Colon cancer

Several risk factors are associated with an increased likelihood of developing colon cancer:

Non-modifiable Factors

Age

As individuals age, the likelihood of developing precancerous polyps and colon cancer increases. The typical age of diagnosis is 68 for men and 72 for women. People over 65 are three times more likely to develop colon cancer than those between 50 and 64. However, colon cancer can also occur in younger adults.

Gender and Race

Research indicates that men have a 30% higher risk of developing colon cancer than women. Additionally, men have a higher mortality rate from the disease.

Race also plays a role in the likelihood of developing colon cancer, with non-Hispanic blacks at greater risk than Asians and non-Hispanic whites.

Medical History of Cancer

A previous diagnosis of colon cancer or polyps increases the chances of developing colon cancer. Individuals with larger polyps are also at a higher risk.

Health Conditions

Certain medical conditions increase the risk of colon cancer, including:

• Inflammatory Bowel Diseases (IBD): These cause inflammation in the intestines and include conditions like Crohn’s disease and ulcerative colitis. Individuals with IBD are 2-6 times more likely to develop colon cancer, with the risk higher if the condition is severe and prolonged.
• Colon Polyps: Around 95% of colorectal cancers develop from polyps, which are growths on the lining of the colon. Larger polyps and older age increase the risk.
• Diabetes Mellitus: Chronic inflammation from diabetes may trigger cancer cell growth in the colon.
• Cholecystectomy: The removal of the gallbladder, which stores bile, can lead to continuous bile acid flow, potentially damaging colon cells and increasing the risk of cancer.

Genetic Conditions

Two key genetic disorders that contribute to colon cancer are:

• Nonpolyposis Colorectal Cancer (NPCC): Also known as Lynch syndrome, this inherited condition affects the gene responsible for DNA repair.
• Familial Adenomatous Polyposis (FAP): This rare inherited condition leads to the formation of numerous polyps in the colon. If untreated, individuals with FAP may develop colon cancer by the age of 35-40.

Other genetic disorders include:

• Gardner syndrome (a variant of FAP)
• Juvenile polyposis syndrome
• Muir-Torre syndrome (a type of Lynch syndrome)
• MUTYH-polyposis
• Peutz-Jeghers syndrome
• Turcot syndrome

Family History

Having a first-degree relative (parent, sibling, or child) diagnosed with colon cancer doubles the risk. The risk is higher if the relative was diagnosed before age 60. The degree of risk depends on:

• The generational distance from the affected relative
• The age at which the relative developed colon cancer
• The number of family members affected
• The presence of other cancers (such as ovarian, pancreatic, endometrial, and urinary tract cancers) in the family

Modifiable or Lifestyle Factors

Unhealthy Diet

Diet plays a significant role in colon health. A diet high in saturated fats, red meat, and processed meats increases the risk of colon cancer. Conversely, a diet low in fiber, fruits, vegetables, calcium, and Vitamin D may contribute to the development of colon cancer.

Alcohol

Excessive alcohol consumption is associated with a higher risk of colon cancer. Studies indicate that individuals who drink 2-3 alcoholic beverages daily have a 20% increased risk, with the risk further rising in those who drink 4 or more drinks daily.

Smoking

Smokers are 2 to 3 times more likely to develop colon cancer compared to non-smokers. The risk increases with the amount of tobacco use and the duration of exposure.

Sedentary Lifestyle

A lack of physical activity is closely linked to an increased risk of colon cancer. Regular exercise helps boost immunity, reduce inflammation, regulate metabolic and hormone levels, and prevent obesity, which can contribute to cancer prevention.

Being Overweight/Obese

Excess weight and obesity are established risk factors for colon cancer. Overweight and obese individuals have a 20-50% greater chance of developing colorectal cancer compared to those of normal weight.

Gut Microbiota

The gut microbiota, which comprises various microorganisms (bacteria, viruses, fungi, and protozoa) in the gastrointestinal tract, plays an essential role in metabolizing toxins, synthesizing vitamins, and protecting against infections. However, alterations in the composition or function of the gut microbiota can contribute to the initiation, promotion, and progression of colon cancer.

Note: Radiation therapy aimed at the abdomen is also associated with an increased risk of developing colon cancer.

Colon cancer develops over time through a series of stages:

• Stage 0 (In Situ Cancer): Cancer is confined to the innermost lining of the colon.
• Stage I: Cancer cells invade the muscle layer of the colon or rectum.
• Stage II A: The tumor extends into the outermost layers of the colon or rectum.
• Stage II B: The tumor grows into the innermost layers of the colon or rectum.
• Stage II C: Cancer spreads to surrounding tissues.
• Stage III A: The tumor spreads into the muscular layers of the intestine and invades 1-3 nearby lymph nodes.
• Stage III B: The tumor grows into the bowel wall or nearby organs and affects 1-3 lymph nodes.
• Stage III C: Cancer spreads to 4 or more lymph nodes.
• Stage IV A: Cancer spreads to distant areas of the body, such as the liver or lungs.
• Stage IV B: Cancer has spread to multiple distant parts of the body.
• Stage IV C: Cancer spreads to the lining of the abdominal cavity.

Colon cancer screening is recommended for individuals between the ages of 45-75, with those at higher risk or older than 75 advised to consult with their doctor. The type of screening chosen depends on:

• Patient preferences
• Medical history
• Personal or family history of colorectal cancer
• Available resources

Common screening tests include:

A. Stool-Based Tests

These tests check for signs of colon cancer in the stool and are easier to perform at home. However, if results are positive, a colonoscopy is recommended. Tests include:

1. Fecal Immunochemical Test (FIT): Detects hidden blood in the stool using antibodies. The sample is collected at home.
2. Guaiac-Based Fecal Occult Blood Test (gFOBT): Detects blood in the stool with a chemical called guaiac. The sample is collected at home and analyzed in a lab. Diet and medications can affect results, so patients are advised to avoid certain substances before the test.
3. FIT-DNA Test: Also known as stool DNA test, it combines FIT with a test that detects abnormal DNA in the stool. This test identifies DNA mutations and hidden blood in stool samples.

B. Colonoscopy

A long, flexible tube with a camera checks for polyps and cancer in the colon and rectum. If abnormal tissues are found, they can be removed during the procedure. It requires bowel cleansing before the test and is recommended every 10 years for individuals without risk factors.

C. Flexible Sigmoidoscopy

A short tube with a camera detects polyps and cancer in the rectum and sigmoid colon. Special preparation, including rectal cleansing, is required. The tool can also remove polyps and abnormal tissue.

D. CT Colonography (Virtual Colonoscopy)

This test uses X-rays to capture images of the colon, which are then reviewed by a doctor. If polyps or cancer are found, a colonoscopy is usually performed to remove them.

E. Biopsy

A biopsy involves examining tissue samples under a microscope. Tissue may be collected during colonoscopy or surgery, or through a needle biopsy guided by CT scan or ultrasound.

F. Biomarker Testing

This test identifies genes, proteins, and other markers specific to the tumor, using tissue obtained from a biopsy.

G. Blood Test

Colon cancer often causes anemia due to continuous bleeding, which can be detected through a complete blood count (CBC). Blood tests can also check for carcinoembryonic antigen (CEA), a protein associated with tumor spread. However, it’s not specific to cancer and is mostly used for tracking treatment progress in patients already diagnosed.

H. Magnetic Resonance Imaging (MRI)

MRI uses a magnetic field and dye to create detailed images of the body. It helps in assessing tumor size and location, especially in advanced stages of cancer.

I. Ultrasound

Ultrasound uses sound waves to produce detailed images of organs. It is particularly useful in identifying how far colon cancer has spread. Endorectal ultrasound is commonly used to assess tumor depth.

J. Chest X-rays

Chest X-rays can detect whether colon cancer has spread to the lungs.

Specialists to Consult

Early detection of colon cancer allows for more treatment options, as precancerous polyps can be removed before they develop into cancer. Therefore, it is essential to seek medical advice promptly. Regular screening is advised for individuals with risk factors, particularly those over 45 years of age. Relevant specialists include:

• Oncologists
• Radiation oncologists
• Oncosurgeons
• Colorectal surgeons

While there is no guaranteed method to prevent colon cancer, several lifestyle changes and measures can reduce the likelihood of developing the disease. These include:

Regular Screening

Since colon cancer typically develops from precancerous polyps that show no symptoms, regular screenings starting at age 45 are crucial. Detecting and removing these polyps early can prevent them from progressing into cancer.

Healthy Diet

A diet high in fiber, such as fruits, vegetables, and whole grains, and rich in calcium and vitamin D, has been linked to a lower risk of colon cancer. On the other hand, diets high in red meat (beef, pork, or lamb) and processed meats may increase the risk. Avoiding such foods can help reduce the chances of developing colon cancer.

Consult a Doctor Before Using NSAIDs

Before taking medications like NSAIDs, it's important to consult a healthcare provider, as they can cause side effects like gastrointestinal bleeding and ulcers. However, some studies suggest that medications like ibuprofen, naproxen, and aspirin may lower the risk of colon cancer.

Maintain Healthy Weight

Being overweight or obese is associated with a higher risk of colon cancer. Maintaining a healthy weight through regular exercise, physical activity, and a balanced diet can help reduce the risk.

Quit Smoking and Limit Alcohol Consumption

Long-term smoking and excessive alcohol use are linked to an increased risk of several cancers, including colon cancer. Quitting both habits can reduce the risk of colon cancer and other types of cancer, such as lung and mouth cancers.

Increase Intake of Essential Nutrients

Some studies suggest that certain vitamins and minerals, including folic acid, vitamin D, calcium, and magnesium, may lower the risk of colon cancer. Consuming foods rich in these nutrients, such as dairy products like milk, cheese, and eggs, may provide protection.

There are several treatment options available for colon cancer, chosen based on factors like the cancer's stage, the patient's age, risk factors, and potential side effects. These treatment methods include:

Surgery

Surgery is one of the most commonly used approaches across all stages of colon cancer. It involves removing the cancerous tissue and may be performed in two ways:

• Local excision: The tumor is removed through a tube inserted into the colon, using a cutting tool. This method is typically used for early-stage cancers.
• Colon resection: In this procedure, part of the colon is also removed along with the tumor. This is done when the tumor is larger.

Ablation Techniques

These methods are used to destroy smaller tumors (less than 4 cm). Ablation options include:

• Radiofrequency ablation: A needle is inserted through the skin, guided by CT or ultrasound, to deliver radio waves that kill cancer cells.
• Microwave ablation: Electromagnetic waves generate high temperatures to destroy cancer cells, often used for larger tumors (up to 6 cm).
• Ethanol (alcohol) ablation: Also called percutaneous ethanol injection (PEI), this technique involves injecting concentrated alcohol into the tumor, guided by ultrasound or CT scans, sometimes requiring multiple injections.
• Cryoablation (cryosurgery): A probe is used to freeze and destroy cancer cells, guided into the body through ultrasound.

Chemotherapy

Chemotherapy uses drugs to target and destroy cancer cells and can be administered in oral form or through injections. These medications are used alone or in combination and may include:

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

Chemotherapy is given in cycles, usually lasting 2 to 3 weeks. The duration and type of chemotherapy depend on the drugs used and the side effects experienced by the patient. The administration method varies depending on the patient’s overall health and the cancer’s stage.

How chemotherapy is given:

• Systemic chemotherapy: The drugs are taken orally or injected into the bloodstream, where they circulate throughout the body to target the tumor.
• Regional chemotherapy: The drugs are injected directly into an artery that supplies blood to the tumor, reducing side effects. An example is hepatic artery infusion for tumors that have spread to the liver.

Chemotherapy during the course of colon cancer:

• Adjuvant chemotherapy: Administered after surgery to kill remaining cancer cells and reduce the risk of cancer recurrence.
• Neoadjuvant chemotherapy: Given before radiation therapy to shrink the tumor and make it easier to remove through radiation.

Common side effects of chemotherapy include:

• Hair loss
• Mouth sores
• Loss of appetite or weight
• Nausea and vomiting
• Diarrhea
• Nail and skin changes
• Hand-foot syndrome
• Neuropathy
• Fatigue
• Easy bruising and bleeding
• Allergic reactions

Discussing side effects with the treatment team is crucial for managing them effectively.

Radiation Therapy

Radiation therapy uses high-energy rays, such as X-rays, to destroy cancer cells. It can be used before, during, or after surgery and is often combined with chemotherapy (chemoradiation). It is especially helpful in advanced stages when cancer has spread to organs like the lungs, brain, or bones. Radiation therapy can be administered in two ways:

• External beam radiation therapy (EBRT): Radiation is directed from outside the body using a machine, typically used when surgery is not an option due to the number or location of tumors.
• Internal radiation therapy: A radioactive substance is placed directly in the rectum near the cancer cells, ensuring radiation is localized to the tumor site. This approach tends to have fewer side effects.

Possible side effects of radiation therapy include:

• Skin irritation
• Nausea
• Rectal discomfort
• Bowel and bladder issues
• Fatigue
• Sexual problems

Targeted Therapy

Targeted therapy involves drugs that specifically attack cancer cells, making it less likely to harm healthy cells compared to chemotherapy or radiation. Some types of targeted therapy include:

• Monoclonal antibodies: These proteins attach to cancer cells and prevent their growth. Examples include:
• Vascular endothelial growth factor (VEGF) inhibitors: Block VEGF, which aids cancer growth by forming new blood vessels. Bevacizumab and ramucirumab are examples.
• Epidermal growth factor receptor (EGFR) inhibitors: These prevent tumor cells from growing by inhibiting EGFR, a protein necessary for cell multiplication. Cetuximab and panitumumab are examples.
• Angiogenesis inhibitors: These prevent new blood vessels from forming, starving cancer cells of nutrients. Examples include Ziv-aflibercept and regorafenib.
• Protein kinase inhibitors: Block proteins required for cancer cell multiplication. Encorafenib is one such drug used in colon cancer.

Immunotherapy

Immunotherapy uses drugs to strengthen the patient’s immune system, enabling it to fight cancer cells more effectively. This treatment is primarily used for advanced colon cancer. Common immunotherapy drugs include ipilimumab, pembrolizumab, and nivolumab.

Colon cancer, when diagnosed early, is often treatable. However, if left untreated, it can become life-threatening. Early screening and diagnosis are vital, especially for individuals exhibiting symptoms or those at risk. Complications associated with colon cancer include:

• Iron deficiency anemia
• Jaundice
• Bowel obstruction
• Colon blockage
• Metastasis (spread to other tissues)
• Recurrence of cancer
• Development of secondary tumors in the colon
• Colon perforation

Acupuncture

Acupuncture can help ease symptoms related to cancer, such as nausea and vomiting, which are common side effects of chemotherapy. It is also effective in relieving pain, shortness of breath, and breathlessness. Acupuncture can be used alongside medical treatments, chemotherapy, or radiation therapy.

Mind-Body Techniques

Mind-body therapies include relaxation practices, yoga, meditation, tai chi, and art therapy. These methods have been shown to help reduce nausea, vomiting, pain, fatigue, anxiety, and depression, while also improving overall well-being. They are especially beneficial for patients undergoing surgery, chemotherapy, and radiation.

Cancer affects a person physically, emotionally, socially, and financially. It brings changes to the patient's life and their family. Medications should be taken as prescribed by healthcare providers.

Certain foods are known to boost the immune system and assist in fighting cancer cells, though these should be used only after consulting a doctor. These include:

• Green Tea: Known for its antioxidant properties that help boost immunity. Caffeine-free options should be used, and it is contraindicated for people with glaucoma.
• Reishi Mushroom: Known for its cancer-fighting properties and immune-boosting effects.
• Turmeric (Haldi): Contains curcumin, which has anti-inflammatory and anti-cancer properties, helping in preventing colon cancer and killing cancer cells.
• Probiotics: Beneficial bacteria like Lactobacillus and Bifidobacterium support the health of the colon and may help prevent or assist in treating colon cancer. Consuming yogurt is also linked to a lower risk of developing colon cancer.
• Polyphenols: Found in foods like cereals, legumes, fruits, vegetables, and beverages such as tea and coffee, polyphenols possess antioxidant properties and may reduce the risk of colon cancer.

Self-Care Tips

Take time daily for activities that bring you joy, such as walking, yoga, napping, watching movies, or socializing with friends. Understanding your emotions and feelings can help you better understand your needs. Consider joining a support group, whether in person, by phone, or online.

Educating yourself about the types, stages, and treatments of cancer can help you stay informed and mentally prepared. Connecting with cancer survivors can uplift your spirits and boost your confidence, aiding in recovery.

Role of Caregivers

Caregivers play a critical role in the treatment process for those diagnosed with colon cancer, especially in older patients who may need more assistance with treatment decisions and management. Caregivers offer:

• Emotional support to ensure the patient doesn't feel isolated
• Help in making treatment decisions
• Participation in doctor visits
• Professional care, such as administering medications, changing dressings, assisting with personal hygiene, and checking surgical sites
• Assistance with meal preparation and feeding

Managing Physical Effects

Cancer treatments often result in various physical changes. It is important to communicate any changes to your healthcare provider, as this helps tailor your treatment plan to alleviate symptoms. Ongoing follow-up care after treatment is essential to monitor long-term effects and detect potential cancer relapse.

Dealing with the Fear of Side Effects

Side effects are common with cancer treatments and may vary depending on multiple factors. It is normal to fear these side effects, but there are several strategies to

manage them effectively, including:

• Taking an active role in your treatment plan to better understand potential side effects.
• Discussing any concerns with your doctor to address or prevent side effects.
• Keeping a journal to track your experiences.
• Talking to loved ones about your fears to reduce anxiety.

Managing Emotional and Social Impacts

A cancer diagnosis can have emotional and social repercussions, such as stress, anxiety, depression, and feelings of helplessness. Some strategies to improve emotional health include:

• Engaging in enjoyable activities like crafting, painting, or singing.
• Exercising regularly to reduce stress.
• Joining a support group, whether online or in person.
• Seeking help from a professional counselor.
• Connecting with someone undergoing similar treatment.
• Listening to podcasts that share survival stories of colon cancer patients.

Managing Treatment Costs

Cancer treatment can be financially burdensome, causing anxiety for patients and their families. Managing these costs can be done by:

• Gaining a clear understanding of treatment costs in advance.
• Communicating any financial difficulties with your healthcare team, who can help find affordable alternatives.
• Seeking financial assistance through oncology social workers, nurses, or doctors.
• Utilizing health insurance resources for support.

Monitoring for Recurrence

Follow-up care after treatment is vital for detecting recurrence, managing long-term side effects, and monitoring overall health. The first five years after treatment are critical for colon cancer patients. Follow-up care includes regular physical exams, tests, and counseling. Cancer rehabilitation may also involve:

• Physical therapy
• Emotional counseling
• Pain management for long-term discomfort
• Nutritional advice