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What Are The Signs And Symptoms Of Colon Cancer

RMG Perera by RMG Perera
August 15, 2022 - Updated on October 21, 2023
in Healthy A-Z
What Are The Signs And Symptoms Of Colon Cancer

In this article, we will explore how you can know about colon cancer and its treatments, the signs and symptoms of colon cancer, survival rate.

What Are The Signs And Symptoms Of Colon Cancer

Colon Cancer (CRC) | Introduction

  • Colorectal carcinoma/cancer (CRC)
  • Cancer involving the large intestine and/or rectum
    • Tumor/growth may affect right colon, lest colon, or rectum
    • Malignant growth arises from polyp
Image 01

Epidemiology

  • 3rd-4th most common type of cancer
  • Approximately 5% of cases are attributed to two genetic causes
  • Most common cause of large bowel obstruction in adults
  • Mean age of onset is 70 years of age

Colon Cancer (CRC) | Fisk Factors

  • Older Age
    • >50 years old
  • Family history of CRC
    • First-degree family members under age of 60
  • History of Inflammatory Bowel Disease
  • Ulcerative colitis
Image 02
Credits: Wikipedia
  • Dietary History
    • Low fiber, processed meats
  • Smoking
  • Alcohol consumption
  • Increased BMI
  • Genetic conditions
    • Familial adenomatous polyposis
    • Lynch syndrome
    • Peutz-Jeghers syndrome
    • Gardner syndrome
    • Turcot syndrome

Colon Cancer (CRC) | Pathophysiology

  • Colon cancer arises from colonic polyps (adenomas: adenomatous polyps)
Image 03
  • Adenocarcinomas represent majority of cases
    • Endoluminal adenocarcinomas
    • 98% are adenocarcinomas
Image 04
Credits: Slidetodoc
Image 05
Credits: Slidetodoc

Other tumor types

  • Kaposi’s sarcoma
    • More likely to occur in HIV-positive/AIDS patients
    • Caused by an infection with human herpesvirus-8 (HHV-8)
  • Carcinoid tumors
    • Neuroendocrine tumor
    • May excrete vary large amounts of serotonin
  • Lymphomas

Colon Cancer (CRC) | Metastasis

Variety of patterns of spread of the cancer

01- Direct invasion/extension

  • Grows within bowel, then may spread through bowel wall and invade into other abdominal structures/organs

02- Hematogenous spread

  • Via gastrointestinal veins to the portal circulation
    • Liver metastases are the most common
  • Via lumbar and vertebral arteries
    • May affect lungs, brain

03- Lymphatic system

  • Regional spread

Colon Cancer (CRC) | Signs & Symptoms

  • May be asymptomatic
  • Abdominal pain
  • Stool changes
    • Caliber
    • Frequency
  • Bowel habit changes
    • Alternating constipation and diarrhea
  • Weight loss
  • Melena and/or hematochezia
    • Iron-deficiency anemia

Colon Cancer (CRC) | Other Clinical Features

Signs and symptoms of large bowel obstruction

  • Nausea & vomiting
  • Constipation
  • Obstipation

Rectal Cancer

  • Rectal “fullness”, mass
  • Tenesmus
  • Sensation of incomplete evacuation

Colon Cancer (CRC) | Screening

  • Fecal occult blood testing (FOBT)
    • Also known as stool guaiac test
  • Prone to false positives
Image 06
  • Fecal immunochemical test (FIT)
    • Preferred over FOBT
  • Digital rectal exam (DRE)

Screening should begin at age of 50
Exceptions: Family history of CRC, begin screening at 40; if earlier diagnosis, start screening 10 years before age of onset

Colon Cancer (CRC) | Diagnosis

  • Flexible sigmoidoscopy
    • Can diagnose approximately ¾ of cases
    • Requires FOBT/FIT
  • Colonoscopy (& Biopsy)
    • Most sensitive and specifics
  • Every 10 years, unless abnormalities are found
Image 07
Credits: Wikipedia
  • Barium enema
    • “Apple core” lesion
Image 08
Credits: Researchgate
  • Carcinoembryonic antigen (CEA)
    • Can be used to prognostic purposes (>5 ng/mL)
    • Important to measure prior to treatment and during follow-up to assess for recurrence
  • CT Scan

Colon Cancer (CRC) | Staging

TNM System of staging (“Tumor, Node, Metastasis”)

Stage 1
T: 1,2 Nodes: 0 Metastasis: 0

Stage 2
T: 3,4 Nodes: 0 Metastasis: 0

Stage 3
T: X Nodes: + Metastasis: 0

Stage 4
T: X Nodes: X Metastasis: 1

T1 – Invasion into submucosa
T2 – Invasion into muscularis propria
T3 – Invasion into muscularis propria and into serosa
T4 – Invasion into adjacent structures or organs

N0 – No regional node involvement
N1 – Metastasis in 1-3 regional nodes
N2 – Metastasis in 4 or regional nodes

M0 – No distant metastases
M0 – Distant metastases

Colon Cancer (CRC) | Treatment & Follow-Up

Non-cancerous polyps

  • Polypectomy (colonoscopy)

Surgical resection of cancerous bowel

  • Colectomy with primary anastomosis

Rectal Cancers

  • Higher recurrence rate
  • Resection

Adjuvant therapy in addition to surgery depends on stage of cancer

  • Most often for patients with stage 3
  • 5-Fluorouracil (5-FU)
  • Capecitabine with oxaliplatin
  • FOLFOX

Palliative if distant spread
For those who have recurrence, 90% will occur within 3 years of surgery
CEA measurement – levels that increase after treatment indicate recurrence

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