Colon cancer is a disease in which malignant (cancer) cells form in the tissues of the colon.
The colon is part of the body’s digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The first 6 feet of the large intestine are called the large bowel or colon. The last 6 inches are the rectum and the anal canal. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors include the following:
- A family history of cancer of the colon or rectum. Learn more about hereditary cancer risk from our Family Cancer Assessment Clinic.
- Certain hereditary conditions, such as familial adenomatous polyposis and hereditary nonpolyposis colon cancer (HNPCC; Lynch Syndrome).
- A history of ulcerative colitis (ulcers in the lining of the large intestine) or Crohn disease.
- A personal history of cancer of the colon, rectum, ovary, endometrium, or breast.
- A personal history of polyps (small areas of bulging tissue) in the colon or rectum.
These and other signs and symptoms may be caused by colon cancer or by other conditions. Check with your doctor if you have any of the following:
- A change in bowel habits.
- Blood (either bright red or very dark) in the stool.
- Diarrhea, constipation, or feeling that the bowel does not empty all the way.
- Stools that are narrower than usual.
- Frequent gas pains, bloating, fullness, or cramps.
- Weight loss for no known reason.
- Feeling very tired.
Tests that examine the colon and rectum are used to detect (find) and diagnose colon cancer.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Digital rectal exam: An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the rectum to feel for lumps or anything else that seems unusual.
- Fecal occult blood test: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.
- Barium enema: A series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metallic
compound) is put into the rectum. The barium coats the lower gastrointestinal tract and
x-rays are taken. This procedure is also called a lower GI series.
- Sigmoidoscopy: A procedure to look inside the rectum and sigmoid (lower) colon for polyps (small areas of bulging tissue), other abnormal areas, or cancer. A sigmoidoscope is inserted through the rectum into the sigmoid colon. A sigmoidoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.
- Colonoscopy: A procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope is inserted through the rectum into the colon. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer. For more information, view the video below.
After colon cancer has been diagnosed, tests are done to find out if cancer cells have spread within the colon or to other parts of the body.
The process used to find out if cancer has spread within the colon or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
The following tests and procedures may be used in the staging process:
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen or chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the colon. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- Surgery: A procedure to remove the tumor and see how far it has spread through the colon.
- Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.
- Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
- The number of red blood cells, white blood cells, and platelets.
- The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the blood sample made up of red blood cells.
- Carcinoembryonic antigen (CEA) assay: A test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of colon cancer or other conditions.
There are three ways that cancer spreads in the body.
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Cancer may spread from where it began to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if colon cancer spreads to the lung, the cancer cells in the lung are actually colon cancer cells. The disease is metastatic colon cancer, not lung cancer.
The following stages are used for colon cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the mucosa (innermost layer) of the colon wall. These abnormal cells may become cancer and spread. Stage 0 is also called carcinoma in situ.
In stage I, cancer has formed in the mucosa (innermost layer) of the colon wall and has spread to the submucosa (layer of tissue under the mucosa). Cancer may have spread to the muscle layer of the colon wall.
Stage II colon cancer is divided into stage IIA, stage IIB, and stage IIC.
- Stage IIA: Cancer has spread through the muscle layer of the colon wall to the serosa (outermost layer) of the colon wall.
- Stage IIB: Cancer has spread through the serosa (outermost layer) of the colon wall but has not spread to nearby organs.
- Stage IIC: Cancer has spread through the serosa (outermost layer) of the colon wall to nearby organs.
Stage III colon cancer is divided into stage IIIA, stage IIIB, and stage IIIC.
In stage IIIA:
- Cancer may have spread through the mucosa (innermost layer) of the colon wall to the submucosa (layer of tissue under the mucosa) and may have spread to the muscle layer of the colon wall. Cancer has spread to at least one but not more than 3 nearby lymph nodes or cancer cells have formed in tissues near the lymph nodes; or
- Cancer has spread through the mucosa (innermost layer) of the colon wall to the submucosa (layer of tissue under the mucosa). Cancer has spread to at least 4 but not more than 6 nearby lymph nodes.
In stage IIIB:
- Cancer has spread through the muscle layer of the colon wall to the serosa (outermost layer) of the colon wall or has spread through the serosa but not to nearby organs. Cancer has spread to at least one but not more than 3 nearby lymph nodes or cancer cells have formed in tissues near the lymph nodes; or
- Cancer has spread to the muscle layer of the colon wall or to the serosa (outermost layer) of the colon wall. Cancer has spread to at least 4 but not more than 6 nearby lymph nodes; or
- Cancer has spread through the mucosa (innermost layer) of the colon wall to the submucosa (layer of tissue under the mucosa) and may have spread to the muscle layer of the colon wall. Cancer has spread to 7 or more nearby lymph nodes.
In stage IIIC:
- Cancer has spread through the serosa (outermost layer) of the colon wall but has not spread to nearby organs. Cancer has spread to at least 4 but not more than 6 nearby lymph nodes; or
- Cancer has spread through the muscle layer of the colon wall to the serosa (outermost layer) of the colon wall or has spread through the serosa but has not spread to nearby organs. Cancer has spread to 7 or more nearby lymph nodes; or
- Cancer has spread through the serosa (outermost layer) of the colon wall and has spread to nearby organs. Cancer has spread to one or more nearby lymph nodes or cancer cells have formed in tissues near the lymph nodes.
Stage IV colon cancer is divided into stage IVA and stage IVB.
- Stage IVA: Cancer may have spread through the colon wall and may have spread to nearby organs or lymph nodes. Cancer has spread to one organ that is not near the colon, such as the liver, lung, or ovary, or to a distant lymph node.
- Stage IVB: Cancer may have spread through the colon wall and may have spread to nearby organs or lymph nodes. Cancer has spread to more than one organ that is not near the colon or into the lining of the abdominal wall.
At Huntsman Cancer Institute, colorectal cancer is treated by a team of specialists, including gastroenterologists (doctors who specialize in diseases of the digestive system), surgeons, medical oncologists, radiation oncologists, nurses, social workers, dietitians, and other professionals.
Different types of treatment are available for patients with colon cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Six types of standard treatment are used:
New treatments are being tested in clinical trials.
Surgery (removing the cancer in an operation) is the most common treatment for all stages of colon cancer. A doctor may remove the cancer using one of the following types of surgery:
- Local excision: If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall. Instead, the doctor may put a tube with a cutting tool through the rectum into the colon and cut the cancer out. This is called a local excision. If the cancer is found in a polyp (a small bulging area of tissue), the operation is called a polypectomy.
- Resection of the colon with anastomosis: If the cancer is larger, the doctor will perform a partial colectomy (removing the cancer and a small amount of healthy tissue around it). The doctor may then perform an anastomosis (sewing the healthy parts of the colon together). The doctor will also usually remove lymph nodes near the colon and examine them under a microscope to see whether they contain cancer.
- Resection of the colon with colostomy: If the doctor is not able to sew the 2 ends of the colon back together, a stoma (an opening) is made on the outside of the body for waste to pass through. This procedure is called a colostomy. A bag is placed around the stoma to collect the waste. Sometimes the colostomy is needed only until the lower colon has healed, and then it can be reversed. If the doctor needs to remove the entire lower colon, however, the colostomy may be permanent.
Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiofrequency ablation is the use of a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in the hospital with general anesthesia.
Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
Chemoembolization of the hepatic artery may be used to treat cancer that has spread to the liver. This involves blocking the hepatic artery (the main artery that supplies blood to the liver) and injecting anticancer drugs between the blockage and the liver. The liver’s arteries then deliver the drugs throughout the liver. Only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on what is used to block the artery. The liver continues to receive some blood from the hepatic portal vein, which carries blood from the stomach and intestine.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.
Types of targeted therapies used in the treatment of colon cancer include the following:
- Monoclonal antibodies: Monoclonal antibodies are made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
- Angiogenesis inhibitors: Angiogenesis inhibitors stop the growth of new blood vessels that tumors need to grow.
These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI's clinical trials website.
When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.
Here's where you can go for support:
- Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
- The G. Mitchell Morris Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist.
- Our Patient and Family Support Services professionals offer HCI patients and their families emotional support and resources for coping with cancer and its impact on daily life.
- The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers support groups, classes, and activities aimed to increase the quality of life and well-being of HCI patients and their families.
Adapted from the National Cancer Institute's Physician Data Query (PDQ®) Cancer Information Summaries
This information last updated on HCI website December 2013
*If you are interested in a trial that is currently marked *Not Open, please contact the Patient Education team at 1-888-424-2100 or firstname.lastname@example.org for other trial options. Enrollment is updated daily.
Forte Research Systems in partnership with Huntsman Cancer Institute
Ignacio Garrido-Laguna, M.D., Ph.D.Locations
|Huntsman Cancer Hospital||(801) 213-4266|
|Huntsman Cancer Hospital||(801) 585-0193|
Specialties: Biliary Cancer, Colon Cancer, Medical Oncology, Oncology, Pancreatic Cancer
Robert E. Glasgow, M.D.Locations
|Huntsman Cancer Hospital||(801) 585-6035|
|University Hospital||(801) 585-6035|
Specialties: Acute Care Surgery, Barrett's Esophagus, Colorectal Surgery, Endocrine Surgery (Adrenal, Thyroid, Parathyroid), Esophageal Diseases, Esophageal Surgery, GI Motility, Gastric/Esophageal Surgery, Gastroesophageal Reflux Disease (GERD), Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Hernia Surgery (open and laparoscopic), Minimally Invasive Gastrointestinal Surgery, Minimally Invasive Lung & Esophageal Surgery, Soft Tissue Sarcoma Surgery, Surgery, General, Therapeutic Endoscopy, Upper Gastrointestinal Tract Surgery
William J. Peche, M.S.P.H., M.D.
Specialties: Colon Cancer, Colorectal Surgery, Endoscopy, Inflammatory Bowel Disease/Crohn's/Ulcerative Colitis, Surgery, General
N. Jewel Samadder, M.Sc., M.D.Locations
|Huntsman Cancer Hospital||(801) 213-9797|
|South Jordan Health Center||(801) 213-9797|
Specialties: Clinical Genetics, Colon Cancer, Gastroenterology, Gastrointestinal Cancers, Pancreatic Cancer
Mark Savarise, M.D.Locations
|South Jordan Health Center||(801) 213-4500|
Specialties: Breast Cancer, Breast Surgery, Colorectal Surgery, Endoscopy, Gastroesophageal Reflux Disease (GERD), Hernia Surgery (open and laparoscopic), Sclerotherapy, Spider Veins, Surgery, General, Therapeutic Endoscopy
Courtney L. Scaife, M.D.Locations
|Huntsman Cancer Institute||(801) 585-6911|
Specialties: Colorectal Surgery, Esophageal Surgery, Gastric/Esophageal Surgery, Gastrointestinal Stromal Tumors, Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Minimally Invasive Gastrointestinal Surgery, Oncology Surgery, Pancreatic Cancer, Sarcoma, Soft Tissue Sarcoma Surgery, Surgery, General, Upper Gastrointestinal Tract Surgery
Sunil Sharma, M.B.A., M.D., FACPLocations
|Huntsman Cancer Hospital||(801) 213-4266|
Specialties: Clinical Scientist, Colon Cancer, Liver Cancer, Oncology, Pancreatic Cancer
John R. Weis, M.D.Locations
|Huntsman Cancer Institute||(801) 585-0262|
Specialties: Colon Cancer, Oncology, Pancreatic Cancer
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