Colon Cancer & Polyps

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What is colon cancer?

The digestive system processes the food and fluids we consume and prepares them for elimination from the body as stool. The colon, or large intestine, is part of the digestive system, along with the small intestine, esophagus, stomach, rectum (the final section of the large intestine), and anus (the opening at the end of the rectum through which stool passes). Colon cancer is the formation of cancer cells in the colon. It is the second leading cause of cancer-related death in the United States.

Certain individuals may be at higher risk for developing colorectal or gastrointestinal cancer, including those who:

Are over 50 years old
Have had other forms of cancer, including a history of colon cancer
Have family members who have had colon cancer
Have polyps in the colon (non-cancerous growths on the walls of the colon)
Have a history of ulcerative colitis or Crohn’s disease
Have a genetic (hereditary) predisposition that could increase their chances

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What are the symptoms of colon cancer?

Most patients with colon cancer do not exhibit any symptoms. However, as the tumor grows, the patient may experience certain symptoms, including:

Changes in bowel habits (i.e., increased frequency of diarrhea or constipation)
Narrow stools
Blood in the stool
Weight loss
Anemia
Other gastrointestinal issues, such as vomiting, cramps, bloating, or incomplete bowel movements

How is colon cancer diagnosed?

Ιf a doctor suspects that a patient may have gastrointestinal cancer or colon cancer, they will review the patient’s medical history, family history, and symptoms, and conduct a physical examination, including a digital rectal exam. The doctor may recommend further tests if necessary, including:

Stool tests to check for blood.
Blood tests, including a complete blood count and biochemical tests to determine the number of red blood cells and check for anemia.
Examination of the colon using sigmoidoscopy or colonoscopy. For these tests, the colon is cleaned with a solution, and a flexible endoscope is inserted through the rectum to examine the colon. Sigmoidoscopy examines the lower part of the colon, while colonoscopy examines the entire colon. The doctor may also take samples from polyps for biopsy (a small tissue sample is removed and examined under a microscope for cancer).
Barium enema. A barium enema is administered to the patient (barium is a substance that helps cancer or other abnormalities stand out on X-rays), followed by a series of X-rays.

What are the stages of colon cancer?

One of the biggest concerns with a cancer diagnosis is whether the cancer has spread (metastasized) beyond its original site. To determine this, the doctor assigns a number (I to IV) to the diagnosis. The higher the number, the more the cancer has spread throughout the body. This process is called “staging.”

The stages of colon cancer include:

Stage I: The cancer has invaded the middle layers of the colon wall but has not penetrated through it.
Stage II: The cancer has penetrated through the muscular wall of the colon.
Stage III: The cancer has spread to nearby lymph nodes close to the colon and rectum.
Stage IV: The cancer has spread to lymph nodes and other sites in the body, such as the liver, lungs, or lining of the abdomen (peritoneum).

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How is colon cancer treated?

The treatment of colon cancer depends on the stage of the cancer, its location, and the overall health of the patient. Several different types of treatment are used, and sometimes different therapies are combined. The primary treatments for colon cancer are surgery and chemotherapy. Rectal cancer (cancers located in the last section of the colon) is also treated with radiation therapy.

Surgery

Surgery is the most commonly used treatment for colon cancer. The colon and rectum require surgery if they are to be treated. Surgery usually involves the removal of the cancer and portions of surrounding tissue. In most cases, the surgeon can reconnect the remaining healthy sections of the colon (anastomosis) after removing the cancer. If the surgeon cannot reconnect the healthy parts of the colon, a colostomy will be necessary. A colostomy is an opening (stoma) through the abdominal wall into the colon. This opening provides a new passage for the elimination of stool. Patients with cancer and a colostomy wear a special bag to collect waste. In most cases, the colostomy is temporary, although for some patients it will be permanent.

Surgical procedures for colon cancer include:

Polypectomy: Polyps are removed during a colonoscopy.
Local excision: This procedure is performed when cancer is in the early stages. It does not require abdominal surgery; instead, the cancer is removed through the anus.
Resection: Total removal of sections of the colon and surrounding tissue, which requires significant surgery.

Laparoscopic surgery

This minimally invasive approach to surgery, such as the laparoscopic method, offers patients the benefit of smaller incisions, less pain, fewer complications, and shorter hospital stays.

Radiation therapy

High-energy X-rays damage or destroy cancer cells to shrink the tumor. Radiation is delivered with special equipment that directs radiation from outside the body (external radiation). Rarely, radiation may also come from an implant containing radioactive material placed within or near the tumor.

Chemotherapy

Chemotherapy drugs kill cancer cells and are given either intravenously (injection into a vein) or orally. Chemotherapy may be administered before surgery to reduce the size of the tumor, making it easier to remove. Chemotherapy may also be given after surgery to kill any remaining cancer cells in the body.

What is the treatment for different stages of colon cancer?

The treatment for colon cancer varies depending on the stage of the disease:

Stage I: Excision and polypectomy for smaller and larger tumors.
Stage II: Excision and anastomosis, sometimes followed by chemotherapy protocols or radiation (or radiation for rectal cancer).
Stage III: Excision and anastomosis followed by chemotherapy or clinical chemotherapy protocols (radiation is used for stage III rectal cancer).
Stage IV: Excision and anastomosis, removal of sections of other organs where cancer has spread, radiation and chemotherapy, clinical chemotherapy protocols, or experimental biological therapy.