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Abdominal Cancer Alliance

What is Colorectal Cancer?

Colorectal cancer is a malignancy that originates in the colon or rectum, the bottom portion of the digestive tract. While colorectal cancers are among the leading causes of cancer-related deaths in the United States, treatments and survival rates have improved over recent decades largely due to effective screening options such as colonoscopies to detect cancers early.

The Basics

The colon is part of the digestive system responsible for removing water and salt from ingested food before expelled as stool. The colon is made up of four sections: ascending, transverse, descending, and sigmoid colon (including the rectum). Colon cancer is classified by the part of the colon it originates from, as well as by the cancer’s subtype.

Colorectal cancer is the third most common cancer and also the third leading cause of cancer-related deaths in the United States; however, survival has consistently improved over the last several decades. [see References: 1] This is largely due to screening with routine colonoscopy, a non-invasive procedure that allows doctors to examine the inside of the colon and rectum using a flexible tube/camera called a colonoscope. A colonoscopy provides visualization of the entire colon allowing biopsies of polyps or areas of concern. A polyp, a small growth within the colon, can begin benign, but has the potential to become cancerous, leading to a colon cancer diagnosis. Routine colonoscopies are recommended every 10 years, beginning at age 45 through 75 years.[2] Recently, the rates of colon cancers in younger populations (under 55 years of age) in the United States have been rising, prompting routine colonoscopies to be recommended in even younger patients who may be at higher risk.[1,3]

The survival rates for colorectal cancer vary greatly depending on the stage of disease at the time of diagnosis. The five-year survival rate for stage I colon cancer is 92%, but dramatically decreases to 12% for stage IV disease.[4]

Abdominal Cancer Alliance

Risk Factors

  • Age: Most commonly occurs after age 50

  • Ethnicity: More common in African American, Hispanic, and Ashkenazi Jewish populations

  • Genetics: Known genetic mutations increase risk such as, Lynch syndrome and familial adenomatous polyptosis (FAP)

  • Family history of colorectal cancer or polyps

  • Certain medical conditions that cause inflammation in the colon, such as Inflammatory bowel disease (IBD) or Crohn’s disease

  • Low fiber & high fat diet (often referred to as a Western diet) that includes a lot of red meat

  • Type 2 diabetes

  • Smoking tobacco

  • Heavy alcohol use

Stomach Ache

Signs & Symptoms

Symptoms may differ, depending on the location of your cancer
 

  • Changes in bowel habits lasting more than 4 weeks, including diarrhea, constipation, and narrowing of the stool shape

  • Rectal bleeding or blood in stool

  • Abdominal pain, cramping, or gas

  • Weight loss

  • Weakness and fatigue

  • A feeling the bowel has not completely emptied

Examining Blood Sample

Evaluation

  • Physical Exam

  • Colonoscopy and upper endoscopy

  • Imaging studies: CT scan, MRI, or PET/CT scan

  • Blood work to include tumor markers

Key Facts

Younger Diagnosis

An increasing number of patients are being diagnosed at a younger age and with more advanced colorectal cancer, which poses a significant clinical challenge.

Chemotherapy
Systemic chemotherapy alone has limited efficacy in advanced and metastatic colorectal cancer, reserving it for palliative treatment.


Multimodal Treatment
The treatment of choice for advanced colorectal cancer is a multimodal approach, including cytoreductive surgery and systemic chemotherapy. The best survival is achieved with a complete cytoreduction and patients with a lower disease burden experience the greatest survival benefit.

CRS/HIPEC
The role of HIPEC at the time of cytoreductive surgery continues to evolve. Current evidence suggests that complete CRS/HIPEC with mitomycin-C is associated with improved abdominal disease control.

Diagnosis and Prognosis

Prognosis for colorectal cancer patients with peritoneal metastases (tumors that spread to the abdominal lining, also called the peritoneum) is highly dependent on the amount of peritoneal spread, quantified using the Peritoneal Cancer Index, or PCI score (a number from 0-39 that surgeons and researchers use to quantify the amount of tumor in the abdominal cavity).[19,27,28] PCI score is highly correlated to the probability of achieving a complete CRS, another key prognostic factor, but also seems to impact survival itself.[29,30] The median overall survival after complete CRS/HIPEC ranges from 25-49 months, with some studies reporting up to 60.1 months and even a “cure.”[21,31] However, even with complete CRS, some studies have shown a decreased survival in patients with a higher PCI. For example, one study reported a median survival of 20 months in patients with a PCI score greater than 20, compared to 33 months in patients with a score less than or equal to 20.[32] To address this, some centers utilize a PCI cutoff to determine candidacy for CRS with or without HIPEC. However, the exact threshold is arbitrary and has yet to be defined statistically. In addition, although the survival is shorter in patients with higher disease burden after CRS/HIPEC, it is still meaningful when a complete CRS is achieved, especially compared to a palliative approach.

Other Resources

More information on colorectal cancer:
American Cancer Society
Fight Colorectal Cancer
Patient Support
American Cancer Society
Colorectal Cancer Alliance
ColonTown

Facing cancer is hard.
But you are not alone - we’re right here with you.

Helping Hands
Patient and Caregiver Network
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Stories of hope

References

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