What is Colon Rectal Cancer?

It occurs in the bowel, which is also known as the intestine and includes the colon (large intestine) and the rectum, which is the lower six inches of the tract. In colorectal cancer, 70% of malignancies occur in the colon (the large intestine) and 30% appear in the rectum.

What is Cancer?

Cancer cells are very similar to cells of the organism from which they originated and have similar (but not identical) DNA and RNA. This is the reason why they are not very often detected by the immune system, in particular if it is weakened. Cancer cells usually have an increased ability to divide rapidly and their number of divisions is not limited by telomeres on DNA (a counter system to limit number of divisions to 40-60). This can lead to the formation of large masses of tissue and in turn may lead to disruption of bodily functions due to destruction of organs or vital structures.

What causes colon rectal cancer?

In most cases, the precise cause is unknown but there are a number of contributory factors which include:
- A family history of colorectal cancer, polyps or inflammatory bowel disease. Approximately 5% of cancers of the colon occur in families with a predisposition to the disease.
- It usually occurs in people over 50.
- Women are at a slightly higher risk than men.
- Those in industrialised parts of the worlds are more susceptible.
- It is thought that a high-meat, high-fat, low- fibre diet encourages the production of carcinogens (cancer-causing substances).

What is the symptoms of colon rectal cancer?

There may not be any symptoms initially. When symptom do occur, they vary widely depending on the location of the cancer within the large intestine. The first symptom may be an inexplicable change in the bowel habit, persisting for more than 10 days. Other symptoms may include: rectal bleeding, blood in the stool and abdominal pain. Some patients might only feel a general weakness and fatigue due to iron deficiency anaemia. Unexplained weight loss may also be noted

What test can be done to detect colon cancer?

When colon cancer is suspected, either a lower GI series (barium enema x-ray) or colonoscopy is performed to confirm the diagnosis and to localize the tumor. A barium enema involves taking x-rays of the colon and the rectum after the patient is given an enema with a white, chalky liquid containing barium. The barium outlines the large intestines on the x-rays. Tumors and other abnormalities appear as dark shadows on the x-rays. For more information, please read the Lower Gastrointestinal Series (Barium Enema) article.
Colonoscopy is a procedure whereby a doctor inserts a long, flexible viewing tube into the rectum for the purpose of inspecting the inside of the entire colon. Colonoscopy is generally considered more accurate than barium enema x-rays, especially in detecting small polyps.If colon polyps are found, they are usually removed through the colonoscope and sent to the pathologist. The pathologist examines the polyps under the microscope to check for cancer.While the majority of the polyps removed through the colonoscopes are benign, many are precancerous. Removal of precancerous polyps prevents the future development of colon cancer from these polyps. For more information, please read the Colonoscopy article.
If cancerous growths are found during colonoscopy, small tissue samples (biopsies) can be obtained and examined under the microscope to confirm the diagnosis. If colon cancer is confirmed by a biopsy, staging examinations are performed to determine whether the cancer has already spread to other organs.
Since colorectal cancer tends to spread to the lungs and the liver, staging tests usually include chest x-rays, ultrasonography, or a CAT scan of the lungs, liver, and abdomen.Sometimes, the doctor may obtain a blood test for CEA (carcinoembyonic antigen). CEA is a substance produced by some cancer cells. It is sometimes found in high levels in patients with colorectal cancer, especially when the disease has spread.

What are the treatments and survival for colon cancer?

Surgery is the most common treatment for colorectal cancer. During surgery, the tumor, a small margin of the surrounding healthy bowel, and adjacent lymph nodes are removed. The surgeon then reconnects the healthy sections of the bowel. In patients with rectal cancer, the rectum is permanently removed. The surgeon then creates an opening (colostomy) on the abdomen wall through which solid waste in the colon is excreted. Specially trained nurses (enterostomal therapists) can help patients adjust to colostomies, and most patients with colostomies return to a normal lifestyle. The long term prognosis after surgery depends on whether the cancer has spread to other organs (metastasis). The risk of metastasis is proportional to the depth of penetration of the cancer into the bowel wall. In patients with early colon cancer which is limited to the superficial layer of the bowel wall, surgery is often the only treatment needed. These patients can experience long term survival in excess of eighty percent. In patients with advanced colon cancer, wherein the tumor has penetrated beyond the bowel wall and there is evidence of metastasis to distant organs, the five year survival rate is less than ten percent.In some patients, there is no evidence of distant metastasis at the time of surgery, but the cancer has penetrated deeply into the colon wall, or reached adjacent lymph nodes. These patients are at risk of tumor recurrence either locally or in distant organs. Chemotherapy in these patients may delay tumor recurrence and improve survival.Chemotherapy is the use of medications to kill cancer cells. It is a systemic therapy, meaning that the medication travels throughout the body to destroy cancer cells. After colon cancer surgery, some patients may harbor microscopic metastasis (small foci of cancer cells that cannot be detected).
Chemo therapy is given shortly after surgery to destroy these microscopic cells. Chemotherapy given in this manner is called adjuvant chemotherapy. Recent studies have shown increased survival and delay of tumor recurrence in some patients treated with adjuvant chemotherapy within five weeks of surgery. Most drug regimens have included the use of 5-flourauracil (5-FU). On the other hand, chemotherapy for shrinking or controlling the growth of metastatic tumors has been disappointing. Improvement in the overall survival for patients with widespread metastasis has not been convincingly demonstrated. Chemotherapy is usually given in a doctor's office, in the hospital as a outpatient, or at home. Chemotherapy is usually given in cycles of treatment periods followed by recovery periods. Side effects of chemotherapy vary from person to person, and also depend on the agents given. Modern chemotherapy agents are usually well tolerated, and side effects are manageable. In general, anticancer medications destroy cells that are rapidly growing and dividing. Therefore, red blood cells, platelets, and white blood cells are frequently affected by chemotherapy. Common side effects include anemia, loss of energy, easy bruising, and a low resistance to infections. Cells in the hair roots and intestines also divide rapidly. Therefore, chemotherapy can cause hair loss, mouth sores, nausea, vomiting, and diarrhea.
Radiation therapy in colorectal cancer has been limited to treating cancer of the rectum. There is a decreased local recurrence of rectal cancer in patients receiving radiation either prior to or after surgery. Without radiation, the risk of rectal cancer recurrence is close to fifty percent. With radiation, the risk is lowered to approximately seven percent. Side effects of radiation treatment include fatigue, temporary or permanent pelvic hair loss, and skin irritation in the treated areas.Other treatments have included the use of localized infusion of chemotherapeutic agents into the liver, the most common site of metastasis. This involves the insertion of a pump into the blood supply of the liver which can deliver high doses of medicine directly to the liver tumor. Response rates for these treatments have been reported to be as high as eighty percent. Side effects, however, can be serious. Additional experimental agents considered for the treatment of colon cancer include the use of cancer-seeking antibodies bound to cancer fighting drugs. Such combinations can specifically seek and destroy tumor tissues in the body.
Other treatments attempt to boost the immune system, the bodies' own defense system, in an effort to more effectively attack and control colon cancer. In patients who are poor surgical risks, but who have large tumors which are causing obstruction or bleeding, laser treatment can be used to destroy cancerous tissue and relieve associated symptoms. Still other experimental agents include the use of photodynamic therapy. In this treatment, a light sensitive agent is taken up by the tumor which can then be activated to cause tumor destruction.

Can Colon and Rectal Cancers be Prevented?

Prevention and early detection are the key to controlling and curing these cancers. Colorectal cancer begins as polyps, which are small, benign (non-cancerous) growths of cells that form on the inner lining of the colon. These polyps may grow larger over time and become cancerous, which is why if any polyps are found, it is usually advisable to have them removed before they can become cancerous. Lifestyle changes can also reduce a person's chances of developing colon cancer. To reduce the risk of colon cancer, it is best to follow a diet that is low in fat and high in fruits, vegetables and fibre. It is also advisable to exercise regularly, to drink alcohol in moderation and for smokers to give up smoking.Oestrogen replacement therapy may reduce the risk of colon cancer in postmenopausal women. Use of contraceptives is also thought to protect against the development of colon and rectal cancer.

Social Factors Not Genetics Drive Racial Disparities in Colorectal Cancer Survival

Correcting social, economic and healthcare inequalities may have the most significant impact in reducing survival differences in colorectal cancer (CRC) between African Americans and Caucasians, according to a new study. Published in the June 1, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, a meta-analysis of data from published studies demonstrated that when socioeconomic factors and treatment utilization were controlled for or equalized, racial disparities were reduced substantially.
Lower socioeconomic status (SES) is well known to be associated with poorer health outcomes, including higher death rates. It is linked to impediments to healthcare access and receiving suboptimal care; higher risk of exposure to occupational and environmental hazards; and riskier behavior and less healthy lifestyles.Survival differences in CRC between African Americans and whites have been well documented in the epidemiology literature. At the beginning of the 21st century, African Americans were dying from CRC at significant higher rates than white Americans. At five years after diagnosis, almost half of African Americans would be dead from CRC compared to just one third (35 percent) of white Americans.
Research indicates that factors such as lower utilization of screening tests, lower rates of surgery and adjuvant chemotherapy, more aggressive tumors, and poor post-treatment surveillance contribute to lower survival rates. However, the fundamental causes of these associations, including the importance of biologic versus socioeconomic factors, remain poorly characterized.For their new study, Dr. Xianglin Du, Tamra Meyer, and Dr. Luisa Franzini of the University Of Texas School Of Public Health at Houston reviewed the literature and aggregated the data from ten studies that investigated the association between CRC survival and race/ethnicity after controlling for SES and treatment.
The meta-analysis approach aims to systematically review the existing literature, to allow a more objective appraisal of the evidence, to examine the heterogeneity between the studies, and if appropriate, to enhance the precision of the effect estimates.The authors found that the overall risk of CRC-related death was only slightly elevated after adjusting for SES and treatment.
African Americans had only marginally higher CRC mortality (hazard ratio: 1.13, 95 percent confidence interval: 1.01-1.28) and all-cause mortality (hazard ratio: 1.14, 95 percent confidence interval: 1.00-1.29)."These findings," conclude the authors, "demonstrated that there is no strong evidence of racial disparities in survival between African-Americans and Caucasians with colon cancer after accounting for racial differences in socioeconomic status." Therefore, conclude the authors, "efforts to eliminate racial disparities in health care and to minimize disparities in socioeconomic status have the potential to reduce racial inequalities in colon cancer survival."

Alternative therapies

Aromatherapy is the use of fragrant substances, called essential oils, distilled from plants to alter mood or improve health. These highly concentrated aromatic substances are either inhaled or applied during massage. Approximately 40 essential oils are commonly used in aromatherapy; among the most popular are lavender, rosemary, eucalyptus, chamomile, marjoram, jasmine, peppermint, lemon, ylang ylang, and geranium.
Art therapy is used to help people manage physical and emotional problems by using creative activities to express emotions. It provides a way for people to come to terms with emotional conflicts, increase self-awareness, and express unspoken and often unconscious concerns about their illness and their lives. "Expressive arts therapy" or "creative arts therapy" may also include dance and movement, drama, poetry, photo therapy and others, as well as the more traditional art methods.
Ayurveda is an ancient Indian system of medicine. It has an integrated approach to the prevention and treatment of illness and tries to maintain or re-establish the harmony between the mind, body, and forces of nature. It combines a number of approaches, such as changes in lifestyle, herbal remedies, exercise, and meditation to strengthen and purify the body and mind and increase spiritual awareness.
Feng shui is the ancient Chinese philosophy and art of placing objects, ornaments, furniture, rooms, buildings, and even towns in position so they promote the beneficial flow of vital energy or life force called qi (or chi). The words feng shui literally mean wind and water.
Yoga is a form of non-aerobic exercise that involves a program of precise posture, breathing exercises, and meditation. In ancient Sanskrit, the word yoga means "union."
Meditation is a mind-body process that uses concentration or reflection to relax the body and calm the mind. It has been defined as the intentional self-regulation of attention, a mental focus on a particular aspect of one's inner or outer experience. One commonly practiced type is Transcendental Meditation, which involves repeating a word or phrase (mantra), either silently or aloud. Another is mindfulness meditation, in which a person observes sensations, perceptions, and thoughts without judgment as they arise. There are other types of meditation that focus attention by walking or visualizing. Meditations that focus on words or images and do not strive for a state of thoughtless awareness are sometimes called quasi-meditative.
Tai chi is an ancient Chinese martial art that is part of Qigong (see Qigong). It is a mind-body, self-healing system that uses movement, meditation, and breathing to improve health and well being.
Qigong is a Chinese system designed to enhance the natural flow of vital energy called qi (or ch'i, pronounced "chee" or "kee") in the body. The process of working toward a regulated, smooth flow of qi is called "gong" (pronounced "kung"). is a broad term that includes healing beliefs and practices of hundreds of indigenous tribes of North America. It combines religion, spirituality, herbal medicine, and rituals that are used to treat people with medical and emotional conditions. There are many tribal differences, so it is not surprising that healing rituals and beliefs vary a great deal. The most sacred traditions are still kept secret, passed along from one healer to the next. Because of these factors, information on healing practices is general and somewhat limited.
Breath work is a general term used to describe a variety of conscious breathing techniques that are used in many relaxation exercises and spiritual healing methods. There are many types of breathwork and facilitators. Focused, deep breathing exercises, such as exaggerating the way you naturally inhale and exhale, is said to promote relaxation, awareness, and emotional release. Since shallow breathing is considered to be a way to avoid feeling one's emotions and an indicator of stress, the goal in breathwork is usually to take long, deep breaths. These breaths are said to be "cleansing" in that they free the body and mind from restrictions, and release toxins that work against a healthy state.
Dance therapy is the therapeutic use of movement to improve the mental and physical well being of a person. It focuses on the connection between the mind and body to promote health and healing. Dance therapy can be considered an expressive therapy.

New Research in Cancer Treatment

Genetically engineered bacteria and virusesSome new promising research uses genetically engineered bacteria and viruses to infect and destroy cancer cells. This could be useful when cancer is already advanced and there are large masses of cancer cells. The potential drawback of these methods is the generation of large amounts of toxins from dying cancer cells, which in turn can suppress the immune system or even kill the patient.Also bacteria and viruses very often mutate which in turn can lead to infection and attack on healthy, non-cancerous cells.
Anti-cancer vaccines Anti-cancer vaccines or even custom-made anti-cancer vaccines for a particular patient and cancer type are also a very promising line of research. By providing fragments of cancer cells to the immune system, one can potentially get the immune system response to destroy live cancer cells. Cancer markers Another promising line of research is related to chemical substances which could be used to mark cancer cells. This in turn will allow easier recognition of these cells by the immune system.
Cancer growth retarders / inhibitors This line of research is related to the use of chemical substances which could retard / inhibit the growth of cancer cells. An interesting research topics are the substances blocking activity of telomerase, the enzyme responsible for the management/elongation of telomeres.Telomerase is found in high concentrations in 80% of tumors and allows tumor cells to gain "immortality" by removing restrictions on the number of cell divisions. This enzyme may also be useful in extending the lifespan of healthy cells and in turn extend the lifespan of the organism (cancer cells and their growth may hold much valuable information about fountain of youth and immortality). All the above mentioned methods show some promise.
However these methods by themselves do not provide reliable cancer treatment. It is possible that some of them in conjunction with the non-traditional treatment of cancer (listed below) will become the standard cancer treatment, in the 21st or 22nd century

"World Cancer Report" by Who

WHO (World Health Organization, division of UN) estimates that only 4% of all cancers are inherited /genetic and that the majority of cancers are preventable ("World Cancer Report", IARC Press, Lyon 2003). According to this report, various cancers are strongly linked to lifestyle and the environment. It lists many of these factors and carcinogens. Cancer world maps shown in the report illustrate that the majority of cancers are in developed countries - which indicates again a strong link between cancer, lifestyle, diet and environment. This statistical data is very consistent with the cancer model outlined in this paper."World Cancer Report" by WHO