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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Illustration
Colon or Rectal Cancer
What is colon or rectal cancer?
Colon or rectal cancer is an uncontrolled growth of cells in
the colon or rectum. The growth of cells is called a tumor.
The colon and rectum are 2 sections of the large intestine.
The tumor disrupts blood vessels in the colon or rectum. It
can cause bleeding in the early stages. In later stages it
can cause a change in bowel habits and block normal bowel
function.
It is important to diagnose and treat the tumor as soon as
possible. If not treated, the cancer can spread through
the bowel wall to lymph nodes and other parts of the body.
The large intestine is one of the 3 most common sites for
cancer to occur. (The other 2 most common sites are the
lungs and the breasts.) This type of cancer usually occurs
after age 50.
Another term for this type of cancer is colorectal cancer.
How does it occur?
Cancer cells are abnormal cells that grow, change in size
and shape, and can continue to grow and spread beyond their
original site (metastasize). They sometimes regrow in the
same area from which they have previously been surgically
removed. Most colorectal cancers arise from a certain type
of polyp that forms on the surface of the wall of the colon.
There are several suspected, but as yet unproven, causes of
colorectal cancer. Because colorectal cancer is more common
in countries where people eat highly refined, low-fiber
diets, it has been thought that diet may contribute to the
disease. Lack of exercise is also a probable cause for this
cancer.
What are the symptoms?
The cancer starts without symptoms. When symptoms do occur
they may include:
- blood in bowel movements (stools)
- constipation
- diarrhea
- weight loss
- anemia
- pain or discomfort in the abdomen
- fullness in the abdomen.
How is it diagnosed?
Your health care provider reviews your symptoms and examines
your rectum and abdomen. A sample of a bowel movement may
be tested for the presence of blood.
Procedures called sigmoidoscopy or colonoscopy allow your
health care provider to look at the inside of the colon and
rectum. Before these tests you take a laxative to clean
your bowel. A sedative to help you relax during the test
is usually recommended. During a sigmoidoscopy or
colonoscopy your health care provider inserts a slim,
flexible, fiber-optic scope into your rectum to view the
inside of your colon. Your provider may remove a small
piece of any tissue that looks abnormal to examine and test
it for cancer (a test called a biopsy).
Your health care provider may instead do a procedure called
a barium enema. In this procedure you are given an enema
that contains dye. X-rays are then taken that show the
inner contour of the colon. If the x-ray images show a
polyp or cancer, you will need to have a colonoscopy to get
a sample of tissue (biopsy) for examination and tests in
the lab.
How is it treated?
Your health care provider will determine the stage of the
cancer, from early to advanced. Your provider may suggest
surgery and do more tests to see if the cancer has spread to
other organs. The stage (or amount of spread) of the cancer
determines the treatment choices and the future course of
the illness.
The tumor or any organs or parts of organs that are affected
by the tumor may be removed with surgery. The surgeon may
cut out the section of the colon that has the cancer and
then rejoin the ends of the intestine. This procedure is
called resection and reanastomosis.
In another procedure called a colostomy, the surgeon removes
the cancerous portion of the colon, makes an opening in the
abdominal wall, and attaches the healthy end of the
shortened colon to the opening in the outside wall of the
abdomen. After this procedure you will pass bowel movements
through this opening. You will wear a colostomy bag outside
your body and under your clothes to collect bowel movements.
A special nurse (called a stomatherapist) will see you
before surgery and help you after surgery to adjust to the
colostomy. In some cases the colostomy is temporary and at
other times it is permanent.
How long will the effects last?
In some cases the cancer may be cured with surgery alone.
You may need additional treatment, such as chemotherapy or
radiation therapy, to prevent or treat the spread of cancer
to other vital organs.
Your chance of cure depends on how far the cancer has
advanced. When a cancer is removed before it has spread
into the wall of the colon, more than 90% of people survive
5 years or longer. This percentage decreases if the cancer
has spread at the time of surgery.
If you have a colostomy, your health care team will help you
adapt to living with a colostomy. Your health care provider
may suggest dietary changes to restrict gas-forming and
odor-causing foods such as beans, eggs, fish, and carbonated
drinks. Most people lead healthy, active lives with
colostomies.
How can I take care of myself?
Follow the treatment that you and your health care provider
determine, and seek the advice of other health professionals
as needed. In addition, maintain a lifestyle that allows
you to:
- Get enough rest and sleep.
- Eat nutritious foods, following your after-surgery diet
instructions.
- Exercise according to your health care provider's
recommendations.
- Relax using techniques such as positive mental imaging,
muscle relaxation exercises, and diaphragmatic breathing
exercises. Seek enjoyable and humorous experiences to
relieve stress.
Talk with a mental health professional about anxiety
concerning cancer if you think it might help.
If you have a colostomy:
- Learn how to take care of your colostomy.
- Learn which foods you should try to avoid because they
cause excess gas or make bowel control difficult.
- Allow yourself time to adjust to changes in your body
image. You may need to change your style of clothing to
accommodate the colostomy.
- Seek sexual counseling for yourself and your partner if
you feel you need it.
- You may feel anger, frustration, grief, and embarrassment
about the cancer and colostomy. Ease your emotional
stress by expressing your feelings.
What can be done to help prevent colorectal cancer from
occurring or recurring?
To prevent or detect recurrence of the cancer, follow the
guidelines your health care provider gives you. Also, you
should:
- Keep your health care provider's appointments and exam
dates for future follow-ups.
- Check yourself for symptoms or signs.
- Call your health care provider if changes occur.
If you do not have colorectal cancer but have a family
history of colon cancer, tell your health care provider so
he or she can arrange for you to be tested regularly. If
you are over 50 years old and have risk factors for
colorectal cancer, your provider may recommend occult blood
screening, sigmoidoscopy, or colonoscopy. (Occult blood
screening is a test for traces of blood in bowel movements.)
People without known risk factors for colorectal cancer
should discuss the advantages and limitations of screening
with their health care provider.
For more information on cancer, contact national and local
organizations such as:
- American Cancer Society, Inc.
1599 Clifton Road, NE
Atlanta, Georgia 30329
Phone: 800-ACS-2345 (800-227-2345)
Web site: http://www.cancer.org
- AMC Cancer Research Center and Foundation
Phone: 800-321-1557
Web site: http://www.amc.org
- Cancer Information Service
Phone: 800-4-CANCER (800-422-6237)
Web site: http://cis.nci.nih.gov
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