Advanced Colorectal Cancer


 

Overview

If you’re currently battling advanced colorectal cancer, you might feel weighed down by the amount of information you are now confronting. However, an educated patient is much better prepared to work as a true partner with the cancer team to make effective – and informed – treatment decisions. This guide will educate you about the cancer you’re now facing and help you learn about the treatment options available to you.

Colorectal cancer is the fourth-most frequently diagnosed cancer in the United States, and it can begin in either the colon or the rectum. Cancer that begins in the colon is called colon cancer, and cancer that begins in the rectum is called rectal cancer. While colorectal cancer is most often discussed as one type of cancer, there are important differences between colon and rectal cancers.

First, colon cancer is much more common. In 2013, an estimated 102,480 new cases of colon cancer will be diagnosed, compared with 40,340 new cases of rectal cancer. The treatment of the two types of cancer can also differ substantially, which is discussed in the Treatment section. In addition, colon cancer occurs slightly more often in women, and rectal cancer occurs more often in men.

Anatomy of the colon and rectum

Before you can begin to understand colorectal cancer, it’s important to understand the general anatomy of the colon and rectum. Both are major organs in the digestive system, which processes everything you eat and drink (Figure 1). Your digestive system helps your body keep the things it needs, such as vitamins, proteins, water and more, and moves the rest as waste material for your body to eliminate. The colon, also known as the large intestine, is about 6 feet long. The last 6 to 12 inches of the colon make up the rectum and the anal canal. The anal canal ends at the anus, which is the opening of the large intestine to the outside of the body.

 

Risk factors

While the exact causes of colorectal cancer are unknown, research has shown that people with the following risk factors have an increased likelihood of developing the disease.

  • Age: Approximately 90 percent of people diagnosed with colorectal cancer are at least 50 years old, and the average age at diagnosis is 72.
  • Race: The highest rates for both types of cancer are found in African-Americans and Caucasians, and the lowest rates are found in Asian-Americans.
  • Diet: While more information is still needed, diets low in fruits, vegetables and whole grains and high in red meats and processed meats have been linked to an increased risk of colorectal cancer. Obesity also increases the risk of colorectal cancer, especially in men.
  • Smoking and drinking: Long-term smokers are at an increased risk of developing colorectal cancer, as are heavy drinkers.
  • Colorectal polyps: Most colorectal cancers are thought to start as a polyp, or an abnormal growth in the inner lining of either the colon or rectum. Although the majority of polyps are not cancerous, some develop into colorectal cancer, usually over many years. The risk of a polyp containing cancer cells is related to the type of polyp and its size.
  • Inflammatory bowel disease (IBD): IBD includes both ulcerative colitis and Crohn’s disease. Both conditions cause a prolonged inflammation of the colon, which can increase the risk of colorectal cancer.
  • Personal history: A history of polyps leads to an increased risk of colorectal cancer, as does prior colorectal cancer.
  • Family history: Approximately 20 percent of people who develop colorectal cancer have had a close relative who has been affected by the disease. The risk increases if the relative had the cancer before age 45, and the risk is even greater if more than one close relative has had the disease.
  • Genetic alterations: About 5 to 10 percent of people diagnosed with colorectal cancer have inherited gene mutations that cause the disease. The two most common inherited genetic alterations linked with colorectal cancer are hereditary nonpolyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP). Colorectal cancer develops at much younger ages in people with either HNPCC or FAP compared with sporadic cancers (cancers not linked to hereditary mutations). Because of this, if you are younger than 50 when your colorectal cancer is diagnosed, your doctor may suggest genetic counseling and testing for HNPCC or FAP. If you have a genetic mutation, a first-degree relative (sibling, child or parent) will have a 50-percent chance of also having the mutation. Thus, genetic counseling and testing can help not only you but also other members in your family who may be affected by the hereditary mutation.
    • HNPCC: Also called Lynch syndrome, HNPCC accounts for 3 to 5 percent of all colorectal cancer diagnoses. It is caused by changes in genes that normally help repair DNA damage. HNPCC most commonly leads to colon cancer, and the lifetime risk of people with HNPCC developing colorectal cancer may be as high as 80 percent.
    • FAP: Approximately 1 percent of all colorectal cancer diagnoses are caused by FAB. Inherited mutations in the APC gene causes FAP, and many people with the syndrome develop hundreds or thousands of polyps in their colon and rectum at a young age. One or more of these polyps usually becomes cancerous, and unless treated, almost all people with FAP will develop colorectal cancer by age 40.

Take control

Advanced colorectal cancer includes late-stage tumors (see Staging) that have already begun to grow or spread. If you have advanced colorectal cancer, you can help yourself feel more in control by learning as much as you can about the specific characteristics of your disease, your treatment options and ways you can help make yourself healthier, both physically and emotionally. Numerous survivors have credited a balance of regular exercise and plenty of rest to feeling better during and after advanced colorectal cancer treatment. Healthy eating habits also help, as they can help people achieve – and maintain – a healthy weight. Spending time with family and friends, getting involved in support groups and/or participating in religion or spirituality are also credited by survivors as helping them thrive during treatment for advanced colorectal cancer.

This content

This content is primarily for people who have advanced colorectal cancer. Family and friends of people with advanced colorectal cancer can also gain insight and knowledge that will help them provide support to their loved ones.

In the content that follows, you will find information about the diagnosis and staging of advanced colorectal cancer, the treatment options for the disease and ways to manage the physical and emotional side effects that accompany it. You will also find information about financial considerations and support and advocacy groups, and throughout the content you will be directed to additional websites to help you better understand advanced colorectal cancer.

Table 1. Types of colorectal cancer

Adenocarcinoma The most common type of colorectal cancer; cancer of the cells that line the inside tissue of the colon or rectum
Carcinoid tumor Cancer of the hormone-producing cells in the colon or rectum
Gastrointestinal stromal tumor (GIST) Cancer of the cells found in the walls of the gastrointestinal tract, called interstitial cells of Cajal (ICC)
Lymphoma Cancer that begins in the lymph tissue in the colon or rectum

Additional Resources

 

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