Prevention

Although many risk factors can be avoided, it is important to keep in mind that avoiding risk factors does not guarantee that you will not get cancer. Also, most people with a particular risk factor for cancer do not actually get the disease. Some people are more sensitive than others to factors that can cause cancer. Talk to your doctor about methods of preventing cancer that might be effective for you.

Colorectal cancer can sometimes be associated with known risk factors for the disease. Many risk factors are modifiable though not all can be avoided.

Diet and Lifestyle – Diet appears to be associated with colorectal cancer risk. Among populations that consume a diet high in fat, protein, calories, alcohol and meat (both red and white), and low in calcium and folate, colorectal cancer is more likely to develop than among populations that consume a low-fat, high-fiber diet. A diet high in saturated fat combined with a sedentary lifestyle may increase the risk of colorectal cancer. There is also evidence that drinking alcohol and smoking cigarettes may be associated with an increased risk of colorectal cancer.
Non-Steroidal Anti-Inflammatory Drugs – Some studies have shown that the use of non-steroidal anti-inflammatory drugs (NSAIDs) may be associated with a reduced risk of colorectal cancer.
Polyp Removal – The removal of polyps in the colon may be associated with a reduced risk of colorectal cancer.

Screening And Treatment

The American Cancer Society (ACS)estimates 98,200 new cases of colon cancer will be diagnosed in 2001. Early detection is key to survival. According to the ACS, 80-90% of patients diagnosed with early stage colorectal cancer are survivors 5 years later. Because colorectal cancers disproportionately strike in the over-50 age group, regular screening tests should begin at that age.

WHAT ARE YOUR OPTIONS?
It is generally agreed that one of the following test regimens be followed by people over 50 years of age with none of the high-risk characteristics:
Fecal Occult Blood Test – Special cards are coated with a stool sample and returned to the physician or lab. This test examines a patients solid waste (stool) for occult (hidden) blood. Taken annually with the following:
Sigmoidoscopy [image] – Sigmoidoscopy is an examination in which a doctor uses a thin, flexible tube with a light to look inside the rectum and colon for polyps, tumors or abnormal areas. This test should be performed once every 3-5 years.
OR
Colonoscopy [image] – Colonoscopy is an examination in which the doctor looks at the colon through a flexible, lighted instrument called a colonoscope. Recommended every 3 to 5 years.
OR
Barium Enema – An enema with a white, chalky solution that contains barium. It is given to a patient to outline the intestines for x-rays, and CT scans. Recommended every 5-10 years.
Digital Rectal Examination – A digital rectal examination is performed during an office visit or prior to sigmoidoscopy or colonoscopy.

ARE YOU AT HIGH-RISK?

You should begin screening tests at 40 years of age and have them conducted more frequently if you fall into a high-risk category for colorectal cancer such as the following:

A strong family history of colorectal cancer or polyps, or colorectal cancer syndromes.
A personal history of colorectal cancer or adenomatous polyps or chronic inflammatory bowel disease such as Crohns Disease..
DO YOU HAVE TROUBLING SYMPTOMS?
You should see a doctor immediately if any of the following symptoms appear:

- Change in bowel habits

- Feeling that you need to have a bowel movement that is no relieved by doing so

- Rectal bleeding or blood in the stool

- Cramping or a steady pain in the area of the stomach

- Decreased appetite

- Weakness or fatigue

- Jaundice (a yellowing of the skin or the whites of the eyes)

HOME TESTING KITS:

The American Cancer Society recommends that colorectal screening tests be conducted in a doctors office or other clinical setting. In a statement to cancer-worya.8k.com, the ACS said tests purchased over the counter employ the same principles as do the tests given out in the clinical setting, but the advantage of the physician's guidance as to the process, plus the very important issues of diet prior to taking the test, usually make for more reliable results. But the most important reason for having colorectal screening take place in the clinical setting is that the stool blood test is only one part of the three tests required for complete screening for this cancer. The stool blood test may be negative but a cancer may be present. That is why we suggest having the digital rectal exam and sigmoidoscopy (or colonoscopy) in addition to that test.




TREATMENT :

After the diagnosis of colon cancer is made, and the staging is confirmed, the next step is treatment. The stage of disease helps determine the treatments that are available. Common treatment options include surgery, which may be limited or extensive, chemotherapy, radiation therapy, or combinations of all three of these modalities.

Surgery

Surgery remains the most common therapy for all stages of colon cancer. The common surgical procedures are listed below.

Local excision or polypectomy- occasionally the cancer is limited to a portion of an otherwise benign polyp. These patients are often cured by polyp removal alone. This surgical procedure does not require the surgeon to cut into the abdomen. The physician performs a colonoscopy or sigmoidoscopy, during which a thin flexible tube fitted with a tiny camera and cutting tool is inserted through the rectum, and the polyp is cut out.
Hemi-colectomy or resection- When the tumor is larger, the surgeon removes the segment of the colon that contains the tumor, a portion of the tissues around it and the nearby lymph nodes. The remaining healthy segments of the colon are then sewn or stapled together. This procedure is known as anastamosis. Hemi-colectomy or resection is generally well tolerated, and bowel function returns to normal a few months after the procedure. Usually there is no need for a colostomy, to collect wastes after this procedure.
Surgical Treatments for Rectal Cancer- Surgical treatments for rectal cancer are different given the location. Small cancers of the rectum, which have not spread to the bowel, are often treated with local excision of the tumor. This is done by the physician using special equipment, and goes through the anus. If the tumor has spread to the bowel, a more extensive procedure involving an anorectal reconstruction is performed.
Adjuvant Radiation

Although patients are often cancer-free after their surgery, radiation therapy is used to eradicate any micro metastases that may remain. These small cancerous cells, which are undetectable at the time of diagnosis, can eventually grow, divide and invade other parts of the body.

Clinical trials have demonstrated the benefits of using radiation and chemotherapy in the adjuvant setting. Radiation, also called radiotherapy, is usually done as an outpatient procedure, after patients have recovered from their surgery. External beam radiation uses a machine delivering invisible high-energy x-rays to the affected areas. Another type of radiation therapy is internal radiation, which uses an implant placed directly into or near the tumor. Radiation therapy is considered a local therapy because it affects the cells only in the treatment area, which was defined by your surgeon and radiation oncologist. External beam radiation treatments often take just a few minutes a day, and are usually given 5 days a week, for 5 to 6 weeks, on an outpatient basis. Internal radiation often requires admission to the hospital.

Adjuvant Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells. Chemotherapy may be given to destroy any micrometastatic cells that remain in the body after surgery. Chemotherapy is systemic therapy. Most chemotherapy drugs are delivered directly into a vein (intravenous). Some chemotherapies are given in pill form. Chemotherapy treatments are typically given once a week, every 3 to 4 weeks. Often a combination of one or more chemotherapy drugs is used to combat cancer cells.

Click here for a more detailed discussion of chemotherapy.

Adjuvant Biological Therapy

Biological therapy, also called biotherapy, and immunotherapy, uses drugs to repair, enhance or stimulate the bodys own immune system to fight cancer. These drugs are known as biological response modifiers, or BRMs. Most biological therapies are delivered into a vein (intravenous) or via a subcutaneous injection.

Side Effects of Your Treatments

Side effects from treatment depend on the type of treatment received and are often different for each person. Most side effects are temporary and resolve after treatments are discontinued. Patients often have different side effects. They should report any symptoms they are having after treatment has begun to their health care team. Common side effects of specific therapies are listed below.

Surgery- Often causes short-term pain at the area of the procedure. May cause temporary constipation or diarrhea. Patients who have a new colostomy after surgery may have irritation and tenderness at the stoma site.
Chemotherapy – Chemotherapy affects fast dividing cells, which may be healthy cells, as well as cancerous. Side effects associated with chemotherapy are related to the specific drugs received and the dose. Common side effects are hair loss (alopecia), nausea, vomiting, diarrhea, mouth sores (mucositis), fatigue, and low blood counts. There are medications available to patients receiving chemotherapy to combat some of these side effects.
Radiation therapy- Similar to chemotherapy radiation affects healthy cells as well as cancer cells. Side effects from radiation often depend on the dose of radiation given, and the body parts being radiated. Common side effects are fatigue, skin changes at the treatment site, decreased appetite, nausea, vomiting, diarrhea, and hair loss at the treatment site.
Biological therapy- Side effects from biological therapy is dependent on the agent being used, and the dose. Common side effects are flu like symptoms, including aches, fever, chills, nausea, diarrhea, rash, fluid retention and fatigue.
All side effects of therapy should be reported to the health care team. Follow-up during and after therapy is important to ensure that changes in health are detected quickly. Often the symptoms are common. The health care team can recommend medications or other treatments to help alleviate them.

Clinical Trials

Often when a diagnosis of cancer is made surgeons and oncologists will ask if a patient is interested in enrolling on a clinical trial. Clinical trials are designed to evaluate the effectiveness of new procedures, devices, or medications. Clinical trials are classified as phase I, phase II, or phase III clinical trials. It can take several years for clinical trials to prove the true value and effectiveness of a new treatment, procedure or device. Patients enrolled in clinical trials receive the same standards of care as other patients who are not enrolled in trials. Trial patients may remove themselves from the study at any point and for any reason.

Participation in clinical trials helps oncologists, surgeons and other physicians find better medications to combat diseases, like cancer, and better ways to prevent and treat disease. The majority of all therapies today are a direct result of knowledge gained from clinical trials.




Edited by Saad Al-Hilly, MD, Director of the Pediatric Blood and Marrow Transplant Program, Experimental Therapeutics and Hematopoiesis, and Pediatric Cancer Research Program at the Columbia University Medical Center, Babies and Children Hospital.