COLON CANCER

Definition
Signs & symptoms
Treatment
Root of the disease

What is the colon?

Colon or commonly known as the large bowel is made up of

the colon ascending, transverse, descending & sigmoid colon
It is approximately 5 feet long and together with the rectum &
anus it is referred to as colorectal

Colorectal cancer (CRC)

CRC is the third most common cancer in Canada but is the second
commonest cause of death from cancer in both men and women
Around 423 Canadians are diagnosed with CRC each week while
175 die each week from this disease
During life time of a Canadian
One in 14 in men and one in 15 women is expected to develop
CRC
Colon cancer has been found to be more common in women while
in men, rectal cancer is more common
Age is considered as a major risk factor for the development of
CRC
The condition is rare before the age of 40 years but the risk
increases with age with a peak of incidence seen between the
ages 60-70

Colorectal cancer (CRC)

Staging of CRC provides a guide on the best treatment option

for that particular patient and also helps in to evaluate the
prognosis.

Colorectal cancer (CRC)

Several staging systems exist but most common ones are

TNM method - primary tumour (T), the status of regional lymph nodes (N),
and the presence or absence of distant metastases (M) used commonly

Dukes classification

Signs & symptoms

CRC patients may present in three ways

Patient complaining of clinical features suggestive of CRC
During screening of high risk patients
Emergency admission from features of CRC e.g. intestinal
obstruction
Signs and symptoms of CRC is non specific in most of the
patients
Early symptoms mimic variety of other diseases of the large
intestines
Some patients may present initially with features of metastatic
disease (spread out of the colon) e.g. enlarged liver, ascites

Signs & symptoms

Some of the common presenting symptoms are as follows

Abdominal pain
A change in the normal bowel habit e.g. diarrhoea,
constipation or both
Blood in stools
Abdominal distension
Weight loss
Feeling of incomplete evacuation of bowel
weakness
Physical findings may include:
Abdominal lump
Palpable mass, blood on digital rectal examination
Metastatic features enlarged liver, ascites

Signs & symptoms

Treatment

Surgical resection of the tumour remains the best treatment

method for localised disease
Type of surgery depends on the stage of the disease
Chemotherapy, immunotherapy (both given systemically),
radiotherapy (local)
Carried out for CRC which has spread beyond the colon
Surgery may sometime be combined with chemotherapy and
radiotherapy or both modalities
This can be done before the surgery or after the surgery
Used to reduce the progression of disease after surgery and
to improve overall survival
Sometimes used to reduce the size of the tumour before
surgery

Treatment

Root of the disease

How does a cancer develop?

Normal cells in the body respond to various

extracellular stimuli & these in turn activates genes that
stimulate cell growth
Cancer arises when a normal cell, for variety of reasons
escapes the normal restrictions placed on its growth and
begins to divide in an abnormal fashion
These extracellular stimuli can be divided in to genetic
and environmental

Root of the disease

Colon cancer can be described as an multifactorial disease in

which more than one stimuli is responsible for the cause of the
disease
Around 80% of cases are sporadic
The following are considered as causes of colon cancer
Genetic factors (about 20% have an inheritable component)
A family history of CRC, specially if a single first degree
relative is affected the risk is increased 2-3 folds while if 2
are affected the risk increases to 3-4 fold
People with polyps e.g. - familial adenomatous
polyposis (FAP) has an almost 100% risk of developing
colon cancer by age 40 years
People with a family history of other cancers e.g. breast,
uterine ovarian

Polyps

Root of the disease

Environmental factors
Diet

a lot of red meat and processed meats increases bowel

cancer risk (Poultry meat doesnt increase the risk).

Alcohol
Fiber containing diet (fruits, vegetables, cereals etc),
calcium and dairy has a protective effect
Obesity (high BMI)
Inflammatory conditions of the colon e.g. Ulcerative colitis
or Crohn;s disease

Colorectal cancer (CRC)

Majority of CRC develops from a growth called polyps which

overtime may turn into a cancer
Normal colonic epithelium changes into adenomatous
polyps which later transforms into invasive colorectal
cancer
Previously mentioned stimuli are responsible for this
transformation

Colorectal cancer (CRC)

References

Cancer research UK. Bowel cancer

Colon Cancer Canada. Fast facts on colorectal cancer
Colorectal cancer: symptoms, diagnosis and treatment. Nationa
l Institute of Health magazine. 2009; Volume 4 Number 2
Merck Manuals Professional Edition. Colorectal cancer
British Medical Journal (BMJ). Best practice
Kumar and Clark's Clinical Medicine, 8th Edition