Colon Cancer Treatment

Answer 1

Alternative Names

Screening for colon cancer; Colonoscopy - screening; Sigmoidoscopy - screening; Virtual colonoscopy - screening

Information

Colon cancer screening can detect polyps and early cancers. Such screening can find abnormalities that can be treated before cancer develops or spreads. Regular screenings may decrease deaths and prevent pain caused by colorectal cancer.

TOOLS OR TESTS

Several tools may be used, either alone or together, to screen for colon cancer:

The first method is a stool test that checks your bowel movements for blood.

• Polyps in the colon and smaller cancers often cause small amounts of bleeding that cannot be seen with the naked eye.
• The most common method used is the fecal occult blood test(FOBT). Newer stool tests are called the fecal immunochemical test (FIT) and stool DNA test (sDNA).

The second method is a sigmoidoscopy exam.

• This test uses a flexible small scope to look at the lower part of your colon. Because it only looks at the last one-third of the large intestine (colon), it may miss some cancers.
• A stool test and sigmoidoscopy should be used together.

The third method is a colonoscopy. A colonoscopy is similar to a sigmoidoscopy, but the entire colon can be viewed. You will usually be mildly sedated during a colonoscopy.

Two other methods may be used:

• Double-contrast barium enemy, a special x-ray of the large intestine, which includes the colon and rectum
• Virtual colonoscopy -- a type of x-ray that uses computer software to create an image

A test called capsule endoscopy (swallowing a small, pill-sized camera) is also being studied, but it is not recommended for standard screening at this time.

SCREENING FOR AVERAGE-RISK PEOPLE

There is not enough evidence to state which screening method is best. Discuss with your doctor which test is most appropriate for you.

Beginning at age 50, both men and women should have a screening test. Some health care providers recommend that African Americans begin screening at age 45.

Screening options for patients with an average risk for colon cancer:

• Colonoscopy every 10 years
• Double-contrast barium enema every 5 years
• Fecal occult blood test (FOBT) every year - if results are positive, a colonoscopy is needed
• Flexible sigmoidoscopy every 5 - 10 years, usually with stool testing FOBT done every 1 - 3 years
• Virtual colonoscopy every 5 years

SCREENING FOR HIGHER-RISK PEOPLE

People with certain risk factors for colon cancer may need earlier (before age 50) or more frequent testing.

More common risk factors are:

• A family history of inherited colorectal cancer syndromes, such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC)
• A strong family history of colorectal cancer or polyps. This usually means first-degree relatives (parent, sibling, or child) who developed these conditions younger than age 60.
• A personal history of colorectal cancer or polyps
• A personal history of chronic inflammatory bowel disease (for example, ulcerative colitis or Crohn's disease)

Screening for these groups of people is more likely to be done using colonoscopy.

See also: Colon cancer

References

Whitlock EP, Lin JS, Liles E, Beil TL, Fu R. Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;149:638-658.

Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM; American College of Gastroenterology. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104:739-750.

Lieberman DA. Clinical practice. Screening for colorectal cancer. N Engl J Med. 2009;361:1179-1187.

Burt RW, Barthel JS, Dunn KB, et al. NCCN clinical practice guidelines in oncology. Colorectal cancer screening. J Natl Compr Canc Netw. 2010;8:8-61.

Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58:130-160.

Reviewed By

Review Date: 11/08/2010

George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 2

Alternative Names

Screening for colon cancer; Colonoscopy - screening; Sigmoidoscopy - screening; Virtual colonoscopy - screening

Information

Colon cancer screening can detect polyps and early cancers. Such screening can detect changes that can be treated before symptoms develop. Regular screenings may decrease deaths and prevent pain caused by colorectal cancer.

Several tools may be used, either alone or in combination, to screen for colon cancer:

1. The first method is stool tests that examine your bowel movements to check for blood. Polyps in the colon and smaller cancers often cause small amounts of bleeding that cannot be seen with the naked eye. The most common one used is the fecal occult blood test(FOBT). Newer stool tests are called the fecal immunochemical test (FIT) and stool DNA test (sDNA).
2. The second method is a sigmoidoscopy exam. This test uses a flexible small scope to look at the lower part of your colon. Because it only looks at the last one-third of the large intestine (colon), it may miss some cancers. Most health care providers recommend that the stool test and sigmoidoscopy be used together.
3. The third method is a colonoscopy exam. A colonoscopy is similar to a sigmoidoscopy, but it allows the entire colon to be viewed. You will usually be mildly sedated during a colonoscopy.

SCREENING RECOMMENDATIONS FOR AVERAGE-RISK PEOPLE

There is not enough evidence to determine which screening method is best. Discuss with your doctor which test is most appropriate for you.

Beginning at age 50, both men and women should have a screening test. Some health care providers recommend that African Americans begin screening at age 45.

Screening options for patients with an average risk for colon cancer:

• Colonoscopyevery 10 years
• Double-contrast barium enema every 5 years
• Fecal occult blood test (FOBT) every year - if results are positive, a colonoscopy is needed
• Flexible sigmoidoscopy every 5 - 10 years, usually with stool testing FOBT done every 1 - 3 years
• Virtual colonoscopy every 5 years

A test called capsule endoscopy (swallowing a small, pill-sized camera) is also being studied, but it is not yet recommended for standard screening at this time.

SCREENING RECOMMENDATIONS FOR HIGHER-RISK PEOPLE

People with certain risk factors for colon cancer may need earlier (before age 50) or more frequent testing.

More common risk factors are:

• A family history of inherited colorectal cancer syndromes, such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC)
• A strong family history of colorectal cancer or polyps. This usually means first-degree relatives (parent, sibling, or child) who developed these conditions younger than age 60.
• A personal history of colorectal cancer or polyps
• A personal history of chronic inflammatory bowel disease (for example, ulcerative colitis or Crohn's disease)

Screening for these groups of people is more likely to be done using colonoscopy.

Recently there has been interest in several new screening tests for colon cancer, including checking DNA in stool samples and the fecal immunochemical test (FIT).

See also: Colon cancer

References

Whitlock EP, Lin JS, Liles E, Beil TL, Fu R. Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;149:638-658.

Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM; American College of Gastroenterology. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104:739-750.

Lieberman Da. Clinical practice. Screening for colorectal cancer. N Engl J Med. 2009;361:1179-1187.

Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58:130-160.

Answer 3

Normal anatomy

The colon, or large intestine, is a muscular tube that begins at the end of the small intestine and ends at the rectum. The colon absorbs water from liquid stool that is delivered to it from the small intestine.

Indication

Colon cancer is the third most common cancer in the United States. Risk factors include a diet low in fiber and high in fat, certain types of colonic polyps, inflammatory bowel disease (such as Crohn's disease or ulcerative colitis), and certain hereditary disorders.

Incision

The treatment of colon cancer depends on the stage of the disease. Stage I cancer is limited to the inner lining of the colon; stage II cancer involves the entire wall of the colon; stage III cancer has spread to the lymph nodes; stage IV cancer has spread to other organs (metastasized).

Procedure

Surgery is the main treatment for colon cancer and removal of the involved colon is required. If the cancer is located near the rectum, a colostomy may be necessary. For stage I and II colon cancer, surgery is usually the only treatment. For stage III or IV colon cancer, chemotherapy is necessary after surgery. There is also some suggestion that chemotherapy may also be helpful in some selected stage II patients. Chemotherapy involves a course of drugs which are toxic to cancer cells.

Aftercare

Stage I and II colon cancer have very high cure rates (60% to 90%); lower cure rates are seen with stage III and IV colon cancer. To detect colon cancer early, when it is most curable, everyone over the age of 55 should have bi-annual endoscopic examinations of the colon.

Reviewed By

Review Date: 02/07/2012

Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 4

Treatments for colon cancer normally includes, surgery, chemotherapy, radiation, and diet changes.

Answer 5

The American Cancer Society has recommended the following screening protocol for those at normal risk over 50 years of age

Answer 6

The colorectal cancer screening can be in the clinic, hospital or even at your own home. Your doctor will give you a kit for you doing it at home and then send it to the lab for testing.

Answer 7

Colon cancer screening is done at your local hospital. For example, Markham-Stouffville Hospital serves York Region with regular colon screening clinics.

Answer 8

colonoscopy