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Colon cancer and rectal cancer, collectively known every bit colorectal cancer, have many similar characteristics and will be discussed as ane cancer type in this section.

Colorectal cancer is currently the tertiary most common cancer in both men and women. Incidence and mortality rates have been declining since the 1980's, partially due to improvements in screening and prevention. In 2021, the American Cancer Order estimates that there will be approximately 104,270 new cases diagnosed and 52,980 deaths due to colorectal cancer in the United States.1

Beneath is a list of the information establish within this department:

Anatomy of the Colon and Rectum
Risk Factors
Symptoms
Detection and Diagnosis
High Take chances Individuals
Pathology Report & Staging
Colon and Rectal Cancer Tumor Biological science
Treatment
Colon and Rectal Cancer Resources
Department Summary

Larn more about colon and rectal cancer or make an engagement at the Winship Cancer Institute of Emory University.

Anatomy

The colon and rectum are parts of the digestive, or gastrointestinal (GI), system. The purpose of this system is to pause down food, absorb nutrients and h2o, and remove waste from the body.

Food matter is largely broken downward in the tum and and so released into the pocket-size intestine. Most of the nutrients from food are absorbed in this region of the digestive system. The pocket-sized intestine continues into the colon, or large intestine, which is divided into four regions (based on location): ascending colon, transverse colon, descending colon, and sigmoid colon

The main purpose of the colon is to absorb water and mineral nutrients from the food matter and store waste. Waste moves from the colon into the final 6 inches of the digestive system, chosen the rectum, and passes out of the body through the anus.

About 95% of colorectal cancers develop in glandular cells that make up the lining of the colon and rectum.ii A cancer that begins in a glandular prison cell is called an adenocarcinoma. Cancer usually starts in the innermost layer of the lining and slowly progresses through the other layers. The image below is a cross section view of the layers of the colon.

Take chances Factors

Factors that may influence gamble of developing colorectal cancer include3 :

Family History of Colorectal Cancer
Personal History of Chronic Inflammatory Bowel Disease
Diabetes
Age
Diets rich in red or processed meat
Excessive drinking of alcohol
Obesity
Concrete Inactivity
Smoking
Makeup of Microbiome

The relative effects of these and other risk factors in any given example of cancer is variable and very hard to determine with accuracy at this fourth dimension. Some of these and other risk factors are discussed on the following sections.

Watch a clip most colon cancer prevention and then click here to watch the full interview with Dr. Roberd Bostick.

Family History of Colorectal Cancer
Cancer cases can be grouped into 2 wide categories, sporadic and familial. Desultory cancers are those in which the affected individual does not have a known family history of the disease. Familial cancers tend to occur in several generations of a family unit and affected individuals oft accept close relatives (blood brother, sister, begetter) with the same cancer type. It is possible that these individuals inherit lacking genes that lead to the development of a particular cancer blazon. Individuals with a family history of colorectal cancer are at an increased risk of developing the affliction. The caste of risk depends upon the blazon of relative affected. For example, take a chance is higher if an firsthand family fellow member has been diagnosed with colorectal cancer. The more closely related an private is to someone with colorectal cancer, the more than likely they will share the defective genes. Inherited colorectal cancer accounts for less than five% of all colorectal cancer cases.four

The two major colorectal cancer susceptibility syndromes are called familial adenomatous polyposis (FAP) and hereditary not-polyposis colorectal cancer (HNPCC):

Familial adenomatous polyposis (FAP): An aberrant growth in the lining of the colon or rectum is called a polyp. Common types of polyps include adenomatous polyps (adenomas), hyperplastic polyps, and inflammatory polyps. Hyperplastic and inflammatory polyps generally do not pose problems. Adenomatous polyps, however, can progress into cancer.5

FAP is a syndrome caused by mutation of the APC (adenomatous polyposis coli) gene. Individuals who are built-in with this mutation develop hundreds to thousands of adenomatous polyps along their colon and rectum. If left untreated, one or more of these polyps is very probable to progress into cancer.6 The boilerplate age of cancer onset in these individulas is twoscore.7 It is possible to detect and remove adenomatous polyps during screening.

The APC gene volition be discussed in the Colorectal Cancer Tumor Biology section of this page and more tin can be plant on the Cancer Genes page.

Familial adenomatous polyposis: the mucosal surface of the colon is carpeted with numerous early on adenomas. (Epitome courtesy of: C. Whitaker Sewell, MD - Professor of Pathology, Emory University Schoolhouse of Medicine)

Hereditary non-polyposis colorectal cancer (HNPCC): HNPCC, likewise chosen Lynch syndrome, is a syndrome caused by mutation of genes that encode proteins involved in Dna repair, in particular the MLH1, MSH2, MSH6 and PMS2 genes.8 Characteristics of HNPCC include development of cancer past the average age of 45, cancer located in the proximal colon, and increased risk of developing certain cancers located outside the colon.9 HNPCC is not associated with the presence of polyps in the colon or rectum.

The MLH1 and MSH2 mismatch repair genes will be discussed in the Colorectal Cancer Tumor Biological science department of this page.

Historic period

For almost all types of cancer studied to date, it seems every bit if the transition from a normal, healthy cell to a cancer cell is step-wise progression that requires genetic changes in several dissimilar oncogenes and tumor suppressors. This is one reason why cancer is much more prevalent in older individuals. In social club to generate a cancer cell, a series of mutations must occur in the same cell. Since the likelihood of whatever factor becoming mutated is very low, it stands to reason that the chance of several unlike mutations occuring in the same cell is truly very unlikely. For this reason, the cells in a 70 year old torso have had more than time to accumulate the changes needed to form cancer cells but those in a child are much less probable to have acquired the required changes. Of course, some children do get cancer but it is much more common in older individuals. More than ninety% of patients are diagnosed with colorectal cancer over the age of 50.10 The graph below shows colon cancer rates in the U.s. as a function of age. The graph was obtained from the National Cancer Institute. 11

Dietary Factors

Incidence of colon cancer correlates greatly with certain lifestyle factors, including diet. It is very difficult, notwithstanding, to place dietary items that cause a particular cancer. Studies prove correlations between chronic heavy booze consumption and an increased take chances of colorectal cancer.12 On the other hand, some dietary factors are associated with a decreased take chances of colorectal cancer. Enquiry suggests that a nutrition rich in fruits and vegetables may provide a protective effect against the illness.xiii Calcium is also thought to possibly play a protective part. Studies with labratory animals show that calcium may bind to fat acids and bile and decrease their harmful consequence on the cells that make up the lining of the colon.14 The influence of these dietary factors on colorectal cancer risk is a topic even so under debate.

Obesity

Several studies have found an clan betwixt increasing body mass index (BMI) and hazard of colorectal cancer. The association has been found more consistently in men than in women, however. This departure may be caused by the effect of the female person hormone estrogen, which is thought to have a protective effect confronting colorectal cancer. Women with high body mass indexes tend to have higher estrogen levels compared to women with lower trunk mass indexes. The higher estrogen levels may annul the negative furnishings of an elevated BMI.10

Smoking

Studies have plant an association between tobacco utilize and an increased number of hyperplastic polyps in the colon and rectum. While nigh practice not, hyperplastic polyps may sometimes develop into colorectal cancer. The link between tobacco and hyperplastic polyps appears to be more dependent upon how recently the smoking occurred rather than duration of smoking.fifteen

Prevention of colorectal cancer

In that location is evidence that taking non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, can reduce the evolution of colon and rectal cancer.xvi However, taking NSAIDs is linked to increased haemorrhage take a chance; the United states Preventive Services Task Forcefulness (in 2014) published their recommendations against routine use of NSAIDs for the prevention of colorectal cancer.17 According to the 2013 American Cancer Society Written report, consumption of milk and calcium every bit well every bit higher blood levels of Vitamin D likewise appear to decrease colorectal cancer chance.18

Makeup of Microbiome

Studies suggest that bacteria in the gut tin can be responsible for the growth and spread of tumors. Researchers believe that certain types of gut bacteria assist tumors flourish, while others show petty to no upshot. 19

Symptoms

Symptoms

At that place are normally no symptoms associated with early-stage colorectal cancer. The American Cancer Gild lists the following symptoms associated with more advanced stages of colorectal cancer:20

Bleeding in the rectum
Bloody stools (Can be bright red or nighttime depending on the location of the tumor)
A alter in bowel habits
Cramps in the colorectal region
Anemia from the blood loss
Weakness and fatigue
Decreased appetite or weight loss

While these symptoms may be caused by factors unrelated to colorectal cancer, it is important to seek medical attention to rule out cancer.

Detection And Diagnosis

The recent development of several colorectal cancer (CRC) screening options has led to the development of complex guidelines and recommendations. There are many unlike possible combinations of tests yet CRC screening is a cancer prevention tool that is not utilized by many of those who might be helped. Negative perceptions almost some of the procedures and the recent application of the test may make them seem unappealing and/or unnecessary.21 CRC is the second-leading crusade of cancer decease in the United states. CRC screening is both necessary and beneficial. People at high risk for colon cancer should start screening earlier than those with normal risk. After diagnosis in that location are several options for treatment.

The American Cancer Society's National Guidelines recommend that those 50 and over at normal adventure should have regular screening with the post-obit options:21

Detection techniques that identify polyps and cancer:

Sigmoidoscopy every 5 years, or
Colonoscopy every 10 years, or
Double dissimilarity barium enema every 5 years, or
CT colonography (virtual colonoscopy) every 5 years

Screening Methods that primarily detect cancer21

Digital rectal examination
Fecal Occult Blood Tests
- Guaiac Fecal occult blood examination (gFOBT) (every yr)
- Fecal immunochemical exam (FIT) every year
Stool DNA test (sDNA test) interval uncertain

Colon Cancer Detection: Loftier Take chances Individuals

Those at college run a risk for colon cancer due to bowel disorders or a family history of the disease should be screened more than frequently and earlier. CRC runs in some families, but there is not always an identified genetic mutation associated with the manual of the disease. On the other hand, several forms of familial colorectal cancer are associated with specific mutations. These diseases tend to occur at an earlier age. In that location are several syndromes that autumn under this category. For example, familial adenomatous polyposis (FAP) causes the formation of numerous colonic polyps, often numbering in the hundreds. Any of these polyps has the potential to become cancerous. Because of the extreme run a risk of cancer with this syndrome, patients with a family history of the disease should begin screening at adolesence. Preventative surgery may be performed to prevent cancer formation.

Hereditary Non-Polyposis Colorectal Cancer (HNPCC) is another inherited condition that places individuals at high risk for colon cancer. This syndrome results in the formation of only a few polyps, but they occur at a very young age. It is suggested that people diagnosed with this syndrome exist screened every 1-2 years starting at the age of 25 or 10 years prior to the youngest CRC diagnosis in their family. Other syndromes with an increased risk in developing CRC are Peutz-Jeghers syndrome, Juvenile Polyposis, and Cowden syndrome. Testing for these syndromes tin take fiscal and psychological implications. Consultation with a genetic counselor provides patients with their available options.21

Pathology Study And Staging

The Pathology Report

If there is a suspicion that a patient may have colorectal cancer, a sample of of tissue (biopsy) may be taken for examination. After a biopsy is taken, the medico who performed the biopsy sends the specimen to a pathologist. The pathologist examines the specimens at both the macroscopic (visible with the naked center) and microscopic (requiring magnification) levels and so sends a pathology study to the physician. The study contains information about the tissue's appearance, cellular brand up, and whether or non the sample appears to be normal or abnormal. For more than information nearly the pathology report, refer to the Diagnosis & Detection section.

Adenocarcinoma arising within a gland of an adenoma of the colon: Annotation the very night staining of the malignant cells, and the presence of nuclei at all levels within the cells. Compare the cells of the adenoma (summit of the gland) with the carcinoma cells (bottom portion of the gland)
(Image courtesy of: C. Whitaker Sewell, Physician - Professor of Pathology, Emory University Schoolhouse of Medicine)

Staging

Staging a cancer is a style of describing the extent of the disease. One of the nearly common methods used for colorectal cancer staging is called the T/N/M system, which assigns a degree of severity based on the size, location, and spread of cancer in the torso. Other, less widely used methods for colorectal cancer staging are the Dukes organization and the Astler-Coller system. Details of the T/N/M system tin can exist institute in the Diagnosis & Detection section.

For more details on cancer staging visit the National Comprehensive Cancer Network.

Tumor Biology

Mutation (too known as epigenetic modification) of specific genes alters the beliefs of cancer cells. The genetic alterations atomic number 82 to changes in the corporeality and/or type of poly peptide product produced by genes (factor expression). Equally changes accumulate, the cells get more than abnormal and cancer progresses. Details about these changes can be found on the Mutation folio. Some of the genes that accept been shown to be important in the development of colorectal cancer are discussed beneath:

APC Gene
TP53 Gene
MSH2 and MLH1 Genes
K- RAS Gene

APC Cistron

APC (adenomatous polyposis coli) is a tumor suppressor cistron that plays a role in jail cell signaling. Mutation in APC is thought to be an of import stride in the initial formation of adenomas.22 Inherited APC mutations result in familial adenomatous polyposis (FAP), a disorder characterized past the growth of hundreds to thousands of polyps along the lining of the colon.

Learn more than about APC and cancer development
Acquire more than about familial adenomatous polyposis (FAP)

Acquired adenomas in the right colon: Two of the larger lesions have developed stalks that connect the neoplastic "head" of the polyp to the mucosal surface. Polyps with stalks are chosen "pedunculated".
(Image courtesy of: C. Whitaker Sewell, MD - Professor of Pathology, Emory University Schoolhouse of Medicine)

Pedunculated adenoma of the colon: The berry-similar "caput" of the polyp is the neoplastic portion; the long stem is composed of normal tissue, and contains the blood supply. (Paradigm courtesy of: C. Whitaker Sewell, Doctor - Professor of Pathology, Emory Academy School of Medicine)

Low power microscopic image of a pedunculated adenoma: The darker staining cells in the caput of the polyp represent the mutated neoplastic cells; the stalk is lined by normal colonic mucosa and contains the vascular supply. (Epitome courtesy of: C. Whitaker Sewell, MD - Professor of Pathology, Emory University Schoolhouse of Medicine)

TP53 Cistron

TP53 is a tumor suppressor cistron that encodes the protein product p53. TP53 is one of the about common mutations in colorectal cancer and has been associated with resistance to chemotherapy treatment and poorer survival.23

Acquire more than about abnormal p53 and cancer development

hMSH2 and hMLH1 Genes

About 15% of colorectal cancers develop as a result of non-functional miskatch repair (MMR) genes, in particular the hMSH2 and hMLH1 genes. 8 When functional, these genes check over Deoxyribonucleic acid to make certain that all base of operations pairs are matched correctly. Changes in MMR gene expression upshot from Dna mutation too as epigenetic changes that alter the action of genes without irresolute the bodily Dna sequence. Loss of MMR part increases the susceptibility of particular DNA sequences to mutation, a condition known every bit microsatellite instability or MSI24

K-RAS Gene

K-RAS is a member of a grouping of genes known as the RAS cistron family. These genes encode proteins that play important roles in jail cell signaling and division. G-RAS is ane of the most frequently mutated oncogenes in colorectal cancer.25

Acquire more about RAS

Treatment

The treatment of colorectal cancer tin be broken down into two categories: early stage and advanced phase. Early stage treatment involves tumors that are confined to the colon or rectum. Advanced stage treatment involves tumors that take spread to other regions of the body. Handling options are dependent upon size of tumor, location, concrete condition of patient, and stage of cancer.

As our focus is on the biology of the cancers and their treatments, we exercise non give detailed treatment guidelines. Instead, nosotros link to organizations in the U.Southward. that generate the handling guidelines.

The National Comprehensive Cancer Network (NCCN) includes the following treatments for colon cancer:

Surgery
Radiation Therapy
Chemotherapy

The National Comprehensive Cancer Network (NCCN) includes the following treatments for rectal cancer:

Surgery
Radiations Therapy
Chemotherapy

Learn more almost colon and rectal cancer or make an appointment at the Winship Cancer Institute of Emory Academy.

For more than information well-nigh how these and other cancer treatments work, refer to the Cancer Treatments section.

Information about clinical trials:

General clinical trial information from CancerQuest
Click here for data virtually clinical trials from the National Cancer Found.
Click here for information about clinical trials from Georgia Clinical Trials Online.
Click hither for information virtually clinical trials at the Winship Cancer Constitute of Emory Academy

Colon Cancer Resources

Section Summary

Introduction

In the U.S., colorectal cancer is the third most common cancer for both men and women.
About 95% of colorectal cancers develop in the glandular cells of the lining.

Risk Factors

Inherited genes play a big part in the germination of colorectal cancer.
The two major colorectal cancer susceptibility syndromes are chosen familial adenomatous polyposis (FAP) and hereditary not-polyposis colorectal cancer (HNPCC).
More than ninety% of colorectal cancer patients are over the age of 50.
A person'due south nutrition tin can increment or decrease his gamble for colon cancer.
Obesity and smoking increase the risk for developing colorectal cancer.

Symptoms

Typically, early-phase colorectal cancers are asymptomatic.
Later stages tin can lead to rectal bleeding, blood in the stool, change in bowel movements, and cramping pain in the lower abdomen.

Pathology Written report & Staging

A biopsy of the tissue tin can be examined for tissue advent, cellular brand up, and abnormalities.
The T/N/M system is one of the most mutual methods used for colorectal cancer staging.
The T/Northward/One thousand arrangement assigns a degree of severity based on size, location, and spread of the cancer.

Tumor Biological science

Many genetic changes occur in cancer. Details can be found in the Mutation section.
1 of the more common mutations in colorectal cancer occurs in the APC cistron which is a tumor suppressor and plays a part in jail cell signaling.

Handling

Early stage handling involves cancers confined to the colon or rectum.
Tardily phase treatment involves tumors that have spread beyond the colon or rectum.
Treatments tin can include: surgery, radiations therapy, chemotherapy, and immunotherapy.