Colon cancer

Symptoms Of Colon Cancer

Colon cancer doesn't always have symptoms. If symptoms persist, 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/fatigue.

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Causes Of Colon Cancer

Normally, body cells grow, divide, and die in a controlled way. Cancer happens when cells grow uncontrollably and don’t die. The exact cause of this in the colon and rectum is not fully known.

One possible reason is changes in DNA that affect oncogenes (genes that help cells survive). When oncogenes are disturbed, it can increase the risk of colon cancer. 

Colorectal cancer often starts as precancerous polyps in the colon or rectum. These polyps can turn into cancer over time.

Certain factors are also associated with an increased risk of colon cancer. The risk factors are described in detail in the next section.

Risk Factors For Colon Cancer

Various risk factors are associated with an increased chance of colon cancer. These include: 

Non-modifiable factors

1. Age: The risk of precancerous polyps and colon cancer rises with age, especially after 65, though it can still occur in younger adults.

2. Gender and race: Men are at a higher risk of developing colon cancer than women. Also, non-Hispanic blacks are at higher risk than Asians and non-Hispanic whites. 

3. History of cancer: The chances of developing colon cancer are higher if you have a previous history of colon cancer or polyps. 

4. Health conditions

• Inflammatory bowel diseases (IBD)
• Colon polyps
• Diabetes mellitus

5. Genetic conditions

• Nonpolyposis colorectal cancer (NPCC)
• Familial adenomatous polyposis (FAP)
• Gardner syndrome
• Juvenile polyposis syndrome
• Muir–Torre syndrome
• MUTYH-polyposis
• Peutz-Jeghers syndrome
• Turcot syndrome

6. Family history: It is estimated that people with first-degree (parents, siblings, and children) relatives diagnosed with colon cancer have a two times higher risk of developing it. 

Modifiable or lifestyle factors 

• Unhealthy diet
• Excessive alcohol consumption
• Sedentary lifestyle
• Obesity
• Smoking

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Other factors

1. Gut microbiota: The gut microbiota is made up of helpful microbes that live in our digestive system and support digestion, vitamin production, and immunity. When this balance is disturbed, it can increase the risk of colon cancer.

2. Radiation therapy: Radiation therapy that focuses on the abdomen also increases the chances of colon cancer. 

3. Cholecystectomy: It is the removal of the gallbladder, which can lead to continuous bile flow, which may irritate colon cells and increase the risk of colon cancer.

Diagnosis Of Colon Cancer

Colon cancer develops 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 intestine's muscular layers and 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 the lungs or 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.

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The common diagnostic tests include: 

1. Stool-based tests

• Fecal immunochemical test (FIT): This test detects the hidden blood in the stool, an early sign of colon cancer.

• Guaiac-based fecal occult blood test (gFOBT): This test detects hidden blood in stool using a chemical reaction, helping identify potential early signs of colon cancer.

• FIT-DNA test: Also called the stool DNA test, it checks for hidden blood and DNA changes linked to colon cancer or polyps in the stool.

2. Colonoscopy

This test uses a long, thin, and flexible tube with a camera on its end to check for polyps and cancer in the rectum and colon. Abnormal tissues can also be removed during a colonoscopy.

3. 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 a tool attached to it. The tool is used to remove polyps and abnormal tissues. 

4. CT colonography (virtual colonoscopy)

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

5. Biopsy

In a biopsy, a small amount of tissue is studied under a microscope to confirm the diagnosis. The tissue can be collected either through colonoscopy or surgery. Sometimes, the tissue is taken using a needle biopsy. 

6. 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 a biopsy. 

7. Blood test

• Complete blood count: This test indicates the status of red blood cells (RBCs) in the blood. It helps in the detection of anemia. 

• Carcinoembryonic antigen (CEA): A protein that indicates the spread of the tumor to other parts of the body. However, it is not highly specific to cancer.

8. Imaging tests

• Magnetic resonance imaging (MRI): It is used to measure the tumor size and to track the location of colon cancer. 

• Ultrasound: It is used to find the locations where a tumor has spread.

• Positron Emission Tomography (PET) scan: It helps detect the spread of colon cancer by highlighting areas of abnormal metabolic activity in the body.PET Scan 

• Chest X-rays: X-rays of the chest are used to detect if colon cancer has spread to the lungs.

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Specialist To Visit

Effective cancer care needs a team-based approach with support from various specialists. Here are the types of doctors who can help:

• Oncologist 
• Radiation oncologist
• Oncosurgeon
• Colorectal surgeon
• Medical oncologist

An oncologist oversees overall cancer treatment and coordinates care with specialists.

A radiation oncologist delivers targeted radiation therapy to shrink tumors and destroy cancer cells.

An oncosurgeon performs surgery to remove cancerous tumors or affected tissues.

A colorectal surgeon specializes in the surgical treatment of colon and rectal cancers.

A medical oncologist manages chemotherapy and other drug-based treatments for colon cancer.

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Prevention Of Colon Cancer

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

1. Get regular screening

• The most effective way to prevent colon cancer is through regular screening starting at age 45.

• It can help detect and remove polyps early before they turn into cancer.

2. Focus on your diet

• Eat more fiber-rich foods like fruits, vegetables, and whole grains.

• Include calcium and vitamin D in your diet.

• Limit red meat (beef, pork, lamb) and processed meats.

• Avoid saturated and trans fats.

3. Avoid medications without a prescription

• Some studies suggest that medications like aspirin, ibuprofen, and naproxen may lower colon cancer risk. 

• However, always consult your doctor first, as they can cause side effects like ulcers and bleeding.

4. Maintaining a healthy body weight

• Being overweight or obese increases the risk of colon cancer.

• Staying active and eating a balanced diet can help maintain a healthy weight and reduce this risk.

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5. Quit smoking and limit alcohol

• Long-term use of alcohol and smoking is associated with an increased risk of cancer. 

• 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.

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6. Take your multivitamins

• Some studies suggest that vitamins and minerals such as folic acid, Vitamin D, calcium, and magnesium decrease the chances of colon cancer.

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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 individual. These include: 

1. Surgery

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

2. Chemotherapy

Chemotherapy involves the use of anticancer drugs to kill cancer cells. The medicines used to treat colon cancer include: 

• 5-Fluorouracil (5FU)
• Calcium leucovorin
• Oxaliplatin
• Capecitabine
• Irinotecan
• Cetuximab 
• Panitumumab 
• Regorafenib

3. Radiation therapy

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

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

4. Ablation technique

• Radiofrequency ablation: In this, the tumor is killed through a needle inserted through the skin. The technique used radio waves to kill the cancer cells.

• Microwave ablation: This technique uses electromagnetic waves that create high temperatures in the body. The high temperature kills cancer cells. 

• 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 to kill cancer cells.

• Cryoablation (cryosurgery or cryotherapy): This technique uses a probe to freeze and kill cancer cells. 

5. Targeted therapy

a) Monoclonal antibodies: These are specialized proteins that can attach to the cancer cells and inhibit their growth. Examples include:

• Bevacizumab 
• Ramucirumab
• Cetuximab
• Panitumumab

b) Angiogenesis inhibitors: This class inhibits the formation of new blood vessels that cancer cells require to grow and multiply. Examples include:

• Ziv-aflibercept
• Regorafenib

c) Protein kinase inhibitors: They block the special proteins that are needed for the 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 boost the immune system, which helps in fighting the cancer cells. It is mostly used in advanced stages of colon cancer. Some of the common examples are:

• Ipilimumab
• Pembrolizumab
• Nivolumab
  
  

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Complications Of Colon Cancer

The complications of colon cancer can include:

• Iron deficiency anemia
• Jaundice
• Bowel obstruction
• Blockage of the colon
• Spreading of cancer to other tissues (metastasis)
• Relapse of cancer
• Development of a secondary tumor in the colon
• Perforation of the colon.

Home-care For Colon Cancer

Some home remedies, like herbs and spices, may support cancer care, but they should never replace medical treatment. Always check with your doctor before trying anything new. These include:

• Green tea: It is rich in antioxidants, which may help reduce inflammation and support overall health during cancer care.

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• Reishi mushroom: It is believed to have potential cancer-fighting properties and may help support the immune system.

• Turmeric (Haldi): Curcumin present in turmeric can help in the prevention of colon cancer. It can also aid in killing cancer cells. 

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• Probiotics: These contain good bacteria that support gut health and reduce inflammation, potentially lowering colon cancer risk. 

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Foods to eat

• Whole grains: Oats, barley, brown rice, corn, sorghum, wheat

• Legumes and pulses: Beans, lentils, chickpeas

• Nuts and seeds: Almonds, walnuts, flaxseeds, canola seeds, olive seeds

• Fruits and vegetables: Apples, berries, grapes, spinach, and broccoli.

Foods to avoid

• Red meat and processed meats

• Deep-fried and oily foods

• Refined sugar and sweets

• Highly processed packaged foods.

Alternative Therapies For Colon Cancer

Some alternative therapies may help ease cancer-related symptoms, but they are not a substitute for conventional treatment. Always talk to your doctor before trying anything new. These include:

1. 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. 

2. 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, and depressive symptoms and improve overall quality of life.

Living With Colon Cancer

Living with colon cancer can be challenging physically and emotionally. But, with the right care, support, and mindset, many find strength they never knew they had. Tips that can help include:

1. Manage physical effects

• Every cancer therapy has numerous physical changes. 

• It is important to discuss every little change happening in your body with your doctor.

• Continuous follow-up even after the end of therapy is recommended to track long-term effects and relapse of cancer. 

2. Cope with the fear of side effects

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

• Talk about the side effects with your doctor, which may help you alleviate and prevent 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. 

3. Manage emotional and social effects

• Engage yourself in activities you like, like crafting, painting, singing, etc.

• Do regular exercise as it helps in reducing stress.

• Join any support group, either online or offline

• Ask for help from a professional counselor 

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

4. Handle the cost of treatment

• Understand the cost of therapy well in advance 

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

• Find financial support resources through oncology social workers, oncology nurses, doctors, or online. 

• Take help through your health insurance partners.

5. Watch for recurrence

• The first 5 years after treatment are very crucial for colon cancer. 

• Follow-up care includes regular physical examinations, tests, and counseling. 

Tips for caregivers

• Encourage and provide mental support to the person dealing with colon cancer

• Understand the course of treatment

• Help the individual manage their symptoms and side effects

• Coordinate their medical appointments and give medications on time

• Assisting them in maintaining personal care and hygiene

• Talk with empathy and a positive attitude

• Help them with household chores

• Handle insurance and billing issues for them.

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