What You Need to Know About Colorectal Cancer
The Colon and Rectum
The rectum and colon are parts of the digestive system which form a long, muscular tube (the large intestine or the large bowel). The colon is the first 4 to 5 feet of the large intestine, and the rectum is the last several inches.
Semi-digested food passes into the colon from the small intestine where water and nutrients are removed from the food and the rest turns into waste (stool). The waste passes into the rectum and out of the body via the anus.
http://www.cancer.gov/cancertopics/wyntk/colon-and-rectal/page2
Understanding Cancer
Cells are the blocks of the tissues which in turn make up the organs in the body. Cancer begins at the level of cells and continue to progress. The cells grow and divide to form new cells and they die when they grow old being replaced by the new cells. Sometimes, this process does not flow in order. New cells are generated when there is no need for them and old cells do not die when they should. This will cause an accumulation of cells that forms a mass of tissue and is called a tumor.
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Risk Factors
Colorectal cancer risk factors are as following:
• Age over 50:
• Colorectal polyps:
• Family history of colorectal cancer:
• Genetic alterations:
o Hereditary nonpolyposis colon cancer (HNPCC)
o Familial adenomatous polyposis (FAP)
• Personal history of cancer
• Ulcerative colitis or Crohn’s disease
• Diet
• Cigarette smoking
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Screening
Screening tests can help your doctor to find polyps or cancer before any symptoms. Finding and removing polyps can potentially prevent colorectal cancer. Also, treatment for colorectal cancer is more likely to be effective when the disease is detected early.
The following screening tests can be used to detect polyps, cancer, or other abnormal areas in colorectal area. The physician can explain more about each test:
• Fecal occult blood test (FOBT)
• Sigmoidoscopy
• Colonoscopy
• Double-contrast barium enema
• Digital rectal exam
• Virtual colonoscopy
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Symptoms
• Change in bowel habits
• Diarrhea or constipation
• Feeling that your bowel does not empty completely
• Finding blood (bright red or very dark) in your stool
• Stools that are narrower than usual
• Frequently having gas pains or cramps, or feeling full or bloated
• Losing weight with no known reason
• Feeling very tired all the time
• Having nausea or vomiting
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Diagnosis
If your screening test results suggest cancer or if you have symptoms, your doctor must find out whether they are due to cancer or some other cause. Your doctor asks about your personal and family medical history and gives you a physical exam. You may have one or more of the tests described in the “Screening” section.
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Staging
If the biopsy shows the presence of cancer, your doctor needs to know the extent (stage) of the disease to plan the best treatment. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body.
Your doctor may order some of the following tests:
• Blood tests:
• carcinoembryonic antigen (CEA)
• Onko-Sure® DR70
• Some other substances in the blood
• Colonoscopy
• Endorectal ultrasound
• Chest x-ray
• CT scan
Your doctor may also use other tests (such as MRI) to see whether the cancer has spread. Sometimes staging is not complete until after surgery to remove the tumor. Doctors describe colorectal cancer by the following stages:
• Stage 0: The cancer is found only in the innermost lining of the colon or rectum. Carcinoma in situ is another name for Stage 0 colorectal cancer.
• Stage I: The tumor has grown into the inner wall of the colon or rectum. The tumor has not grown through the wall.
• Stage II: The tumor extends more deeply into or through the wall of the colon or rectum. It may have invaded nearby tissue, but cancer cells have not spread to the lymph nodes.
• Stage III: The cancer has spread to nearby lymph nodes, but not to other parts of the body.
• Stage IV: The cancer has spread to other parts of the body, such as the liver or lungs.
• Recurrence: This is cancer that has been treated and has returned after a period of time when
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Treatment
Often individuals with colorectal cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask your doctor. It often helps to make a list of questions before an appointment.
Getting a Second Opinion
Before starting treatment, it is always good to seek a second opinion about your diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it.
Treatment Methods
The choice of treatment depends on the location of the tumor in the colon or rectum and the stage. Treatment for colorectal cancer may involve surgery, chemotherapy, biological therapy or radiation therapy. Sometimes, a combination of treatments are chosen.
Cancer treatment is either local therapy or systemic therapy:
• Local therapy
• Systemic therapy
Surgery
The most common treatment for colorectal cancer is surgery.
• Colonoscopy
• Laparoscopy
• Open surgery
Chemotherapy
Chemotherapy uses anticancer drugs to kill cancer cells. The side effects of chemotherapy depend mainly on the specific drugs and the dose. The drugs can harm normal cells that divide rapidly:
• Blood cells
• Cells in hair roots
• Cells that line the digestive tract
Biological Therapy
Some colorectal cancer patients with a spread cancer receive a monoclonal antibody, a type of biological therapy. The monoclonal antibodies bind to colorectal cancer cells and interfere with cancer cell growth and the spread of cancer. One can receive monoclonal antibodies through a vein at the doctor’s office, hospital, or clinic. In some cases, they receive chemotherapy at the same time.
Radiation Therapy
Doctors use different types of radiation therapy to treat cancer. Sometimes people receive two types:
• External radiation
• Internal radiation (implant radiation or brachytherapy)
• Intraoperative radiation therapy (IORT)
Treatment for Colon Cancer
Treatment for Rectal Cancer
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Nutrition and Physical Activity
It is important to eat well and stay as active as you can.
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Rehabilitation
Rehabilitation is an important part of cancer care.
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Follow-up Care
Follow-up care after treatment for colorectal cancer is important. Checkups may include a physical exam (including a digital rectal exam), lab tests (including fecal occult blood test,CEA, Onko-Sure® DR-70 tests), colonoscopy, x-rays, CT scans, or other tests. If you have any health problems between checkups, you should contact your doctor.
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Complementary Medicine
It is natural to want to help yourself feel better. Talk with your doctor if you are thinking about trying anything new. You also may request materials from the National Center for Complementary and Alternative Medicine, which is part of the National Institutes of Health.
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Sources of Support
Living with a serious disease such as colorectal cancer is not easy. One may worry about caring for his family, keeping his job, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy also can be helpful if one wants to talk about his feelings or concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support. Support groups also can help.
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The Promise of Cancer Research
Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). Doctors are studying new ways to prevent, detect, and treat colorectal cancer.
Clinical trials are designed to answer important questions and to find out whether the new approach is safe and effective. Research already has led to advances, and researchers continue to search for more effective approaches.
Research on Prevention
Research is being done to test whether certain dietary supplements or drugs may help prevent colorectal cancer. For example, researchers across the country are studying vitamin D and calcium supplements, selenium supplements, and the drug celecoxib, in people with polyps.
Research on Screening and Diagnosis
Scientists are testing new ways to check for polyps and colorectal cancer. NCI-supported researchers are studying virtual colonoscopy. This is a CT scan of the colon. It makes x-ray pictures of the inside of the colon.
Research on Treatment
Researchers are studying chemotherapy and biological therapy. They are studying new drugs, new combinations, and different doses. In addition, researchers are looking at ways to lessen the side effects of treatment.
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Onko-Sure® Assay Description
Onko-Sure® is a simple, non-invasive, FDA-cleared blood biomarker test used both for monitoring colorectal cancer (CRC) during treatment and for post-treatment CRC recurrence. It is an ELISA-based assay that measures the accumulation of Fibrin/Fibrinogen Degradation Products (FDP) in the serum using a polyclonal antibody against the DR-70® blood biomarker.
For CRC, early identification of recurrence with prompt treatment can lead to a better survival rate and quality of life for the patients.1 For the last 25 years, Carcinoembryonic Antigen (CEA) (sensitivity of 38-69%) and CA 19-9 (sensitivity of 23-65%) have been available blood biomarkers for colorectal cancer (CRC) treatment monitoring; however, similar to any other biomarker, they have their own limitations.1 DR-70® (sensitivity of 54-87%) is the most recent biomarker cleared by the US FDA for the monitoring of colorectal cancer treatment and recurrence. It has been shown by two clinical studies performed in the UK and US in 2010 that combining CEA and DR-70® improves the test sensitivity to 55% higher than that of CEA alone.21-23
References:
1. National Cancer Institute site: http://www.cancer.gov/cancertopics/wyntk/colon-and-rectal/page1/AllPages.
2. Anthony T. Colorectal cancer follow-up in 2005. Surg Oncol Clin N Am. 2006;15:175-193.
3. Shimwell NJ, Wei W, Wilson S, et al. Assessment of novel combinations of biomarkers for the detection of colorectal cancer. Cancer Biomark. 2010;7(3):123-132.
4. Cordero OJ, Imbernon M, De Chiara L. Potential of soluble CD86 as a serum marker for colorectal cancer detection. World J Clin Oncol 2011;2(6):245-261.
5. Hundt S, Haug u, Brenner H. Blood markers for early detection of colorectal cancer: A systematic review. Cancer Epidemiol Biomarkers Prev 2007;16:1935-1953.