Colorectal Cancer: Colorectal Cancer, Also Called Colon Cancer or Large Bowel Cancer, Includes

COLORECTAL CANCER
Endoscopic Image of colon cancer identified in sigmoid colon on screening Colonoscopy
DEFINITION
Colorectal cancer, also called colon cancer or large bowel cancer, includes
cancerous growths in the colon, rectum and appendix. With 655,000 deaths worldwide
per year, it is the fourth most common form of cancer in the United States and the
third leading cause of cancer-related death in the Western world. Colorectal cancers
arise from adenomatous polyps in the colon. These mushroom-shaped growths are
usually benign, but some develop into cancer over time. Localized colon cancer is
usually diagnosed through colonoscopy. Invasive cancers that are confined within the
wall of the colon (TNM stages I and II) are curable with surgery. If untreated, they
spread to regional lymph nodes (stage III), where up to 73% are curable by surgery
and chemotherapy. Cancer that metastasizes to distant sites (stage IV) is usually not
curable, although chemotherapy can extend survival, and in rare cases, surgery and
chemotherapy together have seen patients through to a cure. Radiation is used with
rectal cancer. On the cellular and molecular level, colorectal cancer starts with a
mutation to the Wnt signaling pathway. When Wnt binds to a receptor on the cell, that
sets in motion a chain of molecular events that ends with β-catenin moving into the
nucleus and activating a gene on DNA. In colorectal cancer, genes along this chain are
damaged. Usually, a gene called APC, which is a "brake" on the Wnt pathway, is
damaged. Without a working APC brake, the Wnt pathway is stuck in the "on"
position.
CAUSES
Precancerous growths in the colon

Colon cancer most often begins as clumps of precancerous cells (polyps) on the inside
lining of the colon. Polyps can appear mushroom-shaped. Precancerous growths can
also be flat or recessed into the wall of the colon (nonpolypoid lesions). Nonpolypoid
lesions are more difficult to detect, but are less common. Removing polyps and
nonpolypoid lesions before they become cancerous can prevent colon cancer.
Inherited gene mutations that increase the risk of colon cancer

Inherited gene mutations that increase the risk of colon cancer can be passed through
families, but these inherited genes are linked to only a small percentage of colon
cancers. Inherited gene mutations don't make cancer inevitable, but they can increase
an individual's risk of cancer significantly.
SIGNS AND SYMPTOMS
 Fatigue
 Weakness
 Rectal Bleeding
 Blood in the Stool
 Diarrhea
 Constipation
 Abdominal Pain
PATHOPHYSIOLOGY
DIAGNOSTIC TEST
 Blood tests. Your doctor may order blood tests to better understand what may
be causing your signs and symptoms, but there are no blood tests that can
detect colon cancer. Blood tests may include a complete blood count and organ-
function tests.
 Using a scope to examine the inside of your colon. Colonoscopy uses a long,
flexible and slender tube attached to a video camera and monitor to view your
entire colon and rectum. If any suspicious areas are found, your doctor can
pass surgical tools through the tube to take tissue samples (biopsies) for
analysis.
 Using dye and X-rays to make a picture of your colon. A barium enema
allows your doctor to evaluate your entire colon with an X-ray. Barium, a
contrast dye, is placed into your bowel in an enema form. During a double-
contrast barium enema, air also is added. The barium fills and coats the lining
of the bowel, creating a clear silhouette of your rectum, colon and sometimes a
small portion of your small intestine.
 Using multiple CT images to create a picture of your colon. Virtual
colonoscopy combines multiple computerized tomography (CT) images to create
a detailed picture of the inside of your colon. If you're unable to undergo
colonoscopy, your doctor may recommend virtual colonoscopy.
TREATMENT AND MANAGEMENT
 CHEMOTHERAPY - Chemotherapy uses drugs to destroy cancer cells.

Chemotherapy can be used to destroy cancer cells after surgery, to control
tumor growth or to relieve symptoms of colon cancer. Your doctor may
recommend chemotherapy if your cancer has spread beyond the wall of the
colon or if your cancer has spread to the lymph nodes. In people with rectal
cancer, chemotherapy is typically used along with radiation therapy.
 RADIATION THERAPY - Radiation therapy uses powerful energy sources,
such as X-rays, to kill any cancer cells that might remain after surgery, to
shrink large tumors before an operation so that they can be removed more
easily, or to relieve symptoms of colon cancer and rectal cancer. Radiation
therapy is rarely used in early-stage colon cancer, but is a routine part of
treating rectal cancer, especially if the cancer has penetrated through the wall
of the rectum or traveled to nearby lymph nodes. Radiation therapy, usually
combined with chemotherapy, may be used after surgery to reduce the risk that
the cancer may recur in the area of the rectum where it began.
 MEDICATION - Drugs that target specific defects that allow cancer cells to
proliferate are available to people with advanced colon cancer, including
bevacizumab (Avastin), cetuximab (Erbitux) and panitumumab (Vectibix).
Targeted drugs can be given along with chemotherapy or alone. Targeted drugs
are typically reserved for people with advanced colon cancer.
HEALTH NEWS
Scientists discover bacteria 'which causes colon cancer'

Scientists have discovered a type of bacteria which they
believe could be the cause of many cases of colon cancer.
By Kate Devlin, Medical Correspondent
Published: 8:00AM BST 24 Aug 2009
Researchers have hailed the discovery as like that of H. pylori, the bacteria which was
found to trigger ulcers in the stomach. While it is still unknown whether the colon
cancer related bacteria could be tackled by standard antibiotics, researchers are
hopeful that the breakthrough could point the way to new treatments. The
breakthrough could point the way to vaccines or drugs to fight the disease, one of the
most common forms of cancer in Britain. Researchers have hailed the discovery as like
that of H. pylori, the bacteria which was found to trigger ulcers in the stomach.
While it is still unknown whether the colon cancer related bacteria could be tackled
by standard antibiotics, researchers are hopeful that the breakthrough could point the
way to new treatments. The bacteria is widely known to cause diarrhoea in children
and adults. A previous study in Turkey suggested that it could be linked to the
development of colon cancer. Researchers at Johns Hopkins University in Baltimore
believe that they have uncovered how the bacteria could be a trigger for cancer. Their
research shows that strains of the common Bacteroides fragilis (ETBF) affect immune
cells, encouraging them to allow inflammation of the tissue in the colon. This
inflammation appears to be a precursor to the growth of cancer cells. Dr Cynthia
Sears, an infectious disease expert at Johns Hopkins, said: “This could be the H.
pylori of colon cancer.” Their findings, based on mice bred to carry mutations of a
colon cancer-causing gene, are published in the journal Nature Medicine. Dr Drew
Pardoll, an immunologist at the university, said that in humans the infection
“produces a low-level inflammation that persists for a long time.
“If what we are seeing in mice holds true in humans, the chronic inflammation
damages genetic material in the colon cells, allowing them to grow uncontrollably and
develop into tumours earlier and more progressively than if they were not infected with
ETBF,” he said. Previous research shows that the ETBF microbe can be found in the
gut of up to 20 to 35 per cent of children and adults and as many as 40 per cent of
people with colon cancer.
H. pylori infection occurs when a bacterium called Helicobacter pylori (H. pylori)
infects your stomach or the first part of your small intestine. H. pylori infection is
thought to be present in about half the people in the world. For many people, H. pylori
infection causes no signs or symptoms and doesn't lead to any complications.But for
others, H. pylori can lead to serious complications, such as ulcers and stomach
cancer.

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COLORECTAL CANCER

Endoscopic Image of colon cancer identified in sigmoid colon on screening Colonoscopy

Precancerous growths in the colon

Inherited gene mutations that increase the risk of colon cancer

TREATMENT AND MANAGEMENT

 CHEMOTHERAPY - Chemotherapy uses drugs to destroy cancer cells.

Scientists discover bacteria 'which causes colon cancer'

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