Colorectal Cancer

By: Erin Brink, Michaela Peramaki, Raegan Hickok, and Kyra Bussell
Prevalence/Incidence/Etiology
● Etiology
○ Presence of mutated cells (cancer) at the end of the GI tract near the rectum and colon
● Populations, Prevalence, Incidence
○ 1/23 men, 1/25 women
○ More common in older populations, African Americans and Ashkenazi Jews
● Risk Factors
○ Unchangeable: 50+, personal or family history, inherited syndromes, AA, Ashkenazi Jews, type 2
diabetes
○ Changeable: overweight, obese, inactive, certain diets, smoking, alcohol use
● Transmission
○ Not transmitted from person to person
○ Healthy cells in colon develop mutations in their DNA, if metastatic → transmitted throughout
the body
● Genetics
○ Common genetic associations: Lynch syndrome, familial adenomatous polyposis
○ Uncommon genetic associations: Peutz-Jeghers syndrome, MUTYH associated polyposis
○ Higher risk with familial history
● Prevention
○ Cannot be prevented
○ Addressing changeable risk factors can less or lower risk
○ Early detection via: colonoscopy
○ Some studies suggest NSAIDS, HRT for women and certain vitamins, calcium, and magnesium
may lower risk
Pathology
What type of organism (pathogen) is responsible?
● Colorectal cancer is still vastly researched. Many studies
do not clearly state ONE single cause for the cancer.
● Many state environmental factors, bacteria, genetics, etc
● A study named the “Four Horsemen” states that the 4
researched bacteria have an impact:
○ Fusobacterium nucleatum,
○ Escherichia coli,
○ Bacteroides fragilis
○ Salmonella enterica
● Other studies have found that bacteria involved could be
HPV, streptococcus bovis, streptococcus galloliticus
Tissue Damage Location?
● Tissue damage occurs in the colon, intestines and
rectum.
Pathology Continued
Multiple mechanism are being researched on colorectal cancer
● Intestinal dysbiosis- unbalanced bacteria
● Inflammation
● Evasion of tumoral immune response and activation of pro-tumoral signaling
pathways
Cells involved and how they are affected
● Adenoma is formed via some sort of mechanism above
● Epithelial cells become cancerous through multiple gene mutations
● There is a functional lose of APC (adenomatous polyposis coli) and thus lack
of identification and demolition of tumors
● In return, b-catenin is activated in the cells and causes transformation and
division of the tumor cells (promote proliferation)
● This lack of APC tumor suppressor will decrease T-cell production and
decrease mast cells as well
Stages of Colorectal Cancer
Stage I Stage II Stage III Stage IV

● The cancer is ● The cancer has ● The cancer has ● The cancer has
contained in the grown through now spread to spread to many
inner walls of the all the layers of many adjacent adjacent lymph
rectum. the walls of the lymph nodes nodes and now
● In this stage, bowels. ● Not in the has spread to
there is no spread ● Still has not organs. other organs
to surrounding expanded into ● EX- liver, lungs,
lymph nodes + the lymph nodes etc.
organs. + organs.
Pathology Continued
● Secondary complications may include:
○ Blockage of the colon, causing bowel
obstruction
○ Cancer returning in the colon.
○ Cancer spreading to other organs or
tissues (metastasis)
○ Development of a second primary
colorectal cancer
● Latency Period- 5-10 years to develop
Diagnosis

● Blood tests - supportive of colorectal diagnosis but not used alone to

diagnose
○ Complete blood cell count
○ Liver Enzymes
○ Tumor markers
● Diagnostic colonoscopy
● Proctoscopy
○ Uses an instrument to examine the anal cavity, rectum, sigmoid colon
● Biopsy
● Imaging tests such as
○ Ultrasound, X-Ray, MRI, Angiography, CT-Scan
Treatment
● Stage 0
○ Removal surgery
● Stage 1
○ Multiple removal surgeries needed
● Stage 2
○ Surgery
○ Chemotherapy may also be necessary
● Stage 3
○ Surgery
○ Chemotherapy
○ Possible radiation
● Stage 4
○ Surgery
○ Chemotherapy
○ Radiation
○ Immunotherapy drugs
Signs and Symptoms

● Change in bowel habits

○ Diarrhea
○ Constipation
○ Narrowing of stool
● Weakness and fatigue
● Feeling like you need to make a bowel movement but cannot, and not feeling
relieved after having a bowel movement
● Bright red rectal bleeding
● Blood in stool
● Unintentional weight loss
● Blood test showing a low red blood cell count
Prognosis
● Mortality Rate and Outcomes
○ Will cause around 52,980 deaths in 2021
○ 5 year survival rate is 65%
● Types and Timing of Problems
○ Early stages may present with no problems
○ Later on problems include: change in bowel habits, weakness, fatigue, unexplained weight loss,
and abdominal discomfort
■ Vary by individual
■ Some resolved via treatment others may remain
● Treatment Effectiveness
○ Surgery, radiation, and drug treatments help control growth, reduce metastasis and potentially
cure cancer
○ Effectiveness depends on the stage in which the cancer is detected
○ Surgery cures roughly 50% of patients
● Long Term Disabilities
○ Chronic diarrhea, frequent bowel movements, inability to hold stool, numbness or tingling in
fingers due to chemotherapy
● Rehabilitation/ PT Prognosis
○ Patients struggling with incontinence, general weakness and neuropathy may see PT
■ Benefit from PT before and after treatment, focusing on pelvic floor
■ 3-6 months for recovery after colorectal cancer treatment is completed
Implications for Physical Therapists
Physical therapists need to be cautious of:
● Excessive fatigue
● Weakened bones causing them to easily fracture
● Infections of any surgical incisions
● Balance and coordination issues potentially coming from chemo,
patients are likely to get injured if not monitored closely
The goal:
● Strengthen pelvic floor after treatment as well is before treatment
● Enhancing quality of life
● Strengthening patient in order to handle treatments which can help increase survival rate
● Exercise can help boost immune system
● Increasing aerobic capacity
● Maintaining bone density
● Reduce any swelling
Clinical Pearls

● Individuals are at a higher risk for colorectal cancer if they have familial
history
● PT can occur before and after treatment in order to strengthen the pelvic floor
and help with a better outcome
● Watch for change in bowel movements, blood in the stool, and weight loss
Test Questions

1. T/F Colorectal cancer has a lower risk if there is familial history

a. True
b. False
2. Surgery for colorectal cancer cures roughly __% of patients
a. 5%
b. 25%
c. 50%
d. 100%
3. T/F Physical therapy before treatment (chemo, radiation, etc.) could result in an
increased survival rate.
a. True
b. False
Test Question Answers

1. b. False
2. c. 50%
3. a. True
Sources

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● What is colorectal cancer? Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/colorectal/basic_info/what-is-colorectal-cancer.htm. Published
February 8, 2021. Accessed October 15, 2021.
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