What is Colorectal Cancer?
It is also known as bowel cancer, colon cancer, or rectal cancer, refers to malignant tumors that develop in the lining of the large intestine (colon or rectum). The large intestine is the final portion of the digestive tract and enables the body to absorb water from indigested food before eliminating waste from the body. It begins as small, noncancerous (benign) clumps of cells called polyps that form on the inner wall of the colon or rectum. Some polyps can develop into cancers over time. Early detection and removal of polyps can prevent them from turning malignant.
Risk Factors and Causes
Colorectal Cancer Screening There are several factors that can increase a person's risk of developing it including age, family history, lifestyle choices, and certain medical conditions. The risk rises significantly after the age of 50. Having a first-degree relative (parent, sibling, or child) who has had colorectal cancer also increases one's risk. Certain hereditary syndromes such as familial adenomatous polyposis (FAP) and hereditary nonpolyposis colon cancer (HNPCC, also called Lynch syndrome) raise the chances as well. Unhealthy habits like smoking, obesity, lack of physical activity and poor diet high in red/processed meats also play a role. Medical conditions associated with inflammation of the bowel like inflammatory bowel disease (ulcerative colitis and Crohn's disease) are known risk multipliers. Majority of colorectal cancers develop due to genetic mutations that occur over many years rather than a single identifiable cause.
Signs and Symptoms
The signs and symptoms of it may not manifest until the disease has progressed to an advanced stage. Some common indications to watch out for include changes in bowel habits such as diarrhea, constipation, or stool consistency; rectal bleeding or blood in stool; persistent abdominal discomfort like cramps, gas or pain; weakness, fatigue; unintended weight loss. These symptoms can also be caused by other less serious health issues but still warrants medical evaluation. Screening tests conducted on individuals without outward symptoms are essential to detect colorectal polyps or cancers early before they spread.
Screening and Diagnosis
Several screening options are available to detect colorectal cancer in its earliest and most treatable stages in average-risk adults between 50-75 years of age. The most widely used tests are:
- Fecal immunochemical test (FIT): This checks for blood in the stool every year.
- Highly sensitive fecal immunochemical test (HSgFIT): A more accurate version of FIT that detects even small amounts of blood.
- Stool DNA test: Analyzes stool for certain DNA mutations associated with cancer/polyps. Done every 3 years.
- Flexible sigmoidoscopy: Examines the lower third of the colon every 5 years.
- Colonoscopy: Allows to visualize the entire colon directly and remove polyps. Recommended every 10 years.
- CT colonography: Uses CT imaging to check for tumors in the colon and rectum. Done every 5 years.
If any of the screening tests show an abnormality, follow-up diagnostic colonoscopy is performed to obtain biopsy samples for microscopic analysis to confirm cancer. Additional tests like CT scans, MRI, endoscopic ultrasound help determine the extent of disease. Colonoscopy remains the gold standard for both screening and diagnosing colorectal cancer.
Staging and Prognosis
Once diagnosed, several factors determine the stage and prognosis of it. The TNM (Tumor, Nodes, Metastasis) system is followed internationally to classify the stage based on tumor size, lymph node involvement and metastasis. Stages I and II denote tumors contained within the wall of the colon/rectum, stage III indicates lymph node spread while stage IV means distant organ metastasis. The lower the stage at diagnosis, better the five-year survival ranging from over 90% for stage I to 10-15% for stage IV cancers. Factors like grade, location of primary tumor and patient health also impact outlook. Early detection through screening when still in localized stages I and II presents optimal treatment opportunity and long-term survival.
Treatment and Management
The standard treatment options for it include surgery, chemotherapy, targeted therapy, radiation therapy or a combination based on disease stage. Surgery remains the primary treatment for removing the tumor and involved tissues and is often the only required intervention for early-stage cancers. Chemotherapy using drugs like capecitabine, 5-Fu or oxaliplatin is commonly administered before or after surgery to eliminate any remaining cancer cells for stage II/III disease. Radiation therapy employing high-energy rays to destroy cancer cells may be utilized instead of or along with surgery/drugs for rectal cancer. Targeted biological therapies such as bevacizumab, cetuximab or panitumumab can augment chemotherapy regimens based on molecular tumor characteristics. Palliative care helps alleviate symptoms and maintain quality of life for advanced metastatic cancers. Regular surveillance colonoscopies are vital after initial treatment to enable prompt detection of recurrence. With early detection and coordinated multidisciplinary care, outcomes for it have steadily improved in the past few decades.
Prevention through Healthy Living
Adopting healthy lifestyle behaviors is key to decreasing one's colorectal cancer risk over the long run. In addition to avoiding tobacco, maintaining a normal body weight through diet and exercise can significantly lower risks. It is recommended to eat a diet high in plant-based foods like fruits, vegetables, whole grains and legumes along with limiting processed and red meat consumption. A review of multiple studies associated red and processed meat intake with higher incidence. Anti-inflammatory spices like turmeric and supplements containing omega-3 fatty acids from fish also show promise in helping prevention through their cellular and tissue protective properties. Breastfeeding provides yet another safeguard for mothers against developing colorectal cancer later in life. Maintaining bowel health with adequate fiber/fluid intake and staying socially engaged also promotes overall wellbeing. Regular screening remains the most effective tool for detecting curable colon polyps and cancers in asymptomatic stages. With continued advances in research and care, it can be successfully combated through collective vigilance and lifestyle modifications.
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