If You Have been diagnosed or may have Colorectal Cancer

The colon and rectum are part of the large intestine. Colorectal cancer occurs when tumors form in the lining of the large intestine. It is common in both men and women. The risk of developing colorectal cancer rises after age 50. You're also more likely to get it if you have colorectal polyps, a family history of colorectal cancer, ulcerative colitis or Crohn's disease, eat a diet high in fat, or smoke.

Types and Symptoms:

Colorectal cancer might not cause symptoms right away, but if it does, it may cause one or more of these symptoms:

• A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
• A feeling that you need to have a bowel movement that's not relieved by having one
• Rectal bleeding with bright red blood
• Blood in the stool, which might make the stool look dark brown or black
• Cramping or abdominal (belly) pain
• Weakness and fatigue
• Unintended weight loss

Colorectal cancers can often bleed into the digestive tract. Sometimes the blood can be seen in the stool or make it look darker, but often the stool looks normal. But over time, the blood loss can build up and can lead to low red blood cell counts (anemia). Sometimes the first sign of colorectal cancer is a blood test showing a low red blood cell count.

Some people may have signs that the cancer has spread to the liver with a large liver felt on exam, jaundice (yellowing of the skin or whites of the eyes), or trouble breathing from cancer spread to the lungs.

Many of these symptoms can be caused by conditions other than colorectal cancer, such as infection, hemorrhoids, or irritable bowel syndrome. Still, if you have any of these problems, it’s important to see your doctor right away so the cause can be found and treated, if needed.

Tests:

As part of a physical exam, your doctor will feel your abdomen for masses or enlarged organs, and also examine the rest of your body. You may also have a digital rectal exam (DRE). During this test, the doctor inserts a lubricated, gloved finger into your rectum to feel for any abnormal areas.

Tests to look for blood in your stool

If you are seeing the doctor because of anemia or symptoms you are he or she may recommend a stool test to check for blood that isn’t visible which might be a sign of cancer. These types of tests are done at home and require you to collect 1 to 3 samples of stool from a bowel movement.

Blood tests

Your doctor might also order certain blood tests to help determine if you have colorectal cancer. These tests also can be used to help monitor your disease if you’ve been diagnosed with cancer.

• Complete blood count (CBC): This test measures the different types of cells in your blood. It can show if you have anemia (too few red blood cells). Some people with colorectal cancer become anemic because the tumor has been bleeding for a long time.
• Liver enzymes: You may also have a blood test to check your liver function, because colorectal cancer can spread to the liver.
• Tumor markers: Colorectal cancer cells sometimes make substances called tumor markers that can be found in the blood. Tumor marker tests are used most often along with other tests to monitor patients who have already been diagnosed with colorectal cancer. They may help show how well treatment is working or provide an early warning that a cancer has returned.

Diagnostic colonoscopy

A diagnostic colonoscopy is just like a screening colonoscopy, but it's done because a person is having symptoms, or because something abnormal was found on another type of screening test. For this test, the doctor looks at the entire length of the colon and rectum with a colonoscope, a thin, flexible, lighted tube with a small video camera on the end. It is inserted through the anus and into the rectum and the colon. Special instruments can be passed through the colonoscope to biopsy or remove any suspicious-looking areas such as polyps, if needed. A colonoscopy may be done in a hospital outpatient department, in a clinic, or in a doctor’s office.

Proctoscopy

This test may be done if rectal cancer is suspected. For this test, the doctor looks inside the rectum with a proctoscope, a thin, rigid, lighted tube with a small video camera on the end. It’s put in through the anus. The doctor can look closely at the inside lining of the rectum through the scope. The tumor can be seen, measured, and its exact location can be determined. For instance, the doctor can see how close the tumor is to the sphincter muscles that control the passing of stool.

Biopsy

Usually if a suspected colorectal cancer is found by any screening or diagnostic test, it is biopsied during a colonoscopy. In a biopsy, the doctor removes a small piece of tissue with a special instrument passed through the scope. Less often, part of the colon may need to be surgically removed to make the diagnosis.

Understanding your stage:

Each stage reflects how the disease has advanced into or through the colon or rectum or has spread to nearby or distant organs. Doctors also use the TNM system to more precisely determine the extent of certain cancers in each stage.

This is how the system is defined:

T (tumor): This describes the size of the original tumor.

N (node): This indicates whether the cancer is present in the lymph nodes.

M (metastasis): This refers to whether cancer has spread to other parts of the body.

A number (0-4) or the letter X is assigned to each factor. Using this colorectal cancer staging system, a higher number indicates increasing severity. For instance, a T1 score indicates a smaller tumor than a T2 score. The letter X means the information could not be assessed.

Once the T, N and M scores have been assigned, one of these overall stages is determined:

Stage 0: Abnormal cells or growths, such as polyps, are found on the mucosa (the inside lining of the colon or rectum). This is known as carcinoma in situ because the cells are confined to their place of origin and there is no evidence they have spread to other layers of the colon or rectum or to lymph nodes or have metastasized to other organs. Cells found in stage 0 colorectal cancer may be cancerous or precancerous.

Stage I colorectal cancer: The cancer has grown into the intestinal wall, through the mucosa (the inner lining) and into the submucosa and may have entered the muscle. There is no evidence the cancer has spread to lymph nodes or distant organs.

Stage II colorectal cancer: There are three categories:

Stage IIA: The cancer has grown into the outermost layer of the colon or rectum but has not grown through it. It has not reached nearby organs or lymph nodes and has not spread to distant organs.

Stage IIB: The cancer has grown through all the layers of the colon or rectum but has not spread to lymph nodes or distant organs.

Stage IIC: The cancer has grown through all the layers of the intestine and has grown into nearby organs or tissues. The cancer has not spread to the lymph nodes or distant organs.

Stage III colorectal cancer: There are three categories:

Stage IIIA: The cancer has grown into the intestine wall, through the inner lining and may have entered the muscle. The cancer has spread to up to three lymph nodes near the site of the primary tumor.

Stage IIIB: The cancer has grown into or through the outermost layer of the colon or rectum and may have spread into nearby organs or tissues. The cancer has spread to up to three lymph nodes near the primary site but has not spread to distant organs.

Stage IIIC: The cancer has grown into or through the outermost layer of the colon or rectum and may have spread to four or more lymph nodes near the primary site. The cancer has also spread to nearby organs.

Stage IV colorectal cancer: The most advanced stage of colorectal cancer. If you have been diagnosed with stage IV colorectal cancer, it means that the cancer has metastasized to distant sites, such as the liver or lungs. The cancer may or may not have grown through the wall of the colon or rectum, and lymph nodes may or may not have been affected.

Stage IV colorectal cancer is further divided into two categories, depending on whether or not the metastasis has affected more than one organ. The original tumor can be of any size and lymph nodes may or may not be involved, but if the cancer has spread to one different organ it is considered stage IVA, while more than one organ would be defined as stage IVB.

Stage IV colorectal cancer can be defined by any T or N category, with the only difference stemming from whether the M1 or M2 assignment is more appropriate.

In both forms of stage IV colorectal cancer, the tumor can be of any size (T), and lymph nodes may or may not be involved (N). M1a indicates that the cancer has spread to just one organ, while M1b would mean that more than one organ has been affected.

Treatment

The standard of care for all stages of Colorectal Cancer is to surgically remove as much of the cancer as possible. If you have early-stage cancer, your surgeon may be able to remove the tumor without making an incision in your abdomen, instead using a surgical tool inserted into the rectum. Larger tumors generally require a more complex surgery. Your surgeon will remove the tumor (this is called a resection) and a small amount of healthy tissue surrounding the tumor. By removing the tissue flanking the tumor, your surgeon will be more confident she got the entire tumor. After the resection, she will sew the healthy ends of your colon back together.