Clinical Pharmacy: Colorectal Cancer
Colon Cancer
- a type of cancer that begins in the large
intestines (colon); the colon is the final part
of the digestive tract.
- It affects older adults, though it can happen
at any age.
- Usually, it begins as a small, noncancerous
(benign) clump of cells called “Polyps” that
form on the inside of the colon.
- Over time some of these polyps can become
colon cancers.
Polyps
- are abnormal tissue growths that most often
look like small, flat bumps or tiny mushroom
like stalks. Most Polyps are small and less
than half an inch wide. Polyps in the colon
are the most common, but it is also possible
to develops polyps in places that include: Ear
Canal and Cervix
- Polyps may be small and produce few, if any
symptoms. For this reason, doctors
recommend regular screening tests to help
prevent colon cancer by identifying and
removing polyps before they turn into
cancer.
If colon cancer develops, many treatments are
available to help control it, including:
o Surgery
o Radiation Therapy
o Drug Treatments
➢ Chemotherapy
➢ Targeted Therapy
➢ Immunotherapy
Colon Cancer is sometimes called
“Colorectal Cancer”, which is a term that combines
colon cancer and rectal cancer, which begins in the
rectum.
Signs and Symptoms of Colon Cancer
1. Persistent Change in your bowel habits,
including Diarrhea or Constipation or a
Change in the consistency of your stool.
2. Rectal bleeding or blood in your stool.
3. Persistent abdominal discomfort, such as
Cramps, Gas, or Pain
4. A feeling that your bowel doesn’t empty
completely.
5. Weakness or Fatigue
6. Unexplained weight loss
Many people with colon cancer experience no
symptoms in the early stages of the disease. When
symptoms appear, they’ll like to vary, depending on
the cancer’s size and location in your large intestine.
Causes
Doctors aren’t certain what causes most
colon cancers.
In general, it begins when healthy cells in the
colon develop changes (mutations) in their DNA. A
cell’s DNA contains a set of instructions that tell a
cell what to do.
Healthy cells grow and divide in an orderly
way to keep your body functioning normally, but
when a cell’s DNA is damaged and becomes
cancerous, cells continue to divide – even when new
cells aren’t needed.
With time, the cancer cells can grow to
invade and destroy normal tissue nearby. Cancerous
cells can travel to other parts of the body to form
deposits there (metastasis).
 Clinical Pharmacy: Colorectal Cancer

Factors that may increase your risk of Colon ▪ Family history of Colon Cancer
Cancer: - More likely to develop colon cancer if
with a blood relative who has had the
▪ Old Age
disease. If more than one family
- Colon cancer can be diagnosed at any
member has colon cancer or rectal
age, but most people with colon
cancer, your risk is even greater.
cancer are older than 50.
▪ Low-Fiber, High-Fat Diet
- The rates of colon cancer in people
- Colon cancer and Rectal Cancer may
younger than 50 have been
be associated with a typical Western
increasing, but doctors aren’t sure
Diet, which is low in fiber and high in
why.
fat and calories. Research in this area
▪ African American Race
has had mixed results. Some Studies
- They have a greater risk of colon
have found an increased risk of colon
cancer than do people of other races.
cancer in people who eat diets high
▪ A Personal History of Colorectal Cancer or
in read meat and processed meat.
Polyps
▪ A Sedentary Lifestyle
- If you already had colon cancer or
- People who are inactive are more
noncancerous colon polyps, you have
likely to develop colon cancer.
a greater risk of colon cancer in the
Getting regular physical activity may
future.
reduce your risk of colon cancer.
▪ Inflammatory Intestinal Conditions
▪ Diabetes
- Chronic Inflammatory Diseases of
- People with diabetes or insulin
the Colon, such as Ulcerative Colitis
resistance have an increased risk of
and Cronh’s Disease, can increase
colon cancer.
your risk of colon cancer.
▪ Obesity
▪ Inherited Syndromes that Increase Colon
- People who are obese have
Cancer Risk
increased risk of colon cancer and
- Some gene mutations passed
increased risk of dying of colon
through generations of your family
cancer when compared with people
can increase your risk of colon cancer
considered normal weight.
significantly.
▪ Smoking
- Only a small percentage of colon
▪ Alcohol
cancers are links to inherited genes.
- Heavy use of alcohol increases your
The most common Inherited Syndromes that risk of colon cancer.
increase Colon Cancer Risk are: ▪ Radiation Therapy for Cancer
- Radiation therapy directed at the
I. Familial Adenomatous Polyposis (FAP)
abdomen to treat previous cancers
II. Lynch Syndrome, also known as Hereditary
increases the risk of colon cancer.
Nonpolyposis Colorectal Cancer (HNPCC)
 Clinical Pharmacy: Colorectal Cancer

Prevention
❖ Screening Colon Cancer
- Doctors recommend that people
with an average risk of colon cancer
consider colon cancer screening
around age 50.
- But people with an increased risk
should consider screening sooner.
- Several screening options exist –
each with its own benefits and
drawbacks.
- If a Colonoscopy is used for
screening, Polyps can be removed
during the procedure before they
turn into cancer.
❖ Lifestyle changes to reduce your risk of colon
cancer
- You can take steps to reduce your
risk of colon cancer by making
changes in your everyday life. Take
Steps to:
combining a healthy diet with daily
exercise.
- Aim to lose weight slowly by
increasing the among of exercise you
get and reducing the number of
calories you eat.
Diagnosing Colon Cancer
If your signs and symptoms indicate that you could
have colon cancer, your doctor my recommend one
or more tests and procedures, including:
✓ Colonoscopy
- Uses a long, flexible, and slender
tube attached to a video camera and
monitor to view your entire colon
and rectum.
- If any suspicious areas are found,
your doctor can pass surgical tools
through the tube to take tissue
samples (Biopsies) for analysis and
remove polyps.

1. Eat a variety of Fruits, Vegetables,

and Whole Grains

- Fruits, Vegetables, and Whole

Grains contain vitamins, minerals,
fiber, and antioxidants, which may
play a role in cancer prevention.
- Choose a variety of fruits and
vegetables so that you get an array of
✓ Blood Tests
vitamins and nutrients.
- No blood test can tell you if with
colon cancer, but doctor may test
2. Maintain a Healthy Weight
blood for clues about overall health,
such as Kidney and Liver Function
- If you are at a healthy weight,
Tests.
work to maintain our weight by
 Clinical Pharmacy: Colorectal Cancer
-Doctors may also test your blood for
a chemical sometimes produced by
colon cancers called,
“Carcinoembryonic Antigen (CEA).
- Tracked over time, the level of CEA in
blood may help doctor understand
prognosis and whether cancer is
responding to treatment.
✓ Determining the Extent of the Cancer
- If been diagnosed with colon cancer,
doctors may recommend tests to
determine the extent (stage) of
cancer.
- Staging helps determine what
treatments are most appropriate.
✓ Staging Tests may include Imaging
Procedures such as: Abdominal Pelvic, and
Chest CT Scans. In many cases, the stage of
cancer may be fully determined until after
colon cancer surgery.
- The stages of colon cancer are
indicated by Roman Numerals that
range from O to IV, with the lowest
stages indicating the is limited to the
lining of the inside of the colon.
- By Stage IV, the cancer is considered
advanced and has spread
(metastasized) to other areas of the
body.
Treatment
Which treatments are most likely to help depend on
situation, including:
o The Location of your Cancer
o Stage
o Your other health concerns.
Treatment for colon cancer usually involves surgery
to remove the cancer. Other treatments, such as
Radiation Therapy and Chemotherapy, might also
be recommended.
Surgery for Early-Stage Colon Cancer
- If Colon Cancer is very Small, Doctor
may recommend a minimally
invasive approach to surgery, such
as:
A. Polypectomy
- It is a surgical procedure of removing
the polyps, if cancer is small,
localized completely, completely
contained within a polyp and in a vert
early stage, doctor may be able to
remove it completely during a
colonoscopy.
B. Endoscopic Mucosal Resection
- Larger polyps might be removed
during colonoscopy using special
tools to remove the polyp and a small
amount of the inner lining of the
colon in a procedure called an
“Endoscopic Mucosal Resection”.
 Clinical Pharmacy: Colorectal Cancer
B. Ostomy
C. Laparoscopic Surgery
- When it is not possible to reconnect
- Polyps that can’t be removed during
the healthy portions of colon or
a colonoscopy may be removed using
rectum this procedure will be done.
this minimally invasive surgical
- This involves creating an opening in
procedure.
the wall of the abdomen from a
- Surgeons performs the operation
portion of the remaining bowel for
through several small incisions in the
the elimination of stool into a bag
Abdominal Wall – inserting
that fits securely over the opening.
instruments with attached cameras
- Sometimes this is only temporary,
that display your colon on a video
allowing the colon or rectum to heal
monitor.
after surgery.
- Surgeons may also take samples
from lymph nodes in the area where
C. Lymph Node Removal
the cancer Is located.
- Nearby lymph nodes are usually also
removed during colon cancer surgery
Surgery for More Advance Colon Cancer and tested for cancer.

A. Partial Colectomy Surgery for Advanced Cancer

- The surgeon removes the part of
colon that contains the cancer, along
with a margin of normal tissue on
either side of the cancer.
- Surgeon is often able to reconnect
the healthy portions of colon or
rectum. This procedure can
commonly be done by a minimally
invasive approach like Laparoscopy.
If cancer is very advanced or overall health is
very poor, surgeon may recommend an operation to
relieve a blockage of colon or other conditions to
improve symptoms.
This surgery isn’t done to cure cancer, but
instead to relieve signs and symptoms, such as a
blockage, bleeding, or pain.
In specific cases where the cancer has spread
only to the liver or lung, but overall health is
otherwise good, doctor may recommend Surgery or
other Localized Treatments to remove the cancer.

Chemotherapy may be used before or after

this type of procedure. This approach provides a
chance to be free of cancer over the long term.
 Clinical Pharmacy: Colorectal Cancer
A. Chemotherapy
- Uses drugs to destroy cancer cells.
- This is usually given after surgery if
the cancer is large or has spread to
the lymph nodes.
- In this way, it will kill any cancer cells
that remain in the body and help
reduce the risk of cancer recurrence.
- It might also be used before an
operation to shrink a large cancer so
that it’s easier to remove with
surgery.
- Can also be used to relieve symptoms
of colon cancer that can’t be
removed with surgery or that has
spread to other areas of the body.
- Sometimes it is combined with
Radiation Therapy. This approach
may reduce the side effects
compared with the traditional course
of Chemotherapy and may be just as
effective.
- For some people with low-risk stage
III colon cancer, a shorter course of
chemotherapy after surgery may be
possible.
B. Radiation Therapy
- Uses powerful energy sources, such
as X-rays and Protons, to kill cancer
cells.
- It might be used to shrink a large
cancer before an operation so that it
can be removed more easily. When
surgery isn’t an option, radiation
therapy might be used to relieve
symptoms, such as pain.
C. Targeted Drug Therapy
- Focus on specific abnormalities
present within cancer cells. By
blocking these abnormalities,
targeted drug treatments can cause
cancer cells to die.
- This is usually combined with
chemotherapy and are reserved for
people with advanced colon cancer.
D. Immunotherapy
- A drug treatment that uses your
immune system to fight cancer.
- The body’s disease-fighting immune
system may not attack cancer
because the cancer cells produce
proteins that blind the immune
system cells from recognizing the
cancer cells.
- It works by interfering with that
process.
- Reserved for advanced colon cancer.
- Doctors might test cancer cells to see
if they’re likely to respond to this
treatment.
E. Supportive (Palliative) Care
- A specialized medical care that
focuses on providing relief from pain
and other symptoms of a serious
illness.
- It is provided by a team of doctors,
nurses, and other specially trained
professional that work with you, your
family, and you other doctors to
provide an extra layer of support that
complements your ongoing care.
- This form of care is offered alongside
curative or other treatments.