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GASTRIC CANCER

Definition

Stomach cancer is cancer that occurs in the stomach — the muscular sac located in the upper middle of your abdomen, just below your ribs. Your stomach receives and holds the food you eat and then helps to break down and digest it.

Another term for stomach cancer is gastric cancer. These two terms most often refer to stomach cancer that begins in the mucusproducing cells on the inside lining of the stomach (adenocarcinoma). Adenocarcinoma is the most common type of stomach cancer.

Stomach cancer is uncommon in the United States, and the number of people diagnosed with the disease each year is declining. Stomach cancer is much more common in other areas of the world, particularly Japan.

Signs and symptoms of stomach cancer may include:

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Fatigue Feeling bloated after eating Feeling full after eating little Heartburn Indigestion Nausea Stomach pain Vomiting Weight loss CAUSES Doctors aren't sure what causes stomach cancer. There is a strong correlation between a diet high in smoked, salted and pickled foods and stomach cancer. As the use of refrigeration for preserving foods has increased around the world, the rates of stomach cancer have declined.

In general, cancer begins when an error (mutation) occurs in a cell's DNA. The mutation causes the cell to grow and divide at a rapid rate and to continue living when normal cells would die. The accumulating cancerous cells form a tumor that can invade nearby structures. And cancer cells can break off from the tumor to spread throughout the body.

Adenocarcinoma accounts for the great majority of all stomach cancers.  Cancer that begins in immune system cells (lymphoma).Types of stomach cancer The cells that form the tumor determine the type of stomach cancer. A gastrointestinal stromal tumor (GIST) begins in specific nervous system cells found in your stomach. Types of stomach cancer include:  Cancer that begins in the glandular cells (adenocarcinoma). Hormone-producing cells can develop carcinoid cancer. Lymphoma in the stomach is rare. Risk factors Factors that increase your risk of stomach cancer include:          A diet high in salty and smoked foods A diet low in fruits and vegetables Eating foods contaminated with aflatoxin fungus Family history of stomach cancer Infection with Helicobacter pylori Long-term stomach inflammation (chronic gastritis) Pernicious anemia Smoking Stomach polyps .  Cancer that begins in hormone-producing cells (carcinoid cancer). The walls of the stomach contain a small number of immune system cells that can develop cancer. The type of cells in your stomach cancer helps determine your treatment options. Carcinoid cancer in the stomach is rare. Because the other types of stomach cancer are rare.  Cancer that begins in nervous system tissues. when people use the term "stomach cancer" they generally are referring to adenocarcinoma. The glandular cells that line the inside of the stomach secrete a protective layer of mucus to shield the lining of the stomach from the acidic digestive juices. GIST is a rare form of stomach cancer.

Cancer cells may also have spread to a limited number of nearby lymph nodes. growing into the muscle layer of the stomach wall.  Stage II. Imaging tests used to look for stomach cancer include computerized tomography (CT) and a special type of X-ray exam sometimes called a barium swallow. A thin tube containing a tiny camera is passed down your throat and into your stomach. Determining the extent (stage) of stomach cancer The stage of your stomach cancer helps your doctor decide which treatments may be best for you. growing into nearby structures.Tests and diagnosis Tests and procedures used to diagnose stomach cancer include:  A tiny camera to see inside your stomach (upper endoscopy). depending on your situation. Tests may include CT. The cancer at this stage has spread deeper. This stage of cancer extends beyond the stomach.  Stage III. the cancer may have grown through all the layers of the stomach. At this stage. This means the surgeon makes several small incisions in your abdomen and inserts a special camera that transmits images to a monitor in the operating room. the tumor is limited to the layer of tissue that lines the inside of the stomach. Stages of stomach cancer The stages of adenocarcinoma stomach cancer include:  Stage I.  Imaging tests. Your doctor can look for signs of cancer. Other staging tests may be used. Exploratory surgery is usually done laparoscopically. Tests and procedures used to determine the stage of cancer include:   Imaging tests. Exploratory surgery. positron emission tomography (PET) and magnetic resonance imaging (MRI). If any suspicious areas are found. Your doctor may recommend surgery to look for signs that your cancer has spread beyond your stomach within your abdomen. a piece of tissue can be collected for analysis (biopsy). At this stage. Or it is a smaller cancer that has spread to distant areas of the body.  Stage IV. Cancer may also have spread to more of the lymph nodes. . Or it may be a smaller cancer that has spread more extensively to the lymph nodes.

Radiation therapy Radiation therapy uses high-powered beams of energy. when possible. to kill cancer cells. you may experience digestive problems. Options include:  Removing early-stage tumors from the stomach lining. Surgery carries a risk of bleeding and infection.  Surgery to relieve signs and symptoms. Total gastrectomy involves removing the entire stomach and some surrounding tissue. The esophagus is then connected directly to the small intestine to allow food to move through your digestive system. nausea and vomiting. Chemotherapy drugs travel throughout your body. Removing part of the stomach may relieve signs and symptoms of a growing tumor in people with advanced stomach cancer. In cases of advanced cancer. During subtotal gastrectomy. Chemotherapy is also used after surgery (adjuvant chemotherapy) to kill any cancer cells that might remain in the body. killing cancer cells that may have spread beyond the stomach. radiation therapy may be used to relieve side effects caused by a large tumor. Chemotherapy Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Radiation therapy can be used before surgery (neoadjuvant radiation) to shrink a stomach tumor so it's more easily removed.Treatments and drugs Surgery The goal of surgery is to remove all of the stomach cancer and a margin of healthy tissue. The endoscope is a lighted tube with a camera that's passed down your throat into your stomach.  Removing a portion of the stomach (subtotal gastrectomy). The doctor uses special tools to remove the cancer and a margin of healthy tissue from the stomach lining. Radiation is often combined with chemotherapy. indigestion.  Removing the entire stomach (total gastrectomy). Very small cancers limited to the inside lining of the stomach may be removed using endoscopy in a procedure called endoscopic mucosal resection.  Removing lymph nodes to look for cancer. Chemotherapy can be given before surgery (neoadjuvant chemotherapy) to help shrink a tumor so it can be more easily removed. The energy beams come from a machine that moves around you as you lie on a table. . but it can make you more comfortable. Radiation therapy to your stomach can cause diarrhea. the surgeon removes only the portion of the stomach affected by cancer. surgery can't cure stomach cancer. If all or part of your stomach is removed. such as X-rays. The surgeon examines and removes lymph nodes in your abdomen to look for cancer cells. Radiation therapy can also be used after surgery (adjuvant radiation) to kill any cancer cells that might remain around your stomach. In this case.

Chemotherapy is often combined with radiation therapy. Take an active role in your treatment decisions. stage and your treatment options. Or go online and connect with cancer survivors on message boards. . In fact. plan ahead for the downtimes when you may need to rest more or limit what you do.  Take time for yourself. Stay involved as much as you can. for example.  Connect with other cancer survivors. Chemotherapy may be the only treatment used in people with rare forms of stomach cancer. Also. you may find it helps to stay focused on tasks that help you cope. Sometimes it feels as if people who don't have cancer can't understand what you're going through. try to:  Learn enough about stomach cancer to make decisions about your care. Targeted drugs Targeted therapy uses drugs that attack specific abnormalities within cancer cells. if you feel well enough to do something. At those times. it may help to turn to other cancer survivors for support. Having goals helps you feel in control and can give you a sense of purpose. such as gastric lymphoma and gastrointestinal stromal tumors. You may not be able to work a 40-hour week. Targeted drugs used to treat this cancer include imatinib (Gleevec) and sunitinib (Sutent).  Get involved in your treatment decisions. For example. Together you can decide what treatments are best for you. But don't choose goals you can't possibly reach. Chemotherapy side effects depend on which drugs are used. Targeted drugs are used to treat a rare form of stomach cancer called gastrointestinal stromal tumor. Discuss your concerns and preferences about treatments with your doctor. many people find that continuing to work can be helpful. For the most part. You may also find that you develop deep and lasting bonds with people who are going through the same things you are. Coping and support A cancer diagnosis can be overwhelming and frightening.  Stay active. Chemotherapy may be used alone in people with advanced stomach cancer to help relieve signs and symptoms. The type of stomach cancer you have determines which chemotherapy drugs you'll receive. such as those run by the American Cancer Society. Being diagnosed with cancer doesn't mean you have to stop doing the things you enjoy or normally do. but you may be able to work part time. Eating well. Ask your doctor to write down the details of your cancer — the type. go ahead and do it. Ask your doctor about support groups in your area. relaxing and getting enough rest can help combat the stress and fatigue of cancer. Good sources of information include the National Cancer Institute and the American Cancer Society. Use those details to find more information about stomach cancer and the benefits and risks of each treatment option. Once you start to adjust after the initial shock of your diagnosis.  Set reasonable goals.

Choose a wide variety of colorful fruits and vegetables. If you smoke.  Ask your doctor about your risk of stomach cancer. Smoking increases your risk of stomach cancer. . Protect your stomach by limiting these foods. so there's no way to prevent it. For instance. quit. There are no guidelines to determine who should undergo screening for stomach cancer in the United States. Try to incorporate more fruits and vegetables into your diet each day. But in some cases. Together you may consider periodic endoscopy to look for signs of stomach cancer. gastritis and stomach polyps. as well as many other types of cancer. Quitting smoking can be very difficult. so ask your doctor for help. If you don't smoke. such as anemia. Experiment with herbs and other ways of flavoring foods that don't add sodium. try to:  Eat more fruits and vegetables. don't start.  Stop smoking. If you've been diagnosed with one of these conditions. Some medical conditions increase your risk of stomach cancer. But you can take steps to reduce your risk of stomach cancer by making small changes to your everyday life. ask your doctor how this affects your stomach cancer risk.Prevention It's not clear what causes stomach cancer.  Reduce the amount of salty and smoked foods you eat. you and your doctor may decide your risk is high enough that the benefits of screening outweigh the potential risks.

Treatment of colorectal cancer depends on the location. Rectal cancer is cancer of the last several inches of the colon. and extent of cancer spread. Over time some of these polyps become colon cancers. Diagnosis of colorectal cancer can be made by barium enema or by colonoscopy with biopsy confirmation of cancer tissue. symptoms. such as cramps.S. Polyps may be small and produce few. as well as the age and health of the patient.COLORECTAL CANCER Definition Colon cancer is cancer of the large intestine (colon). Symptoms Signs and symptoms of colon cancer include:       A change in your bowel habits. Together. colon polyps. Most cases of colon cancer begin as small. Colon polyps and early cancer can have no symptoms. When symptoms appear. Surgery is the most common treatment for colorectal cancer. depending on the cancer's size and location in your large intestine. noncancerous (benign) clumps of cells called adenomatous polyps. For this reason. gas or pain A feeling that your bowel doesn't empty completely Weakness or fatigue Unexplained weight loss Many people with colon cancer experience no symptoms in the early stages of the disease. size. Colon cancer facts         Colorectal cancer is a malignant tumor arising from the inner wall of the large intestine. doctors recommend regular screening tests to help prevent colon cancer by identifying polyps before they become colon cancer. Most colorectal cancers develop from polyps. Colorectal cancer is the third leading cause of cancer in males and fourth in females in the U. Risk factors for colorectal cancer include heredity. the lower part of your digestive system. including diarrhea or constipation or a change in the consistency of your stool Rectal bleeding or blood in your stool Persistent abdominal discomfort. if any. Therefore regular screening is important. Removal of colon polyps can prevent colorectal cancer. they're often referred to as colorectal cancers. . they'll likely vary. and long-standing ulcerative colitis.

If benign polyps are not removed from the large intestine. For example. Benign polyps can be easily removed during colonoscopy and are not life-threatening. Once metastasis has occurred in colorectal cancer. called a growth or tumor. When cancer spreads to another part of the body. can be benign or malignant. What is cancer of the colon and rectum? The colon is the part of the digestive system where the waste material is stored. the cancer cells in the liver are colon cancer cells . they can become malignant (cancerous) over time. They affect the body's basic unit. The disease is metastatic colon cancer (it is not liver cancer). They can usually be removed and. cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. Malignant tumors of the large intestine are called cancers. cells from benign tumors do not spread to other parts of the body. muscular tube called the large intestine (also known as the large bowel). Cancer occurs when cells become abnormal and divide without control or order. Cancer cells can also break away and spread to other parts of the body (such as liver and lung) where new tumors form. Benign tumors are not cancer. Malignant tumors are cancer. The rectum is the end of the colon adjacent to the anus. This mass of extra tissue. If cells keep dividing when new cells are not needed. Most important. This is how cancer spreads from the original (primary) tumor to form new tumors in other parts of the body. the new tumor has the same kind of abnormal cells and the same name as the primary tumor. if colon cancer spreads to the liver. a complete cure of the cancer is unlikely. they do not come back. Most of the cancers of the large intestine are believed to have developed from polyps.What is cancer? Cancer is a group of more than 100 different diseases. This orderly process helps keep us healthy. Benign tumors of the large intestine are called polyps. Together. a mass of tissue forms. . Benign tumors are rarely a threat to life. The spread of cancer is called metastasis. Normally. cells divide to produce more cells only when the body needs them. the cell. Cancer cells can invade and damage tissues and organs near the tumor. Benign polyps do not invade nearby tissue or spread to other parts of the body. the colon and rectum are made up of many types of cells. Cancer of the colon and rectum (also referred to as colorectal cancer) can invade and damage adjacent tissues and organs. Tumors of the colon and rectum are growths arising from the inner wall of the large intestine. they form a long. Like all other organs of the body. The spread of colon cancer to distant organs is called metastasis of the colon cancer. Also. in most cases.

removing benign colon polyps can prevent colorectal cancer. Chromosomes contain genetic information inherited from each parent. Colon cancer is a recognized complication of chronic ulcerative colitis. In countries where the people have adopted western diets. The frequency of colorectal cancer varies around the world. the fat intake by the population is much higher than in countries with low cancer rates. the incidence of colorectal cancer is increasing. healthy chromosomes control the growth of cells in an orderly manner. benign colon polyps can acquire additional chromosome damage to become cancerous. Factors that increase a person's risk of colorectal cancer include high fat intake. cancer of the colon and rectum is the third leading cause of cancer in males and the fourth leading cause of cancer in females. . a family history of colorectal cancer and polyps. Therefore. When chromosomes are damaged. For further information.Globally. It is believed that the breakdown products of fat metabolism lead to the formation of cancer-causing chemicals (carcinogens). Some people are more likely to develop colorectal cancer than others. and chronic ulcerative colitis. cell growth becomes uncontrolled. The risk for cancer begins to rise after eight to 10 years of colitis. the presence of polyps in the large intestine. Diet and colon cancer Diets high in fat are believed to predispose humans to colorectal cancer. The risk of developing colon cancer in a patient with ulcerative colitis also is related to the location and the extent of his or her disease. It is common in the Western world and is rare in Asia and Africa. resulting in masses of extra tissue (polyps). Ulcerative colitis and colon cancer Chronic ulcerative colitis causes inflammation of the inner lining of the colon. Colon polyps and colon cancer Doctors believe that most colon cancers develop in colon polyps. In countries with high colorectal cancer rates. Diets high in vegetables and high-fiber foods such as whole-grain breads and cereals may rid the bowel of these carcinogens and help reduce the risk of cancer. Colon polyps are initially benign. Colon polyps develop when chromosome damage occurs in cells of the inner lining of the colon. Over years. please read the Ulcerative Colitis article. What are the causes of colon cancer? Doctors are certain that colorectal cancer is not contagious (a person cannot catch the disease from a cancer patient). Normally.

ovarian cancer. Since the cancers associated with ulcerative colitis have a more favorable outcome when caught at an earlier stage. Approximately 20% of cancers are associated with a family history of colon cancer. and are at very high risk of developing colon cancer early in life. FAP (familial adenomatous polyposis) is a hereditary colon cancer syndrome where the affected family members will develop countless numbers (hundreds. shortness of breath. weakness. and the ampulla (the part where the bile ducts drain into the duodenum just beyond the stomach). Nevertheless. a person affected by familial polyposis syndrome is almost sure to develop colon cancer from these polyps. And 5 % of colon cancers are due to hereditary colon cancer syndromes. Unless the condition is detected and treated (treatment involves removal of the colon) early. When precancerous changes are found. the lifetime risk of developing colon cancer is 18% (a threefold increase over the general population in the United States).8% at 50 years. AFAP (attenuated familial adenomatous polyposis) is a milder version of FAP. Genetics and colon cancer A person's genetic background is an important factor in colon cancer risk. abdominal pain. and chromosome damages cause genetic defects that lead to the formation of colon polyps and later colon cancer. Cancers usually develop in the 40s. narrow stools. The damaged chromosomes can only be found in the polyps and the cancers that develop from that cell.5% at 10 years. the chromosome damages are acquired (develop in a cell during adult life).Current estimates of the cumulative incidence of colon cancer associated with ulcerative colitis are 2. But in hereditary colon cancer syndromes. they are still at very high risk of developing colon cancers at young ages. Chromosomes contain genetic information. yearly examinations of the colon often are recommended after eight years of known extensive disease. usually at young ages. cramps. extensive colon involvement. and cancers of the ureters (the tubes that connect the kidneys to the bladder). These patients are also at risk of developing other cancers such as cancers in the thyroid gland. a long duration of colitis. usually in the right colon. Even though family history of colon cancer is an important risk factor. samples of tissue (biopsies) can be taken to search for precancerous changes in the lining cells of the colon. Affected members develop less than 100 colon polyps. change in bowel habits. Hereditary colon cancer syndromes are disorders where affected family members have inherited cancer-causing genetic defects from one or both of the parents. and 10. HNPCC (hereditary nonpolyposis colon cancer) is a hereditary colon cancer syndrome where affected family members can develop colon polyps and cancers. During these examinations. removal of the colon may be necessary to prevent colon cancer. They include fatigue. stomach.6% at 30 years. and those with primary sclerosing cholangitis (PSC). diarrhea or constipation. Patients who have inherited the hereditary colon cancer syndrome genes are at risk of developing large number of colon polyps. They are also at risk of having gastric polyps and duodenal polyps. or . Patients at higher risk of cancer are those with a family history of colon cancer. weight loss. in their 30s to 40s. MYH polyposis syndrome is a recently discovered hereditary colon cancer syndrome. majority (80%) of colon cancers occur sporadically in patients with no family history of colon cancer. Certain HNPCC patients are also at risk of developing uterine cancer. 7. stomach cancer. In sporadic polyps and cancers (polyps and cancers that develop in the absence of family history). Among first-degree relatives of colon cancer patients. What are the symptoms of colon cancer? Symptoms of colon cancer are numerous and nonspecific. sometimes thousands) of colon polyps starting during the teens. and the biliary tract (the ducts that drain bile from the liver to the intestines). red or dark blood in stool. Affected members typically develop 10-100 polyps occurring at around 40 years of age. the chromosome defects are inherited at birth and are present in every cell in the body. and are at high risk of developing colon cancer. and also are at risk of developing cancers in other organs.

bloating. Colonoscopy is generally considered more accurate than barium enema x-rays. narrowed stool. right-sided cancers cause iron deficiency anemia due to the slow loss of blood over a long period of time. Stool samples can be obtained to test for occult blood (see below). Symptoms vary according to where in the large bowel the tumor is located. please read the following articles: Irritable Bowel Syndrome. chalky liquid containing barium. staging examinations are performed to determine whether the cancer has already spread to other organs. How can colon cancer be prevented? Unfortunately. the doctor may obtain a blood test for CEA (carcinoembyonic antigen). ulcerative colitis. It is sometimes found in high levels in patients with colorectal cancer. The right colon is spacious. Iron deficiency anemia causes fatigue. Crohn's Disease. and cancers of the right colon can grow to large sizes before they cause any abdominal symptoms. please read the Colonoscopy article. cramps. For more information. small tissue samples (biopsies) can be obtained and examined under the microscope to confirm the diagnosis. and bloating. The pathologist examines the polyps under the microscope to check for cancer. Bright red blood in the stool may also indicate a growth near the end of the left colon or rectum What tests can be done to detect colon cancer? When colon cancer is suspected. they are usually removed through the colonoscope and sent to the pathologist. colon cancers can be well advanced before they are detected. Crohn's disease. The left colon is narrower than the right colon. and Peptic Ulcer Disease. Multiple world health organizations have suggested general screening guidelines. diverticulosis. Colon cancer can be present for several years before symptoms develop. For more information on these conditions. Removal of precancerous polyps prevents the future development of colon cancer from these polyps. ultrasonography. The barium outlines the large intestines on the x-rays. If colon cancer is confirmed by a biopsy. A barium enema involves taking x-rays of the colon and the rectum after the patient is given an enema with a white. abdominal pains. and shortness of breath. the doctor inserts a gloved finger into the rectum to feel for abnormal growths. Since colorectal cancer tends to spread to the lungs and the liver. diarrhea. Other conditions such as irritable bowel syndrome (spastic colon). liver. Typically. many are precancerous. . early detection still significantly improves the chances of a cure by surgically removing the cancer before the disease spreads to other organs. cancers of the left colon are more likely to cause partial or complete bowel obstruction. Tumors and other abnormalities appear as dark shadows on the x-rays. especially when the disease has spread. and peptic ulcer disease can have symptoms that mimic colorectal cancer. The prostate gland can be examined at the same time. Therefore. please read the Lower Gastrointestinal Series (Barium Enema) article. While the majority of the polyps removed through the colonoscopes are benign. Sometimes. Ulcerative Colitis. especially in detecting small polyps. Even in cases where cancer has already developed. flexible viewing tube into the rectum for the purpose of inspecting the inside of the entire colon. Cancers causing partial bowel obstruction can cause symptoms of constipation. either a lower GI series (barium enema x-ray) or colonoscopy is performed to confirm the diagnosis and to localize the tumor. During digital examination of the rectum. CEA is a substance produced by some cancer cells. For more information. weakness. Colonoscopy is a procedure whereby a doctor inserts a long. and abdomen. Digital rectal examination and stool occult blood testing It is recommended that all individuals over the age of 40 have yearly digital examinations of the rectum and their stool tested for hidden or "occult" blood. If cancerous growths are found during colonoscopy. Diverticulosis. If colon polyps are found. or a CAT scan of the lungs. The most effective prevention of colon cancer is early detection and removal of precancerous colon polyps before they turn cancerous. staging tests usually include chest x-rays.

Patients with a prior history of polyps or colon cancer may also undergo colonoscopies to exclude recurrence. If a polyp or cancer is found.. It is also important to realize that stool which has tested negative for occult bl ood does not mean the absence of colorectal cancer or polyps. In patients suspected of having colon tumors. patients with a positive stool occult blood should undergo further evaluations involving barium enema x-rays. should be referred for genetic counseling followed possibly by genetic testing. The small amount of blood mixed into the stool is usually not visible to the naked eye. However. and (3) alleviating concern for members who test negative for the hereditary genetic defects. It is important to remember that having stool tested positive for occult blood does not necessarily mean the person has colon cancer. Patients with hereditary colon cancer syndromes such as FAP.An important screening test for colorectal cancers and polyps is the stool occult blood test. (2) identifying high risk members so that screening may begin to prevent other cancers such as ultrasound tests for uterine cancer. For example. Families with multiple members having colon cancers. Tumors of the colon and rectum tend to bleed slowly into the stool. a flexible sigmoidoscopy screening tests is recommended every three to five years. The majority of colon polyps can be completely removed by colonoscopy without open surgery. Colon cancers found under these circumstances tend to be early and have a better long-term prognosis. Flexible sigmoidoscopy and colonoscopy Beginning at age 50. and having other cancers such as cancers of the ureters. members having cancers at young ages. AFAP. and to explain the source of the bleeding. Genetic testing without prior counseling is discouraged because of the extensive family education that is involved and the complicated nature of interpreting the test results. flexible sigmoidoscopies or screening colonoscopies are performed even if the stool occult blood tests are negative. and in those with high risk factors for developing colorectal polyps and cancer. Diet and colon cancer to prevent colon cancer . members with multiple colon polyps. Usually. Recent studies have shown that the use of screening flexible sigmoidoscopy can reduce mortality from colon cancer. This is a result of the detection of polyps or early cancers in people with no symptoms. for example in FAP. and MYH are recommended to begin colonoscopies early. and HNPCC hereditary colon cancer syndromes. The commonly used stool occult blood tests rely on chemical color conversions to detect microscopic amounts of blood. and should have regular colonoscopies to look for precancerous changes in the colon lining. Please read the Colon Cancer Screening article. and upper endoscopies for stomach and duodenal cancers. duodenum. a complete colonoscopy is recommended. Flexible sigmoidoscopy is an exam of the rectum and the lower colon using a viewing tube (a short version of colonoscopy). Patients with a high risk of developing colorectal cancer may undergo colonoscopies starting at earlier ages than 50. Many other conditions can cause occult blood in the stool. The recommendations differ depending on the genetic defect. at least 20% of colon cancers can be missed by stool occult blood screening. urine examinations for ureter cancer. Recently doctors are recommending screening colonoscopies instead of screening flexible sigmoidoscopies for healthy individuals starting at ages 50-55. or five years earlier than the earliest precancerous colon polyp discovered in a first-degree relative. AFAP. HNPCC. colonoscopies may begin during teenage years to look for the development of colon polyps. Genetic counseling and testing Blood tests are now available to test for FAP. These tests are both convenient and inexpensive. MYH. etc. The advantages of genetic counseling followed by genetic testing include: (1) identifying family members at high risk of developing colon cancer to begin colonoscopies early. A small amount of stool sample is smeared on a special card for occult blood testing. colonoscopies. three consecutive stool cards are collected. Even under ideal testing conditions. Many patients with colon polyps are tested negative for stool occult blood. and other tests to exclude colon cancer. patients with family history of colon cancer are recommended to start screening colonoscopies at an age 10 years before the earliest colon caner diagnosed in a first-degree relative. Patients with a long history (greater than 10 years) of chronic ulcerative colitis have an increased risk of colon cancer. A person who tests positive for stool occult blood has a 30% to 45% chance of having a colon polyp and a 3% to 5% chance of having a colon cancer. uterus.

and a low resistance to infections. There is a decreased local recurrence of rectal cancer in patients receiving radiation either prior to or after surgery. It is a systemic therapy. Additional experimental agents considered for the treatment of colon cancer include the use of cancer-seeking antibodies bound to cancer-fighting drugs. in the hospital as a outpatient. The risk of metastasis is proportional to the depth of penetration of the cancer into the bowel wall. nausea. surgery is often the only treatment needed. eggs. Side effects of radiation treatment include fatigue. the tumor. Chemotherapy is given shortly after surgery to destroy these microscopic cells. Chemotherapy is usually given in a doctor's office. Chemotherapy is usually given in cycles of treatment periods followed by recovery periods. and skin irritation in the treated areas. Other treatments have included the use of localized infusion of chemotherapeutic agents into the liver. Without radiation. Therefore. Side effects. Cells in the hair roots and intestines also divide rapidly. nondigestible part of plant material present in fruits. red blood cells. The long-term prognosis after surgery depends on whether the cancer has spread to other organs (metastasis). the most common site of metastasis. dairy products. These patients are at risk of tumor recurrence either locally or in distant organs. vomiting. These patients can experience long-term survival in excess of 80%. anticancer medications destroy cells that are rapidly growing and dividing. mouth sores. In addition. Fiber is the insoluble. however. chemotherapy can cause hair loss. On the other hand. The surgeon then reconnects the healthy sections of the bowel. Therefore. temporary or permanent pelvic hair loss. or at home. thus allowing less time for a potential carcinogen to react with the intestinal lining. Common side effects include anemia. Chemotherapy in these patients may delay tumor recurrence and improve survival. Most drug regimens have included the use of 5-flourauracil (5-FU). For additional information. In some patients. wherein the tumor has penetrated beyond the bowel wall and there is evidence of metastasis to distant organs. please read the Colon Cancer Prevention article. In patients with advanced colon cancer. In patients with early colon cancer which is limited to the superficial layer of the bowel wall. loss of energy. Radiation therapy in colorectal cancer has been limited to treating cancer of the rectum. and most patients with colostomies return to a normal lifestyle. In general. but the cancer has penetrated deeply into the colon wall or reached adjacent lymph nodes. Specially trained nurses (enterostomal therapists) can help patients adjust to colostomies. During surgery. Chemotherapy given in this manner is called adjuvant chemotherapy. the five-year survival rate is less than 10%. It is postulated that high fiber in the diet leads to the creation of bulky stools which can rid the intestines of potential carcinogens. Recent studies have shown increased survival and delay of tumor recurrence in some patients treated with adjuvant chemotherapy within five weeks of surgery. meaning that the medication travels throughout the body to destroy cancer cells. Major sources of fat are meat. and white blood cells are frequently affected by chemotherapy. easy bruising. there is no evidence of distant metastasis at the time of surgery. and diarrhea. The surgeon then creates an opening (colostomy) on the abdomen wall through which solid waste in the colon is excreted. and whole-grain breads and cereals. Chemotherapy is the use of medications to kill cancer cells. a small margin of the surrounding healthy bowel. Response rates for these treatments have been reported to be as high as eighty percent. In patients with rectal cancer. can be serious. the risk is lowered to approximately 7%. Improvement in the overall survival for patients with widespread metastasis has not been convincingly demonstrated.People can change their eating habits by reducing fat intake and increasing fiber (roughage) in their diet. After colon cancer surgery. Such combinations can specifically seek and destroy . What are the treatments and survival for colon cancer? Surgery is the most common treatment for colorectal cancer. some patients may harbor microscopic metastasis (small foci of cancer cells that cannot be detected). platelets . the risk of rectal cancer recurrence is close to 50%. and adjacent lymph nodes are removed. With radiation. and oils used in cooking. Modern chemotherapy agents are usually well tolerated. vegetables. Side effects of chemotherapy vary from person to person. fiber leads to the more rapid transit of fecal material through the intestine. and side effects are manageable. and also depend on the agents given. chemotherapy for shrinking or controlling the growth of metastatic tumors has been disappointing. the rectum is permanently removed. This involves the insertion of a pump into the blood supply of the liver which can deliver high doses of medicine directly to the liver tumor. salad dressings.

the bodies' own defense system. . In this treatment. In patients who are poor surgical risks.tumor tissues in the body. a light sensitive agent is taken up by the tumor which can then be activated to cause tumor destruction. but who have large tumors which are causing obstruction or bleeding. in an effort to more effectively attack and control colon cancer. Other treatments attempt to boost the immune system. laser treatment can be used to destroy cancerous tissue and relieve associated symptoms. Still other experimental agents include the use of photodynamic therapy.