgery. If the cancer has spread, you may need
radiation therapy,
chemotherapy, or both.
Initial treatment
You and your doctor will work
together to decide what your treatment should be. You will consider your own
preferences and your general health, but the
stage of your cancer is the most important tool for
choosing your treatment.
Surgery is almost
always used to remove
colorectal cancer. Your doctor may use one of the following types of surgery:
Polypectomy. When the cancer is still just in a polyp, it will be removed during colonoscopy or
sigmoidoscopy.
Resection. If your cancer is larger, your doctor will remove the cancer and a small amount of healthy tissue. The healthy ends of the
colon or rectum are then sewn back together. During this operation, your doctor
will also remove some of your lymph nodes for testing.
Resection and
colostomy. Sometimes it isn't
possible to rejoin the ends of the colon or rectum after the cancer is removed. Your doctor will do a colostomy and make an opening on the
outside of your abdomen where waste can pass through into a colostomy bag. The
colostomy may be temporary until your colon heals. Or it may be permanent if
the entire lower colon or rectum was removed.
Sometimes it is possible to have laparoscopic surgery to remove the cancer. This is surgery where very small incisions are made in the belly. A tiny camera and special instruments are used to remove the cancer. For the best results, it is important to have an experienced surgeon.5
Even after removing all the cancer that can be found with surgery, your doctor may say you need other treatment. This may be chemotherapy, radiation, or both (chemoradiation).
Chemotherapy uses
medicines—given either as pills or through a needle—to destroy cancer cells
throughout the body. Several medicines are often used together. Research studies continue to look for the best combinations of medicines. Your doctor will recommend treatment based on the type and stage of cancer that you have.
Radiation therapy, which uses X-rays to destroy cancer cells,
is standard treatment for some types of cancer in the rectum. Radiation therapy
is often combined with surgery or chemotherapy. Radiation may be given from a machine outside the body that targets the cancer (external radiation). Or it may be given inside the body, with radiation sealed in seeds or wires (internal radiation).
Compared to surgery alone,
radiation therapy given before surgery for rectal cancer may reduce the risk
that the cancer will return and may help you live longer.6
Side effects of treatment
Surgery, chemotherapy, or radiation can have serious side effects. But your medical team will help you manage the side effects of your treatment. This may include medicines for pain following surgery or medicines to control nausea and vomiting if you have chemotherapy.
Talk with your doctor and medical team about your side effects. Some side effects, such as pain or tingling in your hands or feet that gets worse (peripheral neuropathy), may be a sign that your medicines need to be changed.
For tips on how to manage side effects at home, see the Home Treatment section of this topic.
Additional information about colon and rectal cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/colon-and-rectal.
Ongoing treatment
After your treatment, you will
need regular checkups by a
family doctor,
general practitioner,
medical oncologist,
radiation oncologist, or
surgeon, depending on your case. During your follow-up
visits you may have one or more of these tests:
Physical exams. How often you have
these depends on your general health and the type of colorectal cancer you
have. In general, you will see your doctor several times a year for 3 to 5
years and then return to once-a-year checkups.
Colonoscopy, to inspect the inner surface of your
colon and rectum for new problems
Carcinoembryonic antigen (CEA) and other blood tests, to check the success of your
treatment and find out whether the cancer has returned
CT scan or
MRI, to see if the cancer has spread to other
organs
Treatment if the condition gets worse
Colorectal cancer comes back after surgery in about half of people who have surgery
to remove the cancer.6 The cancer may be more likely
to come back after surgery if it was not discovered in an early stage. Cancer that has spread or comes back is harder to treat, but sometimes treatments are successful. For more information, see
the topic
Colorectal Cancer, Metastatic and Recurrent.
What to think about
After you have had colorectal
cancer, your chances of having it again go up. It's important to continue to
see your doctor and be tested regularly to help find any returning cancer or
new polyps early.
Clinical trials are designed to find
better ways to treat people with cancer and are based on the most current
information. Some people who meet the criteria for participation choose to
enroll in such clinical trials.
Prevention
Screening for colorectal cancer
Some tests can prevent
colorectal cancer. Screening tests look for a certain
disease or condition before any symptoms appear. Experts recommend routine
colon cancer testing for everyone age 50 and older who has a normal risk for
colon cancer. Your doctor may recommend earlier or more frequent testing if you have a higher risk for colon cancer. Talk to
your doctor about when you should be tested.
Fewer than half of
people who are older than 50 are screened for colorectal cancer. According to
the American Cancer Society, if everyone were tested, tens of thousands of
lives could be saved each year.
The following guidelines are for
people who do not have an increased risk for colorectal
cancer.
Colorectal cancer screening guidelines for people 50 and older at average risk
Test
Frequency
Stool
test,* such as the
fecal occult blood test (FOBT), fecal
immunochemical test (FIT), or stool DNA test (sDNA)
*Others recommend
combining a stool test with a sigmoidoscopy.
Recommendations from the U.S. Preventive Services Task Force
People ages 50 to 75 should have a fecal occult blood test
(FOBT), sigmoidoscopy, or colonoscopy.
People who have a sigmoidoscopy every 5 years should also have a stool test (FOBT) at regular intervals.
Some people older than 75
may benefit from screening tests. Others may not. Talk to your doctor about
continuing testing for colon cancer after age 75.
Recommendations from other groups
The American Cancer Society (ACS), the American
Gastroenterological Association (AGA), and the American College of
Gastroenterologists (ACG) recommend routine testing for people age 50 and older
who have a normal risk for colon cancer. Your doctor may recommend earlier or more frequent testing if you have a higher risk for colon cancer. Talk to your doctor about when you should be tested.
Here are other things you can do to help prevent colorectal
cancer:
Watch your weight. Being very overweight may increase your risk. And carrying extra fat around the waist seems to be more of a risk than carrying extra fat in the hips or thighs.
Eat well. Healthy eating includes a variety of foods. Eat more whole grains, fruits, vegetables, poultry, and fish. And eat less red meat, refined grains, and sweets.
Limit drinking. Drink less than 2 alcohol drinks a day. People who drink 2 or more alcohol drinks a day have a slightly higher risk
for colorectal cancer.2
Get active. Keep up a physically active lifestyle. Being fit
leads to an improved sense of well-being, improved appearance, and
increased stamina and strength.
Quit smoking. If you smoke cigarettes, quit smoking to reduce your risk.
What to think about
If you have a
very strong family history of colon cancer, you may want to talk to your doctor or a
genetic counselor about having a blood test to look for changed genes.
Genetic testing can tell you whether you carry a
changed, or mutated, gene that can cause colon cancer. Having certain genes
greatly increases your risk of colon cancer.
You have a very strong
family history if each of the following is true:
You have at least three relatives who have had
colon cancer, and at least one of them is a parent, brother, or
sister.
Those relatives are spread over two generations in a row
(for example, a parent and a grandparent).
One of those relatives
had cancer before age 50.
Home Treatment
Managing side effects
You can do things at home to help manage
the side effects of
colorectal cancer or its treatment. Be sure to follow
your doctor's advice on any drugs you are taking. Healthy habits such as eating
a balanced diet and getting enough sleep and exercise may help control your
symptoms.
Home treatment for diarrhea includes
resting your stomach by not eating for several hours or until you feel better
and watching for signs of dehydration. Check with your doctor before using any
drugs for your diarrhea.
Home treatment for constipation includes gentle exercise, drinking plenty of fluids, and
eating lots of fruits, vegetables, and foods that contain fiber. Check with
your doctor before using a laxative.
Home treatment for fatigue includes getting extra rest while you are having
chemotherapy or radiation therapy. Let your symptoms be your guide. You may be
able to stay with your usual routine and just get some extra sleep. Fatigue is
often worse at the end of treatment or just after treatment is completed.
Home treatment for sleep problems includes going to
bed at the same time every night, exercising during the day, and avoiding
caffeine late in the day.
Home treatment for pain can range from
hot packs or cold packs to relaxation or aromatherapy and can improve your
physical and mental well-being. Not all forms of cancer and cancer treatment
cause pain. Talk to your doctor before using any home treatment for
pain.
Drink cold liquids, such as water or iced
tea, or eat flavored ice treats or frozen juices.
Eat foods that
are easy to swallow, such as gelatin, ice cream, or custard.
Drink
from a straw.
Rinse your mouth several times a day with a warm
saltwater rinse. Mix 1 tsp (5 g) of salt with 8 fl oz (0.2 L) of warm
water.
Managing stress
Learning that you have colorectal cancer and being treated for it can be
very stressful. There are steps you can take to reduce your stress. You may want to talk with family or friends. Some people find that spending time alone is what they need.
Consider
meeting with a counselor or joining a support group of others who have
colorectal cancer. Your doctor may also be able to help you find other sources
of support and information. Learning relaxation techniques, such as yoga or
visualization exercises, may also help you reduce your stress.
Your feelings about your body may change after treatment.
Dealing with your body image may involve talking
openly with your partner about your worries and discussing your feelings with a
doctor.
For more information about learning how to live with cancer, read "Taking Time: Support for People With Cancer" from the National Cancer Institute. This booklet is available online at www.cancer.gov/cancertopics/takingtime.
Medications
Chemotherapy is the use of medicines to control
the cancer's growth or relieve symptoms. Often the medicines are given through a
needle in your vein, and your blood vessels carry the medicines through your body.
Sometimes the medicines are available as pills you can swallow. Sometimes they are
given as a shot, or injection.
Several medicines are used to
treat
colorectal cancer. There are also several medicines
available for treating side effects.
Medicine choices
A combination of drugs often works better than a single
drug in treating colorectal cancer. The most commonly used drugs are:
Hair loss, a side effect common with some types of
chemotherapy, is usually not a side effect of these drugs.
Treating the side effects
Your doctor may
prescribe medicines that can help relieve side effects of chemotherapy. These
side effects can include mouth sores, diarrhea, nausea, and vomiting. Your
doctor may prescribe
medicines to control nausea and vomiting. These drugs
may include:
Serotonin antagonists, such as
dolasetron (Anzemet), granisetron (Kytril), or ondansetron (Zofran). These
drugs more effectively prevent nausea and vomiting caused by chemotherapy when
they are combined with
corticosteroids, such as
dexamethasone.
Aprepitant (Emend), which is used in
combination with dexamethasone and ondansetron as part of a 3-day
program.
Antiemetics, such as promethazine and
prochlorperazine.
There also are things you can do at home to manage side
effects. See Home Treatment for more information.
What to think about
Chemotherapy
and
radiation may be combined to treat some types of
colorectal cancer. Radiation or chemotherapy given before or after surgery can
destroy microscopic areas of cancer to increase the chances of a cure.
Surgery
Surgery to remove cancer is almost always the
main treatment for
colorectal cancer. The type of surgery depends on the
size and location of your cancer.
Side effects are common after
surgery. You may be able to reduce the severity of your side effects at home.
See Home Treatment for more information.
Surgery choices
Polypectomy. When colorectal cancer is
discovered in its very early stages, it can be removed during a
sigmoidoscopy or
colonoscopy. The surgeon cuts out not just the polyp,
but also a small amount of tissue around it. The surgeon does not need to cut
into the abdomen.
Bowel resection. This operation
involves cutting out the cancer as well as the sections of the colon or rectum
that are next to it. Then the two healthy ends of the colon or rectum are sewn
back together. The surgery can be done in two ways:
Open resection. The surgeon makes a long
incision in the abdomen, completes the bowel resection, and closes the
incision.
Laparoscopic surgery. This is done with several small incisions in the belly
for a tiny camera and special instruments. But laparoscopic surgery cannot always be
done, such as when the cancer has spread to areas outside the colon.
Your doctor may suggest radiation therapy or chemotherapy if he or she thinks the cancer may come back (recur). If the cancer has spread to nearby lymph nodes, you may need chemotherapy after your surgery. Or if your surgery shows that the cancer has spread outside your colon or rectum, you may need radiation therapy.
What to think about
Polypectomy or local excision is
used when the cancer has been caught in its early stages. Bowel resection is
used when the cancer is larger. Sometimes after this major operation, the two
ends of the colon or rectum cannot be sewn back together. When this happens, a
colostomy is performed. Most people do not need a
colostomy.
Radiation therapy uses X-rays to destroy
colorectal cancer cells and shrink tumors. It is often
used to treat rectal cancer, usually combined with surgery. It is used less
often to treat colon cancer. It may also be combined with
chemotherapy.
Radiation may be given:
Externally, using a machine outside the body
that points a beam of radiation at the tumor.
Internally, by placing tiny radioactive "seeds" next to or into
the cancer.
Compared to surgery alone, radiation given before surgery
may reduce the risk that rectal cancer will return and may help you live
longer.6
Complementary therapies
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
Mind-body treatments like the ones listed above may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment, but they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.
Clinical trials
You may be interested in taking part in research studies called clinical trials. Clinical trials are based on the most up-to-date information and are designed to find better ways to treat people who have cancer. People who do not want standard treatments or are not cured by standard treatments may want to take part in clinical trials. These are ongoing in most parts of the United States and in some other countries around the world for all stages of colorectal cancer.
Other Places To Get Help
Organizations
American Cancer Society (ACS)
Phone:
1-800-ACS-2345 (1-800-227-2345)
Web Address:
www.cancer.org
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free number have information about services and activities
in local areas and can provide referrals to local ACS divisions.
American College of
Gastroenterology
6400 Goldsboro Road
Suite 200
Bethesda, MD 20817
Phone:
(301) 263-9000
Web Address:
http://patients.gi.org
The American College of Gastroenterology is an organization of digestive disease specialists. The website contains information about common gastrointestinal problems.
American Society of Colon and Rectal
Surgeons
85 West Algonquin Road
Suite 550
Arlington Heights, IL 60005
Phone:
(847) 290-9184
Fax:
(847) 290-9203
Email:
ascrs@fascrs.org
Web Address:
www.fascrs.org
The American Society of Colon and Rectal Surgeons is the leading
professional society representing more than 1,000 board-certified colon and
rectal surgeons and other surgeons dedicated to treating people with diseases
and disorders affecting the colon, rectum, and anus.
Cancer.Net
Phone:
1-888-651-3038 (571) 483-1780
Fax:
(571) 366-9537
Email:
contactus@cancer.net
Web Address:
www.cancer.net
Cancer.Net is the information website of the American
Society of Clinical Oncology (ASCO) for people living with cancer and for those
who care for them. ASCO is the world's leading professional organization
representing physicians of all oncology subspecialties. Cancer.Net provides
current oncologist-approved information on living with cancer.
National Cancer Institute (NCI)
6116 Executive Boulevard
Suite 300
Bethesda, MD 20892-8322
Phone:
1-800-4-CANCER (1-800-422-6237)
Web Address:
www.cancer.gov (or
https://livehelp.cancer.gov/app/chat/chat_launch for live help
online)
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
National Institutes of Health: Health
Information
9000 Rockville Pike
Bethesda, MD 20892
Phone:
(301) 496-4000
TDD:
(301) 402-9612
Email:
NIHinfo@od.nih.gov
Web Address:
http://health.nih.gov
The U.S. National Institutes of Health (NIH) conducts
and supports medical research to improve people's health and save lives. NIH
provides access to health and wellness information, free newsletters, current
research, health databases, fact sheets, and many other resources.
American Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012.
American Cancer Society (2011). Colorectal Cancer Facts and Figures 2011–2013. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/ColorectalCancerFactsFigures/colorectal-cancer-facts-figures-2011-2013-page.
Libutti SK, et al. (2011). Cancer of the colon. In VT DeVita Jr. et al., eds., DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 9th ed., pp. 1084–1126. Philadelphia: Lippincott Williams and Wilkins.
Winawer S, et al. (2003).
Colorectal cancer screening and surveillance: Clinical guidelines and
rationale—Update based on new evidence. Gastroenterology, 124(2): 544–560.
National Comprehensive Cancer Network (2012). Colon cancer. NCCN Clinical Practice Guidelines in Oncology, version 3. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.
Lewis C (2007). Colorectal cancer screening, search
date November 2006. Online version of BMJ Clinical Evidence:
http://www.clinicalevidence.com.
Other Works Consulted
Cherny NJ (2011). Diarrhea and constipation. In VT DeVita Jr. et al., eds., DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 9th ed., pp. 2329–2336. Philadelphia: Lippincott Williams and Wilkins.
National Cancer Institute (2010). Colon Cancer PDQ: Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/colon/HealthProfessional.
National Cancer Institute (2011). Colon Cancer PDQ: Treatment—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/colon/Patient.
National Cancer Institute (2011). Rectal Cancer PDQ: Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/rectal/HealthProfessional/allpages.
National Cancer Institute (2012). Genetics of Colorectal Cancer PDQ—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/genetics/colorectal/healthprofessional/allpages.
National Cancer Institute (2012). Rectal Cancer Treatment (PDQ)—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/rectal/Patient.
National Comprehensive Cancer Network (2012). Rectal cancer. NCCN Clinical Practice Guidelines in Oncology, version 3. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.
American Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012.
American Cancer Society (2011). Colorectal Cancer Facts and Figures 2011–2013. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/ColorectalCancerFactsFigures/colorectal-cancer-facts-figures-2011-2013-page.
Libutti SK, et al. (2011). Cancer of the colon. In VT DeVita Jr. et al., eds., DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 9th ed., pp. 1084–1126. Philadelphia: Lippincott Williams and Wilkins.
Winawer S, et al. (2003).
Colorectal cancer screening and surveillance: Clinical guidelines and
rationale—Update based on new evidence. Gastroenterology, 124(2): 544–560.
National Comprehensive Cancer Network (2012). Colon cancer. NCCN Clinical Practice Guidelines in Oncology, version 3. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.
Lewis C (2007). Colorectal cancer screening, search
date November 2006. Online version of BMJ Clinical Evidence:
http://www.clinicalevidence.com.
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How this information was developed to help you make better health decisions.
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