Colorectal Cancer:

What Is It?

Colorectal cancer is the third most frequently diagnosed cancer in men and women and the
second highest cause of cancer deaths in the U.S. Yet, when found early, it is highly curable. This
type of cancer occurs when abnormal cells grow in the lining of the large intestine (colon) or
rectum. Learn more about who gets colorectal cancer, how it is detected, and what the latest
treatments can accomplish.

Colorectal Cancer: How It Starts

Colorectal cancers often begin as polyps – benign growths on the surface of the colon. The two
most common types of intestinal polyps are adenomas and hyperplastic polyps. They develop
when there are errors in the way cells grow and repair the lining of the colon. Most polyps remain
benign, but some have the potential to turn cancerous. Removing them early prevents colorectal
cancer.
Risk Factors You Can't Control

Your risk of colorectal cancer depends on genetics and lifestyle. Factors you can't control include:
•Age – most patients are older than 50
•Polyps or inflammatory bowel disease
•Family history of colorectal cancer
•History of ovarian or breast cancer
Risk Factors You Can Control
Some factors that raise the risk of colorectal cancer are within your control:
•Diet high in red, processed, or heavily cooked meats
•Being overweight (excess fat around the waist)
•Exercising too little
•Smoking or drinking alcohol
Colorectal Cancer Warning Signs
There are usually no early warning signs for colorectal cancer. For this reason it's important to get
screened. Detecting cancer early means it's more curable. As the disease progresses, patients
may notice blood in the stool, abdominal pain, a change in bowel habits (such as constipation or
diarrhea), unexplained weight loss, or fatigue. By the time these symptoms appear, tumors tend
to be larger and more difficult to treat.

Colorectal Cancer Screening

Because colorectal cancer is stealthy, screenings are the key to early detection. Beginning at age
50, most people should have a colonoscopy every 10 years. This procedure uses a tiny camera
to examine the entire colon and rectum. These tests not only find tumors early, but can actually
prevent colorectal cancer by removing polyps (shown here).

Virtual Colonoscopy

There is now an alternative to colonoscopy that uses CT scan images to construct a 3-D model of
your colon. Called virtual colonoscopy, the procedure can reveal polyps or other abnormalities
without actually inserting a camera inside your body. The main disadvantage is that if polyps are
found, a real colonoscopy will still be needed to remove and evaluate them.

X-Rays of the Colon (Lower GI)

X-Rays of the colon -- using a chalky liquid known as barium as a contrast agent -- allow your
doctor a glimpse at the interior of the colon and rectum, offering another way to detect polyps,
tumors, and changes in the intestinal tissue. Shown here is an "apple core" tumor constricting the
colon. Like the virtual colonoscopy, any abnormalities that appear on the X-rays will need to be
followed up with a conventional colonoscopy.

Diagnosing Colorectal Cancer

If testing reveals a possible tumor, the next step is a biopsy. During a colonoscopy, your doctor
will remove polyps and take tissue samples from any parts of the colon that look unusual. This
tissue is examined under a microscope to determine whether or not it is cancerous. Shown here
is a color-enhanced, magnified view of colon cancer cells.

Staging Colorectal Cancer

If cancer is detected, it will be "staged," a process of finding out how far the cancer has spread.
Tumor size may not correlate with the stage of cancer. Staging also enables your doctor to
determine what type of treatment you will receive.
•Stage I – Cancer has not spread beyond the inside of the colon or rectum
•Stage II – Cancer has spread into the muscle layer of the colon or rectum
•Stage III - Cancer has spread to one or more lymph nodes in the area
•Stage IV – Cancer has spread to other parts of the body, such as the liver, lung, or bones. This
stage does NOT depend on how deep the tumor has penetrated or if the disease has spread to
the lymph nodes near the tumor.
Colorectal Cancer Survival Rates

The outlook for your recovery depends on the stage of your cancer, with higher stages meaning
more serious cancer. The five-year survival rate refers to the percentage of patients who live at
least five years after being diagnosed. Stage I has a 93% five-year survival rate while stage IV
has a five-year survival rate of only 8%.

Colorectal Cancer Surgery

In all but the last stage of colorectal cancer, the usual treatment is surgery to remove the tumor
and surrounding tissue. In the case of larger tumors, it may be necessary to take out an entire
section of the colon and/or rectum. The good news is that surgery has a very high cure rate in the
early stages. If the cancer has spread to the liver, lungs, or other organs, surgery is not likely to
offer a cure -- but removing the additional tumors, when possible, may reduce symptoms.

Treating Advanced Colorectal Cancer

When colorectal cancer has spread to one or more lymph nodes (stage III), it can still be cured.
Treatment typically involves a combination of surgery, radiation (being administered here), and
chemotherapy. If the cancer comes back after initial treatment or spreads to other organs, it
becomes much more difficult to cure. But radiation and chemotherapy can still relieve symptoms
and help patients live longer.

Coping With Chemotherapy

Chemotherapy has come a long way from the days of turning people's stomachs. Newer drugs
are less likely to cause this problem, and there are also medications to control nausea if it does
occur. Clinical trials continue to search for chemotherapy drugs that are more effective and
tolerable.
Radiofrequency Ablation

Radiofrequency ablation (RFA) uses intense heat to burn away tumors. Guided by a CT scan, a
doctor inserts a needle-like device that delivers heat directly to a tumor and the surrounding area.
This offers an alternative for destroying tumors that cannot be surgically removed. In patients with
a limited number of liver metastases that cannot be removed by surgery, chemotherapy is
sometimes combined with RFA for tumor destruction.
Preventing Colorectal Cancer: Diet
There are steps you can take to dramatically reduce your odds of developing colorectal cancer.
Researchers estimate that eating a nutritious diet, getting enough exercise, and controlling body
fat could prevent 45% of colorectal cancers. The National Cancer Institute recommends a low-fat
diet that includes plenty of fiber and at least five servings of fruits and vegetables per day.
Preventing Cancer With Exercise

Physical activity appears to be a powerful weapon in the defense against colorectal cancer. In
one study, the most active participants were 24% less likely to have the cancer than the least
active people. It didn't matter whether the activity was linked to work or play. The American
Cancer Society recommends exercising for at least 30 minutes most days of the week.

More Reading on Colorectal Cancer

•Colon Cancer (Colorectal Cancer)

•Colon Cancer Prevention
•Colon Polyps
•Colon Cancer Screening And Surveillance
•Colonoscopy
•Virtual Colonoscopy
•Flexible Sigmoidoscopy
Digestive disease myths
Researchers have only recently begun to understand the many, often complex, diseases that
affect the digestive system. Accordingly, people are gradually replacing folklore, old wives' tales,
and rumors about the causes and treatments of digestive diseases with accurate, up-to-date
information. But misunderstandings still exist, and, while some folklore is harmless, some can be
dangerous if it keeps a person from correctly preventing or treating an illness. This slideshow lists
some common misconceptions about digestive diseases, followed by the facts as professionals
understand them today.

Myth # 1 Ulcers: Spicy food and stress cause stomach ulcers.

False - The truth is, the majority of stomach ulcers are caused either by infection with a bacterium
called Helicobacter pylori (H. pylori) or by use of pain medications such as aspirin, ibuprofen, or
naproxen, the so-called nonsteroidal antiinflammatory drugs (NSAIDs). Most H. pylori-related
ulcers can be cured with antibiotics. NSAID-induced ulcers can be cured with time, stomach-
protective medications, antacids, and avoidance of NSAIDs. Now that it is appreciated that H.
pylori and NSAIDs are the cause of most ulcers and patients are being managed appropriately,
the ulcers that are coming to medical attention are increasingly likely to be unrelated to H. pylori
or NSAIDs. Spicy food and stress (except when associated with extreme medical conditions) may
aggravate ulcer symptoms in some people, but they do not cause ulcers. Ulcers can also be
caused by cancer.

Myth # 2 Heartburn: Smoking a cigarette helps relieve heartburn.

False - Actually, cigarette smoking may contribute to heartburn. Heartburn occurs when the lower
esophageal sphincter (LES) - a muscle between the esophagus and stomach - relaxes, allowing
the acidic contents of the stomach to splash back (reflux) into the esophagus. People who smoke
more frequently have inflammation of the esophagus (esophagitis), presumably caused by
increased reflux of acid, that is the basis of heartburn. The increased reflux is believed to be due
to the fact that cigarette smoking causes the LES to relax.

Myth # 3 Celiac Disease: Celiac disease is a rare childhood disease.

False - Celiac disease affects both children and adults. About 1 in 200 people in the United
States have the genetic predisposition for celiac disease although not all of them have the
disease. Sometimes celiac disease first causes symptoms during childhood, usually diarrhea,
growth failure, and failure to thrive. But the disease can also first cause symptoms in adults of any
age. These symptoms may be vague and therefore attributed to other conditions. Symptoms can
include bloating and abdominal distention, flatulence, diarrhea, and abdominal pain due to the
involvement of the small intestine as well as skin rash, anemia, and thinning of the bones
(osteoporosis) due to malabsorption of nutrients by the diseased intestine. Celiac disease may
cause such nonspecific symptoms for several years before being correctly diagnosed and
treated.

People with celiac disease should not eat any foods containing gluten, a protein in wheat, rye,
and barley, whether they have symptoms or not. In celiac disease, gluten provokes an
inflammatory reaction by the body that destroys the lining of the small intestine, which interferes
with the absorption of nutrients. Even a small amount of gluten can cause damage, and
sometimes no symptoms will be apparent.

Myth # 4 Bowel Regularity: Bowel regularity means a bowel movement every day.
False - The frequency of bowel movements among normal, healthy people varies from three a
day to three a week, and some perfectly healthy people fall outside both ends of this range.
Nevertheless, even three bowel movements a day can be abnormal in someone who usually has
one bowel movement a day. People with irritable bowel syndrome (IBS) may have fluctuating
numbers of stools each day as well as fluctuating consistency of their stools.

Myth # 5 Constipation: Habitual use of enemas to treat constipation is harmless.

False? - It is not clear whether or not habitual use of enemas is harmless since there has been
very little study of the effects of enemas or laxatives over the long term. Early studies showed that
laxatives might injure the colon if taken chronically by impairing contraction of the colonic
muscles, and this finding was extrapolated to include enemas. The data from the studies is not
strong, however. In fact, some physicians feel that enemas are preferred over laxatives since
they are a more "natural" means of stimulating a bowel movement. (Enemas mimic a large
amount of stool in the rectum, the usual stimulus for a bowel movement.) An ongoing need for
enemas is not normal; you should see a doctor if you find yourself relying on them or any other
medication to have a bowel movement.

Myth # 6 Diverticulosis: Diverticulosis is an uncommon and serious problem.

False - Actually, the majority of Americans over age 60 have diverticulosis, but only a small
percentage have symptoms or complications. Diverticulosis is a condition in which little sacs or
out-pouchings, called diverticula, develop in the wall of the colon. These sacs tend to appear and
increase in number as individuals age. Most people have no symptoms and learn that they have
diverticula after an X-ray or intestinal examination (for example, colonoscopy or barium enema)
that is being done for a purpose unrelated to the diverticulosis. Less than 10 per cent of people
with diverticulosis ever develop complications such as infection (diverticulitis), bleeding, or
perforation of the colon.

Myth # 7 Inflammatory Bowel Disease (Ulcerative Colitis and Crohn's Disease): Inflammatory
bowel disease is caused by psychological problems.
False - Inflammatory bowel disease is the general name for two diseases that cause inflammation
in the intestines, Crohn's disease and ulcerative colitis. The cause of the disease is unknown, but
researchers speculate that it may result from a virus or bacteria interacting with the body's
immune system. No evidence has been found to support the theory that inflammatory bowel
disease is caused by tension, anxiety, or any other psychological factor or disorder, although
these can aggravate the discomfort caused by the disease.

Myth # 8 Cirrhosis: Cirrhosis is only caused by alcoholism.

False - Alcoholism is just one of many causes of cirrhosis. Cirrhosis is scarring and decreased
function of the liver. In the United States, alcohol causes less than one-half of cirrhosis cases.
The remaining cases are from diseases that cause liver damage. For example, in children,
cirrhosis may result from cystic fibrosis, alpha-1 antitrypsin deficiency, biliary atresia, glycogen
storage diseases, and other rare diseases. In adults, cirrhosis may be caused by hepatitis B or C,
primary biliary cirrhosis, diseases of abnormal storage of metals (like iron or copper) in the body,
severe reactions to prescription drugs, or injury to the ducts that drain bile from the liver. In adults,
cirrhosis can also be caused by nonalcoholic steatohepatitis (NASH), which is becoming the most
common liver disease in the United States, affecting 2 to 5 percent of Americans. NASH is
associated with the increasing prevalence of obesity and diabetes.

Myth # 9 Ostomy Surgery: After ostomy surgery, men become impotent, and women have
impaired sexual function and are unable to become pregnant.
False - Ostomy surgery does not, in general, interfere with a person's sexual or reproductive
capabilities. Ostomy surgery is a procedure in which the diseased part of the small or large
intestine is removed and the remaining intestine is attached to an opening in the abdomen. Stool
is collected in a bag taped to the skin over the opening. Alternatively, an internal pouch that
collects the stool may be formed from a portion of the intestine. The pouch then can be emptied
by insertion of a catheter at regular intervals.

Although some men who have had radical ostomy surgery for cancer lose the ability to achieve
and sustain an erection, most men do not, or, if they do, it is temporary. This is caused by
damage to the nerves that supply the penis. If erectile dysfunction persists, a variety of solutions
are available. A urologist, a doctor who specializes in such problems, can help find the best
solution.
In women, ostomy surgery does not damage sexual or reproductive organs, so it is not a direct
cause of sexual problems or sterility. Factors such as pain and the adjustment to a new body
image may create temporary sexual problems, but they can usually be resolved with time and, in
some cases, counseling. Unless a woman has had a hysterectomy to remove her uterus, she can
still bear children.

More Reading on Digestive Diseases

•Celiac Disease
•Inflammatory Bowel Disease (IBD)
•Ulcerative Colitis
•Crohn's Disease
•Cirrhosis
•Irritable Bowel Syndrome (IBS)
•Constipation
•Heartburn and Gastroesophageal Reflux Disease (GERD)
•Diverticulitis (Diverticulosis)
What are a diverticulum and diverticula?
A diverticulum is a small bulging sac pushing outward from the colon wall. More than one bulging
sac is referred to as diverticula. Diverticula can occur throughout the colon but are most common
near the end of the left colon called the sigmoid colon.

What is diverticulitis?

A diverticulum or diverticula can become infected or even rupture. When they rupture, the
condition is called diverticulitis. The ruptured diverticulum results in infection in the tissues
surrounding the colon.

What is diverticulosis?

Diverticulosis is a condition where a patient has diverticula in the colon. A patient who suffers the
consequences of diverticulosis in the colon is referred to as having diverticular disease.

How common is diverticular disease?

Diverticular disease is more common in developed or industrialized countries, for example, the
United States, England, and Australia, where the diet is typically low in fiber and high in highly
processed carbohydrates. Diverticular disease is much less common in countries where the diet
is typically high in fiber, for example, Asia and Africa.

Who gets diverticular disease?

Diverticular disease is uncommon before the age of 40, and is seen in more than 50% of people
over the age of 60 in the United States. Approximately 10%-25% of people with diverticular
disease develop diverticulitis (rupture or infection of the diverticula).

What causes diverticula?

As the body ages, the outer layer of the intestinal wall thickens. This causes the open space
inside the colon to narrow. Stool moves more slowly through the colon, increasing the pressure.
Hard stools (such as those produced by a low fiber diet) or a slower "transit time" through the
colon can also increase pressure. Frequent, repeated straining during bowel movements also
increases pressure and may contribute to the formation of diverticula.

How does diet contribute to diverticulosis?

A diet low in fiber can create hard stools, and lead to constipation. As mentioned previously, with
frequent and repeated straining during bowel movements, pressure inside the colon increases
and contributes to the formation of diverticula. Adding more fiber to the diet can help prevent
constipation and may decrease the risk for diverticular disease.

What foods are high in fiber?

Fiber is found in fruits, vegetables, whole grains, and legumes (dried beans, peas, and lentils).
There are two types of fiber, soluble (dissolves in water) and insoluble.
•Soluble fiber forms a soft gel-like substance in the digestive tract.
•Insoluble fiber passes through the digestive tract nearly unchanged.
•Both of these are necessary to keep stool soft and moving easily through the digestive tract to
prevent constipation.
What are the most common symptoms of diverticular disease?
Most patients with diverticular disease do not have symptoms; however, 20% of patients with
diverticular disease will develop symptoms including:
•abdominal cramping,
•constipation, and
•diarrhea.
These symptoms are related to difficulty passing stool along the left colon narrowed by
diverticular disease.

What are the serious symptoms and complications of diverticulitis?

More serious symptoms and complications of diverticular disease include:

•diverticulitis (rupture or infection of the diverticulum),
•a collection of puss in the pelvis (an abscess),
•colonic obstruction,
•generalized infection of the abdominal cavity (bacterial peritonitis), and
•bleeding into the colon.
What causes bleeding with diverticular disease?
Diverticular bleeding occurs when the expanding diverticulum erodes into a blood vessel at the
base of the diverticulum. The patient may pass red, dark, or maroon-colored blood and clots
without any associated abdominal pain. Bleeding may be intermittent or continuous (lasting
several days). Patients with active bleeding usually are hospitalized for monitoring. Patients with
persistent, severe bleeding require surgical removal of the diverticula.
When should I call the doctor?

A patient should see their healthcare provider if they have persistent:

•abdominal pain,
•unexplained fevers,
•diarrhea, or
•vomiting
If a patient has rectal bleeding they should see their health care provider even if the bleeding
stops on its own. Bleeding may be a sign of diverticulosis, diverticulitis, or other serious diseases.

When should I go to the emergency department?

The following symptoms suggest a complication and warrant an immediate visit to an emergency
department.

1.Worsening abdominal pain

2.Persistent fever with abdominal pain
3.Vomiting so severe that the patient can't keep anything down
4.Persistent constipation for an extended period of time.
5.Severe pain or other symptoms that the patient had previously when they had diverticulitis.

How is diverticulitis diagnosed?

Diverticula can be seen via barium x-ray (barium enema). The diverticula are seen as barium
filled pouches protruding from the colon wall. Direct visualization of the colon can be achieved
through flexible sigmoidoscopy or colonoscopy. In patients suspected of having a diverticular
abscess causing persistent pain and fever, ultrasound and CT scan of the abdomen and pelvis
can be done to detect collections of pus.

What is the treatment for a patient with diverticular disease with minimum or no symptoms?

Many patients with diverticular disease have minimal or no symptoms and thus do not require
specific treatment. A high fiber diet and fiber supplements are recommended to prevent
constipation and formation of more diverticula.
What is the medical treatment for mild abdominal pain due to diverticular disease?
Patients with mild symptoms (for example, abdominal pain due to muscular spasm in the area of
the diverticula) may benefit from anti-spasmodic drugs such as:

•chlordiazepoxide (Librax),
•dicyclomine (Bentyl),
•hyoscyamine (Levsin),
•atropine, scopolamine, phenobarbital, hyoscyamine (Donnatal), and
•diphenoxylate and atropine (Lomotil)

Some doctors recommend the avoidance of nuts, corn, and seeds to prevent complications of
diverticulosis, but it is uncertain if these dietary restrictions are beneficial.

Are antibiotics used in the treatment of diverticulitis?

When diverticulitis occurs, oral antibiotics are sufficient when symptoms are mild. Examples of
commonly prescribed antibiotics include:
•ciprofloxacin (Cipro),
•metronidazole (Flagyl), and
•doxycycline (Vibramycin).
Liquid or low fiber foods are advised during acute attacks of diverticulitis.
When is surgery necessary for a patient with diverticulitis?
Diverticulitis that does not respond to medical treatment requires surgical intervention. Surgery
usually involves drainage of any collections of pus and surgical removal of the segment of the
colon containing the diverticula (usually the sigmoid colon). Surgical removal of bleeding
diverticula is necessary for patients with persistent bleeding. Sometimes the diverticula can erode
into the adjacent bladder, causing severe recurrent urine infections and passage of gas during
urination. This situation also requires surgery.
Can diverticular disease be prevented?
Once formed, diverticula are permanent. No treatment has been found to prevent complications
of diverticular disease. Diets high in fiber increases stool bulk and prevents constipation, and
theoretically may help prevent further diverticular formation or worsening of the diverticular
condition. As mentioned previously, some doctors recommend avoiding nuts, corn, and seeds
which can plug diverticular openings and cause diverticulitis. Whether avoidance of such foods is
beneficial is unclear.
More Reading on Diverticulitis
•Diverticulitis (Diverticulosis)
•Diverticulitis and Diet
•Diverticulosis - What Should I Avoid Eating
•Diverticulitis Symptoms & Abdominal Pain - I Waited Too Long
•How Much Fiber Decreases Diverticulosis Risk?
•Digestive Disease Myths