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National Cancer Institute

PDQ® bullet Treatment  bullet Patients

Colon cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is cancer of the colon?
STAGE EXPLANATION
Stages of cancer of the colon
Stage 0 or carcinoma in situ
Stage I
Stage II
Stage III
Stage IV
Recurrent
TREATMENT OPTION OVERVIEW
How cancer of the colon is treated
Treatment by stage
STAGE 0 COLON CANCER
STAGE I COLON CANCER
STAGE II COLON CANCER
STAGE III COLON CANCER
STAGE IV COLON CANCER
RECURRENT COLON CANCER
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is cancer of the colon?

Cancer of the colon, a common form of cancer, is a disease in which cancer (malignant) cells are found in the tissues of the colon. The colon is part of the body's digestive system. The purpose of the digestive system is to remove nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from the foods eaten and to store the waste until it passes out of the body. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The last 6 feet of intestine is called the large bowel or colon.

Genes are markers in cells associated with hereditary traits. Abnormal genes have been found in patients with some forms of colon and rectal cancer. Tests are being developed to determine who carries these genes long before cancer appears.

Screening tests (such as a rectal examination, proctoscopy, and colonoscopy) may be done regularly in patients who are at higher risk to get cancer. These tests may be done in patients who are over age 50; who have a family history of cancer of the colon, rectum, or of the female organs; who have had small noncancerous growths (polyps) in the colon; or who have a history of ulcerative colitis (ulcers in the lining of the large intestines). A doctor may order these tests to look for cancer if there is a change in bowel habits or if there is any bleeding from the rectum.

A doctor will usually begin by giving the patient a rectal examination. In a rectal examination the doctor, wearing thin gloves, puts a greased finger into the rectum and gently feels for lumps. The doctor may then check the material collected from the rectum to see if there is any blood in it.

The doctor may also want to look inside the rectum and lower colon with a special instrument called a sigmoidoscope or a proctosigmoidoscope. This examination, called a proctoscopy or procto examination, finds about half of all colon and rectal cancers. The test is usually done in a doctor's office. Some pressure may be felt, but usually with no pain.

The doctor may also want to look inside the rectum and the entire colon (colonoscopy) with a special tool called a colonoscope. This test is also done in a doctor's office. Some pressure may be felt, but usually with no pain.

If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy. Biopsies are usually done during the proctoscopy or colonoscopy, in a doctor's office.

The prognosis (chance of recovery) and choice of treatment depend on the stage of the cancer (whether it is just in the inner lining of the colon or if it has spread to other places) and the patient's general state of health. After treatment, a blood test (to measure amounts of carcinoembryonic antigen or CEA in the blood) and x-rays may be done to see if the cancer has come back.


STAGE EXPLANATION


Stages of cancer of the colon

Once cancer of the colon is found (diagnosed), more tests will be done to find out if cancer cells have spread to other parts of the body (staging). In order to stage colon cancer, a surgical procedure will need to be performed. Knowing the stage of the disease will assist the doctor in effectively planning further treatment. The following stages are used for cancer of the colon:


Stage 0 or carcinoma in situ

Stage 0 cancer of the colon is very early cancer. The cancer is found only in the innermost lining of the colon.


Stage I

The cancer has spread beyond the innermost lining of the colon to the second and third layers and involves the inside wall of the colon, but has not spread to the outer wall of the colon or outside the colon.

Stage I colon cancer is sometimes called Dukes A colon cancer.


Stage II

Cancer has spread outside the colon to nearby tissue, but it has not gone into the lymph nodes. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They produce and store cells that fight infection.)

Stage II colon cancer is sometimes called Dukes B colon cancer.


Stage III

Cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They produce and store cells that fight infection.)

Stage III colon cancer is sometimes called Dukes C colon cancer.


Stage IV

Cancer has spread to other parts of the body.

Stage IV colon cancer is sometimes called Dukes D colon cancer.


Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the colon or in another part of the body. Recurrent cancer of the colon is often found in the liver and/or lungs.


TREATMENT OPTION OVERVIEW


How cancer of the colon is treated

There are treatments for all patients with cancer of the colon. Three kinds of treatments are available:

Surgery is the most common treatment of all stages of cancer of the colon. A doctor may take out the cancer from the colon using one of the following:

If the cancer is found at a very early stage, the doctor may take out the
cancer without cutting into the abdomen. Instead, the doctor may put a
tube through the rectum into the colon and cut the tumor out. This is
called a local excision. If the cancer is found in a small bulging piece of
tissue (called a polyp), the operation is called a polypectomy.

If the cancer is larger, the doctor will take out the cancer and a small
amount of healthy tissue around it (bowel or colon resection). The healthy
parts of the colon are then sewn together (anastomosis). The doctor will
also take out lymph nodes near the intestine and look at them under the
microscope to see if they contain cancer.

If the doctor is not able to sew the colon back together, he or she will
make an opening (stoma) on the outside of the body for waste to pass out of
the body. This is called a colostomy. Sometimes, the colostomy is only
needed until the colon has healed, and then it can be reversed. However,
the doctor may have to take out the entire lower colon and the colostomy is
permanent. If a patient has a colostomy, a special bag will need to be worn
to collect body wastes. This special bag, which sticks to the skin around
the stoma with a special glue, can be thrown away after it is used. This bag
does not show under clothing, and most people take care of these bags
themselves.

Radiation therapy is the use of x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that contain radiation through thin plastic tubes (internal radiation therapy) in the intestine area. Radiation can be used alone or in addition to surgery and/or chemotherapy.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by inserting a needle into a vein. A patient may be given chemotherapy through a tube that will be left in the vein while a small pump gives the patient constant treatment over a period of weeks. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the colon. If the cancer has spread to the liver, the patient may be given chemotherapy directly into the artery going to the liver.

If the doctor removes all the cancer that can be seen at the time of the operation, the patient may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after an operation to a person who has no cancer cells that can be seen is called adjuvant chemotherapy.

Biological treatment tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological treatment is sometimes called biological response modifier (BRM) therapy or immunotherapy.


Treatment by stage

Treatments for cancer of the colon depend on the stage of the disease and the patient's general health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of cancer of the colon. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


STAGE 0 COLON CANCER

Treatment may be one of the following:

1. Local excision or simple polypectomy to remove all the cancer.

2. Bowel resection.


STAGE I COLON CANCER

Treatment is usually surgery (bowel resection) to remove the cancer and join the cut ends of the bowel.


STAGE II COLON CANCER

Treatment may be one of the following:

1. Treatment is usually surgery (bowel resection) to remove the cancer.

2. Clinical trials of chemotherapy, radiation therapy, or biological therapy following surgery.

3. If the tumor has spread to nearby tissue, a patient may also receive chemotherapy and/or radiation therapy following surgery.


STAGE III COLON CANCER

Treatment may be one of the following:

1. Treatment is usually surgery (bowel resection) to remove the cancer followed by chemotherapy.

2. Clinical trials of chemotherapy, radiation therapy, and/or biological therapy following surgery.


STAGE IV COLON CANCER

Treatment may be one of the following:

1. Surgery (bowel resection) to remove the cancer or to make the colon go around the cancer so that it can still work.

2. Surgery to remove parts of other organs such as the liver, lungs, and ovaries, where the cancer may have spread.

3. Radiation therapy to relieve symptoms.

4. Chemotherapy to relieve symptoms.

5. Clinical trials of chemotherapy or biological therapy.


RECURRENT COLON CANCER

If the cancer has come back (recurred) in only one part of the body, treatment may consist of an operation to take out the cancer. If the cancer has spread to several parts of the body, a doctor may give a patient either chemotherapy or radiation therapy. The patient may also choose to participate in a clinical trial testing new chemotherapy drugs or biological therapy.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about cancer of the colon, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, trained information specialists can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public on request. The following booklet about cancer of the colon may be helpful:

What You Need To Know About Cancer of the Colon and Rectum

The following general booklets on topics related to cancer may also be helpful:

What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where people can get materials and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 05/1999


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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