Healthy cells grow and divide in an orderly way to keep your body functioning normally. But when a cell's DNA is damaged and becomes cancerous, cells continue to divide - even when new cells aren't needed. As the cells accumulate, they form a tumor. With time, the cancer cells can grow to invade and destroy normal tissue nearby. Colon cancer is a type of cancer that develops when tumorous growths develop in the large intestine. Over time some of these polyps can become colon cancers. Colon cancer is sometimes called colorectal cancer, which is a term that combines colon cancer and rectal cancer, which begins in the rectum.
How does colon cancer start?
In general, colon cancer begins when healthy cells in the colon develop changes (mutations) in their DNA. A cell's DNA contains a set of instructions that tell a cell what to do. It usually begins as small, noncancerous (benign) clumps of cells called polyps that form on the inside of the colon. Most colon cancers begin as benign polyps. These are either flat or knob-like growths on the lining of the large intestine. While some polyps remain benign (non-cancerous), some may become malignant (cancerous) over time.
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Here, you will find information about signs and symptoms, causes and risk factors, types, diagnosis, staging and prevention about colon cancer.
Many people with colon cancer experience no symptoms in the early stages of the disease. When symptoms appear, they'll likely vary, depending on the cancer's size and location in your large intestine. Signs and symptoms of colon cancer include:
A persistent change in your bowel habits, including diarrhea or constipation
Rectal bleeding or blood in your stool
Persistent abdominal discomfort, such as cramps, gas or pain
A feeling that your bowel doesn't empty completely
Weakness or fatigue, Unexplained weight loss
Dark stools, or blood in the stool
Vomiting, Shortness of breath
Feeling tired all the time
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Factors that may increase your risk of colon cancer include:
Older age: Majority of people with colon cancer are older than 50.
Inflammatory intestinal conditions: Chronic inflammatory diseases of the colon, such as ulcerative colitis and Crohn's disease, can increase your risk of colon cancer.
Diet: There is an increased risk of colon cancer in people who eat diets high in red meat and processed meat.
Inactivity: Being physically inactive increases the risk of developing colon cancer. Staying active by doing even light workouts each day may help reduce this risk.
Obesity/Being overweight: People who are obese have an increased risk of colon cancer.
Alcohol use: People who drink heavily or regularly may also be putting themselves at greater risk of colon cancer.
Smoking: People who smoke are more likely to develop colon cancer than those who do not. Smoking cigarettes also increases the risk of many other types of cancer.
A personal history of colorectal cancer or polyps: If you're already had colon cancer or noncancerous colon polyps, you have a greater risk of colon cancer in the future.
Inherited syndromes that increase colon cancer risk: Some gene mutations passed through generations of your family can increase your risk of colon cancer.
There are several types of colon cancer, and each originates in a different type of cell. The main types of colon cancer include:
Adenocarcinoma: The vast majority of colon cancer is adenocarcinoma. This is a cancer of the cells that line the inside surface of the colon.
Carcinoid Tumors: Carcinoid tumors start in hormone-producing cells in the intestines.
Gastrointestinal Stromal Tumors: Gastrointestinal stromal tumors can be a type of soft tissue sarcoma that can be found anywhere in the gastrointestinal tract but is rare in the colon. These tumors can also be other types of sarcoma that start in the blood vessels or connective tissue of the colon.
Lymphoma: Lymphoma is a cancer of the immune system. It more commonly starts in the lymph nodes but can start in the colon.
Squamous cell carcinomas: These develop in the blood vessels or smooth muscle cells of the colon. There are several different carcinoma subtypes, including leiomyosarcomas and angiosarcomas.
Leiomyosarcomas: Another form of sarcoma, leiomyosarcoma essentially means "cancer of smooth muscle." The colon and rectum have three layers of the type of muscle affected by leiomyosarcoma.
An early diagnosis of colon cancer gives you the best chance of curing it. In addition to a physical examination, the following tests may be used to diagnose colon cancer.
Colorectal cancer can be diagnosed by a variety of tests.
Blood tests (Complete blood count, tumor markers and liver enzymes)
Imaging tests (X-rays, CT scan, MRI scan, PET scan, ultrasound, angiography)
Diagnostic colonoscopy (done after you show symptoms)
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When a colon cancer is diagnosed, additional tests are performed to determine the extent of the disease. This process is called staging. Staging determines how advanced a colon cancer has become. The stage refers to the extent of the cancer or how far it has spread. Staging colon cancer is essential to determine the best treatment approach. One tool that is used to describe the stages of colon cancer is the TNM system.
The staging system most often used for colorectal cancer is TNM system, which is based on 3 key pieces of information:
The extent (size) of the tumor (T): How far has the cancer grown into the wall of the colon or rectum? These layers, from the inner to the outer, include: the inner lining (mucosa), The fibrous tissue beneath this muscle layer (submucosa), a thick muscle layer (muscularis propria), the thin, outermost layers of connective tissue (subserosa and serosa) that cover most of the colon but not the rectum.
The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes? If so, where and how many?
The spread (metastasis) to distant sites (M): Has the cancer spread to distant lymph nodes or distant organs such as the liver or lungs? If so, where and how much?
We at CAN-C has team of specialists to provide comprehensive care and treatment for people with colon cancer in Bangalore.
You can take steps to reduce your risk of colon cancer by making changes in your everyday life. Take steps to:
Eat a variety of fruits, vegetables and whole grains: Fruits, vegetables and whole grains contain vitamins, minerals, fiber and antioxidants, which may play a role in cancer prevention.
Reduce consumption of red and processed meat: Moderate effect of red meat in increasing risk of colon cancer, especially with processed meat.
Limit your alcohol intake: and if you choose to drink alcohol, limit the amount of alcohol you drink.
Stop smoking: If you do smoke, stopping smoking will reduce your risk.
Engage in regular physical activity: Try to get at least 30 minutes of exercise on most days.
Maintain a healthy body weight
Which treatments are most likely to help you depends on your particular situation, including the location of your cancer, its stage and your other health concerns. Treatment for colon cancer usually involves surgery to remove the cancer. Other treatments, such as radiation therapy and chemotherapy, might also be recommended.
Our cancer specialists provide the very best colon cancer treatment in Bangalore and ensure the best outcomes are achieved for each patient.
Surgery is often the main treatment for earlier-stage colon cancers. The type of surgery used depends on the stage (extent) of the cancer, where it is, and the goal of the surgery.
Any type of colon surgery needs to be done on a clean and empty colon. You will be put on a special diet before surgery and may need to use laxative drinks and enemas to get all of the stool out of your colon.
1. Polypectomy and local excision: Some early stage colon cancers and most polyps can be removed during a colonoscopy. This is a procedure that uses a long flexible tube with a small video camera on the end that's put into the person's rectum and threaded into the colon. These surgeries can be done during a colonoscopy:
For a polypectomy, the cancer is removed as part of the polyp, which is cut at its stalk (the part that looks like the stem of a mushroom). This is usually done by passing a wire loop through the colonoscope to cut the polyp off the wall of the colon with an electric current.
A local excision is a slightly more involved procedure. Tools are used through the colonoscope to remove small cancers on the inside lining of the colon along with a small amount of surrounding healthy tissue on the wall of colon. When cancer or polyps are taken out this way, the doctor doesn't have to cut into the abdomen (belly).
2. Colectomy: A colectomy is surgery to remove all or part of the colon. Nearby lymph nodes are also removed. If only part of the colon is removed, it's called a hemicolectomy, partial colectomy, or segmental resection. If all of the colon is removed, it's called a total colectomy. Total colectomy isn't often needed to treat colon cancer.
A colectomy can be done in 2 ways:
Open colectomy: The surgery is done through a single long incision (cut) in the abdomen (belly).
Laparoscopic-assisted colectomy: The surgery is done through many smaller incisions and special tools. A laparoscope is a long, thin lighted tube with a small camera and light on the end that lets the surgeon see inside the abdomen. It's put into one of the small cuts, and long, thin instruments are put in through the others to remove part of the colon and lymph nodes.
CAN-C: Provide colon cancer treatment in Bangalore and help you live life as fully as you can.
Radiation therapy uses high-energy rays (such as x-rays) or particles to destroy cancer cells. It's more often used to treat people with colon cancer. For some colon cancers, treating with chemotherapy at the same time can make radiation therapy work even better. Using these 2 treatments together is called chemoradiation or chemoradiotherapy.
It's not common to use radiation therapy to treat colon cancer, but it may be used in select cases:
1. Before surgery (along with chemo) to help shrink a tumor and make it easier to remove.
2. After surgery, if the cancer has attached to an internal organ or the lining of the belly (abdomen). Radiation therapy may be used to try to kill any cancer cells that may have been left behind.
3. During surgery, right to the area where the tumor was, to kill any cancer cells that may be left behind.
4. Along with chemo to help control cancers if a person is not healthy enough for surgery.
5. To ease symptoms if advanced cancer is causing intestinal blockage, bleeding, or pain.
6. To help treat cancer that has spread to other areas, such as the bones or brain.
Types of radiation therapy:
Different types of radiation therapy can be used to treat colon cancers.
1. External-beam radiation therapy (EBRT): This is the type of radiation therapy used most often for people with colon cancer. The radiation is focused on the cancer from a machine outside the body. It's a lot like getting an x-ray, but the radiation is more intense.
2. Internal radiation therapy (brachytherapy): This type of radiation therapy might be used to treat some colon cancers. For this treatment, a radioactive source is put inside your rectum next to or into the tumor. This allows the radiation to reach the rectum without passing through the skin and other tissues of the belly (abdomen), so it's less likely to damage nearby tissues.
Chemotherapy (chemo) is often used to treat colon cancer. It's the use of drugs to kill cancer cells. Chemotherapy for colon cancer is usually given after surgery if the cancer is larger or has spread to the lymph nodes. In this way, chemotherapy may kill any cancer cells that remain in the body and help reduce the risk of cancer recurrence.
You can get chemotherapy in different ways.
1. Systemic chemotherapy: Drugs are put right into your blood through a vein or you take them by mouth. The drugs enter your bloodstream and reach all areas of your body. This can help reduce the risk of colon cancer spreading to other parts of the body.
2. Regional chemotherapy: Drugs are put right into an artery that leads to the part of the body with the tumor. This focuses the chemo on the cancer cells in that area. It reduces side effects by limiting the amount of drug reaching the rest of your body. Hepatic artery infusion, or chemo given directly into the hepatic artery, is an example of regional chemotherapy sometimes used for cancer that has spread to the liver.
Chemo may be used at different times during treatment for colon cancer:
1. Adjuvant chemo is given after surgery. The goal is to kill any cancer cells that might have been left behind at surgery because they were too small to see, as well as cancer cells that might have escaped from the main tumor and settled in other parts of the body but are too small to see on imaging tests. This helps lower the chance that the cancer will come back.
2. Neoadjuvant chemo is given (sometimes with radiation) before surgery to try to shrink the cancer and make it easier to remove.
3. For advanced cancers that have spread to other organs like the liver, chemo can be used to help shrink tumors and ease problems they're causing. While it's not likely to cure the cancer, this often helps people feel better and live longer.
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Targeted drug treatments are developed in order to focus on specific abnormalities present within cancer cells and make cancer cells to die. Targeted therapy drugs work differently from standard chemotherapy (chemo) drugs. Targeted drugs are usually combined with chemotherapy. Targeted drugs are typically reserved for people with advanced colon cancer.
Drugs that target blood vessel formation (VEGF)
Vascular endothelial growth factor (VEGF) is a protein that helps tumors form new blood vessels (a process known as angiogenesis) to get nutrients they need to grow. Drugs that stop VEGF from working can be used to treat some colon cancers. These include:
These drugs are given as infusions into your vein, in most cases along with chemotherapy. When combined with chemo, these drugs can often help people with advanced colon cancers live longer.
Drugs that target cells with EGFR changes
Epidermal growth factor receptor (EGFR) is a protein that helps cancer cells grow. There's often a lot of it on the surface of cancer cells. Drugs that target EGFR can be used to treat some advanced colon cancers. These include:
Immunotherapy is a drug treatment that uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells from recognizing the cancer cells. Immunotherapy works by interfering with that process. Immunotherapy is usually reserved for advanced colon cancer.
An important part of the immune system is its ability to keep itself from attacking the body's normal cells. To do this, it uses "checkpoint" proteins on immune cells, which act like switches that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to keep the immune system from attacking them. But drugs that target these checkpoints hold a lot of promise as cancer treatments.
Drugs called checkpoint inhibitors can be used for people whose colon cancer cells have tested positive for specific gene changes, such as a high level of microsatellite instability (MSI-H), or changes in one of the mismatch repair (MMR) genes. The drugs are used for people whose cancer is still growing after treatment with chemotherapy. They might also be used to treat people whose cancer can't be removed with surgery, has come back (recurred) after treatment, or has spread to other parts of the body (metastasized).
PD-1 inhibitors: Pembrolizumab (Keytruda) and nivolumab (Opdivo) are drugs that target PD-1, a protein on immune system cells called T cells that normally help keep these cells from attacking other cells in the body. By blocking PD-1, these drugs boost the immune response against cancer cells.
CTLA-4 inhibitor: Ipilimumab (Yervoy) is another drug that boosts the immune response, but it has a different target. It blocks CTLA-4, another protein on T cells that normally helps keep them in check. This drug can be used along with nivolumab (Opdivo) to treat colon cancer, but it's not used alone.
CAN-C: Expertise in colon cancer treatment in Bangalore.
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