Colon cancer

Symptoms Of Colon Cancer

Colon cancer always doesn't have symptoms. Therefore, regular screening is very important for early diagnosis. If symptoms persists, they may include: 

• Abdominal pain

• Body aches

• Cramps

• Diarrhea

• Constipation

• Feeling of incomplete evacuation

• Unexplained weight loss

• Rectal bleeding or blood in the stools

• Tiredness or fatigue

The symptoms alone do not confirm cancer. So, it is necessary to consult the doctor in case you are experiencing any of the symptoms. 

Here are some of the common signs and symptoms of cancer you need to know.
Click To Know!

Causes Of Colon Cancer

Every cell of the body follows a process of growth, division, and death. Cancer develops when cells multiply uncontrollably without dying. The exact cause of the abnormal multiplication of cells in colon and rectum is not known. One such reason is changes in the DNA that affects oncogenes – genes that help the cell to stay alive. Disturbance in the oncogenes predisposes the person to colon cancer. 

Mostly, colorectal cancer begins as precancerous polyps. These polyps slowly develop into cancerous tissue. The early diagnosis at the precancerous stage can prevent the development of cancer. 

Read about the common causes of colorectal cancer.
Tap To Read!

Risk Factors For Colon Cancer

There are various risk factors that are associated with an increased chance of colon cancer: 

Non-modifiable factors 

1. Age

The chances of precancerous polyps and colon cancer increases as we grow old. The average age at which colon cancer is diagnosed is 68 years and 72 years for men and women respectively. People above the age of 65 have three times more chances of having colon cancer than the people at the age of 50 to 64 years. However, sometimes even younger adults can develop colon cancer.

2. Gender and race 

Studies suggest that men have 30 times higher risk of developing colon cancer than women. Also, the mortality rate from colon cancer is also higher in men. 

Race also determines the chances of developing colon cancer. Non-Hispanic blacks are at higher risk than Asians and non-Hispanic whites. 

3. Medical history of cancer

The chances of developing colon cancer are more if you have a previous history of colon cancer or polyps. People with larger polyps are more prone to develop colon cancer.

4. Health conditions

Certain health conditions also increase the chances of colon cancer. This include:

• Inflammatory bowel diseases (IBDs): It causes inflammation in the gut and includes diseases such as ulcerative colitis and Crohn’s disease. People diagnosed with any sort of IBDs have 2-6 times higher chances of having colon cancer. The risk increases if the disease is severe and prolonged. 

• Colon polyps: 95% of the colorectal cancer develops from polyps – tissue growths from the lining of the colon. The chances increase with large polyp size and age of the patient. 

• Diabetes mellitus: Diabetes induces chronic inflammation which may trigger the growth of cancer cells in the colon.

• Cholecystectomy: It refers to the surgical removal of gallbladder. Gallbladder stores bile and releases it when required. After the removal of gallbladder, there is a continuous flow of bile acids which can damage the cells of the colon and predispose to colon cancer.

5. Genetic conditions

The two most important genetic disorders that are responsible for colon cancer include:

• Nonpolyposis colorectal cancer (NPCC): Also known as Lynch syndrome, it is an inherited abnormality in a gene that normally repairs our body's DNA.

• Familial adenomatous polyposis (FAP): It is a rare inherited disorder in which there are chances of developing thousands of polyps in the colon. It is estimated that people with a history of untreated FAP in their early life may get colon cancer by the age of 35-40 years. 

Other genetic conditions include:

• Gardner syndrome, which is a different type of FAP

• Juvenile polyposis syndrome

• Muir–Torre syndrome, which is a variant of Lynch syndrome

• MUTYH-polyposis cancare

• Peutz-Jeghers syndrome

• Turcot syndrome, another variant

6. Family history

It is estimated that people with first-degree (parents, siblings, and children) relatives diagnosed with colon cancer have two times higher risk of developing it. However, second and third degree affected relatives can also increase the risk. The risk increases if the relatives are diagnosed with colon cancer before the age of 60. The severity of risk depend upon:

•  Generational distance from the affected relative

•  The age at which relative developed colon cancer

•  The number of family members affected

• Diagnosis of other cancers such as ovarian, pancreatic, endometrial, and urinary tract in the family

Modifiable or lifestyle factors 

1. Unhealthy diet
Since colon is a part of the digestive system, diet plays a key role in maintaining its health. Excessive consumption of saturated fats, red meat, and processed meat increases the chances of colon cancer. Diet low in fiber, fruits, vegetables, calcium, and Vitamin D also contribute to developing colon cancer.  

2. Alcohol
Excessive consumption of alcohol also increases the risk of colon cancer. Studies suggest that the risk of colon cancer increases by 20% in individuals having 2-3 drinks daily. The risk increases further, if you are used to drinking 4 or more alcoholic drinks in a day.

3. Smoking
People who smoke have a 2 to 3 fold increased risk for developing colon cancer in comparison to non-smokers. The risk increases with the dose and time of exposure to the tobacco. 

4. Sedentary lifestyle
Lack of physical activity is also closely linked with colon cancer. Regular physical activity has been shown to improve immunity, reduce inflammation and stress, regulate metabolic rate and hormone levels and prevent obesity and, as a result, may help protect against cancer development.

5. Being overweight/obese
Excessive weight and obesity are a known risk factor for colon cancer. Overweight/obese men and women have about 50% and 20% greater risk of developing colorectal cancer in comparison to people with normal weight, respectively.

6. Gut microbiota
The gut microbiota or gut flora comprises a population of diverse microorganisms (bacteria, viruses, fungi, and protozoa) inhabiting the gastrointestinal tract. The key functions of gut microbiota is to metabolise toxins, synthesize vitamins, and defend against infection. However, change in the composition and functionality of the normal gut microbiota may lead to initiation, promotion and progression of colon cancer. 

Note: It is also found that radiation therapy that focuses on the abdomen also increases the chances of colon cancer. 

Diagnosis Of Colon Cancer

The colon cancer is developed gradually in the following stages: 

Stage 0 ( cancer in situ): The cancer cells are limited to the inner lining of the colon. 

Stage I: The cancer cells start attacking the muscular layer of the colon or rectum.

Stage II A: Tumor starts growing into the outermost layers of the colon or rectum.

Stage II B: The tumor starts growing into the innermost layers of the colon or rectum.

Stage II C: The tumor starts spreading to the nearby tissues. 

Stage III A: The tumor starts growing into the muscular layers of the intestine and starts invading the nearby 1-3 lymph nodes.

Stage III B: The tumor starts growing into the bowel wall or to surrounding organs and 1-3 lymph nodes.

Stage III C: The cancer has spread to 4 or more lymph nodes.

Stage IV A: The cancer has spread to one distant part of the body such as lungs and liver.

Stage IV B: The cancer has spread to more than one distant part of the body.

Stage IV C: The cancer has spread to the lining of the abdominal cavity.

The screening tests for colon cancer are recommended for all the individuals aged between 45-75 years. Individuals who have higher risks or are older than 75 years, should consult their doctor about their screening. The type of screening tests used usually depends on:  

• Preferences of the patient

• Medical condition of the patient

• Personal or family history of colorectal cancer

• Resources available 

The common screening tests include: 

A. Stool based tests

These tests examine the stool for any signs of colon cancer. They are easier than colonoscopy because patients can perform it at home. However, colonoscopy is recommended in case stool-based tests come positive. This include: 

1. Fecal immunochemical test (FIT): This test detects the hidden blood in the stool using antibodies. The stool is collected at home using a kit provided by your healthcare provider. 

2. Guaiac-based fecal occult blood test (gFOBT): This test uses a chemical known as guaiac to detect blood in the stool. The sample is collected at home using a home kit which is then evaluated in the lab. gFOBT test results are affected by the diet and some drugs. So, a person going for this test are advised to avoid the following: 

• NSAIDs such as ibuprofen and aspirin 7 days before testing as they can give false-positive results because of their bleeding tendencies. 

• Vitamin C either from citrus fruits or supplements 3-7 days from testing as it can interfere with the chemical used in the test.

• Red meat as they can give false-positive results.

3. FIT-DNA test: Also known as stool DNA test or multitarget stool DNA (MT-sDNA) test, this test combines FIT test alongwith a test that detects abnormal DNA in the stool. Colon cancer or polyps cells have DNA mutations in certain cells. This test detects these mutations along with the hidden blood in the stool. 

B.  Colonoscopy

This test uses a long, thin and flexible tube with a camera on its end to check polyps and cancer in the rectum and the colon. During colonoscopy, abnormal tissues can also be removed. This examination requires bowel cleansing before the test. This test is also used as a follow up test and after positive screening tests to complete and confirm the screening results. It is recommended to be done once in every 10 years in the person without having any risk factors. 

C. Flexible sigmoidoscopy

This test detects polyps and cancer in the rectum and sigmoid colon using a sigmoidoscope. A sigmoidoscope is a short tube with a camera and tool attached to it. The tool is used to remove polyps and abnormal tissues. Special preparations such as cleansing of rectum and colon are required before the test. 

D. CT colonography (virtual colonoscopy)

This test captures the images of the entire colon using X-rays. The images are then studied by a doctor using the computer screen. Colonoscopy is usually performed to remove polyps after CT colonography, if it confirms the presence of polyps or cancer. 

E. Biopsy

In biopsy, a small amount of tissue is studied under a microscope. The tissue can be collected either through colonoscopy or surgery. Sometimes, the tissue is taken using needle biopsy. It uses a needle to collect the tissue through the skin. CT scan or ultrasound helps to find the location of the tumor. 

F. Biomarker testing

This test is used to detect certain genes, proteins, and other factors that are highly specific to the tumor. The test is performed on a tumor sample taken from biopsy. 

G. Blood test

People having colon cancer often become anemic because of the continuous bleeding in the rectum and colon. A complete blood count test indicates the status of red blood cells (RBCs) in the blood. This helps in the detection of anemia. 

Blood test is also used to detect the level of carcinoembryonic antigen (CEA) – a protein that indicates the spread of tumor to other parts of the body. However, it is not highly specific to cancer, so it is mostly used in the patients who are already taking the treatment. This helps in tracking the progress of the treatment. 

H. Magnetic resonance imaging (MRI)

MRI uses a magnetic field to produce detailed images of the body using a dye. The dye helps in obtaining a clear picture of the organs. It is used to measure the tumor size and to track the location of colon cancer. 

I. Ultrasound 

Ultrasound uses sound waves to produce a detailed image of the internal organs. It is used to find the locations in which a tumor has spread. Endorectal ultrasound is most commonly used to detect how deep colon cancer has spread. 

J. Chest X-rays

X-ray of the chest is used to detect if the colon cancer has spread to the lungs.

Apart from these diagnostic tests, some methods are also there that can help find out whether one has the cancer-causing gene. Read more about inherited cancers and the role of genetic cancer tests. 
Click To Read!

Specialist To Visit 

Early detection of colon cancer gives more treatment options. Precancerous polyps can be easily removed before they turn into cancer. Therefore, it is very important to consult at the right time. 

Regular screening and consultation is recommended for people with risk factors such as older adults (above 45 years of age). Doctors specializing in different areas of cancer treatment include: 

• Oncologist 

• Radiation oncologist

• Oncosurgeon

• Colorectal surgeon

To get the right diagnosis, it is important to consult the right doctor. Consult India’s best doctors online.
Consult Now!

Prevention Of Colon Cancer

There is no sure shot way to prevent colon cancer. However, some measures can decrease the risk of developing colon cancer that include:

1. Go for regular screening 

Most of the colon cancer develops from its precancerous polyps stage with no symptoms. The most effective way to prevent colon cancer is regular screening, starting from 45 years of age. This helps in the detection and removal of the polyps in its initial stage before turning into cancer. 

2. Eat a healthy diet

A diet low in saturated and trans fats, high in fiber such as fruits, vegetables and whole grains and rich in calcium and Vitamin D is known to be associated with decreased risk of colon cancer. Diet that includes red meat (beef, pork or lamb) and processed meat increases the risk of colon cancer. Avoiding such foods can help in the prevention of colon cancer.

Here's more superfoods that can help in fighting cancer.
Check Now!

3. Consult doctor before taking NSAIDs 

Do consult your healthcare provider before starting certain medications such as NSAIDs because they can cause side effects such as gastrointestinal bleeding and ulcers. However, some studies suggest that medications such as ibuprofen, naproxen, and aspirin can decrease the risk of colon cancer.

4. Maintain a healthy body weight

Since, overweight and obesity are linked with colon cancer, maintaining a healthy weight through physical activity, exercise, and a good diet helps in the prevention of colon cancer. 

Weight loss is 99% mental and 1% physical. Start your journey today.
Click Here!

5. Quit alcohol and smoking

Long term use of alcohol and smoking is associated with an increased risk of cancers. Quitting both can help in the prevention of colon cancer as well as some other types of cancers such as lung cancer, mouth cancer, etc. 

Tobacco is injurious to health. Say no to tobacco. Try our smoking cessation product range.
Check Out!

6. Increase the intake of vitamins and minerals

Some studies suggest that vitamins and minerals such as folic acid, Vitamin D, calcium, and magnesium decrease the chances of colon cancer. One can prevent colon cancer by taking foods rich in these nutrients such as milk, cheese, and eggs.

There are certain myths associated with cancer such as cancer always ends up with the death of the patient. Watch the video by our expert as he debunks more myths of cancer.

Treatment Of Colon Cancer

There are various treatment options for colon cancer which are given considering the risk factors, stage of colon cancer, side effects, and age of the patient. The treatment options include: 

1. Surgery 

It includes removal of cancer through an operation. It is one of the most commonly used methods in all the stages of colon cancer. It can be performed in either of the two ways: 

• Local excision: In this, the tumor is removed through the tube inserted in the colon with a cutting tool at its end. It is mostly used in the early stages of cancer. 

• Resection of colon: In this, a part of the colon is also removed along with the cancer. It is used when the tumor is large.

2. Ablation technique

This technique is used to kill small tumors which are usually less than 4 cm in size. Ablation technique includes: 

• Radiofrequency ablation: In this, the tumor is killed by a needle inserted through the skin. The needle is guided by a CT scan or ultrasound. The technique uses radio waves to kill the cancer cells.

• Microwave ablation: This technique uses electromagnetic waves that create high temperature in the body. The high temperature kills cancer cells. This treatment is usually used to kill large tumors (upto 6 cms).

• Ethanol (alcohol) ablation: It is also known as percutaneous ethanol injection (PEI). In this procedure, concentrated alcohol is injected into the tumor using a needle. The needle is guided through an ultrasound or CT scan. In some cases, multiple exposure of alcohol is required to kill cancer cells.

• Cryoablation (cryosurgery or cryotherapy): This technique uses a probe to freeze and kill cancer cells. The probe is guided into the skin using ultrasound with a needle. 

3. Chemotherapy

Chemotherapy involves the use of anticancer drugs to kill cancer cells. They are available in the form of oral formulations and injections. Injections can be given directly into the vein over a few minutes or as an infusion over a long period of time. The medicines used to treat colon cancer include: 

• 5-Fluorouracil (5FU)

• Leucovorin

• Oxaliplatin

• Capecitabine

• Irinotecan

• Cetuximab 

• Panitumumab 

• Regorafenib

These drugs are either used alone or in combinations. Chemotherapy is given in cycles that are often 2 to 3 weeks long. The duration of chemotherapy depends upon the type of drugs used and the side effects. The way in which chemotherapy is given depends upon the overall health of the patient and the stage of cancer. 

How is chemotherapy given?

Anticancer drugs can be given in either of the two ways: 

• Systemic chemotherapy: In this, the medicines are taken through the mouth or injected into the bloodstream. The drug reaches the tumor site through the blood and kills cancer cells.

• Regional chemotherapy: Drugs are directly injected into the artery that has access to the tumor site. This helps in reducing the side effects. One such example of regional chemotherapy is hepatic artery infusion in which a drug is directly injected into the hepatic artery. This is used in the conditions where cancer has spread to the liver. 

How chemotherapy is used in the entire course of colon cancer?

• Adjuvant chemotherapy: It is given after surgery to kill small cancer cells that might have left because of their small size. It reduces the chances of relapse of cancer after the surgery. 

• Neoadjuvant chemotherapy: This is given before the radiation therapy to reduce the size of the tumor. This makes it easy to remove the tumor through radiation.

What are the side effects of chemotherapy?

The side effects of the chemotherapy depends upon: 

• Type of drug

• Dose of drug

• Duration of therapy

Some of the common side effects include:

• Hair loss

• Mouth ulcers

• Loss of appetite or weight loss

• Nausea and vomiting

• Diarrhea

• Nail changes

• Skin changes

• Hand-foot syndrome

• Neuropathy

• Tiredness

• Easy bleeding

• Allergic reactions

It is important to discuss the side effects with your cancer team so that the right treatment can be given timely. 

4. Radiation therapy

It involves the use of high energy rays such as X-rays to kill cancer cells. It can be used before, during and after the surgery. In various cases, it is given along with chemotherapy (chemoradiation). In the advanced stages, when colon cancer has spread to other organs such as lungs, brain, and bones, radiotherapy is useful. It can be given in two ways: 

• External beam radiation therapy (EBRT): EBRT is the most commonly used radiation therapy for colon cancer. In this, intense radiation is given from outside the body using a machine. This technique is used if there are a small number of tumors where surgery is contraindicated. 

• Internal radiation therapy: In this, a radioactive substance is placed in the rectum near cancer cells. This helps in specific exposure of the radiation to the targeted site. This therapy has lesser side effects.

Radiation therapy can have some short and long-term side effects such as: 

• Skin irritation

• Nausea

• Rectal irritation

• Bowel incontinence

• Bladder irritation

• Tiredness

• Sexual problems

5. Targeted therapy

It also involves the use of drugs to identify and kill specific cancer cells due to which it has lesser side effects than chemotherapy and radiation therapy. Various drugs used in targeted therapy include:

1. Monoclonal antibodies: These are specialized proteins that can attach to the cancer cells and inhibit their growth. They are given by infusion. Monoclonal antibodies can be: 

• Vascular endothelial growth factor (VEGF) inhibitors: They kill cancer cells by inhibiting VEGF – a substance that helps in the formation of new blood vessels and aids in the growth of cancer. Some of the common examples are bevacizumab and ramucirumab. 

• Epidermal growth factor receptor (EGFR) inhibitors: This class of monoclonal antibodies stop the growth of tumor cells by inhibiting EGFR, a protein that helps in the growth and multiplication of cancer cells. Some of the common examples are cetuximab and panitumumab. 

2. Angiogenesis inhibitors: This class inhibits the formation of new blood vessels that cancer cells require to grow and multiply. Examples include Ziv-aflibercept and regorafenib.

3. Protein kinase inhibitors: They block the special proteins that are needed for multiplication of cancer cells. Encorafenib is one such drug used in colon cancer. 

6. Immunotherapy

This therapy involves the use of drugs that modulate the immune system. Drugs given during immunotherapy boosts the immune system of the patient that helps in fighting the cancer cells. It is mostly used in advanced stages of colon cancer. Some of the common examples are ipilimumab, pembrolizumab and nivolumab.

Complications Of Colon Cancer

Colon cancer, if diagnosed at an early stage can be treated easily. But, in case treatment is not taken for a long period of time, it can be life threatening. It is important to screen and diagnose in case of any related symptoms or risk factors. The complications of colon cancer include:

• Iron deficiency anemia

• Jaundice

• Bowel obstruction

• Blockage of the colon

• Spreading of cancer to other tissues (metastasis)

• Relapse of cancer

• Development of secondary tumor in the colon

• Perforation of the colon

Home-care For Colon Cancer

Cancer affects physically, socially, emotionally, and financially. There are certain changes in the life of the patient that affects him/her along with the family. The medications should be taken as prescribed by a doctor. 

There are several foods that are known to boost immunity and help in fighting cancer cells. However, these foods should be used after consulting with a doctor. These include:

Green tea

It contains antioxidants that help in boosting the immunity. Caffeine-free products should be used. Green tea is contraindicated in certain people such as people suffering from glaucoma. It should always be initiated before consulting your doctor.

Reishi mushroom

It is known to have cancer fighting properties along with immune boosting effects. 

Turmeric (Haldi)

It is also shown to have some anti-cancer and anti-inflammatory properties. Curcumin present in turmeric helps in the prevention of colon cancer. It also aids in killing cancer cells. 

Probiotics

Since microbiota plays a very important role in the progression of colon cancer, probiotics can be used for prevention or as an adjuvant therapy in the treatment of colon cancer. Probiotics such as Lactobacillus, Streptococcus, Enterococcus, Lactococcus, Bifidobacterium and Leuconostoc play a very important role in maintaining the health of the colon. Individuals who consume yogurt have lesser chances of developing colon cancer.

Here’s more about the health benefits of probiotics.
Click To Read!

Polyphenols

They are found in various plants and are known to have anti-cancer properties. Many foods contain polyphenols including cereals and legumes (barley, corn, nuts, oats, rice, sorghum, wheat, beans, and pulses), oilseeds (rapeseed, canola, flaxseed, and olive seeds), fruits and vegetables, and beverages (fruit juices, tea, and coffee). They also poesses antioxidant properties and thus, reduces the risk of colon cancer.

Ways to take care of yourself

• Spend at least 15-30 minutes each day to do something that you like. It could be going for a walk, performing yoga, taking a nap, watching a movie, or talking with friends etc. 

• Understand your feelings and emotions. It helps you in understanding your needs. 

• Join a support group either in person, on phone, or through online. 

• Learn more about the types, stages, and treatment of cancer to be more aware of your condition and be prepared mentally. 

• Connect with a cancer survivor as it can boost your confidence and spread positivity to help you recover fast. 

• Note down atleast one positive feeling or gesture that you received from a nurse, doctor, or a co-patient. 

Role of caregivers 

Caregivers play a very important role in the overall disease outcome of the patient diagnosed with colon cancer. The need for caregiver support increases with the age of the patient. Older patients require the support of caregivers as they are less proactive through the treatment approach and decision making. The important role of caregivers are:  

• Providing emotional support so that patient does not feel alone

• Making decisions about diseases management options

• Participating in doctor appointments

• Providing professional support as they are trained in handling patients 

• Giving the medicines to the patient on time, change dressings, help to take bath, and check the surgery sites 

• Helping with meals

Alternative Therapies For Colon Cancer

Acupuncture

It helps in alleviating cancer related symptoms such as nausea and vomiting which are the most common side effects of chemotherapy. It also reduces pain, shortness of breath, and breathlessness. This can be used after medical therapy or during chemotherapy and radiation therapy. 

Mind-body therapies

It includes relaxation techniques, yoga, meditation, tai chi, and art therapies. They are shown to reduce nausea and vomiting, pain, fatigue, anxiety, insomnia, depressive symptoms and improving overall quality of life. It is very helpful in patients undergoing surgery, chemotherapy, and radiation therapy. 

Find out the amazing health benefits of Yoga. 
Click To Read!

Living With Colon Cancer

Managing physical effects

Every cancer therapy has numerous physical changes. It is important to discuss every little change happening in your body to your doctor. This helps doctors in modulating your treatment regimen to alleviate the symptoms. Continuous follow up even after the end of therapy is recommended to track long term effects and relapse of cancer. 

Managing the fear of side effects

Every cancer therapy has side effects which may vary depending on various factors. It is completely common to have fear from side effects. However, there are various options available to manage the side effects effectively. These include: 

• Take an active role in your treatment plan. This helps you in knowing about possible side effects well in advance. 

• Talk about the side effects to your doctor that may help you in alleviating and preventing the side effects.

• Maintain a journal in which you can write about your experiences. 

• Talk about your fear to your loved ones. This will reduce your anxiety. 

Managing emotional and social effects

Diagnosis of cancer can have emotional and social effects on the patient. This includes stress, anxiety, depression, sadness, and a feeling of helplessness. Some of the easy steps that can be taken to manage your emotional health is to: 

• Engage yourself in activities you like such as crafting, painting, and singing. 

• Do regular exercise as it helps in reducing stress.

• Join any support group either online or offline.

• Ask help from a professional counselor.

• Meet someone who is undergoing the same type of treatment.

• Listen to a podcast related to survival stories of the patients with colon cancer

Managing the cost of cancer treatment

Cancer treatment can be very expensive and this can give anxiety and stress to the patient and his/her family. This can be managed through: 

• Understanding the cost of therapy well in advance. 

• Communicating any financial issues with the cancer team. This will help doctors to look for affordable alternatives.

• Finding financial support resources though oncology social workers, oncology nurses, doctors, or online. 

• Taking help through your health insurance partners.

Watching for recurrence

Follow up care even after the completion of treatment is required to check relapse, managing long term side effects and overall health. The first 5 years after treatment is very crucial for colon cancer. Follow up care includes regular physical examinations, tests, and counseling. Cancer rehabilitation is also required to give: 

• Physical therapy

• Emotional counseling

• Managing the long term pain

• Nutritional guidance