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Colorectal cancer
Classification and external resources

Diagram of the stomach, colon, and rectum
ICD-10 C18.-C20.
ICD-9 153.0-154.1
ICD-O: M8140/3 (95% of cases)
OMIM 114500
DiseasesDB 2975
MedlinePlus 000262
eMedicine med/413 med/1994 ped/3037
.Colorectal cancer, also called colon cancer or large bowel cancer, includes cancerous growths in the colon, rectum and appendix.^ The colon is also called the large intestine.

^ Polyps are benign (non-cancerous) growths of the colon and rectum.
  • Colorectal Cancer and Colon Cancer Symptoms, Treatment and Prevention | Florida Hospital Digestive Health Center 10 February 2010 13:37 UTC www.floridahospitaldigestive.com [Source type: Academic]

^ This stage is also called Duke's A colon cancer.

.With 655,000 deaths worldwide per year, it is the fifth most common form of cancer in the United States and the third leading cause of cancer-related death in the Western world.^ Metastatic colorectal carcinoma (MCRC), the second leading cause of cancer-related death in the United States, has represented a treatment quandary.
  • Deciphering Metastatic Colorectal Carcinoma 25 September 2009 0:48 UTC www2.mdanderson.org [Source type: Academic]

^ Colorectal cancer, or cancer of the colon or rectum, is the second-leading cause of cancer-related deaths in the United States.

^ It is responsible for 1.3 million deaths each year and is the most common form of cancer in men and second most common cancer in women.
  • Gene Makes Drinkers More Prone to Colon Cancer 10 February 2010 13:36 UTC www.empowereddoctor.com [Source type: Academic]

[1][2] .Colorectal cancers arise from adenomatous polyps in the colon.^ Colorectal cancer refers to cancer of the colon or rectum.
  • CGH Medical Center - Colorectal Cancer Prevention 10 February 2010 13:37 UTC www.cghmc.com [Source type: FILTERED WITH BAYES]

^ Alternative Names Colorectal cancer; Cancer - colon .
  • What is Colon cancer? 10 February 2010 13:36 UTC www.medhelp.org [Source type: Academic]

^ Polyp removal can prevent colon cancer.
  • University of California Los Angeles - David Geffen School of Medicine - Colorectal Cancer Risk Factors 10 February 2010 13:37 UTC cancer.med.ucla.edu [Source type: Academic]

.These mushroom-shaped growths are usually benign, but some develop into cancer over time.^ These growths can become cancerous over time if left untreated.

^ Truth: Polyps are benign growths that, if left unchecked, have the potential to develop into cancer.
  • UMCCC News: 12 myths about colon cancer 10 February 2010 13:36 UTC www.cancer.med.umich.edu [Source type: FILTERED WITH BAYES]
  • UMHS Press Release: 12 myths about colon cancer 10 February 2010 13:36 UTC www.med.umich.edu [Source type: FILTERED WITH BAYES]

^ Although most of these polyps are benign, some develop into cancer over a period of time.
  • Colon Cancer Surgery | Opticolon.com 10 February 2010 13:36 UTC www.opticolon.com [Source type: FILTERED WITH BAYES]

.Localized colon cancer is usually diagnosed through colonoscopy.^ Q. How is colon cancer diagnosed?
  • Colon Cancer symptoms treatment information signs bowel colorectal 10 February 2010 13:36 UTC www.aicr.org.uk [Source type: Academic]

^ How do doctors diagnose colon cancer?

^ How is colon cancer diagnosed?
  • Colon Cancer Symptoms, Diagnosis, and Treatment- Mass General Hospital 10 February 2010 13:36 UTC www2.massgeneral.org [Source type: Academic]
  • Colon Cancer and IBD 10 February 2010 13:36 UTC www.rush.edu [Source type: Academic]

.Invasive cancers that are confined within the wall of the colon (TNM stages I and II) are curable with surgery.^ Colon Cancer Information, types of colon cancer, stages of colon cancer .
  • Colon Cancer Information, types of colon cancer, stages of colon cancer 10 February 2010 13:36 UTC www.thehealthresource.com [Source type: Academic]

^ What is Stage 4 colon cancer?

^ What is the difference in the stages of colon cancer ?
  • Colon Cancer how to detect it and treatments for it 10 February 2010 13:36 UTC coloncancerinformation.net [Source type: Academic]

.If untreated, they spread to regional lymph nodes (stage III), where up to 73% are curable by surgery and chemotherapy.^ In stage III, lymph nodes are involved but not distant sites.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ Stage III Cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body.
  • Treatment of Colon Cancer | Treatments for Colon Cancer | Adjutant Treatment of Colon Cancer 10 February 2010 13:36 UTC www.meds.com [Source type: Academic]

^ Stage III: Your cancer has spread to one or more lymph nodes in the area.
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

.Cancer that metastasizes to distant sites (stage IV) is usually not curable, although chemotherapy can extend survival, and in rare cases, surgery and chemotherapy together have seen patients through to a cure.^ For rectal cancer, chemotherapy and radiation usually are given before or after surgery.
  • Colorectal Cancer - Colorectal Cancer Description - Colorectal Cancer Symptoms - Colorectal Cancer Prevention - Colorectal Cancer Treatment 10 February 2010 13:37 UTC symptomchecker.about.com [Source type: Academic]

^ Stage IV rectal cancer is treated primarily with chemotherapy and palliative surgery, if necessary.
  • Q&A: Colorectal Cancer « FOX News Health Blog « FOXNews.com 10 February 2010 13:37 UTC health.blogs.foxnews.com [Source type: FILTERED WITH BAYES]

^ Stage IV is metastasized cancer.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

[3] .Radiation is used with rectal cancer.^ Radiation is often used, even in early stages of rectal cancer.
  • Colon Cancer - Information on how to treat this form of cancer usingalternative and integrated approaches 10 February 2010 13:36 UTC www.cancure.org [Source type: Academic]

^ For rectal cancer, chemotherapy and radiation can be used before or after surgery.
  • Colorectal Cancer - Colorectal Cancer Description - Colorectal Cancer Symptoms - Colorectal Cancer Prevention - Colorectal Cancer Treatment 10 February 2010 13:37 UTC symptomchecker.about.com [Source type: Academic]

^ Radiation is sometimes used with surgery and chemotherapy, particularly for rectal cancer.

.On the cellular and molecular level, colorectal cancer starts with a mutation to the Wnt signaling pathway.^ Molecular characterization of colorectal cancer in Newfoundland .
  • Colorectal Cancer Research Publications 10 February 2010 13:37 UTC www.mshri.on.ca [Source type: Academic]

^ KRAS mutations in lung and colorectal cancer .

^ Start and spread of colorectal cancer .
  • ACS :: What Is Colorectal Cancer? 10 February 2010 13:37 UTC www.cancer.org [Source type: FILTERED WITH BAYES]

.When Wnt binds to a receptor on the cell, that sets in motion a chain of molecular events that ends with β-catenin moving into the nucleus and activating a gene on DNA. In colorectal cancer, genes along this chain are damaged.^ Molecular characterization of colorectal cancer in Newfoundland .
  • Colorectal Cancer Research Publications 10 February 2010 13:37 UTC www.mshri.on.ca [Source type: Academic]

^ The molecular characterization of colorectal cancer in Newfoundland .
  • Colorectal Cancer Research Publications 10 February 2010 13:37 UTC www.mshri.on.ca [Source type: Academic]

^ Gene which is activated when DNA damage occurs to correct DNA damage before a cell divides.
  • Colorectal Cancer Research Definitions 10 February 2010 13:37 UTC www.mshri.on.ca [Source type: Academic]

.Usually, a gene called APC, which is a "brake" on the Wnt pathway, is damaged.^ The test for FAP syndrome involves examining DNA in blood cells called lymphocytes (white blood cells), looking for mutations in the APC gene.
  • genome.gov | Learning About Colon Cancer 10 February 2010 13:36 UTC www.genome.gov [Source type: Academic]

^ It is caused by a change in a specific gene called APC. Unless FAP is treated, it usually leads to colorectal cancer by age 40.
  • Cancer Recovery Foundation: Colorectal Cancer: Risk Factors 10 February 2010 13:37 UTC www.cancerrecovery.org [Source type: Academic]
  • Are You At Risk For Colorectal Cancer? - Beth Israel Deaconess Medical Center (new) News Story - WCVB Boston 10 February 2010 13:37 UTC www.thebostonchannel.com [Source type: News]

^ This gene change is called the I1307K APC mutation.
  • AtlantiCare - Cancer Care - Screening Procedures - Colon Cancer 10 February 2010 13:36 UTC www.atlanticare.org [Source type: FILTERED WITH BAYES]

.Without a working APC brake, the Wnt pathway is stuck in the "on" position.^ Intestinal cancer is initiated by Wnt-pathway-activating mutations in genes such as adenomatous polyposis coli ( APC ).
  • Access : Crypt stem cells as the cells-of-origin of intestinal cancer : Nature 22 September 2009 21:31 UTC www.nature.com [Source type: Academic]

[3]

Contents

Signs and symptoms

.The symptoms of colorectal cancer depend on the location of tumor in bowel and whether it has spread to elsewhere in the body (metastasis).^ Possible signs and symptoms of colorectal cancer: .

^ Symptoms of Colorectal cancer .
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]
  • Symptoms of Colorectal cancer - WrongDiagnosis.com 10 February 2010 13:37 UTC www.wrongdiagnosis.com [Source type: Academic]

^ Symptoms of colorectal cancer include: .
  • Colorectal Cancer 10 February 2010 13:36 UTC www.metrohealth.org [Source type: FILTERED WITH BAYES]

.Most of the symptoms may occur in other diseases as well, and hence none of the symptoms mentioned here is diagnostic of colorectal cancer.^ Symptoms of Colorectal cancer .
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]
  • Symptoms of Colorectal cancer - WrongDiagnosis.com 10 February 2010 13:37 UTC www.wrongdiagnosis.com [Source type: Academic]

^ These symptoms may be caused by colorectal cancer or by other conditions.
  • Colorectal Cancer: The Facts - Rhode Island Cancer Council, Inc. 10 February 2010 13:36 UTC www.ricancercouncil.org [Source type: Academic]
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ Symptoms of colorectal cancer include: .
  • Colorectal Cancer 10 February 2010 13:36 UTC www.metrohealth.org [Source type: FILTERED WITH BAYES]

.Symptoms and signs are divided into local, constitutional (affecting the whole body) and metastatic (caused by spread to other organs).^ The cancer has spread to nearby lymph nodes, but has not spread to other organs in the body.
  • Cancer Center 10 February 2010 13:37 UTC www.rush.edu [Source type: Academic]
  • Colorectal Cancer - University of Chicago Medical Center 10 February 2010 13:37 UTC www.uchospitals.edu [Source type: Academic]
  • http://www.ecommunity.com/health/index.aspx?pageid=P00362 10 February 2010 13:37 UTC www.ecommunity.com [Source type: Academic]
  • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]
  • Norwood Hospital - Colorectal Cancer 10 February 2010 13:37 UTC www.caritasnorwood.org [Source type: Academic]

^ If colorectal cancer spreads, or metastasizes, to other organs in the body, it often spreads to .
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ The disease has spread into the lymph nodes but has not spread to other parts of the body.

Local

.Local symptoms are more likely if the tumor is located closer to the anus.^ Local symptoms usually appear if the tumor is located closer to the anus.
  • What is Colon Cancer | What is Cancer - The Blog about Cancer 10 February 2010 13:36 UTC www.whatiscancer.com [Source type: Academic]

^ Symptoms can vary depending on the location of a tumor.
  • Cancer of the Colon and Rectum 10 February 2010 13:36 UTC www.puristat.com [Source type: Academic]

^ Generally, the nearer the tumor is to the anus, the more bowel symptoms there will be.
  • Medical Tourism - Healthbase - Colon cancer or colorectal cancer 10 February 2010 13:36 UTC www.healthbase.com [Source type: Academic]

.There may be a change in bowel habit (new-onset constipation or diarrhea in the absence of another cause), and a feeling of incomplete defecation (tenesmus) and reduction in diameter of stool; tenesmus and change in stool shape are both characteristic of rectal cancer.^ Change in bowel movement (constipation or diarrhea), incomplete defecation (tenesmus), and change of stool shape are characteristics of rectal cancer.
  • What is Colon Cancer | What is Cancer - The Blog about Cancer 10 February 2010 13:36 UTC www.whatiscancer.com [Source type: Academic]

^ See news and articles on Bowel cancer.
  • Bowel cancer solutions through foods, herbs and nutritional supplements 11 September 2009 12:26 UTC www.healingfoodreference.com [Source type: FILTERED WITH BAYES]

^ Changes in bowel habits, such as new problems with persistent diarrhea or constipation may occur.
  • Colon Cancer 10 February 2010 13:36 UTC www.hmc.psu.edu [Source type: Academic]

.Lower gastrointestinal bleeding, including the passage of bright red blood in the stool, may indicate colorectal cancer, as may the increased presence of mucus.^ Blood in your stool (bright red, black or very dark).
  • AGA | Patient Center | Digestive Conditions | Colorectal Cancer Prevention & Treatment 10 February 2010 13:37 UTC www.gastro.org [Source type: FILTERED WITH BAYES]

^ Blood in the stool may be a sign of polyps or cancer.
  • Colorectal Cancer Screening (PDQ®) 10 February 2010 13:37 UTC www.fccc.edu [Source type: Academic]
  • Colorectal Cancer Screening - National Cancer Institute 10 February 2010 13:37 UTC healthpromotionresearch.cancer.gov [Source type: Academic]

^ Blood (either bright red or very dark) in the stool .
  • http://jamesline.com/cancertypes/gi/about/colon/ 10 February 2010 13:36 UTC jamesline.com [Source type: Academic]
  • Colon Cancer Treatment - National Cancer Institute 10 February 2010 13:36 UTC healthpromotionresearch.cancer.gov [Source type: Academic]
  • Colon Cancer Treatment - National Cancer Institute 10 February 2010 13:36 UTC biobehavioral.cancer.gov [Source type: Academic]

.Melena, black stool with a tarry appearance, normally occurs in upper gastrointestinal bleeding (such as from a duodenal ulcer) but is sometimes encountered in colorectal cancer when the disease is located in the beginning of the large bowel.^ Next Diseases » Colorectal cancer » Introduction   Colorectal cancer .
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

^ Colorectal cancer occurs when tumors form in the lining of the large intestine, also called the large bowel.
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ Colorectal Cancer is cancer that occurs in the colon or rectum.
  • Colon Cancer Screening Saves Lives! 10 February 2010 13:36 UTC www.achosp.org [Source type: FILTERED WITH BAYES]

.A tumor that is large enough to fill the entire lumen of the bowel may cause bowel obstruction.^ If a cancer grows large enough, it can completely block the bowel, causing "bowel obstruction."
  • Colon and Rectal Cancer Treatment Information 10 February 2010 13:36 UTC www.canceranswers.com [Source type: FILTERED WITH BAYES]

^ Partial large-bowel obstruction may cause colicky abdominal pain and bloating.

^ When tumors grow to a large size, they may cause a change in the bowel habits.
  • Colorectal cancer, Information about Colorectal cancer 10 February 2010 13:37 UTC www.faqs.org [Source type: Academic]

.This situation is characterized by constipation, abdominal pain, abdominal distension and vomiting.^ Large tumors can block bowel and cause constipation, abdominal pain, abdominal distension and vomiting.
  • What is Colon Cancer | What is Cancer - The Blog about Cancer 10 February 2010 13:36 UTC www.whatiscancer.com [Source type: Academic]

^ Blood in the stool Diarrhea Constipation Bowel obstruction, causing nausea, vomiting and abdominal distention Abdominal pain Pelvic pain Anemia due to blood Loss Weight loss Loss of appetite Fatigue .
  • Colon Cancer 10 February 2010 13:36 UTC www.tirgan.com [Source type: Academic]

^ The symptoms of colorectal cancer include a change in bowel habits, such as diarrhea, constipation or the feeling that the bowel doesnt empty completely; blood in the stool; abdominal pain or discomfort; vomiting; unexplained weight loss; and constant fatigue.
  • NEA Clinic - Northeast Arkansas Health Clinics, Jonesboro Arkansas 10 February 2010 13:37 UTC www.neaclinic.com [Source type: Academic]

.This occasionally leads to the obstructed and distended bowel perforating and causing peritonitis.^ Bowel cancer is the most common internal cancer in Australia (after prostate cancer in men and breast cancer in women) and is the leading cause of cancer death in non-smokers.
  • GUT Foundation 10 February 2010 13:37 UTC www.gut.nsw.edu.au [Source type: FILTERED WITH BAYES]

^ Sometimes inflamed diverticula can cause narrowing of the bowel, leading to an obstruction.

^ At any point, stones may obstruct the cystic duct, which leads from the gallbladder to the common bile duct, and cause pain (biliary colic) or infection and inflammation (cholecystitis.

.Certain local effects of colorectal cancer occur when the disease has become more advanced.^ More about prognosis of Colorectal cancer .
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

^ Next Diseases » Colorectal cancer » Introduction   Colorectal cancer .
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

^ Age —Colorectal cancer is more likely to occur as people get older.
  • Colorectal Cancer - Ostomy, Colostomy, Ileostomy and Urostomy 10 February 2010 13:37 UTC www.ostomysoftware.com [Source type: Academic]

.A large tumor is more likely to be noticed on feeling the abdomen, and it may be noticed by a doctor on physical examination.^ More advanced tumors can become noticeable upon feeling the abdomen.
  • What is Colon Cancer | What is Cancer - The Blog about Cancer 10 February 2010 13:36 UTC www.whatiscancer.com [Source type: Academic]

^ But recent studies suggest that smokers may be up to 40 percent more likely to develop colorectal cancers than non-smokers.
  • Colorectal Cancer-Los Alamitos Medical Center-Los Alamitos, CA 10 February 2010 13:37 UTC www.losalamitosmedctr.com [Source type: Academic]

^ If you came to this web page feeling that you may be experiencing colon cancer warning sighs, go see your doctor and get tested.
  • Don't Ignore Colon Cancer Warning Signs 10 February 2010 13:36 UTC www.buzzle.com [Source type: FILTERED WITH BAYES]

.The disease may invade other organs, and may cause blood or air in the urine (invasion of the bladder) or vaginal discharge (invasion of the female reproductive tract).^ Blood in the urine may be a sign of bladder or kidney cancer.

^ Larger tumors may invade the bladder or the female reproductive tract resulting to blood or air in the urine or vaginal discharge for females.
  • What is Colon Cancer | What is Cancer - The Blog about Cancer 10 February 2010 13:36 UTC www.whatiscancer.com [Source type: Academic]

^ Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these cells to invade other tissues, either by direct growth into adjacent tissue through invasion or by implantation into distant sites by metastasis.

Constitutional

.If a tumor has caused chronic occult bleeding, iron deficiency anemia may occur; this may be experienced as fatigue, palpitations and noticed as pallor (pale appearance of the skin).^ It may be characterized by fatigue, palpitations, and pale skin.
  • What is Colon Cancer | What is Cancer - The Blog about Cancer 10 February 2010 13:36 UTC www.whatiscancer.com [Source type: Academic]

^ Constitutional symptoms appear if a tumor has lead to chronic occult bleeding resulting to iron deficiency anemia.
  • What is Colon Cancer | What is Cancer - The Blog about Cancer 10 February 2010 13:36 UTC www.whatiscancer.com [Source type: Academic]

^ It can cause ulceration leading to bleeding and an iron deficiency, which may develop into anemia due to a chronic blood loss.
  • Intestinal Cancer, Gastro oesophageal Cancer, Intestine Cancer Herbal, Intestine Cancer Acupuncture Chinese Herbal Medicine 22 September 2009 21:31 UTC www.geocities.com [Source type: Academic]

.Colorectal cancer may also lead to weight loss, generally due to a decreased appetite.^ The symptoms of colorectal cancer may include: .
  • Colorectal Cancer and Colon Cancer Symptoms, Treatment and Prevention | Florida Hospital Digestive Health Center 10 February 2010 13:37 UTC www.floridahospitaldigestive.com [Source type: Academic]

^ You may not have colorectal cancer.
  • Colon Cancer Information | HalfLytely Bowel Prep Kits 10 February 2010 13:36 UTC www.halflytely.com [Source type: General]

^ In general, colorectal cancers are slow growing.
  • Colorectal Cancer Basics (Health & Wellbeing: Colorectal Cancer) 10 February 2010 13:37 UTC www.videojug.com [Source type: FILTERED WITH BAYES]

.More unusual constitutational symptoms are an unexplained fever and one of several paraneoplastic syndrome.^ Other constitutional symptoms are unexplained fever and paraneoplastic syndrome, the most common being thrombosis.
  • What is Colon Cancer | What is Cancer - The Blog about Cancer 10 February 2010 13:36 UTC www.whatiscancer.com [Source type: Academic]

^ The same symptoms as above, but more severe.
  • Second Opinion . Colon Cancer | PBS 10 February 2010 13:36 UTC www.pbs.org [Source type: FILTERED WITH BAYES]

^ This infection can cause the diverticula to swell or burst and may produce symptoms such as pain, fever, chills, and, in severe cases, infection of the abdominal cavity ( peritonitis ).
  • Laparoscopic Colon Cancer Surgery – La Jolla, North County, and All San Diego 10 February 2010 13:36 UTC www.lajollasurgical.com [Source type: Academic]

.The most common paraneoplastic syndrome is thrombosis, usually deep vein thrombosis.^ Other constitutional symptoms are unexplained fever and paraneoplastic syndrome, the most common being thrombosis.
  • What is Colon Cancer | What is Cancer - The Blog about Cancer 10 February 2010 13:36 UTC www.whatiscancer.com [Source type: Academic]

^ Two of the most common are hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome, and familial adenomatous polyposis (FAP).
  • Colon cancer: MedlinePlus Medical Encyclopedia 10 February 2010 13:36 UTC www.nlm.nih.gov [Source type: Academic]
  • Colon cancer - MMCI 10 February 2010 13:36 UTC mmci2.adam.com [Source type: Academic]
  • Colon Cancer | Wake Forest University Baptist Medical Center 10 February 2010 13:36 UTC www2.wfubmc.edu [Source type: Academic]
  • Colon cancer 10 February 2010 13:36 UTC www.pennmedicine.org [Source type: Academic]
  • Colon cancer 10 February 2010 13:37 UTC www.pennmedicine.org [Source type: Academic]

^ Lynch Syndrome/Hereditary Non-Polyposis Colorectal Cancer (HNPCC) : This is the most common of the inherited colorectal cancer syndromes and is thought to account for 5% to 10% of all colorectal cancer cases.

Metastatic

.Colorectal cancer most commonly spreads to the liver.^ Colorectal cancer tends to spread to the liver and/or lungs.
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ When colorectal cancer does spread, it tends to spread to the liver or lungs.
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ Start and spread of colorectal cancer .
  • ACS :: What Is Colorectal Cancer? 10 February 2010 13:37 UTC www.cancer.org [Source type: FILTERED WITH BAYES]

.This may go unnoticed, but large deposits in the liver may cause jaundice and abdominal pain (due to stretching of the capsule).^ Partial large-bowel obstruction may cause colicky abdominal pain and bloating.

^ Abdominal pain or unexplained weight loss may be symptoms that occur as the disease progresses.
  • Colon Cancer 10 February 2010 13:36 UTC www.hmc.psu.edu [Source type: Academic]

^ One of the following: Flexible sigmoidoscopy - a diagnostic procedure that allows the physician to examine the inside of a portion of the large intestine, and is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding.
  • Colon Cancer and IBD 10 February 2010 13:36 UTC www.rush.edu [Source type: Academic]

.If the tumor deposit obstructs the bile duct, the jaundice may be accompanied by other features of biliary obstruction, such as pale stools.^ Most individuals with FAP develop polyps without symptoms, while others may have diarrhea, constipation, abdominal cramps, blood in stool or weight loss.

^ If the cancer has spread to the lymph nodes or to other organs in the body, additional treatment such as chemotherapy or radiation therapy may be suggested.
  • Colon Cancer 10 February 2010 13:36 UTC www.hmc.psu.edu [Source type: Academic]

^ Other imaging studies such as chest x-rays, CT scans, and MRI scans may also be done if symptoms or other test results suggest a recurrence.
  • LapColonSurgery.com - Colon Cancer Treatment Options 10 February 2010 13:36 UTC www.lapcolonsurgery.com [Source type: FILTERED WITH BAYES]

Risk factors

.
Micrograph of a tubular adenoma (left of image), a type of colonic polyp and a precursor of colorectal cancer.
^ Colorectal cancer is cancer of the colon or rectum.
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

^ Colorectal cancer is cancer that occurs in the colon or rectum.

^ What are the types of colorectal cancer?
  • Colorectal Cancer - University of Chicago Medical Center 10 February 2010 13:37 UTC www.uchospitals.edu [Source type: Academic]
  • http://www.ecommunity.com/health/index.aspx?pageid=P00362 10 February 2010 13:37 UTC www.ecommunity.com [Source type: Academic]

.Normal colorectal mucosa is seen on the right.^ Concentrations of CEA and CA]9-9 were analyzed simultaneously in serum, cancer tissue, and normal colonic mucosa of 41 colorectal cancer patients operated for cure.

^ However, fairly unclear is whether quantitative content of CEA and CA19-9 in cancer tissue and adjacent normal mucosa of colorectal cancer patients is correlated to prognosis.

H&E stain.
.The lifetime risk of developing colon cancer in the United States is about 7%.^ How do I know if I am at risk for colon cancer?
  • Colon Cancer (Health & Wellbeing: Colorectal Cancer) 10 February 2010 13:36 UTC www.videojug.com [Source type: FILTERED WITH BAYES]

^ Volume 3: prevention of colon cancer in the United States.
  • Colon Cancer Screening | Newsletter: Volume 11 10 February 2010 13:36 UTC www.salix.com [Source type: FILTERED WITH BAYES]

^ Colon cancer takes about 10 years to develop, he noted.
  • Colon Cancer Screening - Marshfield Clinic Health News 10 February 2010 13:36 UTC www.marshfieldclinic.org [Source type: FILTERED WITH BAYES]

.Certain factors increase a person's risk of developing the disease.^ Several factors increase the risk of developing the disease.
  • colorectal cancer (pathology) -- Britannica Online Encyclopedia 10 February 2010 13:37 UTC www.britannica.com [Source type: Academic]

^ Anything that increases a person's chance of developing a disease.
  • Health Concerns - Colon Cancer 10 February 2010 13:36 UTC www.menopauserx.com [Source type: Academic]

^ A risk factor is anything that is linked to an increased chance of developing a disease.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

[4] These include:
  • Age. .The risk of developing colorectal cancer increases with age.^ People who smoke have an increased risk of developing polyps and colorectal cancer.
    • Colorectal Cancer - An Understanding 10 February 2010 13:37 UTC www.patientadvocate.org [Source type: FILTERED WITH BAYES]

    ^ Large increase in risk — Some conditions greatly increase the risk of colorectal cancer.
    • Colon cancer screening 10 February 2010 13:36 UTC www.uptodate.com [Source type: Academic]

    ^ Obesity increases your risk of dying of colorectal cancer.

    .Most cases occur in the 60s and 70s, while cases before age 50 are uncommon unless a family history of early colon cancer is present.^ There is a strong family history of cancer.

    ^ Risk Factors for Colon Cancer: •Age, which is the most common risk factor.
    • Topics CBS Cares - CBS.com 10 February 2010 13:37 UTC www.cbs.com [Source type: FILTERED WITH BAYES]

    ^ Most cases occur in the 60s and 70s, while cases before age 50 are uncommon unless a family history of early colon cancer is present.
    • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

    [5]
  • .
  • Polyps of the colon, particularly adenomatous polyps, are a risk factor for colon cancer.^ How do I know if I am at risk for colon cancer?
    • Colon Cancer (Health & Wellbeing: Colorectal Cancer) 10 February 2010 13:36 UTC www.videojug.com [Source type: FILTERED WITH BAYES]
    • Colorectal Cancer - advice videos on Colorectal Cancer 10 February 2010 13:37 UTC www.videojug.com [Source type: Academic]

    ^ Risk Factors for Colon Cancer: •Age, which is the most common risk factor.
    • Topics CBS Cares - CBS.com 10 February 2010 13:37 UTC www.cbs.com [Source type: FILTERED WITH BAYES]

    ^ Exercise cuts risk of colon cancer .
    • Top 10 Colon Cancer Prevention Tips - Basics of Colon Cancer Prevention | NowPublic Photo Archives 10 February 2010 13:36 UTC www.nowpublic.com [Source type: General]

    .The removal of colon polyps at the time of colonoscopy reduces the subsequent risk of colon cancer.
  • History of cancer.^ Finding and removing polyps may reduce the risk of colorectal cancer.
    • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

    ^ How do I know if I am at risk for colon cancer?
    • Colon Cancer (Health & Wellbeing: Colorectal Cancer) 10 February 2010 13:36 UTC www.videojug.com [Source type: FILTERED WITH BAYES]

    ^ The removal of colon polyps at the time of colonoscopy reduces the subsequent risk of colon cancer.
    • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

    .Individuals who have previously been diagnosed and treated for colon cancer are at risk for developing colon cancer in the future.^ How do I know if I am at risk for colon cancer?
    • Colon Cancer (Health & Wellbeing: Colorectal Cancer) 10 February 2010 13:36 UTC www.videojug.com [Source type: FILTERED WITH BAYES]
    • Colorectal Cancer - advice videos on Colorectal Cancer 10 February 2010 13:37 UTC www.videojug.com [Source type: Academic]

    ^ How is colon cancer diagnosed?
    • Colon Cancer Symptoms, Diagnosis, and Treatment- Mass General Hospital 10 February 2010 13:36 UTC www2.massgeneral.org [Source type: Academic]
    • Colon Cancer and IBD 10 February 2010 13:36 UTC www.rush.edu [Source type: Academic]
    • ColonCancerFactSheet.com: Colon Cancer Facts, Information and Home Test Kits 10 February 2010 13:36 UTC coloncancerfactsheet.com [Source type: Academic]

    ^ Exercise cuts risk of colon cancer .
    • Top 10 Colon Cancer Prevention Tips - Basics of Colon Cancer Prevention | NowPublic Photo Archives 10 February 2010 13:36 UTC www.nowpublic.com [Source type: General]

    .Women who have had cancer of the ovary, uterus, or breast are at higher risk of developing colorectal cancer.
  • Heredity:
    • Family history of colon cancer, especially in a close relative before the age of 55 or multiple relatives.^ How do I know if I am at risk for colon cancer?
      • Colon Cancer (Health & Wellbeing: Colorectal Cancer) 10 February 2010 13:36 UTC www.videojug.com [Source type: FILTERED WITH BAYES]

      ^ There is a strong family history of cancer.

      ^ Vitamin D and colon cancer People who have higher levels of vitamin D in their blood have a lower risk of colon cancer.

      [6]
    • .
    • Familial adenomatous polyposis (FAP) carries a near 100% risk of developing colorectal cancer by the age of 40 if untreated
    • Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome
  • Smoking.^ Members of these families have a very high risk of developing colorectal cancer.
    • Colorectal Cancer - An Understanding 10 February 2010 13:37 UTC www.patientadvocate.org [Source type: FILTERED WITH BAYES]

    ^ Colorectal cancer: Guideline Development Group .
    • Colorectal cancer 10 February 2010 13:37 UTC www.nice.org.uk [Source type: Academic]

    ^ A role for MLH3 in hereditary nonpolyposis colorectal cancer.
    • NEJM -- Hereditary Colorectal Cancer 10 February 2010 13:37 UTC content.nejm.org [Source type: Academic]

    .Smokers are more likely to die of colorectal cancer than non-smokers.^ More about prognosis of Colorectal cancer .
    • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

    ^ Today there are more ways than ever to treat colorectal cancer.
    • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

    ^ Age —Colorectal cancer is more likely to occur as people get older.
    • Colorectal Cancer - Ostomy, Colostomy, Ileostomy and Urostomy 10 February 2010 13:37 UTC www.ostomysoftware.com [Source type: Academic]

    .An American Cancer Society study found that "Women who smoked were more than 40% more likely to die from colorectal cancer than women who never had smoked.^ Men were significantly more likely to have a lesion detected than women.
    • eMJA: Outcomes after 10 years of a community-based flexible sigmoidoscopy screening program for colorectal carcinoma 25 September 2009 0:48 UTC www.mja.com.au [Source type: Academic]

    ^ More about prognosis of Colorectal cancer .
    • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

    ^ Scientists are studying colorectal cancer to learn more about it.
    • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

    .Male smokers had more than a 30% increase in risk of dying from the disease compared to men who never had smoked."^ A 50% increase in risk was associated with smoking more than a pack a day relative to never smoking.
    • Colon cancer: Prevention - Health Professional Information [NCI PDQ] - AOL Health 10 February 2010 13:36 UTC www.aolhealth.com [Source type: Academic]

    ^ It affects men more than women.
    • Prostate Cancer Treatment - Prostate Cancer - Colon Cancer - Prostate Health - Irritable Bowel Syndrome - IBS 10 February 2010 13:36 UTC www.nutrition2000.com [Source type: FILTERED WITH BAYES]

    ^ Male smokers had more than a 30% increase in risk of dying from the disease compared to men who never had smoked."
    • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

    [7][8]
  • Diet. .Studies show that a diet high in red meat[9] and low in fresh fruit, vegetables, poultry and fish increases the risk of colorectal cancer.^ Prevention Studies show that a diet high in vegetables, fruit and fibre can reduce risk of bowel cancer.
    • Bowel Cancer Symptoms, Causes and Treatment on HKCF 11 September 2009 12:26 UTC www.cancer-fund.org [Source type: FILTERED WITH BAYES]

    ^ Increased intakes of folate from the diet may reduce a woman’s risk of colorectal cancer ...

    ^ Red meat, chicken, and fish consumption and risk of colorectal cancer.
    • March is National Colorectal Cancer Awareness Month | Highlight HEALTH 10 February 2010 13:37 UTC www.highlighthealth.com [Source type: Academic]

    .In June 2005, a study by the European Prospective Investigation into Cancer and Nutrition suggested that diets high in red and processed meat, as well as those low in fiber, are associated with an increased risk of colorectal cancer.^ There maybe an increase in the risk of cancer implantation into the skin.
    • colorectal | colon cancer screening |symptoms|signs 10 February 2010 13:36 UTC www.healthscreening.sg [Source type: Academic]

    ^ The ingestion of a high-fiber diet may be protective against colorectal cancer.

    ^ Studies suggest that people who eat less meat are at lower risk of developing colorectal cancer.
    • Colorectal cancer 10 February 2010 13:37 UTC www.umm.edu [Source type: Academic]

    .Individuals who frequently eat fish showed a decreased risk.^ Studies on individuals who are on long term low-dosage non-steroid anti-inflammatory (Aspirin, for example) show that these drugs have a protective effect.
    • COLORECTAL CARCINOMA 25 September 2009 0:48 UTC www.pote.hu [Source type: Academic]

    ^ Recent studies are showing people who consume the most trans fat increase their risk of colon cancer by a staggering 86 percent.
    • colon cancer news and articles 10 February 2010 13:36 UTC www.naturalnews.com [Source type: Academic]

    ^ Studies suggest that people who eat less meat are at lower risk of developing colorectal cancer.
    • Colorectal cancer 10 February 2010 13:37 UTC www.umm.edu [Source type: Academic]

    [10] .However, other studies have cast doubt on the claim that diets high in fiber decrease the risk of colorectal cancer; rather, low-fiber diet was associated with other risk factors, leading to confounding.^ Factors that decrease risk — Factors that may decrease risk include: .
    • Colon cancer screening 10 February 2010 13:36 UTC www.uptodate.com [Source type: Academic]

    ^ The ingestion of a high-fiber diet may be protective against colorectal cancer.

    ^ Eating a high fiber diet helps to prevent colorectal cancer.
    • Hemorrhoid.net - COLON CANCER AND RECTAL CANCER - Screening, Symptoms, Diagnosis & Treatment 10 February 2010 13:36 UTC www.hemorrhoid.net [Source type: Academic]

    [11] .The nature of the relationship between dietary fiber and risk of colorectal cancer remains controversial.
  • Physical inactivity.^ Patients at risk of familial colorectal cancer.
    • NEJM -- Hereditary Colorectal Cancer 10 February 2010 13:37 UTC content.nejm.org [Source type: Academic]

    ^ The nature of the relationship between dietary fiber and risk of colorectal cancer remains controversial.
    • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

    ^ Average Risk You are at average risk for colorectal cancer if you: .
    • AGA | Patient Center | Digestive Conditions | Colorectal Cancer Prevention & Treatment 10 February 2010 13:37 UTC www.gastro.org [Source type: FILTERED WITH BAYES]

    .People who are physically active are at lower risk of developing colorectal cancer.
  • Virus.^ If you are not physically active, you have a greater chance of getting colorectal cancer.
    • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

    ^ Vitamin D and colon cancer People who have higher levels of vitamin D in their blood have a lower risk of colon cancer.

    ^ People who smoke have an increased risk of developing polyps and colorectal cancer.
    • Colorectal Cancer - An Understanding 10 February 2010 13:37 UTC www.patientadvocate.org [Source type: FILTERED WITH BAYES]

    .Exposure to some viruses (such as particular strains of human papilloma virus) may be associated with colorectal cancer.
  • Primary sclerosing cholangitis offers a risk independent to ulcerative colitis
  • Low levels of selenium.^ Finding and removing polyps may reduce the risk of colorectal cancer.
    • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

    ^ Ulcerative colitis , High Dietary Fat and Low Dietary Fiber can each increase the risk of this cancer.
    • Colon Cancer 10 February 2010 13:36 UTC www.tirgan.com [Source type: Academic]

    ^ The association of mismatch repair gene polymorphisms and colorectal cancer risk.
    • Colorectal Cancer Research Publications 10 February 2010 13:37 UTC www.mshri.on.ca [Source type: Academic]

    [12][13]
  • .
  • Inflammatory bowel disease.^ A personal experience with inflammatory bowel disease.

    ^ You have inflammatory bowel disease.
    • Colon Cancer Screening Saves Lives! 10 February 2010 13:36 UTC www.achosp.org [Source type: FILTERED WITH BAYES]

    ^ Inflammatory bowel disease.
    • Colorectal Cancer Screening: Summary 10 February 2010 13:37 UTC www.ahrq.gov [Source type: Academic]
    • Risk Factors for Colorectal Cancer 10 February 2010 13:37 UTC my.clevelandclinic.org [Source type: Academic]

    [14][15] .About one percent of colorectal cancer patients have a history of chronic ulcerative colitis.^ More about prognosis of Colorectal cancer .
    • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

    ^ Reseach about Colorectal cancer .
    • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

    ^ You have a family history of colorectal cancer.

    .The risk of developing colorectal cancer varies inversely with the age of onset of the colitis and directly with the extent of colonic involvement and the duration of active disease.^ How do I know if I am at risk for colon cancer?
    • Colorectal Cancer - advice videos on Colorectal Cancer 10 February 2010 13:37 UTC www.videojug.com [Source type: Academic]

    ^ The type and duration of colorectal cancer treatment depend upon the extent of the disease and when it is discovered.
    • Preventing Colon Cancer 10 February 2010 13:36 UTC hoptechno.com [Source type: FILTERED WITH BAYES]

    ^ Risk Factors for Colon Cancer: •Age, which is the most common risk factor.
    • Topics CBS Cares - CBS.com 10 February 2010 13:37 UTC www.cbs.com [Source type: FILTERED WITH BAYES]

    .Patients with colorectal Crohn's disease have a more than average risk of colorectal cancer, but less than that of patients with ulcerative colitis.^ More about prognosis of Colorectal cancer .
    • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

    ^ A history of ulcerative colitis (ulcers in the lining of the large intestine) or Crohn's disease.

    ^ The two main types are Crohn's disease and ulcerative colitis.

    [16]
  • Environmental factors.[14] .Industrialized countries are at a relatively increased risk compared to less developed countries that traditionally had high-fiber/low-fat diets.^ A diet high in fat and calories and low in fiber, fruits and vegetables has been linked to a greater risk of developing colorectal cancer.

    ^ People at highest risk tend to consume a high-fat, low-fiber diet.
    • Colorectal Cancer: Tumors of the Digestive System: Merck Manual Home Edition 10 February 2010 13:37 UTC www.merck.com [Source type: Academic]

    ^ The risk increases after the age of 40 and if one is on a high fat-low fibre diet.
    • colorectal | colon cancer screening |symptoms|signs 10 February 2010 13:36 UTC www.healthscreening.sg [Source type: Academic]

    .Studies of migrant populations have revealed a role for environmental factors, particularly dietary, in the etiology of colorectal cancers.
  • Exogenous hormones.^ Colorectal cancer is caused by both environmental and genetic factors.
    • Colon Cancer - Diagnosing Colon Cancer | eHow.com 10 February 2010 13:36 UTC www.ehow.com [Source type: Academic]

    ^ Hormone therapy and colorectal cancer .
    • Colon cancer blog: From MedicineWorld.Org 10 February 2010 13:36 UTC medicineworld.org [Source type: Academic]

    ^ Dietary factors in human colorectal cancer.
    • WHFoods: Colorectal Cancer 10 February 2010 13:36 UTC www.whfoods.com [Source type: Academic]

    .The differences in the time trends in colorectal cancer in males and females could be explained by cohort effects in exposure to some gender-specific risk factor; one possibility that has been suggested is exposure to estrogens.^ Every one of us is at risk for colorectal cancer.

    ^ Large increase in risk — Some conditions greatly increase the risk of colorectal cancer.
    • Colon cancer screening 10 February 2010 13:36 UTC www.uptodate.com [Source type: Academic]

    ^ Possible signs of colorectal cancer include: .
    • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

    [17] .There is, however, little evidence of an influence of endogenous hormones on the risk of colorectal cancer.^ Hormone therapy and colorectal cancer .
    • Colon cancer blog: From MedicineWorld.Org 10 February 2010 13:36 UTC medicineworld.org [Source type: Academic]

    ^ What are the risk factors of Colorectal Cancer?

    ^ You are at increased risk for colorectal cancer if you: .

    .In contrast, there is evidence that exogenous estrogens such as hormone replacement therapy (HRT), tamoxifen, or oral contraceptives might be associated with colorectal tumors.^ Hormone therapy and colorectal cancer .
    • Colon cancer blog: From MedicineWorld.Org 10 February 2010 13:36 UTC medicineworld.org [Source type: Academic]

    ^ Exogenous hormones such as exposure to estrogens might be associated with colorectal tumors.
    • What is Colon Cancer | What is Cancer - The Blog about Cancer 10 February 2010 13:36 UTC www.whatiscancer.com [Source type: Academic]

    ^ Recent use of hormone replacement therapy and the prevalence of colorectal adenomas.
    • Cancer of the Colon 10 February 2010 13:36 UTC www.drmirkin.com [Source type: Academic]

    [18]
  • Alcohol. .Drinking, especially heavily, may be a risk factor.^ Factors that decrease risk — Factors that may decrease risk include: .
    • Colon cancer screening 10 February 2010 13:36 UTC www.uptodate.com [Source type: Academic]

    ^ Drinking beer is a known risk factor.
    • COLORECTAL CARCINOMA 25 September 2009 0:48 UTC www.pote.hu [Source type: Academic]

    ^ Risk factors may include: .
    • Cancer Center 10 February 2010 13:37 UTC www.rush.edu [Source type: Academic]
    • Colorectal Cancer - University of Chicago Medical Center 10 February 2010 13:37 UTC www.uchospitals.edu [Source type: Academic]
    • Colorectal Cancer 10 February 2010 13:37 UTC www.healthsystem.virginia.edu [Source type: Academic]
    • http://www.ecommunity.com/health/index.aspx?pageid=P00362 10 February 2010 13:37 UTC www.ecommunity.com [Source type: Academic]
    • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]
    • Norwood Hospital - Colorectal Cancer 10 February 2010 13:37 UTC www.caritasnorwood.org [Source type: Academic]
    • Norwood Hospital - Colorectal Cancer 10 February 2010 13:37 UTC www.caritasnorwood.org [Source type: Academic]

    [19]

Alcohol

.The WCRF panel report Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective finds the evidence "convincing" that alcoholic drinks increase the risk of colorectal cancer in men.^ Finding and removing polyps may reduce the risk of colorectal cancer.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

^ Prevention of colorectal cancer: .
  • Cancer Center 10 February 2010 13:37 UTC www.rush.edu [Source type: Academic]
  • Colorectal Cancer 10 February 2010 13:37 UTC www.stjosephsatlanta.org [Source type: Academic]
  • Colorectal Cancer - University of Chicago Medical Center 10 February 2010 13:37 UTC www.uchospitals.edu [Source type: Academic]
  • Colorectal Cancer 10 February 2010 13:37 UTC www.healthsystem.virginia.edu [Source type: Academic]
  • http://www.ecommunity.com/health/index.aspx?pageid=P00362 10 February 2010 13:37 UTC www.ecommunity.com [Source type: Academic]
  • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]
  • Norwood Hospital - Colorectal Cancer 10 February 2010 13:37 UTC www.caritasnorwood.org [Source type: Academic]

^ Large increase in risk — Some conditions greatly increase the risk of colorectal cancer.
  • Colon cancer screening 10 February 2010 13:36 UTC www.uptodate.com [Source type: Academic]

[20]
.The NIAAA reports that: "Epidemiologic studies have found a small but consistent dose-dependent association between alcohol consumption and colorectal cancer[21][22] even when controlling for fiber and other dietary factors.^ The nature of the relationship between dietary fiber and risk of colorectal cancer remains controversial.
  • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

^ What are some of the risk factors for colorectal cancer?
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ Nutritional factors in colorectal cancer risk: a case-control study in Majorca.

[23][24] .Despite the large number of studies, however, causality cannot be determined from the available data."^ In determining a prognosis—the likely course or outcome of a disease—a doctor may look at cancer survival statistics taken from studies of large groups of patients.
  • Colon cancer treatment; colorectal cancer; rectal cancer treatment - nccn.com 10 February 2010 13:36 UTC www.nccn.com [Source type: FILTERED WITH BAYES]

^ However, more studies are needed to determine whether this type of test can accurately detect colorectal cancer or precancerous polyps in people who do not have symptoms.
  • Colorectal Cancer Screening Fact Sheet - National Cancer Institute 10 February 2010 13:37 UTC www.9aday.cancer.gov [Source type: Academic]

^ However, results from large-scale population studies on the sensitivity and specificity of such markers have not been reported as yet.

[19]
."Heavy alcohol use may also increase the risk of colorectal cancer" (NCI).^ Finding and removing polyps may reduce the risk of colorectal cancer.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

^ It is used as a tumor marker for colorectal cancer.

^ Large increase in risk — Some conditions greatly increase the risk of colorectal cancer.
  • Colon cancer screening 10 February 2010 13:36 UTC www.uptodate.com [Source type: Academic]

.One study found that "People who drink more than 30 grams of alcohol per day (and especially those who drink more than 45 grams per day) appear to have a slightly higher risk for colorectal cancer."^ More about prognosis of Colorectal cancer .
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

^ They found that those who possessed the ADH1C*1 gene had a greater risk of developing colorectal cancer - but only when they consumed more than 30 grams of alcohol (about two drinks) per day.
  • Gene Makes Drinkers More Prone to Colon Cancer 10 February 2010 13:36 UTC www.empowereddoctor.com [Source type: Academic]

^ Scientists are studying colorectal cancer to learn more about it.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

[25] .Another found that "The consumption of one or more alcoholic beverages a day at baseline was associated with approximately a 70% greater risk of colon cancer."^ What decreases the risks of colon cancer...
  • Colon Cancer - Kosmix : Reference, Videos, Images, News, Shopping and more... 10 February 2010 13:36 UTC www.kosmix.com [Source type: Academic]

^ Alcohol Drinking alcoholic beverages may increase the risk of colorectal cancer.
  • Colorectal Cancer Prevention (PDQ®) 10 February 2010 13:37 UTC www.fccc.edu [Source type: Academic]

^ It is estimated that approximately 70% of patients with colon cancer are positive for EGFR. .
  • Recurrent Colon Cancer | CancerConsultants 10 February 2010 13:36 UTC www.cancerconsultants.com [Source type: Academic]
  • University of Florida Shands Cancer Center: Recurrent Colon Cancer 10 February 2010 13:36 UTC www.ufscc.ufl.edu [Source type: Academic]

[26][27][25]
.One study found that "While there was a more than twofold increased risk of significant colorectal neoplasia in people who drink spirits and beer, people who drank wine had a lower risk.^ People who smoke have an increased risk of developing polyps and colorectal cancer.
  • Colorectal Cancer - An Understanding 10 February 2010 13:37 UTC www.patientadvocate.org [Source type: FILTERED WITH BAYES]

^ Studies suggest that people who eat less meat are at lower risk of developing colorectal cancer.
  • Colorectal cancer 10 February 2010 13:37 UTC www.umm.edu [Source type: Academic]

^ People with UC has a significant risk of CRC. 5.
  • colorectal | colon cancer screening |symptoms|signs 10 February 2010 13:36 UTC www.healthscreening.sg [Source type: Academic]

In our sample, people who drank more than eight servings of beer or spirits per week had at least a one in five chance of having significant colorectal neoplasia detected by screening colonoscopy.".[28]
.Other research suggests that "to minimize your risk of developing colorectal cancer, it's best to drink in moderation."^ Obesity increases your risk of dying of colorectal cancer.

^ Age and health history can affect the risk of developing colorectal cancer.
  • Cancer Center 10 February 2010 13:37 UTC www.rush.edu [Source type: Academic]
  • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]

^ Alcohol Drinking alcoholic beverages may increase the risk of colorectal cancer.
  • Colorectal Cancer Prevention (PDQ®) 10 February 2010 13:37 UTC www.fccc.edu [Source type: Academic]

[19]
On its colorectal cancer page, the National Cancer Institute does not list alcohol as a risk factor;[29] however, on another page it states, "Heavy alcohol use may also increase the risk of colorectal cancer".[30]
.Drinking may be a cause of earlier onset of colorectal cancer.^ These symptoms may be caused by colorectal cancer or by other conditions.
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ What causes colorectal cancer?
  • Colorectal Cancer - Topic Overview - Yahoo! Health 10 February 2010 13:36 UTC health.yahoo.com [Source type: FILTERED WITH BAYES]
  • Colorectal Cancer 10 February 2010 13:36 UTC www.metrohealth.org [Source type: FILTERED WITH BAYES]
  • Colorectal Cancer - Topic Overview - Health.com 10 February 2010 13:36 UTC www.health.com [Source type: General]
  • Cancer Center 10 February 2010 13:37 UTC www.rush.edu [Source type: Academic]
  • Colorectal Cancer - University of Chicago Medical Center 10 February 2010 13:37 UTC www.uchospitals.edu [Source type: Academic]
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]
  • Colorectal Cancer 10 February 2010 13:37 UTC www.healthsystem.virginia.edu [Source type: Academic]
  • Health24 - Cancer, About Cancer 10 February 2010 13:37 UTC www.health24.com [Source type: Academic]
  • http://www.ecommunity.com/health/index.aspx?pageid=P00362 10 February 2010 13:37 UTC www.ecommunity.com [Source type: Academic]
  • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]
  • Colorectal Cancer - Topic Overview - MSN Health & Fitness - Health Topics 10 February 2010 13:37 UTC health.msn.com [Source type: General]
  • Norwood Hospital - Colorectal Cancer 10 February 2010 13:37 UTC www.caritasnorwood.org [Source type: Academic]

^ Alcohol Drinking alcoholic beverages may increase the risk of colorectal cancer.
  • Colorectal Cancer Prevention (PDQ®) 10 February 2010 13:37 UTC www.fccc.edu [Source type: Academic]

[31]

Pathogenesis

.Colorectal cancer is a disease originating from the epithelial cells lining the colon or rectum of the gastrointestinal tract, as a result of mutations along the 'Wnt signaling pathway.^ Colorectal cancer is cancer of the colon or rectum.
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

^ Next Diseases » Colorectal cancer » Introduction   Colorectal cancer .
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

^ KRAS mutations in lung and colorectal cancer .

.Some of the mutations are inherited, and others are acquired.^ In HNPCC, 1 MMR gene mutation is inherited; errors in microsatellite sequences follow somatic activation of the other MMR gene allele in precancerous and cancerous cells.
  • Genetic Testing for Inherited Susceptibility to Colorectal Cancer 10 February 2010 13:37 UTC www.bcbst.com [Source type: Academic]

^ Some cases appear to be inherited, while others seem to occur randomly or to have nongenetic causes.
  • colorectal cancer (pathology) -- Britannica Online Encyclopedia 10 February 2010 13:37 UTC www.britannica.com [Source type: Academic]

^ In some people polyps may be inherited, while in others they are not inherited.
  • MACGN - Hereditary Nonpolyposis Colorectal Cancer (HNPCC) 10 February 2010 13:37 UTC www.macgn.org [Source type: Academic]

[32][33] .The most commonly mutated gene in all colorectal cancer is the APC gene, which produces the APC protein.^ KRAS mutations in lung and colorectal cancer .

^ The majority of colorectal cancer polyps have mutations in both copies of the Apc gene.
  • Colorectal Cancer Research Definitions 10 February 2010 13:37 UTC www.mshri.on.ca [Source type: Academic]

^ The I1307K polymorphism of the APC gene in colorectal cancer.
  • NEJM -- Hereditary Colorectal Cancer 10 February 2010 13:37 UTC content.nejm.org [Source type: Academic]

The APC protein is the "brake" on the β-catenin protein. .Without APC, β-catinin moves into the nucleus, binds to DNA, and activates more proteins.^ Since stool in this location is more solidly formed, its passage can become blocked from moving into the rectum by a growing tumor.

^ Glutathione: Glutathione is a small protein that is involved in detoxification; it binds to toxins in the body and transforms them into a form that can be excreted in urine or bile.
  • Recurrent Colon Cancer | CancerConsultants 10 February 2010 13:36 UTC www.cancerconsultants.com [Source type: Academic]
  • University of Florida Shands Cancer Center: Recurrent Colon Cancer 10 February 2010 13:36 UTC www.ufscc.ufl.edu [Source type: Academic]

^ Inheriting the mutated FAP or HNPCC gene means that because of an altered protein produced from the DNA, an individual is much more likely, or more susceptible to colon cancer.

.(If APC isn't mutated in colorectal cancer, then β-catinin itself is.^ KRAS mutations in lung and colorectal cancer .

^ With HNPCC, people develop a single colorectal cancer rather than an unusual number of polyps, as in FAP. Individuals with the HNPCC gene mutations have an 80% lifetime risk of developing colorectal cancer.
  • Tennessee Oncology - Colon Cancer Screening and Prevention 10 February 2010 13:36 UTC www.tnoncology.com [Source type: Academic]

^ It is hypothesized that the APC I1307K mutation itself does not cause colon cancer; rather this particular mutation appears to create a weak spot in the gene that makes it more susceptible to additional genetic changes that may in turn lead to colon cancer.
  • Genetic Testing for Inherited Susceptibility to Colorectal Cancer 10 February 2010 13:37 UTC www.bcbst.com [Source type: Academic]

)[3]
But it's not enough for the Wnt-APC-beta-catinin signaling pathway to get stuck in the "on" position. .Other mutations must occur for the cell to become cancerous.^ Some polyps become cancerous, others do not.
  • AGA | Patient Center | Digestive Conditions | Colorectal Cancer Prevention & Treatment 10 February 2010 13:37 UTC www.gastro.org [Source type: FILTERED WITH BAYES]

^ Once the cancer spreads to lymph nodes or other organs, successful treatment becomes more difficult.
  • EmblemHealth - Health & Wellness: Colorectal Cancer (The Basics) 10 February 2010 13:37 UTC emblemhealth.com [Source type: Academic]

^ These nodes are removed because the lymph system is one of the ways cancer cells spread to other parts of the body.

.The TP53 protein, produced by the p53 gene, normally monitors cell division and kills cells if they have Wnt pathway defects.^ They produce and store cells that fight infection.
  • Treatment of Colon Cancer | Treatments for Colon Cancer | Adjutant Treatment of Colon Cancer 10 February 2010 13:36 UTC www.meds.com [Source type: Academic]

^ Monoclonal antibodies are proteins produced in a laboratory that can identify a cancer cell for destruction or prevent the tumor cell from dividing.

^ Tumor suppressor gene: Gene that normally functions to inhibit cell growth and division cycles.
  • Colorectal Cancer Research Definitions 10 February 2010 13:37 UTC www.mshri.on.ca [Source type: Academic]

.But eventually, a clone of cells gets a second mutation, in the p53 gene, and it transforms from a large adenoma into an invasive carcinoma.^ Studies suggested that MSI colon cancers have a much lower incidence of mutations in the K-ras oncogene and the p53 tumor suppressor gene than non-MSI colon cancers.
  • Metastatic Colorectal Cancer: Systemic Treatment: Biological Markers 10 February 2010 13:37 UTC www.medscape.com [Source type: Academic]

^ Hereditary Nonpolyposis Colorectal Carcinoma (HNPCC): HNPCC comes from an inherited gene mutation that causes cancer in 70 to 80% of the people with that mutation.
  • Colorectal Cancer: Tumors of the Digestive System: Merck Manual Home Edition 10 February 2010 13:37 UTC www.merck.com [Source type: Academic]

^ Neoplastic cells contained in layered DNA are continuously shed into the large bowel lumen.
  • NGC - NGC Summary 10 February 2010 13:37 UTC www.guideline.gov [Source type: Academic]

(Sometimes p53 isn't mutated, but another protective protein named BAX is.)[3]
.Another protein that's supposed to kill cells when they become cancerous is TGF-β.^ Then, as they get larger, they can become cancerous.
  • Colon Cancer Endoscopy 10 February 2010 13:36 UTC gicare.com [Source type: Academic]

^ It can help kill cancer cells.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

^ Although radiation therapy (the use of high-energy beams to kill cancer cells) is not typically used in the treatment of colon cancer, your doctor may recommend radiation therapy if the tumor has become attached to another structure in the body or to control bleeding.
  • Colon cancer treatment; colorectal cancer; rectal cancer treatment - nccn.com 10 February 2010 13:36 UTC www.nccn.com [Source type: FILTERED WITH BAYES]

.But in at least half of colorectal cancers, TGF-β also has a deactivating mutation.^ KRAS mutations in lung and colorectal cancer .

^ Less than 10 percent of colorectal cancers are caused by inherited gene mutations.

^ With HNPCC, people develop a single colorectal cancer rather than an unusual number of polyps, as in FAP. Individuals with the HNPCC gene mutations have an 80% lifetime risk of developing colorectal cancer.
  • Tennessee Oncology - Colon Cancer Screening and Prevention 10 February 2010 13:36 UTC www.tnoncology.com [Source type: Academic]

(Sometimes TGF-β isn't deactivated, but a downstream protein named SMAD is.)[3]
.Some genes are oncogenes -- they are overexpressed in colorectal cancer.^ Collectively they are referred to as colorectal cancers.
  • Colon Cancer - MD Anderson Cancer Center 10 February 2010 13:36 UTC www.mdanderson.org [Source type: Academic]

^ Some tests can prevent colorectal cancer .
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

^ What are some of the risk factors for colorectal cancer?
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

.For example, RAS, RAF, and PI3K, which normally encourage the cell to divide in response to growth factors, can become mutated with mutations that make them oversignal the cell.^ Calcium has been shown to reduce abnormal growths and induce normal turnover of cells in the gastrointestinal system, the report noted.
  • Calcium Helps Ward Off Colon Cancer - US News and World Report 10 February 2010 13:36 UTC www.usnews.com [Source type: News]

^ Proto-oncogenes, which are part of the normal genome and involved in growth and regulation, may facilitate cell cycle turnover and cellular proliferation when abnormally activated.
  • ASCRS: Colon And Rectal Cancer 10 February 2010 13:36 UTC www.fascrs.org [Source type: Academic]

^ Targeted therapies are methods that attack some part of cancer cells that make them different from normal cells.
  • Colorectal Cancer 10 February 2010 13:36 UTC www.metrohealth.org [Source type: FILTERED WITH BAYES]

PTEN normally inhibits PI3K, but sometimes PTEN gets mutated.[3]

Diagnosis

Endoscopic image of colon cancer identified in sigmoid colon on screening colonoscopy in the setting of Crohn's disease.
.Colorectal cancer can take many years to develop and early detection of colorectal cancer greatly improves the chances of a cure.^ "We are currently almost helpless in preventing many cancers or detecting them early when they can be cured.
  • Community Leaders Speak Out for Colon Cancer Screening 10 February 2010 13:36 UTC www.endcoloncancernow.org [Source type: General]

^ The prognosis for colorectal cancer depends on how early the disease is detected.
  • What Is Colorectal Cancer? | LIVESTRONG.COM 10 February 2010 13:37 UTC www.livestrong.com [Source type: Academic]

^ What is the chance that my colon cancer will be cured?

.The National Cancer Policy Board of the Institute of Medicine estimated in 2003 that even modest efforts to implement colorectal cancer screening methods would result in a 29 percent drop in cancer deaths in 20 years.^ In Colorectal cancer initiatives: Implementation Guide .
  • Implementing Colorectal Cancer Screening: Workshop Summary 10 February 2010 13:37 UTC www.nap.edu [Source type: Academic]

^ What methods are used to screen people for colorectal cancer?
  • Colorectal Cancer - Ostomy, Colostomy, Ileostomy and Urostomy 10 February 2010 13:37 UTC www.ostomysoftware.com [Source type: Academic]
  • Colorectal Cancer Screening Fact Sheet - National Cancer Institute 10 February 2010 13:37 UTC www.9aday.cancer.gov [Source type: Academic]

^ Screening sigmoidoscopy and colorectal cancer mortality.
  • eMJA: Outcomes after 10 years of a community-based flexible sigmoidoscopy screening program for colorectal carcinoma 25 September 2009 0:48 UTC www.mja.com.au [Source type: Academic]

.Despite this, colorectal cancer screening rates remain low.^ How can you screen for colorectal cancer?
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

^ The cost is low compared with other colorectal cancer screening tests.
  • Colorectal Cancer Screening Fact Sheet - National Cancer Institute 10 February 2010 13:37 UTC www.9aday.cancer.gov [Source type: Academic]

^ Colorectal cancer screening is safe and effective.
  • AGA | Patient Center | Digestive Conditions | Colorectal Cancer Prevention & Treatment 10 February 2010 13:37 UTC www.gastro.org [Source type: FILTERED WITH BAYES]

[34] .Therefore, screening for the disease is recommended in individuals who are at increased risk.^ Recommendations for screening people at increased risk are the same as for level 1.
  • NGC - NGC Summary 10 February 2010 13:37 UTC guidelines.gov [Source type: FILTERED WITH BAYES]

^ Recommendations for screening people who are at increased risk are the same as for cascade 1.
  • NGC - NGC Summary 10 February 2010 13:37 UTC guidelines.gov [Source type: FILTERED WITH BAYES]

^ Cancer risk increases with duration of disease.

.There are several different tests available for this purpose.^ There are several different types of staging systems , so it's important to ask your doctor to explain carefully what stage your cancer is in and what that means.
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

^ There are also several drugs available for treating side effects.
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

^ There is considerable variability reported in the literature on the sensitivity and specificity of available guaiac-based stool tests.
  • NGC - NGC Summary 10 February 2010 13:37 UTC www.guideline.gov [Source type: Academic]

.
  • Digital rectal exam (DRE): The doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas.^ (DRE) - a physician or healthcare provider inserts a gloved finger into the rectum to feel for anything unusual or abnormal.
    • Colorectal Cancer - University of Chicago Medical Center 10 February 2010 13:37 UTC www.uchospitals.edu [Source type: Academic]
    • Colorectal Cancer 10 February 2010 13:37 UTC www.healthsystem.virginia.edu [Source type: Academic]
    • http://www.ecommunity.com/health/index.aspx?pageid=P00362 10 February 2010 13:37 UTC www.ecommunity.com [Source type: Academic]

    ^ Digital rectal exam: An exam of the rectum.
    • FUDA CANCER HOSPITAL GUANGZHOU 10 February 2010 13:36 UTC www.orienttumor.com [Source type: Academic]
    • Colon Cancer | Your Cancer Today 10 February 2010 13:36 UTC www.yourcancertoday.com [Source type: Academic]
    • Colon Cancer Treatment PDQ®: Treatment - Patient Information NCI - MSN Health & Fitness - Cancer 10 February 2010 13:36 UTC health.msn.com [Source type: Academic]
    • Colon cancer: Treatment - Patient Information [NCI PDQ] | NYU Cancer Institute 10 February 2010 13:36 UTC ci.med.nyu.edu [Source type: Academic]
    • Colon Cancer Treatment (PDQ®) 10 February 2010 13:36 UTC www3.fccc.edu [Source type: Academic]

    ^ A doctor or nurse inserts a lubricated, gloved finger into the rectum to feel for lumps or anything else that seems unusual.

    .It only detects tumors large enough to be felt in the distal part of the rectum but is useful as an initial screening test.
  • Fecal occult blood test (FOBT): a test for blood in the stool.^ A fecal occult blood test (FOBT) checks for hidden blood in the stool .
    • Colorectal Cancer - Ostomy, Colostomy, Ileostomy and Urostomy 10 February 2010 13:37 UTC www.ostomysoftware.com [Source type: Academic]

    ^ Reducing mortality from colorectal cancer by screening for fecal occult blood.
    • Early detection improves chances to beat colorectal cancer. - Global Hospital & Healthcare Management 10 February 2010 13:37 UTC www.hhmglobal.com [Source type: Academic]

    ^ Stool blood test (fecal occult blood test – FOBT): This test is used to find small amounts of hidden (occult) blood in the stool.
    • Colorectal Cancer 10 February 2010 13:36 UTC www.metrohealth.org [Source type: FILTERED WITH BAYES]

    Two types of tests can be used for detecting occult blood in stools i.e. guaiac based (chemical test) and immunochemical. .The sensitivity of immunochemical testing is superior to that of chemical testing without an unacceptable reduction in specifity.^ Nonrandomized trial with concurrent or historical controls Case-control study Study of sensitivity and specificity of a diagnostic test Population-based descriptive study Class D: .
    • NGC - NGC Summary 10 February 2010 13:37 UTC www.guideline.gov [Source type: Academic]

    ^ Furthermore, patient and physician compliances vary inversely with the sensitivity and specificity of the screening tests.
    • Update on Colorectal Cancer - March 15, 2000 - American Academy of Family Physicians 10 February 2010 13:37 UTC www.aafp.org [Source type: Academic]

    ^ There is considerable variability reported in the literature on the sensitivity and specificity of available guaiac-based stool tests.
    • NGC - NGC Summary 10 February 2010 13:37 UTC www.guideline.gov [Source type: Academic]

    [35]
  • .
  • Endoscopy:
    • Sigmoidoscopy: A lighted probe (sigmoidoscope) is inserted into the rectum and lower colon to check for polyps and other abnormalities.
    • Colonoscopy: A lighted probe called a colonoscope is inserted into the rectum and the entire colon to look for polyps and other abnormalities that may be caused by cancer.^ Colonoscopy Sigmoidoscopy Note: Only colonoscopy can see the entire colon.
      • Colon Cancer - Kosmix : Reference, Videos, Images, News, Shopping and more... 10 February 2010 13:36 UTC www.kosmix.com [Source type: Academic]
      • Colon cancer 10 February 2010 13:36 UTC www.shands.org [Source type: Academic]
      • Colon Cancer | Wake Forest University Baptist Medical Center 10 February 2010 13:36 UTC www2.wfubmc.edu [Source type: Academic]
      • Colon cancer 10 February 2010 13:36 UTC www.drexelmed.edu [Source type: Academic]
      • A-Z Health Library 10 February 2010 13:37 UTC www.universityhealth.org [Source type: Academic]
      • http://ssmhealth.adam.com/content.aspx?pid=1&gid=000262 10 February 2010 13:37 UTC ssmhealth.adam.com [Source type: Academic]

      ^ Two important tools for detecting polyps, cancer, and other colon diseases are flexible sigmoidoscopy and colonoscopy.
      • Colorectal Cancer | AHealthyMe.com 10 February 2010 13:37 UTC www.ahealthyme.com [Source type: Academic]

      ^ Cancer that begins in the colon is called colon cancer , and cancer that begins in the rectum is called rectal cancer .

      .A colonoscopy has the advantage that if polyps are found during the procedure they can be immediately removed.^ Polyps can be easily removed during a routine colonoscopy.
      • Colon Cancer Deaths Could Make Big Drop, Experts Say 10 February 2010 13:36 UTC www.huffingtonpost.com [Source type: General]

      ^ If a polyp is found, the doctor may remove it.
      • Colorectal Cancer 10 February 2010 13:36 UTC www.metrohealth.org [Source type: FILTERED WITH BAYES]

      ^ If any polyps are found, they should be removed if possible.
      • Colorectal Cancer 10 February 2010 13:36 UTC www.metrohealth.org [Source type: FILTERED WITH BAYES]

      Tissue can also be taken for biopsy.
.In the United States, colonoscopy or FOBT plus sigmoidoscopy are the preferred screening options.^ Fecal occult blood test (FOBT) Flexible sigmoidoscopy Colonoscopy Polypectomy - removal of a polyp, which may help in diagnosis of cancer.
  • Symptoms of Colorectal cancer - WrongDiagnosis.com 10 February 2010 13:37 UTC www.wrongdiagnosis.com [Source type: Academic]

^ The first reports from the four ongoing randomised trials on flexible sigmoidoscopy screening are expected over the course of the next several years [ 4–7 ], while similar randomised trials on colonoscopy screening have not, so far, been launched.
  • PLoS Medicine: The Science and Politics of Colorectal Cancer Screening 10 February 2010 13:37 UTC www.plosmedicine.org [Source type: Academic]

^ This option is based on evidence that screening double-contrast barium enema and fluoroscopic barium enema by a gastrointestinal radiologist can image the entire colon and detect cancers and large polyps almost as well as colonoscopy or flexible sigmoidoscopy.
  • NGC - NGC Summary 10 February 2010 13:37 UTC www.guideline.gov [Source type: Academic]

Other screening methods

.
  • Double contrast barium enema (DCBE): First, an overnight preparation is taken to cleanse the colon.^ Double contrast barium enema every 10 years .
    • Update on Colorectal Cancer - March 15, 2000 - American Academy of Family Physicians 10 February 2010 13:37 UTC www.aafp.org [Source type: Academic]

    ^ A double contrast barium enema (DCBE) is a series of x-rays of the colon and rectum.
    • Health Concerns - Colon Cancer 10 February 2010 13:36 UTC www.menopauserx.com [Source type: Academic]

    ^ Double contrast Barium Enema X-ray.
    • colorectal | colon cancer screening |symptoms|signs 10 February 2010 13:36 UTC www.healthscreening.sg [Source type: Academic]

    .An enema containing barium sulfate is administered, then air is insufflated into the colon, distending it.^ When a barium solution (which looks and feels like watery chalk) is put into the colon and rectum using an enema (a tube inserted into the rectum) and then air is pumped in through a flexible catheter, a detailed outline of the colon and rectum can be seen in an x–ray.
    • Colon Cancer Screening | Newsletter: Volume 11 10 February 2010 13:36 UTC www.salix.com [Source type: FILTERED WITH BAYES]

    ^ Barium, a contrast dye, is placed into your bowel in an enema form.

    ^ Click Image to Enlarge barium enema with air contrast (Also called a double contrast barium enema.
    • Colorectal Cancer - University of Chicago Medical Center 10 February 2010 13:37 UTC www.uchospitals.edu [Source type: Academic]
    • http://www.ecommunity.com/health/index.aspx?pageid=P00362 10 February 2010 13:37 UTC www.ecommunity.com [Source type: Academic]

    .The result is a thin layer of barium over the inner lining of the colon which is visible on X-ray films.^ Barium enema - A test in which a chalky liquid which is resistant to x-rays is inserted into the large intestine, making it visible on x-ray film and permitting the doctor to see any defects, obstructions or masses.
    • MACGN - Hereditary Nonpolyposis Colorectal Cancer (HNPCC) 10 February 2010 13:37 UTC www.macgn.org [Source type: Academic]

    ^ A polyp on the inner lining is an indication or symptom of the first of the colon cancer stages.

    ^ Sigmoid cancer starts in the inner layer of tissue in the wall of the colon and rectum.

    .A cancer or a precancerous polyp can be detected this way.^ In this way, polyps or a cancer can be seen by the doctor.
    • Health24 - Cancer, About Cancer 10 February 2010 13:37 UTC www.health24.com [Source type: Academic]

    ^ Fortunately, a colonoscopy every 10 years after the age of 50 is an effective means of detecting colon cancer at its earliest stages and, if a polyp is detected, it can be removed during the examination.
    • Community Leaders Speak Out for Colon Cancer Screening 10 February 2010 13:36 UTC www.endcoloncancernow.org [Source type: General]

    ^ Two important tools for detecting polyps, cancer, and other colon diseases are flexible sigmoidoscopy and colonoscopy.
    • Colorectal Cancer | AHealthyMe.com 10 February 2010 13:37 UTC www.ahealthyme.com [Source type: Academic]

    .This technique can miss the (less common) flat polyp.
  • Virtual colonoscopy replaces X-ray films in the double contrast barium enema (above) with a special computed tomography scan and requires special workstation software in order for the radiologist to interpret.^ Double contrast barium enema every 10 years .
    • Update on Colorectal Cancer - March 15, 2000 - American Academy of Family Physicians 10 February 2010 13:37 UTC www.aafp.org [Source type: Academic]

    ^ Double-contrast barium enema .

    ^ A double contrast barium enema (DCBE) is a series of x-rays of the colon and rectum.
    • Health Concerns - Colon Cancer 10 February 2010 13:36 UTC www.menopauserx.com [Source type: Academic]

    .This technique is approaching colonoscopy in sensitivity for polyps.^ Colonoscopy has a sensitivity of 90 percent for small polyps but only 75 percent for diminutive polyps.
    • Update on Colorectal Cancer - March 15, 2000 - American Academy of Family Physicians 10 February 2010 13:37 UTC www.aafp.org [Source type: Academic]

    .However, any polyps found must still be removed by standard colonoscopy.
  • Standard computed axial tomography is an x-ray method that can be used to determine the degree of spread of cancer, but is not sensitive enough to use for screening.^ What methods are used to screen people for colorectal cancer?
    • Colorectal Cancer - Ostomy, Colostomy, Ileostomy and Urostomy 10 February 2010 13:37 UTC www.ostomysoftware.com [Source type: Academic]
    • Colorectal Cancer Screening Fact Sheet - National Cancer Institute 10 February 2010 13:37 UTC www.9aday.cancer.gov [Source type: Academic]

    ^ If a polyp is found, the doctor may remove it.
    • Colorectal Cancer 10 February 2010 13:36 UTC www.metrohealth.org [Source type: FILTERED WITH BAYES]

    ^ Use of colonoscopy to screen asymptomatic adults for colorectal cancer.
    • Colorectal Cancer - Ostomy, Colostomy, Ileostomy and Urostomy 10 February 2010 13:37 UTC www.ostomysoftware.com [Source type: Academic]
    • eMJA: Outcomes after 10 years of a community-based flexible sigmoidoscopy screening program for colorectal carcinoma 25 September 2009 0:48 UTC www.mja.com.au [Source type: Academic]

    .Some cancers are found in CAT scans performed for other reasons.
  • Blood tests: Measurement of the patient's blood for elevated levels of certain proteins can give an indication of tumor load.^ Some tests can prevent colorectal cancer .
    • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

    ^ Carcinoembryonic antigen (CEA) assay : A test that measures the level of CEA in the blood.
    • Cancer Information | UPMC Cancer Centers 10 February 2010 13:36 UTC www.upmccancercenters.com [Source type: Academic]
    • http://jamesline.com/cancertypes/gi/about/colon/ 10 February 2010 13:36 UTC jamesline.com [Source type: Academic]
    • Colon Cancer Treatment - National Cancer Institute 10 February 2010 13:36 UTC healthpromotionresearch.cancer.gov [Source type: Academic]

    ^ Some blood tests that may be done include: .
    • Colon Cancer Symptoms, Diagnosis, and Treatment- Mass General Hospital 10 February 2010 13:36 UTC www2.massgeneral.org [Source type: Academic]

    .In particular, high levels of carcinoembryonic antigen (CEA) in the blood can indicate metastasis of adenocarcinoma.^ Carcinoembryonic antigen (CEA) assay : A test that measures the level of CEA in the blood.
    • Cancer Information | UPMC Cancer Centers 10 February 2010 13:36 UTC www.upmccancercenters.com [Source type: Academic]
    • http://jamesline.com/cancertypes/gi/about/colon/ 10 February 2010 13:36 UTC jamesline.com [Source type: Academic]
    • Colon Cancer Treatment - National Cancer Institute 10 February 2010 13:36 UTC healthpromotionresearch.cancer.gov [Source type: Academic]

    ^ Carcinoembryonic antigen (CEA) assay: A test that measures the level of CEA in the blood.
    • Colon Cancer Foundation Home 10 February 2010 13:36 UTC www.coloncancerfoundation.org [Source type: FILTERED WITH BAYES]
    • Colon Cancer | Your Cancer Today 10 February 2010 13:36 UTC www.yourcancertoday.com [Source type: Academic]
    • Colon Cancer Treatment PDQ®: Treatment - Patient Information NCI - MSN Health & Fitness - Cancer 10 February 2010 13:36 UTC health.msn.com [Source type: Academic]
    • National Cancer Alliance 10 February 2010 13:36 UTC www.cancersociety.com [Source type: Academic]
    • Colon cancer: Treatment - Patient Information [NCI PDQ] | NYU Cancer Institute 10 February 2010 13:36 UTC ci.med.nyu.edu [Source type: Academic]
    • Colon Cancer Treatment (PDQ®) 10 February 2010 13:36 UTC www3.fccc.edu [Source type: Academic]

    ^ Complete blood cell count Chemistries and liver function tests Serum carcinoembryonic antigen (CEA) should be obtained preoperatively as it carries prognostic value and when highly elevated may indicate more advanced, disseminated disease.
    • Colon Cancer, Adenocarcinoma: Differential Diagnoses & Workup - eMedicine Oncology 10 February 2010 13:36 UTC emedicine.medscape.com [Source type: Academic]

    .These tests are frequently false positive or false negative, and are not recommended for screening, it can be useful to assess disease recurrence.
  • Genetic counseling and genetic testing for families who may have a hereditary form of colon cancer, such as hereditary nonpolyposis colorectal cancer (HNPCC) or familial adenomatous polyposis (FAP).
  • Positron emission tomography (PET) is a 3-dimensional scanning technology where a radioactive sugar is injected into the patient, the sugar collects in tissues with high metabolic activity, and an image is formed by measuring the emission of radiation from the sugar.^ Large geographic differences are observed in the occurrence of hereditary nonpolyposis colorectal cancer (HNPCC).
    • Hereditary Colorectal Cancer: eMedicine Gastroenterology 10 February 2010 13:37 UTC emedicine.medscape.com [Source type: Academic]

    ^ What methods are used to screen people for colorectal cancer?
    • Colorectal Cancer - Ostomy, Colostomy, Ileostomy and Urostomy 10 February 2010 13:37 UTC www.ostomysoftware.com [Source type: Academic]
    • Colorectal Cancer Screening Fact Sheet - National Cancer Institute 10 February 2010 13:37 UTC www.9aday.cancer.gov [Source type: Academic]

    ^ A role for MLH3 in hereditary nonpolyposis colorectal cancer.
    • NEJM -- Hereditary Colorectal Cancer 10 February 2010 13:37 UTC content.nejm.org [Source type: Academic]

    .Because cancer cells often have very high metabolic rate, this can be used to differentiate benign and malignant tumors.^ Tumors can be either benign or malignant.
    • Health Concerns - Colon Cancer 10 February 2010 13:36 UTC www.menopauserx.com [Source type: Academic]

    ^ It uses high-energy rays to kill cancer cells.
    • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

    ^ Malignant tumors are cancer.
    • Colon Cancer (Colorectal Cancer) Information, Causes, Symptoms, Prevention and Treatment on MedicineNet.com 10 February 2010 13:36 UTC www.medicinenet.com [Source type: Academic]
    • Health Concerns - Colon Cancer 10 February 2010 13:36 UTC www.menopauserx.com [Source type: Academic]

    .PET is not used for screening and does not (yet) have a place in routine workup of colorectal cancer cases.
  • Whole-Body PET imaging is the most accurate diagnostic test for detection of recurrent colorectal cancer, and is a cost-effective way to differentiate resectable from non-resectable disease.^ What methods are used to screen people for colorectal cancer?
    • Colorectal Cancer - Ostomy, Colostomy, Ileostomy and Urostomy 10 February 2010 13:37 UTC www.ostomysoftware.com [Source type: Academic]
    • Colorectal Cancer Screening Fact Sheet - National Cancer Institute 10 February 2010 13:37 UTC www.9aday.cancer.gov [Source type: Academic]

    ^ By themselves, they cannot diagnose cancer and are not used as a screening test .
    • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

    ^ This is currently the most effective tool for detecting polyps and cancers.
    • Preventing Colon Cancer 10 February 2010 13:36 UTC hoptechno.com [Source type: FILTERED WITH BAYES]

    .A PET scan is indicated whenever a major management decision depends upon accurate evaluation of tumour presence and extent.
  • Stool DNA testing is an emerging technology in screening for colorectal cancer.^ Screening sigmoidoscopy and colorectal cancer mortality.
    • eMJA: Outcomes after 10 years of a community-based flexible sigmoidoscopy screening program for colorectal carcinoma 25 September 2009 0:48 UTC www.mja.com.au [Source type: Academic]

    ^ The type and duration of colorectal cancer treatment depend upon the extent of the disease and when it is discovered.
    • Preventing Colon Cancer 10 February 2010 13:36 UTC hoptechno.com [Source type: FILTERED WITH BAYES]

    ^ Evaluating test strategies for colorectal cancer screening: A decision analysis for the U.S. Preventive Services Task Force.
    • Implementing Colorectal Cancer Screening: Workshop Summary 10 February 2010 13:37 UTC www.nap.edu [Source type: Academic]

    .Pre-malignant adenomas and cancers shed DNA markers from their cells which are not degraded during the digestive process and remain stable in the stool.^ Tubular polyps, which protrude mushroom-like Villous adenomas, which are flat and spreading and are more apt to become malignant (cancerous) Polyps are very common, and most of them are benign.
    • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

    ^ Screening tests that detect occult blood in the stool or identify adenomatous polyps can prevent the occurrence of colorectal cancers by allowing the detection and removal of pre-cancerous lesions before they undergo malignant transformation.
    • Hemorrhoid.net - COLON CANCER AND RECTAL CANCER - Screening, Symptoms, Diagnosis & Treatment 10 February 2010 13:36 UTC www.hemorrhoid.net [Source type: Academic]

    ^ Measurement of tumor markers in serum of colorectal cancer patients after surgery is a sensitive method in early diagnosis of systemic spread of tumor cells.

    .Capture, followed by PCR amplifies the DNA to detectable levels for assay.^ It is the first automated assay for detecting the Septin 9 gene in plasma and the first cancer assay available with Abbott's m2000 PCR-based molecular diagnostic system.
    • New Abbott Gene-Based Test for Colorectal Cancer Receives CE Mark | SYS-CON CANADA 10 February 2010 13:37 UTC ca.sys-con.com [Source type: Academic]

    ^ Cells from the mucosal surface of the colon are shed into the lumen of the colon, and DNA alterations seen in colorectal cancer and in adenomas can be detected using a multitargeted DNA assay.
    • NGC - NGC Summary 10 February 2010 13:37 UTC www.guideline.gov [Source type: Academic]

    .Clinical studies have shown a cancer detection sensitivity of 71%–91%.^ Beta-carotene and other carotenoids have been shown in some studies to decrease the risks of developing both colon cancer and rectal cancer.
    • WHFoods: Colorectal Cancer 10 February 2010 13:36 UTC www.whfoods.com [Source type: Academic]

    ^ Some recent studies indicate that CT colonoscopy has a high accuracy rate in detecting adenomas and cancers.
    • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

    ^ And according to a new study in the American Journal of Clinical Nutrition , vegetarians have a much lower risk of developing cancer than people who eat meat.
    • Stand Up To Cancer: March 2009 Archives 22 September 2009 21:31 UTC www.standup2cancer.org [Source type: General]

    [36]

Monitoring

.Carcinoembryonic antigen (CEA) is a protein found on virtually all colorectal tumors.^ Tumor markers include carcinoembryonic antigen (CEA) and CA 19-9.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ The health care provider may also order a blood test called a CEA assay to measure carcinoembryonic antigen , a protein that is sometimes detected in greater amounts in patients with colorectal cancer.
  • Colorectal Cancer Screening Fact Sheet - National Cancer Institute 10 February 2010 13:37 UTC www.9aday.cancer.gov [Source type: Academic]

^ The patients who responded best to treatment did not have thoracic lymph node involvement and did not have an elevated carcinoembryonic antigen level (a type of protein found on the surface of cancer cells).
  • University of Florida Shands Cancer Center: Recurrent Colon Cancer 10 February 2010 13:36 UTC www.ufscc.ufl.edu [Source type: Academic]

.CEA may be used to monitor and assess response to treatment in patients with metastatic disease.^ Routine use of CEA levels alone for monitoring response to treatment should not be recommended.
  • FUDA CANCER HOSPITAL GUANGZHOU 10 February 2010 13:36 UTC www.orienttumor.com [Source type: Academic]

^ These may include a blood test called a CEA assay to measure a protein called carcinoembryonic antigen that is sometimes higher in patients with colorectal cancer.
  • Hemorrhoid.net - COLON CANCER AND RECTAL CANCER - Screening, Symptoms, Diagnosis & Treatment 10 February 2010 13:36 UTC www.hemorrhoid.net [Source type: Academic]

^ "Heavy alcohol use may also increase the risk of colorectal cancer" Primary sclerosing cholangitis offers a risk independent to ulcerative colitis The treatment depends on the staging of the cancer.
  • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

.CEA can also be used to monitor recurrence in patients post-operatively.^ CRC may have a high level of CEA. CEA is useful in monitoring patients for recurrence after surgery.
  • colorectal | colon cancer screening |symptoms|signs 10 February 2010 13:36 UTC www.healthscreening.sg [Source type: Academic]

^ CRC has been removed using such minimally invasive technique and the advantage is faster post-operative recovery with less pain.
  • colorectal | colon cancer screening |symptoms|signs 10 February 2010 13:36 UTC www.healthscreening.sg [Source type: Academic]

^ The significance of CEA, CA19-9 and CA72-4 was evaluated the for early detection of disease recurrence, on the basis of retrospective evaluation of routine data in patients with colorectal carcinoma.

[citation needed]

Pathology

Gross appearance of a colectomy specimen containing two adenomatous polyps (the brownish oval tumors above the labels, attached to the normal beige lining by a stalk) and one invasive colorectal carcinoma (the crater-like, reddish, irregularly-shaped tumor located above the label).
Gross appearance of a colectomy specimen containing one invasive colorectal carcinoma (the crater-like, reddish, irregularly-shaped tumor).
.
Micrograph of an invasive adenocarcinoma (the most common type of colorectal cancer).
^ Types of Polyps - Types of Polyps lists the most common polyps.

^ The 3 main types of treatment for colorectal cancer are: .
  • Colorectal Cancer 10 February 2010 13:36 UTC www.metrohealth.org [Source type: FILTERED WITH BAYES]

^ The following are the most common symptoms of colorectal cancer.
  • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]

.The cancerous cells are seen in the center and at the bottom right of the image (blue).^ Even if the doctor removes all of the cancer that can be seen at the time of the operation, some patients may receive chemotherapy after surgery to kill any cancer cells that are left.
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ Cells from the mucosal surface of the colon are shed into the lumen of the colon, and DNA alterations seen in colorectal cancer and in adenomas can be detected using a multitargeted DNA assay.
  • NGC - NGC Summary 10 February 2010 13:37 UTC www.guideline.gov [Source type: Academic]

^ Stained cells were analyzed by flow cytometry analysis at FACScan core services of the University of Colorado Cancer Center (Denver, CO).
  • Grape Seed Extract Inhibits In vitro and In vivo Growth of Human Colorectal Carcinoma Cells — Clinical Cancer Research 10 February 2010 13:37 UTC clincancerres.aacrjournals.org [Source type: Academic]

Near normal colon-lining cells are seen at the top right of the image.
Histopathologic image of colonic carcinoid stained by hematoxylin and eosin.
.The pathology of the tumor is usually reported from the analysis of tissue taken from a biopsy or surgery.^ A biopsy can be taken of any tissue that looks abnormal.
  • Colon Cancer Symptoms, Diagnosis, and Treatment- Mass General Hospital 10 February 2010 13:36 UTC www2.massgeneral.org [Source type: Academic]

^ A biopsy , in which a sample of tissue is taken from the inside of your intestine and examined under a microscope.
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

^ The stage of the cancer (stage 0, I, II, III, or IV, or 0 to 4), or the extent to which cancer has spread from its original site to other parts of the body, is usually determined after surgical treatment and laboratory analysis of the tissue sample removed during surgery.
  • Colorectal Cancer - Colon Cancer, Colonoscopy - Life Extension Health Concern 10 February 2010 13:36 UTC www.lef.org [Source type: Academic]

.A pathology report will usually contain a description of cell type and grade.^ Adenomatous is a description of the type of cell involved in the cancer.
  • Health24 - Cancer, About Cancer 10 February 2010 13:37 UTC www.health24.com [Source type: Academic]

^ Cancer patients’ white blood cells (WBCs) have been reported to contain low levels of vitamin C when compared with WBCs of healthy people.

^ These fractions usually contain glycopeptide derived from glycoprotein of mucin-type (0-glycoside type).
  • Cancer cell specific monoclonal antibodies and corresponding hybridomas, and their preparation and use. - Patent EP0255367 22 September 2009 21:31 UTC www.freepatentsonline.com [Source type: Academic]

.The most common colon cancer cell type is adenocarcinoma which accounts for 95% of cases.^ Surgery is the most common treatment for all stages of colon cancer.
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ Types of Polyps - Types of Polyps lists the most common polyps.

^ Follow-up: Colon Cancer, Adenocarcinoma .
  • Colon Cancer, Adenocarcinoma: eMedicine Oncology 10 February 2010 13:36 UTC emedicine.medscape.com [Source type: Academic]
  • Colon Cancer, Adenocarcinoma: Differential Diagnoses & Workup - eMedicine Oncology 10 February 2010 13:36 UTC emedicine.medscape.com [Source type: Academic]

.Other, rarer types include lymphoma and squamous cell carcinoma.^ Other GIT carcinomas producing CEA include carcinomas of the stomach, pancreas, oesophagus and biliary tract.
  • ISPUB - Verification Of Biological Characteristics Of Resection Lines Of Colorectal Carcinoma By Quantitative Expression Of MRNA CEA And TIMP-1 25 September 2009 0:48 UTC www.ispub.com [Source type: Academic]

^ Very rare cases of squamous cell carcinoma of the rectum have been reported.

^ Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.
  • http://jamesline.com/cancertypes/gi/about/colon/ 10 February 2010 13:36 UTC jamesline.com [Source type: Academic]
  • Colon Cancer Treatment - National Cancer Institute 10 February 2010 13:36 UTC healthpromotionresearch.cancer.gov [Source type: Academic]

.Cancers on the right side (ascending colon and cecum) tend to be exophytic, that is, the tumour grows outwards from one location in the bowel wall.^ As it grows, the tumour can narrow or block the bowel.
  • colorectal | colon cancer screening |symptoms|signs 10 February 2010 13:36 UTC www.healthscreening.sg [Source type: Academic]

^ Cancer on the right side .
  • Symptoms of Colorectal cancer - WrongDiagnosis.com 10 February 2010 13:37 UTC www.wrongdiagnosis.com [Source type: Academic]

^ The cecum and ascending colon , the first and second parts of the colon, are on the right side of your abdomen.
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

.This very rarely causes obstruction of feces, and presents with symptoms such as anemia.^ Colorectal cancer can cause symptoms such as blood in the stool, changes in normal bowel habits (constipation and/or diarrhea), narrowing of the stool, abdominal pain and distension, anemia, weight loss, and constant fatigue.
  • Colorectal Cancer - Colon Cancer, Colonoscopy - Life Extension Health Concern 10 February 2010 13:36 UTC www.lef.org [Source type: Academic]

^ Polyps usually produce no symptoms, but may cause rectal bleeding, which in turn may cause anemia.
  • Colorectal Cancer - Colon Cancer, Colonoscopy - Life Extension Health Concern 10 February 2010 13:36 UTC www.lef.org [Source type: Academic]

^ Often, treatments cause flu-like symptoms, such as chills, fever, weakness, and nausea.
  • Health Concerns - Colon Cancer 10 February 2010 13:36 UTC www.menopauserx.com [Source type: Academic]

.Left-sided tumours tend to be circumferential, and can obstruct the bowel much like a napkin ring.^ Right-sided lesions are more likely to bleed and cause diarrhea, while left-sided tumors are usually detected later and could present with bowel obstruction.
  • Colon Cancer, Adenocarcinoma: eMedicine Oncology 10 February 2010 13:36 UTC emedicine.medscape.com [Source type: Academic]

^ Cancer in the portion of the colon nearest the left side of the body and areas close to the rectum are the most common cause for a change in bowel habits and consistency of the stool.

^ A left side lesion is usually scirrhous, annular and presents as obstruction, alteration in the bowel habits and passage of blood or mucous mixed with bowel movement ( 2 ).
  • ISPUB - Outcome Of Patients With Acute Intestinal Obstruction Due To Colorectal Carcinoma 25 September 2009 0:48 UTC www.ispub.com [Source type: Academic]

.Adenocarcinoma is a malignant epithelial tumor, originating from glandular epithelium of the colorectal mucosa.^ Colorectal cancer occurs when malignant tumors form in the lining of the large intestine, also called the large bowel.
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ Tumor epithelial cell matrix metalloproteinase 9 is a target for antimetastatic therapy in colorectal cancer.
  • Warm Hepatic Ischemia-Reperfusion Promotes Growth of Colorectal Carcinoma Micrometastases in Mouse Liver via Matrix Metalloproteinase-9 Induction -- Nicoud et al. 67 (6): 2720 -- Cancer Research 25 September 2009 0:48 UTC cancerres.aacrjournals.org [Source type: Academic]

^ Adenocarcinoma of the colon and rectum develops in the glands of the intestine’s inner lining (mucosa) and accounts for 95 percent of colorectal cancer cases.
  • Colorectal Cancer - Colon Cancer, Colonoscopy - Life Extension Health Concern 10 February 2010 13:36 UTC www.lef.org [Source type: Academic]

.It invades the wall, infiltrating the muscularis mucosae, the submucosa and thence the muscularis propria.^ Tumor may invade submucosa (T1) or muscularis propria (T2) .
  • Colon Cancer, Adenocarcinoma: Differential Diagnoses & Workup - eMedicine Oncology 10 February 2010 13:36 UTC emedicine.medscape.com [Source type: Academic]

^ T2 : Tumor invades muscularis propria.
  • COLON CANCER - a knol by Alan 10 February 2010 13:36 UTC knol.google.com [Source type: Academic]

^ Inset shows serosa, muscle, submucosa and mucosa layers of the colon wall, and lymph nodes and blood vessels.
  • Colon Cancer - Medpedia 10 February 2010 13:36 UTC wiki.medpedia.com [Source type: Academic]
  • http://jamesline.com/cancertypes/gi/about/colon/ 10 February 2010 13:36 UTC jamesline.com [Source type: Academic]

.Tumor cells describe irregular tubular structures, harboring pluristratification, multiple lumens, reduced stroma ("back to back" aspect).^ It has been shown in a number of studies to inhibit the formation of tumors in the colon and other locations, to increase apoptosis of mutated cells, and to reduce tumor growth.
  • WHFoods: Colorectal Cancer 10 February 2010 13:36 UTC www.whfoods.com [Source type: Academic]

.Sometimes, tumor cells are discohesive and secrete mucus, which invades the interstitium producing large pools of mucus/colloid (optically "empty" spaces) - mucinous (colloid) adenocarcinoma, poorly differentiated.^ Colorectal adenocarcinoma can be divided in three grades: Grade I (low grade or well-differentiated), grade II (average grade or moderately differentiated) and grade III (poorly differentiated).
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

^ The microscopic appearance of colon adenocarcinomas may be that of well-differentiated or poorly differentiated glandular structures.
  • Colon Cancer, Adenocarcinoma: Differential Diagnoses & Workup - eMedicine Oncology 10 February 2010 13:36 UTC emedicine.medscape.com [Source type: Academic]

^ Cells from benign tumors do not invade the tissues around them.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

.If the mucus remains inside the tumor cell, it pushes the nucleus at the periphery - "signet-ring cell."^ Signet-ring cell carcinomas appear to have a worse prognosis than ordinary colon adenocarcinoma.
  • www.patientcenters.com -- Colon & Rectal Cancer Center -- Prognostic Factors 10 February 2010 13:36 UTC www.patientcenters.com [Source type: Academic]

^ Radiation therapy uses x-rays to kill cancer cells that might remain after an operation or to shrink large tumors before an operation so that they can be removed surgically.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ It continues to explain what happens to cancer cells and how the cells can create a mass called a tumor ,or even push its way through a...

.Depending on glandular architecture, cellular pleomorphism, and mucosecretion of the predominant pattern, adenocarcinoma may present three degrees of differentiation: well, moderately, and poorly differentiated.^ The microscopic appearance of colon adenocarcinomas may be that of well-differentiated or poorly differentiated glandular structures.
  • Colon Cancer, Adenocarcinoma: Differential Diagnoses & Workup - eMedicine Oncology 10 February 2010 13:36 UTC emedicine.medscape.com [Source type: Academic]

^ Colorectal adenocarcinoma can be divided in three grades: Grade I (low grade or well-differentiated), grade II (average grade or moderately differentiated) and grade III (poorly differentiated).
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

^ Poorly differentiated tumors connote a worse prognosis than well-differentiated tumors diagnosed at the same stage.
  • www.patientcenters.com -- Colon & Rectal Cancer Center -- Prognostic Factors 10 February 2010 13:36 UTC www.patientcenters.com [Source type: Academic]

[37]
.Most colorectal cancer tumors are thought to be cyclooxygenase-2 (COX-2) positive.^ It is used as a tumor marker for colorectal cancer.

^ The most common treatment for colorectal cancer is .
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ Surgery to remove the tumor is the most common treatment for colorectal cancer.
  • Health Concerns - Colon Cancer 10 February 2010 13:36 UTC www.menopauserx.com [Source type: Academic]

.This enzyme is generally not found in healthy colon tissue, but is thought to fuel abnormal cell growth.^ In stage 0 , abnormal cells are found in the innermost lining of the colon .
  • Cancer Information | UPMC Cancer Centers 10 February 2010 13:36 UTC www.upmccancercenters.com [Source type: Academic]
  • http://jamesline.com/cancertypes/gi/about/colon/ 10 February 2010 13:36 UTC jamesline.com [Source type: Academic]
  • Colon Cancer Treatment - National Cancer Institute 10 February 2010 13:36 UTC healthpromotionresearch.cancer.gov [Source type: Academic]

^ A polyp is a growth of tissue on the inside of the colon.
  • Colorectal Cancer Basics (Health & Wellbeing: Colorectal Cancer) 10 February 2010 13:37 UTC www.videojug.com [Source type: FILTERED WITH BAYES]

^ In Stage 0 , abnormal cells are found in the innermost lining of the colon.
  • Colon Cancer - Medpedia 10 February 2010 13:36 UTC wiki.medpedia.com [Source type: Academic]

Staging

.Colon cancer staging is an estimate of the amount of penetration of a particular cancer.^ What is the stage of my colon cancer?

^ Stage I (also called Dukes A colon cancer) .
  • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]

^ Stages of colon and rectal cancer What is colon and rectal cancer?
  • What is Colon and rectal cancer? 10 February 2010 13:36 UTC www.consumerreports.org [Source type: FILTERED WITH BAYES]

.It is performed for diagnostic and research purposes, and to determine the best method of treatment.^ People with colorectal cancer may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

^ The purpose of phase I trials is to evaluate new drugs in order to determine the best way of administering the drug and whether the drug has any anticancer activity in patients.
  • Recurrent Colon Cancer | CancerConsultants 10 February 2010 13:36 UTC www.cancerconsultants.com [Source type: Academic]
  • University of Florida Shands Cancer Center: Recurrent Colon Cancer 10 February 2010 13:36 UTC www.ufscc.ufl.edu [Source type: Academic]

^ It is the responsibility of the treating physician or other health care provider, relying on independent experience and knowledge of the patient, to determine the best course of treatment for the patient.
  • American Society of Clinical Oncology Provisional Clinical Opinion: Testing for KRAS Gene Mutations in Patients With Metastatic Colorectal Carcinoma to Predict Response to Anti-Epidermal Growth Factor Receptor Monoclonal Antibody Therapy -- Allegra et al. 27 (12): 2091 -- Journal of Clinical Oncology 25 September 2009 0:48 UTC jco.ascopubs.org [Source type: Academic]

.The systems for staging colorectal cancers depend on the extent of local invasion, the degree of lymph node involvement and whether there is distant metastasis.^ Stage II colorectal cancer - cancer has spread locally beyond colon/rectum but not to lymph nodes.
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

^ Colorectal cancer that has invaded the lymph nodes or the liver are in the advanced stage.
  • colorectal | colon cancer screening |symptoms|signs 10 February 2010 13:36 UTC www.healthscreening.sg [Source type: Academic]

^ Stage III colon cancer denotes lymph node involvement.
  • FUDA CANCER HOSPITAL GUANGZHOU 10 February 2010 13:36 UTC www.orienttumor.com [Source type: Academic]

.Definitive staging can only be done after surgery has been performed and pathology reports reviewed.^ If the cancer is found at a more advanced stage, the doctor may perform a colectomy, a type of surgery that .
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ Both the stage and grade can only be accurately determined from examination of the tumour specimen under the microscope after surgery.
  • colorectal | colon cancer screening |symptoms|signs 10 February 2010 13:36 UTC www.healthscreening.sg [Source type: Academic]

^ [CrossRef] [Web of Science] [Medline] Lynch HT, Fitzgibbons R Jr. Surgery, desmoid tumors, and familial adenomatous polyposis: case report and literature review.
  • NEJM -- Hereditary Colorectal Cancer 10 February 2010 13:37 UTC content.nejm.org [Source type: Academic]

.An exception to this principle would be after a colonoscopic polypectomy of a malignant pedunculated polyp with minimal invasion.^ Colonoscopy – a small malignant polyp may be removed from your colon or upper rectum with a colonoscope.

^ How long would a 5mm adenomatous colon polyp take to turn into malignant cancer?

^ A small malignant polyp may be removed from the colon or upper rectum with a colonoscope.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

.Preoperative staging of rectal cancers may be done with endoscopic ultrasound.^ Stages of colon and rectal cancer What is colon and rectal cancer?
  • What is Colon and rectal cancer? 10 February 2010 13:36 UTC www.consumerreports.org [Source type: FILTERED WITH BAYES]

^ "Heavy alcohol use may also increase the risk of colorectal cancer" Primary sclerosing cholangitis offers a risk independent to ulcerative colitis The treatment depends on the staging of the cancer.
  • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

^ Stages of colon and rectal cancer Your doctor will need to find out how advanced your cancer is.
  • What is Colon and rectal cancer? 10 February 2010 13:36 UTC www.consumerreports.org [Source type: FILTERED WITH BAYES]

.Adjunct staging of metastasis include Abdominal Ultrasound, CT, PET Scanning, and other imaging studies.^ Staging tests may include imaging procedures such as abdominal and chest CT scans.
  • OhioHealth - Colon cancer 10 February 2010 13:36 UTC www.ohiohealth.com [Source type: General]

^ An alternative to CT Scan is an ultrasound scan which is cheaper.
  • colorectal | colon cancer screening |symptoms|signs 10 February 2010 13:36 UTC www.healthscreening.sg [Source type: Academic]

^ Other common clinical presentations include iron-deficiency anemia, rectal bleeding, abdominal pain, change in bowel habits, and intestinal obstruction or perforation.
  • Colon Cancer, Adenocarcinoma: eMedicine Oncology 10 February 2010 13:36 UTC emedicine.medscape.com [Source type: Academic]

.The most common staging system is the TNM (for tumors/nodes/metastases) system, from the American Joint Committee on Cancer (AJCC).^ Surgery is the most common treatment for all stages of colon cancer.
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ For all stages of rectal cancer, surgery is the most common treatment.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

^ TNM staging system .
  • Update on Colorectal Cancer - March 15, 2000 - American Academy of Family Physicians 10 February 2010 13:37 UTC www.aafp.org [Source type: Academic]

The TNM system assigns a number based on three categories. ."T" denotes the degree of invasion of the intestinal wall, "N" the degree of lymphatic node involvement, and "M" the degree of metastasis.^ Stage III colon cancer denotes lymph node involvement.
  • FUDA CANCER HOSPITAL GUANGZHOU 10 February 2010 13:36 UTC www.orienttumor.com [Source type: Academic]

^ CRC spreads by direct extension through the bowel wall, hematogenous metastasis, regional lymph node metastasis, perineural spread, and intraluminal metastasis.
  • Colorectal Cancer: Tumors of the GI Tract: Merck Manual Professional 10 February 2010 13:37 UTC www.merck.com [Source type: Academic]

^ The prognosis of patients with colon cancer is clearly related to the degree of penetration of the tumor through the bowel wall, the presence or absence of nodal involvement, and the presence or absence of distant metastases.
  • FUDA CANCER HOSPITAL GUANGZHOU 10 February 2010 13:36 UTC www.orienttumor.com [Source type: Academic]

.The broader stage of a cancer is usually quoted as a number I, II, III, IV derived from the TNM value grouped by prognosis; a higher number indicates a more advanced cancer and likely a worse outcome.^ Stage I, II, and III cancers are considered potentially curable.
  • Colon Cancer - Kosmix : Reference, Videos, Images, News, Shopping and more... 10 February 2010 13:36 UTC www.kosmix.com [Source type: Academic]
  • Colon Cancer | Wake Forest University Baptist Medical Center 10 February 2010 13:36 UTC www2.wfubmc.edu [Source type: Academic]

^ This number is likely to be higher for the laparoscopic treatment of rectal cancer.
  • NGC - NGC Summary 10 February 2010 13:36 UTC www.guideline.gov [Source type: Academic]

^ II and III) colon cancer.
  • Colon Cancer - Medpedia 10 February 2010 13:36 UTC wiki.medpedia.com [Source type: Academic]

Details of this system are in the graph below:
AJCC stage TNM stage TNM stage criteria for colorectal cancer[38]
Stage 0 Tis N0 M0 Tis: Tumor confined to mucosa; cancer-in-situ
Stage I T1 N0 M0 T1: Tumor invades submucosa
Stage I T2 N0 M0 T2: Tumor invades muscularis propria
Stage II-A T3 N0 M0 T3: Tumor invades subserosa or beyond (without other organs involved)
Stage II-B T4 N0 M0 T4: Tumor invades adjacent organs or perforates the visceral peritoneum
Stage III-A T1-2 N1 M0 N1: Metastasis to 1 to 3 regional lymph nodes. T1 or T2.
Stage III-B T3-4 N1 M0 N1: Metastasis to 1 to 3 regional lymph nodes. T3 or T4.
Stage III-C any T, N2 M0 N2: Metastasis to 4 or more regional lymph nodes. Any T.
Stage IV any T, any N, M1 M1: Distant metastases present. Any T, any N.
Dukes system
.
Micrograph of a colorectal adenocarcinoma metastasis to a lymph node.
^ N1 : Metastasis in 1 to 3 regional lymph nodes.
  • COLON CANCER - a knol by Alan 10 February 2010 13:36 UTC knol.google.com [Source type: Academic]

^ However, in our series, none of the superficial subtypes had a significantly higher incidence of lymph node metastasis than the polypoid lesions.
  • Early Colorectal Cancer with Special Reference to the SuperficialNonpolypoid Type from a Histopathologic Point of View 25 September 2009 0:48 UTC www.crossref.org [Source type: Academic]

^ The incidence of lymph node metastasis among submucosal carcinomas showed no significant difference between the superficial type and the polypoid type.
  • Early Colorectal Cancer with Special Reference to the SuperficialNonpolypoid Type from a Histopathologic Point of View 25 September 2009 0:48 UTC www.crossref.org [Source type: Academic]

.The cancerous cells are at the top center-left of the image, in glands (circular/ovoid structures) and eosinophilic (bright pink).^ Even if the doctor removes all of the cancer that can be seen at the time of the operation, some patients may receive chemotherapy after surgery to kill any cancer cells that are left.
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ Stained cells were analyzed by flow cytometry analysis at FACScan core services of the University of Colorado Cancer Center (Denver, CO).
  • Grape Seed Extract Inhibits In vitro and In vivo Growth of Human Colorectal Carcinoma Cells — Clinical Cancer Research 10 February 2010 13:37 UTC clincancerres.aacrjournals.org [Source type: Academic]

^ If this happens, the doctor cannot be sure that all the cancer has been removed, and radiation therapy is used to kill the cancer cells left behind after surgery.
  • Colorectal Cancer 10 February 2010 13:36 UTC www.metrohealth.org [Source type: FILTERED WITH BAYES]

H&E stain.
Dukes classification is an older and less complicated staging system, that predates the TMN system, and was first proposed by Dr. Cuthbert Dukes in 1932; it identifies the stages as:[39]
  • A - Tumour confined to the intestinal wall
  • B - Tumour invading through the intestinal wall
  • C - With lymph node(s) involvement (this is further subdivided into C1 lymph node involvement where the apical node is not involved and C2 where the apical lymph node is involved)
  • D - With distant metastasis
.A few cancer centers still use this staging system.^ One common system used to describe colon cancer stages is: .

^ The following stages are used for colon cancer: .
  • Colon Cancer - Medpedia 10 February 2010 13:36 UTC wiki.medpedia.com [Source type: Academic]
  • Cancer Information | UPMC Cancer Centers 10 February 2010 13:36 UTC www.upmccancercenters.com [Source type: Academic]
  • Colon Cancer | Your Cancer Today 10 February 2010 13:36 UTC www.yourcancertoday.com [Source type: Academic]
  • Colon Cancer Treatment PDQ®: Treatment - Patient Information NCI - MSN Health & Fitness - Cancer 10 February 2010 13:36 UTC health.msn.com [Source type: Academic]
  • National Cancer Alliance 10 February 2010 13:36 UTC www.cancersociety.com [Source type: Academic]
  • http://jamesline.com/cancertypes/gi/about/colon/ 10 February 2010 13:36 UTC jamesline.com [Source type: Academic]
  • Colon cancer: Treatment - Patient Information [NCI PDQ] | NYU Cancer Institute 10 February 2010 13:36 UTC ci.med.nyu.edu [Source type: Academic]
  • Colon Cancer Treatment - National Cancer Institute 10 February 2010 13:36 UTC healthpromotionresearch.cancer.gov [Source type: Academic]

^ "Heavy alcohol use may also increase the risk of colorectal cancer" Primary sclerosing cholangitis offers a risk independent to ulcerative colitis The treatment depends on the staging of the cancer.
  • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

Prevention

.Most colorectal cancers should be preventable, through increased surveillance, improved lifestyle, and, probably, the use of dietary chemopreventative agents.^ Prevention of colorectal cancer: .
  • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]

^ It is used as a tumor marker for colorectal cancer.

^ Primary and secondary prevention in colorectal cancer.
  • Implementing Colorectal Cancer Screening: Workshop Summary 10 February 2010 13:37 UTC www.nap.edu [Source type: Academic]

Surveillance

.Most colorectal cancer arise from adenomatous polyps.^ Most large bowel cancer, regardless of what has caused it, arises from what are called adenomatous polyps.
  • Health24 - Cancer, About Cancer 10 February 2010 13:37 UTC www.health24.com [Source type: Academic]

^ Most colorectal cancers arise from malignant transformation of a benign polyp.
  • Colorectal Cancer - Colon Cancer, Colonoscopy - Life Extension Health Concern 10 February 2010 13:36 UTC www.lef.org [Source type: Academic]

^ Most colorectal cancer develops from small growths called polyps.
  • Colon Cancer - Kosmix : Reference, Videos, Images, News, Shopping and more... 10 February 2010 13:36 UTC www.kosmix.com [Source type: Academic]

.These lesions can be detected and removed during colonoscopy.^ Fortunately, a colonoscopy every 10 years after the age of 50 is an effective means of detecting colon cancer at its earliest stages and, if a polyp is detected, it can be removed during the examination.
  • Community Leaders Speak Out for Colon Cancer Screening 10 February 2010 13:36 UTC www.endcoloncancernow.org [Source type: General]

^ During a sigmoidoscopy or a colonoscopy, a biopsy (sample of tissue) is removed from the colon or rectum and examined under a microscope in order to detect abnormal growths.
  • Colorectal cancer 10 February 2010 13:37 UTC www.umm.edu [Source type: Academic]

^ If an abnormality is detected during virtual colonoscopy, most patients would be referred for a standard colonoscopy the same day.
  • Colorectal Cancer Screening Fact Sheet - National Cancer Institute 10 February 2010 13:37 UTC www.9aday.cancer.gov [Source type: Academic]

.Studies show this procedure would decrease by > 80% the risk of cancer death, provided it is started by the age of 50, and repeated every 5 or 10 years.^ The risk of a metachronous cancer is 30 percent at 10 years after resection and 50 percent at 15 years after resection.
  • Update on Colorectal Cancer - March 15, 2000 - American Academy of Family Physicians 10 February 2010 13:37 UTC www.aafp.org [Source type: Academic]

^ Colonoscopy every 10 years .
  • Colorectal Cancer | AHealthyMe.com 10 February 2010 13:37 UTC www.ahealthyme.com [Source type: Academic]
  • Update on Colorectal Cancer - March 15, 2000 - American Academy of Family Physicians 10 February 2010 13:37 UTC www.aafp.org [Source type: Academic]

^ What decreases the risks of colon cancer...
  • Colon Cancer - Kosmix : Reference, Videos, Images, News, Shopping and more... 10 February 2010 13:36 UTC www.kosmix.com [Source type: Academic]

[40]
.As per current guidelines under National Comprehensive Cancer Network, in average risk individuals with negative family history of colon cancer and personal history negative for adenomas or Inflammatory Bowel diseases, flexible sigmoidoscopy every 5 years with fecal occult blood testing annually or double contrast barium enema are other options acceptable for screening rather than colonoscopy every 10 years (which is currently the Gold-Standard of care).^ A cluster-randomized controlled trial comparing fecal occult blood testing with flexible sigmoidoscopy.
  • Implementing Colorectal Cancer Screening: Workshop Summary 10 February 2010 13:37 UTC www.nap.edu [Source type: Academic]

^ This option is based on evidence that screening double-contrast barium enema and fluoroscopic barium enema by a gastrointestinal radiologist can image the entire colon and detect cancers and large polyps almost as well as colonoscopy or flexible sigmoidoscopy.
  • NGC - NGC Summary 10 February 2010 13:37 UTC www.guideline.gov [Source type: Academic]

^ Flexible sigmoidoscopy every five years .
  • Update on Colorectal Cancer - March 15, 2000 - American Academy of Family Physicians 10 February 2010 13:37 UTC www.aafp.org [Source type: Academic]

Lifestyle and nutrition

.The comparison of colorectal cancer incidence in various countries strongly suggests that sedentarity, overeating (i.e., high caloric intake), and perhaps a diet high in meat (red or processed) could increase the risk of colorectal cancer.^ There are groups that have a high incidence of colorectal cancer.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

^ The penetrance of germ-line mutations that increase the risk of colorectal cancer varies.
  • NEJM -- Hereditary Colorectal Cancer 10 February 2010 13:37 UTC content.nejm.org [Source type: Academic]

^ Well-done grilled red meat increases the risk of colorectal adenomas.

.In contrast, a healthy body weight, physical fitness, and good nutrition decreases cancer risk in general.^ Shike M. Body weight and colon cancer.

^ What decreases the risks of colon cancer...
  • Colon Cancer - Kosmix : Reference, Videos, Images, News, Shopping and more... 10 February 2010 13:36 UTC www.kosmix.com [Source type: Academic]

^ Beta-carotene and other carotenoids have been shown in some studies to decrease the risks of developing both colon cancer and rectal cancer.
  • WHFoods: Colorectal Cancer 10 February 2010 13:36 UTC www.whfoods.com [Source type: Academic]

.Accordingly, lifestyle changes could decrease the risk of colorectal cancer as much as 60-80%.^ What decreases the risks of colon cancer...
  • Colon Cancer - Kosmix : Reference, Videos, Images, News, Shopping and more... 10 February 2010 13:36 UTC www.kosmix.com [Source type: Academic]

^ Food groups and colorectal cancer risk.

^ Patients at risk of familial colorectal cancer.
  • NEJM -- Hereditary Colorectal Cancer 10 February 2010 13:37 UTC content.nejm.org [Source type: Academic]

[41]
.A high intake of dietary fiber (from eating fruits, vegetables, cereals, and other high fiber food products) has, until recently, been thought to reduce the risk of colorectal cancer and adenoma.^ Finding and removing polyps may reduce the risk of colorectal cancer.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

^ People whose diets are high in fruits and vegetables seem to have a reduced risk.
  • GHI - Health & Wellness: Colorectal Cancer (The Basics) 10 February 2010 13:37 UTC www.ghi.com [Source type: Academic]
  • EmblemHealth - Health & Wellness: Colorectal Cancer (The Basics) 10 February 2010 13:37 UTC emblemhealth.com [Source type: Academic]

^ Food groups and colorectal cancer risk.

.In the largest study ever to examine this theory (88,757 subjects tracked over 16 years), it has been found that a fiber rich diet does not reduce the risk of colon cancer.^ The cancer is found in the innermost lining of the colon.
  • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]

^ It increases the risk for colon cancer.
  • Health Concerns - Colon Cancer 10 February 2010 13:36 UTC www.menopauserx.com [Source type: Academic]

^ Who is at risk for colon cancer?
  • Colorectal Cancer | AHealthyMe.com 10 February 2010 13:37 UTC www.ahealthyme.com [Source type: Academic]

[42] .A 2005 meta-analysis study further supports these findings.^ Hispanics, Blacks at Raised Colon Cancer Risk (27-JUN-2005) U.S. minorities more prone to advanced disease than whites, study finds .
  • Health news, discussions, articles, and resources 10 February 2010 13:36 UTC news.healingwell.com [Source type: Academic]

^ These findings provide strong evidence in support of the diagnosis of hereditary nonpolyposis colorectal cancer.
  • NEJM -- Hereditary Colorectal Cancer 10 February 2010 13:37 UTC content.nejm.org [Source type: Academic]

^ Oxygen Reduces Risk of Wound Infection (25-Oct-2005) The higher the mixture, the lower the likelihood of problems, study finds .
  • Health news, discussions, articles, and resources 10 February 2010 13:36 UTC news.healingwell.com [Source type: Academic]

[43]
.The Harvard School of Public Health states: "Health Effects of Eating Fiber: Long heralded as part of a healthy diet, fiber appears to reduce the risk of developing various conditions, including heart disease, diabetes, diverticular disease, and constipation.^ Diets high in fruits and vegetables appear to be associated with reduced risk.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ High fat and meat diets are a risk factor, especially combined with minimal fruit, vegetable, and fiber intake.

^ Click on any of the symptoms below to see a full list of other causes including diseases, medical conditions, toxins, drug interactions, or drug side effect causes of that symptom.
  • Symptoms of Colorectal cancer - WrongDiagnosis.com 10 February 2010 13:37 UTC www.wrongdiagnosis.com [Source type: Academic]

.Despite what many people may think, however, fiber probably has little, if any effect on colon cancer risk."^ What decreases the risks of colon cancer...
  • Colon Cancer - Kosmix : Reference, Videos, Images, News, Shopping and more... 10 February 2010 13:36 UTC www.kosmix.com [Source type: Academic]

^ People with ulcerative colitis (UC) are at increased risk for colon cancer.

^ It increases the risk for colon cancer.
  • Health Concerns - Colon Cancer 10 February 2010 13:36 UTC www.menopauserx.com [Source type: Academic]

[44]

Chemoprevention

.More than 200 agents, including the above cited phytochemicals, and other food components like calcium or folic acid (a B vitamin), and NSAIDs like aspirin, are able to decrease carcinogenesis in pre-clinical development models: Some studies show full inhibition of carcinogen-induced tumours in the colon of rats.^ Nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin.

^ Calcium, vitamin D, and dairy foods and the occurrence of colon cancer in men.

^ Some studies have shown that vitamin C intake can help to decrease the incidence of colon tumors.
  • WHFoods: Colorectal Cancer 10 February 2010 13:36 UTC www.whfoods.com [Source type: Academic]

.Other studies show strong inhibition of spontaneous intestinal polyps in mutated mice (Min mice).^ Some studies show that regularly eating red meat, which is rich in saturated fat and protein, increases risk, while others find no connection.
  • GHI - Health & Wellness: Colorectal Cancer (The Basics) 10 February 2010 13:37 UTC www.ghi.com [Source type: Academic]
  • EmblemHealth - Health & Wellness: Colorectal Cancer (The Basics) 10 February 2010 13:37 UTC emblemhealth.com [Source type: Academic]

^ It has been shown in a number of studies to inhibit the formation of tumors in the colon and other locations, to increase apoptosis of mutated cells, and to reduce tumor growth.
  • WHFoods: Colorectal Cancer 10 February 2010 13:36 UTC www.whfoods.com [Source type: Academic]

^ A computer then assembles these pictures into detailed images that can show polyps and other abnormalities.
  • Colorectal Cancer Screening Fact Sheet - National Cancer Institute 10 February 2010 13:37 UTC www.9aday.cancer.gov [Source type: Academic]

.Chemoprevention clinical trials in human volunteers have shown smaller prevention, but few intervention studies have been completed today.^ This summary section refers to specific treatments under study in clinical trials , but it may not mention every new treatment being studied.

^ The treatments listed here have been shown in clinical trials to improve survival and/or reduce mortality and have been approved for use by the US Food and Drug Administration.
  • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

^ Would a clinical trial (research study) be appropriate for me?
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

.The "chemoprevention database" shows the results of all published scientific studies of chemopreventive agents, in people and in animals.^ There was a European study which showed promising results in limiting the neuropathy caused by Oxaliplatin, by using an infusion of Glutathione.

^ This may be why medical studies are beginning to show that people who get 1000-1500 mg of calcium a day in their diet have less colon cancer.
  • Colon Polyps and Cancer Treatments, Diagnosis, Symptoms- Colon Polyps and Cancer 10 February 2010 13:36 UTC gicare.com [Source type: Academic]

^ Meat and how it is cooked Most, but not all, studies 26 show meat eaters have a high risk of colon cancer.

[45]

Aspirin chemoprophylaxis

.Aspirin should not be taken routinely to prevent colorectal cancer, even in people with a family history of the disease, because the risk of bleeding and kidney failure from high dose aspirin (300 mg or more) outweigh the possible benefits.^ More about prognosis of Colorectal cancer .
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

^ Prevention of colorectal cancer: .
  • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]

^ Next Diseases » Colorectal cancer » Introduction   Colorectal cancer .
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

[46]
.A clinical practice guideline of the U.S. Preventive Services Task Force (USPSTF) recommended against taking aspirin (grade D recommendation).^ Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ Guide to Clinical Preventive Services, 2007.
  • Implementing Colorectal Cancer Screening: Workshop Summary 10 February 2010 13:37 UTC www.nap.edu [Source type: Academic]

^ The U.S. Preventive Services Task Force (USPSTF) does not recommend the routine use of aspirin or other NSAIDs to prevent colorectal cancer in people at average risk for this disease.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

[47] .The Task Force acknowledged that aspirin may reduce the incidence of colorectal cancer, but "concluded that harms outweigh the benefits of aspirin and NSAID use for the prevention of colorectal cancer". A subsequent meta-analysis concluded "300 mg or more of aspirin a day for about 5 years is effective in primary prevention of colorectal cancer in randomised controlled trials, with a latency of about 10 years".[48] However, long-term doses over 81 mg per day may increase bleeding events.^ Finding and removing polyps may reduce the risk of colorectal cancer.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

^ More about prognosis of Colorectal cancer .
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

^ Prevention of colorectal cancer: .
  • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]

[49]

Calcium

.The meta-analysis by the Cochrane Collaboration of randomized controlled trials published through 2002 concluded "Although the evidence from two RCTs suggests that calcium supplementation might contribute to a moderate degree to the prevention of colorectal adenomatous polyps, this does not constitute sufficient evidence to recommend the general use of calcium supplements to prevent colorectal cancer.".[50] Subsequently, one randomized controlled trial by the Women's Health Initiative (WHI) reported negative results.^ In Colorectal cancer initiatives: Implementation Guide .
  • Implementing Colorectal Cancer Screening: Workshop Summary 10 February 2010 13:37 UTC www.nap.edu [Source type: Academic]

^ Prevention of colorectal cancer: .
  • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]

^ It is used as a tumor marker for colorectal cancer.

[51] .A second randomized controlled trial reported reduction in all cancers, but had insufficient colorectal cancers for analysis.^ Clinical Trials for Colorectal cancer .
  • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

^ A randomized, controlled trial of three interventions.
  • Implementing Colorectal Cancer Screening: Workshop Summary 10 February 2010 13:37 UTC www.nap.edu [Source type: Academic]

^ Randomized, controlled trial Class B: .
  • NGC - NGC Summary 10 February 2010 13:37 UTC www.guideline.gov [Source type: Academic]

[52]

Vitamin D

.A scientific review undertaken by the National Cancer Institute found that vitamin D was beneficial in preventing colorectal cancer, which showed an inverse relationship with blood levels of 80 nmol/L or higher associated with a 72% risk reduction compared with lower than 50 nmol/L.[53].^ Prevention of colorectal cancer: .
  • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]

^ The association of mismatch repair gene polymorphisms and colorectal cancer risk.
  • Colorectal Cancer Research Publications 10 February 2010 13:37 UTC www.mshri.on.ca [Source type: Academic]

^ Images courtesy of the National Cancer Institute.

A possible mechanism is inhibition of Hedgehog signal transduction.[54]

Management

.The treatment depends on the staging of the cancer.^ Treatment depends partly on the stage of the cancer.
  • Colon Cancer - Kosmix : Reference, Videos, Images, News, Shopping and more... 10 February 2010 13:36 UTC www.kosmix.com [Source type: Academic]

^ "Heavy alcohol use may also increase the risk of colorectal cancer" Primary sclerosing cholangitis offers a risk independent to ulcerative colitis The treatment depends on the staging of the cancer.
  • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

^ Treatment of stage I colon cancer usually involves resection /anastomosis.
  • Colon Cancer - Medpedia 10 February 2010 13:36 UTC wiki.medpedia.com [Source type: Academic]

.When colorectal cancer is caught at early stages (with little spread) it can be curable.^ Stages of colorectal cancer include: .
  • Colorectal cancer 10 February 2010 13:37 UTC www.umm.edu [Source type: Academic]

^ What are the stages of colorectal cancer?
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]
  • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]

^ Colorectal cancers often do not bleed in the earliest (i.e., most curable) stage.
  • Update on Colorectal Cancer - March 15, 2000 - American Academy of Family Physicians 10 February 2010 13:37 UTC www.aafp.org [Source type: Academic]

.However, when it is detected at later stages (when distant metastases are present) it is less likely to be curable.^ However when it is detected at later stages (when distant metastases are present) it is less likely to be curable.
  • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

^ Stage D distant spread (metastases) to the rest of the body, for example lung and liver.
  • Health24 - Cancer, About Cancer 10 February 2010 13:37 UTC www.health24.com [Source type: Academic]

^ However, most cases are detected at a later stage and so, overall, close to 60% of people diagnosed with the disease survive five years.

.Surgery remains the primary treatment while chemotherapy and/or radiotherapy may be recommended depending on the individual patient's staging and other medical factors.^ Chemotherapy may be given after surgery to kill any remaining cancer cells.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ The three primary treatment options are: surgery, chemotherapy and radiation.

^ The oncologist will recommend a treatment plan for each individual.
  • Health Information - Yale Medical Group 10 February 2010 13:37 UTC ymghealthinfo.org [Source type: Academic]

.Because colon cancer primarily affects the elderly, it can be a challenge to determine how aggressively to treat a particular patient, especially after surgery.^ How is colon cancer diagnosed?
  • Colon Cancer Symptoms, Diagnosis, and Treatment- Mass General Hospital 10 February 2010 13:36 UTC www2.massgeneral.org [Source type: Academic]

^ How do we treat CRC? What is the role of surgery?
  • colorectal | colon cancer screening |symptoms|signs 10 February 2010 13:36 UTC www.healthscreening.sg [Source type: Academic]

^ Surgery is almost always used to treat colon and rectal cancer.
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

.Clinical trials suggest that "otherwise fit" elderly patients fare well if they have adjuvant chemotherapy after surgery, so chronological age alone should not be a contraindication to aggressive management.^ Clinical trials of chemotherapy and/or biologic therapy .

^ Clinical trials of chemotherapy and/or biologic therapy.
  • Colon Cancer Treatment PDQ®: Treatment - Patient Information NCI - MSN Health & Fitness - Cancer 10 February 2010 13:36 UTC health.msn.com [Source type: Academic]
  • Colon cancer: Treatment - Patient Information [NCI PDQ] | NYU Cancer Institute 10 February 2010 13:36 UTC ci.med.nyu.edu [Source type: Academic]
  • Colon Cancer Treatment (PDQ®) 10 February 2010 13:36 UTC www3.fccc.edu [Source type: Academic]

^ Clinical trials of chemotherapy, radiation therapy , and/or biologic therapy after surgery .

[55]

Surgery

.Surgeries can be categorised into curative, palliative, bypass, fecal diversion, or open-and-close.^ Open surgery – the surgeon makes a large cut into your abdomen to remove the tumour and part of the healthy colon or rectum.

.Curative Surgical treatment can be offered if the tumor is localized.^ Surgery is best treatment for localized resectable cancer is usually an operation known as surgical resection.

^ Standard treatment of colon cancer has been open surgical resection of the primary and regional lymph nodes for localized disease.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

^ Non-Surgical Treatment Boosts Liver Cancer Survival (27-MAY-2005) Ablation therapy uses needle to destroy inoperable tumors .
  • Health news, discussions, articles, and resources 10 February 2010 13:36 UTC news.healingwell.com [Source type: Academic]

.
  • Very early cancer that develops within a polyp can often be cured by removing the polyp (i.e., polypectomy) at the time of colonoscopy.
  • In colon cancer, a more advanced tumor typically requires surgical removal of the section of colon containing the tumor with sufficient margins, and radical en-bloc resection of mesentery and lymph nodes to reduce local recurrence (i.e., colectomy).^ Finding and removing polyps may reduce the risk of colorectal cancer.
    • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

    ^ Colorectal cancer often develops from noncancerous adenomatous intestinal polyps in the colon that can become malignant or cancerous over time.
    • Colorectal cancer Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 February 2010 13:37 UTC wrongdiagnosis.com [Source type: Academic]

    ^ Colorectal cancer that has invaded the lymph nodes or the liver are in the advanced stage.
    • colorectal | colon cancer screening |symptoms|signs 10 February 2010 13:36 UTC www.healthscreening.sg [Source type: Academic]

    .If possible, the remaining parts of colon are anastomosed together to create a functioning colon.^ In many cases, the surgeon can reconnect the healthy parts of the colon back together after removing the cancer.
    • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

    ^ The patient will have a colostomy in the right lower part of his abdomen in which the colon is attached to the skin and a new opening created for the discharge of faeces.
    • colorectal | colon cancer screening |symptoms|signs 10 February 2010 13:36 UTC www.healthscreening.sg [Source type: Academic]

    ^ Part of the colon containing the cancer and nearby healthy tissue is removed, a stoma is created, and a colostomy bag is attached to the stoma.
    • Cancer Information | UPMC Cancer Centers 10 February 2010 13:36 UTC www.upmccancercenters.com [Source type: Academic]
    • Colon Cancer Treatment PDQ®: Treatment - Patient Information NCI - MSN Health & Fitness - Cancer 10 February 2010 13:36 UTC health.msn.com [Source type: Academic]
    • Colon cancer: Treatment - Patient Information [NCI PDQ] | NYU Cancer Institute 10 February 2010 13:36 UTC ci.med.nyu.edu [Source type: Academic]
    • Colon Cancer Treatment - National Cancer Institute 10 February 2010 13:36 UTC healthpromotionresearch.cancer.gov [Source type: Academic]
    • Colon Cancer Treatment (PDQ®) 10 February 2010 13:36 UTC www3.fccc.edu [Source type: Academic]

    In cases when anastomosis is not possible, a stoma (artificial orifice) is created.
  • Curative surgery on rectal cancer includes total mesorectal excision (lower anterior resection) or abdominoperineal excision.
.In case of multiple metastases, palliative (non curative) resection of the primary tumor is still offered in order to reduce further morbidity caused by tumor bleeding, invasion, and its catabolic effect.^ In case of multiple mestatasis, palliative resection of the primary tumour is still offered in order to reduce further morbidity caused by tumor bleeding, invasion and its catabolic effect.
  • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

^ Surgical resection/anastomosis or bypass of obstructing primary lesions in selected cases.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

^ There are several non-surgical options for palliative treatment of inoperable primary or secondary liver cancer including percutaneous cryosurgery and percutaneous radiofrequency ablation.

.Surgical removal of isolated liver metastases is, however, common and may be curative in selected patients; improved chemotherapy has increased the number of patients who are offered surgical removal of isolated liver metastases.^ Surgical resection of isolated metastases (liver, lung, ovaries).
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

^ Surgery is also curative in 20% of patients who develop resectable metastases in the liver.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

^ Predictive markers that direct the selection of the correct chemotherapy regimen and appropriate patient population to be treated in the adjuvant setting would help to identify patients who would benefit from adjuvant therapy.
  • Metastatic Colorectal Cancer: Systemic Treatment: Biological Markers 10 February 2010 13:37 UTC www.medscape.com [Source type: Academic]

.If the tumor invaded into adjacent vital structures which makes excision technically difficult, the surgeons may prefer to bypass the tumor (ileotransverse bypass) or to do a proximal fecal diversion through a stoma.^ If the tumor invaded into adjacent vital structures which makes excision technically difficult, the surgeons may prefer to bypass the tumor (ileotransverse bypass) or to do a proximal fecal diversion through a stoma.
  • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

^ Stage II : The tumor extends more deeply into or through the wall of the colon or rectum.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

^ Doctors may use radiation before surgery to shrink a tumor in the rectum and make it easier to remove.
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

.The worst case would be an open-and-close surgery, when surgeons find the tumor unresectable and the small bowel involved; any more procedures would do more harm than good to the patient.^ Surgery: A procedure to remove the tumor.
  • Colon Cancer - Medpedia 10 February 2010 13:36 UTC wiki.medpedia.com [Source type: Academic]

^ The worst case would be an open-and-close surgery, when surgeons find the tumor unresectable and the small bowel involved; any more procedures would do more harm then good to the patient.
  • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

^ Laboratory studies are done with a goal of assessing patients organ function (liver, kidneys) in anticipation of diagnostic and therapeutic procedures (imaging, biopsy, surgery, chemotherapy) and also to estimate tumor burden (CEA level).
  • Colon Cancer, Adenocarcinoma: Differential Diagnoses & Workup - eMedicine Oncology 10 February 2010 13:36 UTC emedicine.medscape.com [Source type: Academic]

This is uncommon with the advent of laparoscopy and better radiological imaging. .Most of these cases formerly subjected to "open and close" procedures are now diagnosed in advance and surgery avoided.^ The worst case would be an open-and-close surgery, when surgeons find the tumor unresectable and the small bowel involved; any more procedures would do more harm then good to the patient.
  • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

^ An estimated 149,000 cases of colon cancer will be diagnosed this year, making it the third most common cancer .
  • Colon Cancer - Kosmix : Reference, Videos, Images, News, Shopping and more... 10 February 2010 13:36 UTC www.kosmix.com [Source type: Academic]

^ In these cases, the cells of the immune system detect the fact that this cell is now different and destroy it before it does any damage.
  • WHFoods: Colorectal Cancer 10 February 2010 13:36 UTC www.whfoods.com [Source type: Academic]

.Laparoscopic-assisted colectomy is a minimally-invasive technique that can reduce the size of the incision and may reduce post-operative pain.^ Laparoscopic-assisted colectomy is a minimally-invasive technique that can reduce the size of the incision, minimize the risk of infection and reduce post-operative pain.
  • Colon Cancer Support Group - DailyStrength 10 February 2010 13:36 UTC www.dailystrength.org [Source type: General]

^ The standard technique for a colectomy is open, invasive surgery.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ Laparoscopic cholecystectomy requires general anesthesia, but patients can still leave the hospital earlier than with open surgery, and there is less post-operative pain and disability than with the open procedure.

As with any surgical procedure, colorectal surgery may result in complications including
.
  • wound infection, Dehiscence (bursting of wound) or hernia
  • anastomosis breakdown, leading to abscess or fistula formation, and/or peritonitis
  • bleeding with or without hematoma formation
  • adhesions resulting in bowel obstruction.^ Other common clinical presentations include iron-deficiency anemia, rectal bleeding, abdominal pain, change in bowel habits, and intestinal obstruction or perforation.
    • Colon Cancer, Adenocarcinoma: eMedicine Oncology 10 February 2010 13:36 UTC emedicine.medscape.com [Source type: Academic]

    ^ They include skin infection or breakdown, hernias, narrowing of the stoma, bleeding, and collapse.
    • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

    ^ Chronic inflammation such as in ulcerative colitis can result in genetic alterations which then lead into dysplasia and carcinoma formation.

    A 5-year study of patients who had surgery in 1997 found the risk of hospital readmission to be 15% after panproctocolectomy, 9% after total colectomy, and 11% after ileostomy[56]
  • adjacent organ injury; most commonly to the small intestine, ureters, spleen, or bladder
  • Cardiorespiratory complications such as myocardial infarction, pneumonia, arrythmia, pulmonary embolism etc

Chemotherapy

.Chemotherapy is used to reduce the likelihood of metastasis developing, shrink tumor size, or slow tumor growth.^ The use of radiation before surgery can help shrink the size of the tumor.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ Radiation may also be used before or during surgery to shrink the tumor, and it may be recommended after surgery to reduce the risk of recurrence.
  • Colorectal cancer 10 February 2010 13:37 UTC www.umm.edu [Source type: Academic]

^ It has been shown in a number of studies to inhibit the formation of tumors in the colon and other locations, to increase apoptosis of mutated cells, and to reduce tumor growth.
  • WHFoods: Colorectal Cancer 10 February 2010 13:36 UTC www.whfoods.com [Source type: Academic]

.Chemotherapy is often applied after surgery (adjuvant), before surgery (neo-adjuvant), or as the primary therapy (palliative).^ Chemotherapy after surgery is called adjuvant therapy .
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

^ Chemotherapy may be used after surgery and is known as adjuvant therapy.
  • Health24 - Cancer, About Cancer 10 February 2010 13:37 UTC www.health24.com [Source type: Academic]

^ Chemotherapy given before surgery is called neoadjuvant therapy .
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

.The treatments listed here have been shown in clinical trials to improve survival and/or reduce mortality rate and have been approved for use by the US Food and Drug Administration.^ A link to a list of current clinical trials is included for each treatment section.
  • Cancer Information | UPMC Cancer Centers 10 February 2010 13:36 UTC www.upmccancercenters.com [Source type: Academic]
  • http://jamesline.com/cancertypes/gi/about/colon/ 10 February 2010 13:36 UTC jamesline.com [Source type: Academic]
  • Colon cancer: Treatment - Patient Information [NCI PDQ] | NYU Cancer Institute 10 February 2010 13:36 UTC ci.med.nyu.edu [Source type: Academic]

^ Irinotecan (CPT-11) has been approved by the Food and Drug Administration for the treatment of patients whose tumors are refractory to 5-FU.[ 38 , 39 ] Participation in clinical trials is appropriate.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

^ It has been approved by the Food and Drug Administration for the treatment of patients with metastatic disease that is refractory to 5-FU. The designations in PDQ that treatments are "standard" or "under clinical evaluation" are not to be used as a basis for reimbursement determinations.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

.In colon cancer, chemotherapy after surgery is usually only given if the cancer has spread to the lymph nodes (Stage III).^ Treatment of stage I colon cancer usually involves resection /anastomosis.
  • Colon Cancer - Medpedia 10 February 2010 13:36 UTC wiki.medpedia.com [Source type: Academic]

^ The three standard treatments for colon cancer are surgery, chemotherapy, and radiation.
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ Colorectal cancer that has invaded the lymph nodes or the liver are in the advanced stage.
  • colorectal | colon cancer screening |symptoms|signs 10 February 2010 13:36 UTC www.healthscreening.sg [Source type: Academic]

.At the 2008 annual meeting of the American Society of Clinical Oncology, researchers announced that colorectal cancer patients that have a mutation in the KRAS gene do not respond to certain therapies, those that inhibit the epidermal growth factor receptor (EGFR)--namely Erbitux (cetuximab) and Vectibix (panitumumab).^ What are some of the risk factors for colorectal cancer?
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ More recently, therapies have been approved that target the Epithelial Growth Factor Receptor (EGFR) in lung and colorectal cancer.

^ Proceedings of the American Society of Clinical Oncology 17: A-1, 1a, 1998.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

[57] .Following recommendations by ASCO, patients should now be tested for the KRAS gene mutation before being offered these EGFR-inhibiting drugs.^ Patients with metastatic cancer should have tumors tested for KRAS gene status.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ The results of tests for mutations should be revealed to the patient on a one-to-one basis.
  • NEJM -- Hereditary Colorectal Cancer 10 February 2010 13:37 UTC content.nejm.org [Source type: Academic]

^ Molecular prognostic factors such as p53, loss of heterozygosity for 18q, 9 mutations of deleted in colon cancer gene ( DCC ), EGFR amplification, and KRAS mutations have all been investigated but are not currently used as prognostic factors in standard clinical practice.
  • Colon Cancer, Adenocarcinoma: Differential Diagnoses & Workup - eMedicine Oncology 10 February 2010 13:36 UTC emedicine.medscape.com [Source type: Academic]

[58] .In July 2009, the US Food and Drug Administration (FDA) updated the labels of two anti-EGFR monoclonal antibody drugs (panitumumab (Vectibix) and cetuximab (Erbitux)) indicated for treatment of metastatic colorectal cancer to include information about KRAS mutations.^ Symptoms of colorectal cancer include: .
  • Colorectal Cancer 10 February 2010 13:36 UTC www.metrohealth.org [Source type: FILTERED WITH BAYES]

^ FDA Approves Cetuximab (Erbitux®) for Metastatic Colorectal Cancer (2/20/2004) The US Food and Drug Administration (FDA) announced on February 12, 2004 the approval of Erbitux® for the treatment of metastatic colorectal cancer.

^ Information about complementary and alternative forms of treatment for patients with cancer.
  • Colon cancer: Prevention - Health Professional Information [NCI PDQ] - AOL Health 10 February 2010 13:36 UTC www.aolhealth.com [Source type: Academic]

[59]
.However, having the normal KRAS version does not guarantee that these drugs will benefit the patient.^ However, these patients are a heterogeneous group.
  • The American Gastroenterological Association - Publications | AGA eDigest 22 September 2009 21:31 UTC www.gastro.org [Source type: Academic]

^ This benefit was only observed in patients whose tumors did not contain a mutation in the KRAS gene.

^ This benefit was only observed in patients whose tumors did not contain a mutation in the KRAS gene (those with wild type).

[57]
“The trouble with the .KRAS mutation is that it’s downstream of EGFR,” says Richard Goldberg, MD, director of oncology at the Lineberger Comprehensive Cancer Center at the University of North Carolina.^ KRAS mutations in lung and colorectal cancer .

^ Molecular prognostic factors such as p53, loss of heterozygosity for 18q, 9 mutations of deleted in colon cancer gene ( DCC ), EGFR amplification, and KRAS mutations have all been investigated but are not currently used as prognostic factors in standard clinical practice.
  • Colon Cancer, Adenocarcinoma: Differential Diagnoses & Workup - eMedicine Oncology 10 February 2010 13:36 UTC emedicine.medscape.com [Source type: Academic]

^ More recently, the predictive value of KRAS mutation in metastatic colorectal cancer (mCRC) patients treated with monoclonal antibodies in combination with chemotherapy has been suggested.

“It doesn’t matter if you plug the socket if there’s a short downstream of the plug. .The mutation turns [EGFR] into a switch that’s always on.” But this doesn’t mean that having normal, or wild-type, KRAS is a fail-safe.^ This benefit was only observed in patients whose tumors did not contain a mutation in the KRAS gene (those with wild type).

^ 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.

^ This is what it means to be part of a cancer community, the otherwise negative things about this disease can be turned into a positve by helping others.

“It isn’t foolproof,” cautions Goldberg. “If you have wild-type .KRAS, you’re more likely to respond, but it’s not a guarantee.” Tumors shrink in response to these drugs in up to 40 percent of patients with wild-type KRAS, and progression-free and overall survival is increased.^ If you're inactive, you're more likely to develop colon cancer.

^ We're signing you up.
  • Colon Cancer - Kosmix : Reference, Videos, Images, News, Shopping and more... 10 February 2010 13:36 UTC www.kosmix.com [Source type: Academic]

^ Colon Polyps Double-contrast barium enema Cause of cancer Cancer treatments Chemotherapy Chemotherapy Metastatic Diet and cancer Tumor Cancer patients Radiation therapy Alternative Cancer Treatments Breast self-exam Adenomatous Cancers Liver cancer Types of cancer Thyroid cancer more...
  • Colon Cancer - Kosmix : Reference, Videos, Images, News, Shopping and more... 10 February 2010 13:36 UTC www.kosmix.com [Source type: Academic]

.The cost benefit of testing patients for the KRAS gene could potentially save about $740 million a year by not providing EGFR-inhibiting drugs to patients who would not benefit from the drugs.^ The test was also studied to see if it could predict who would benefit from receiving chemotherapy.

^ Predictive markers that direct the selection of the correct chemotherapy regimen and appropriate patient population to be treated in the adjuvant setting would help to identify patients who would benefit from adjuvant therapy.
  • Metastatic Colorectal Cancer: Systemic Treatment: Biological Markers 10 February 2010 13:37 UTC www.medscape.com [Source type: Academic]

^ The American Cancer Society estimated that there would be nearly 150,000 new cases of colorectal cancer in the U.S. last year -- and about 1,700 in Connecticut.
  • Colon & Rectal Cancer Program - Hartford Hospital, Connecticut 10 February 2010 13:36 UTC www.harthosp.org [Source type: Academic]

."With the assumption that patients with mutated Kras (35.6% of all patients) would not receive cetuximab (other studies have found Kras mutation in up to 46% of patients), theoretical drug cost savings would be $753 million; considering the cost of Kras testing, net savings would be $740 million."^ The others are patient acceptability, safety, and cost.

^ In some studies, all patients receive the new treatment.
  • Health Concerns - Colon Cancer 10 February 2010 13:36 UTC www.menopauserx.com [Source type: Academic]

^ All patients were examined in 3 consecutive studies.
  • Prognostic Aspects of 18F-FDG PET Kinetics in Patients with Metastatic Colorectal Carcinoma Receiving FOLFOX Chemotherapy -- Dimitrakopoulou-Strauss et al. 45 (9): 1480 -- The Journal of Nuclear Medicine 25 September 2009 0:48 UTC jnm.snmjournals.org [Source type: Academic]

[60]
.
  • Adjuvant (after surgery) chemotherapy.^ Chemotherapy after surgery is called adjuvant therapy .
    • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

    ^ They're also less likely to receive the recommended surgery, adjuvant chemotherapy, and radiation treatment after a cancer diagnosis.

    ^ However, a randomized trial of post-operative 5-FU plus levamisole compared to surgery alone showed no survival advantage to postoperative adjuvant chemotherapy.
    • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

    .One regimen involves the combination of infusional 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX)
  • In clinical trials for treated/untreated metastatic disease.^ Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial.
    • Metastatic Colorectal Cancer: Systemic Treatment: Biological Markers 10 February 2010 13:37 UTC www.medscape.com [Source type: Academic]

    ^ Oxaliplatin (Eloxatin) is related to cisplatin, a widely used platinum-based chemotherapy drug.
    • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

    ^ For patients who are not candidates for clinical trials, postoperative chemotherapy with fluorouracil (5-FU)/leucovorin for 6 months.
    • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

    [61]

Radiation therapy

.Radiotherapy is not used routinely in colon cancer, as it could lead to radiation enteritis, and it is difficult to target specific portions of the colon.^ Radiation is seldom used to treat metastatic colon cancer.
  • Colorectal Cancer 10 February 2010 13:36 UTC www.metrohealth.org [Source type: FILTERED WITH BAYES]

^ The following stages are used for colon cancer: .
  • Colon Cancer - Medpedia 10 February 2010 13:36 UTC wiki.medpedia.com [Source type: Academic]
  • Cancer Information | UPMC Cancer Centers 10 February 2010 13:36 UTC www.upmccancercenters.com [Source type: Academic]
  • Colon Cancer Treatment PDQ®: Treatment - Patient Information NCI - MSN Health & Fitness - Cancer 10 February 2010 13:36 UTC health.msn.com [Source type: Academic]
  • http://jamesline.com/cancertypes/gi/about/colon/ 10 February 2010 13:36 UTC jamesline.com [Source type: Academic]
  • Colon cancer: Treatment - Patient Information [NCI PDQ] | NYU Cancer Institute 10 February 2010 13:36 UTC ci.med.nyu.edu [Source type: Academic]

^ Targeted drug therapy Drugs that target specific defects that allow cancer cells to proliferate are available to people with advanced colon cancer, including bevacizumab (Avastin), cetuximab (Erbitux) and panitumumab (Vectibix).

.It is more common for radiation to be used in rectal cancer, since the rectum does not move as much as the colon and is thus easier to target.^ Colorectal cancer is a term used to refer to cancer that starts in the colon or rectum.
  • Colorectal Cancer 10 February 2010 13:36 UTC www.metrohealth.org [Source type: FILTERED WITH BAYES]

^ It is common to have colon or rectal cancer without symptoms.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ A family history of cancer of the colon or rectum .

Indications include:
  • Colon cancer
    • pain relief and palliation - targeted at metastatic tumor deposits if they compress vital structures and/or cause pain
  • Rectal cancer
    • neoadjuvant - given before surgery in patients with tumors that extend outside the rectum or have spread to regional lymph nodes, in order to decrease the risk of recurrence following surgery or to allow for less invasive surgical approaches (such as a low anterior resection instead of an abdomino-perineal resection)
    • adjuvant - where a tumor perforates the rectum or involves regional lymph nodes (AJCC T3 or T4 tumors or Duke's B or C tumors)
    • palliative - to decrease the tumor burden in order to relieve or prevent symptoms
.Sometimes chemotherapy agents are used to increase the effectiveness of radiation by sensitizing tumor cells if present.^ Radiation is sometimes used with surgery and chemotherapy, particularly for rectal cancer.

^ Therefore, induction of cell cycle arrest and apoptosis by chemopreventive agents could be an effective approach to check uncontrolled cell proliferation and survival in tumor cells.
  • Grape Seed Extract Inhibits In vitro and In vivo Growth of Human Colorectal Carcinoma Cells — Clinical Cancer Research 10 February 2010 13:37 UTC clincancerres.aacrjournals.org [Source type: Academic]

^ It has been shown in a number of studies to inhibit the formation of tumors in the colon and other locations, to increase apoptosis of mutated cells, and to reduce tumor growth.
  • WHFoods: Colorectal Cancer 10 February 2010 13:36 UTC www.whfoods.com [Source type: Academic]

Immunotherapy

.Bacillus Calmette-Guérin (BCG) is being investigated as an adjuvant mixed with autologous tumor cells in immunotherapy for colorectal cancer.^ It is used as a tumor marker for colorectal cancer.

^ Of note, some histologies, especially a mucinous signet-ring cell variant of colorectal cancer, may not be well visualized on a PET scan.
  • Colon Cancer, Adenocarcinoma: Differential Diagnoses & Workup - eMedicine Oncology 10 February 2010 13:36 UTC emedicine.medscape.com [Source type: Academic]

^ Celecoxib attenuated capecitabine induced hand-and-foot syndrome (HFS) and diarrhea and improved time to tumor progression in metastatic colorectal cancer (MCRC).
  • Metastatic Colorectal Cancer: Systemic Treatment: Biological Markers 10 February 2010 13:37 UTC www.medscape.com [Source type: Academic]

[62]

Cancer Vaccine

.TroVax, a cancer vaccine,[63] produced by Oxford BioMedica [64], is in Phase III trials for renal cancers, and phase III trials are planned for colon cancers.^ II and III) colon cancer.
  • Colon Cancer - Medpedia 10 February 2010 13:36 UTC wiki.medpedia.com [Source type: Academic]

^ For stages I, II, and III cancer, more extensive surgery is needed to remove the part of the colon that is cancerous.

^ In 2000, the Phoenix Colon Cancer Prevention Network published results of a randomized trial casting doubt on these observations.

[65]

Treatment of liver metastases

.According to the American Cancer Society statistics in 2006,[66] over 20% of patients present with metastatic (stage IV) colorectal cancer at the time of diagnosis, and up to 25% of this group will have isolated liver metastasis that is potentially resectable.^ In its early stages, colorectal cancer usually .
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ American Cancer Society (2008).
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

^ Stages of colorectal cancer include: .
  • Colorectal cancer 10 February 2010 13:37 UTC www.umm.edu [Source type: Academic]

.Lesions which undergo curative resection have demonstrated 5-year survival outcomes now exceeding 50%.^ Riethmuller G, Holz E, Schlimok G, et al.: Monoclonal antibody therapy for resected Dukes' C colorectal cancer: seven-year outcome of a multicenter randomized trial.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

^ The risk of a metachronous cancer is 30 percent at 10 years after resection and 50 percent at 15 years after resection.
  • Update on Colorectal Cancer - March 15, 2000 - American Academy of Family Physicians 10 February 2010 13:37 UTC www.aafp.org [Source type: Academic]

^ Surgical resection remains the best treatment for colorectal metastases isolated to the liver; however, 5-year survival rates following liver resection are only 40% to 50%, with liver recurrence being a significant reason for treatment failure.
  • Warm Hepatic Ischemia-Reperfusion Promotes Growth of Colorectal Carcinoma Micrometastases in Mouse Liver via Matrix Metalloproteinase-9 Induction -- Nicoud et al. 67 (6): 2720 -- Cancer Research 25 September 2009 0:48 UTC cancerres.aacrjournals.org [Source type: Academic]

[67]
.Resectability of a liver metastasis is determined using preoperative imaging studies (CT or MRI), intraoperative ultrasound, and by direct palpation and visualization during resection.^ Chest radiograph or chest CT scan Abdominal barium study to better delineate primary lesion preoperatively Abdominal/pelvic computerized tomography (CT scan), contrast ultrasound of the abdomen/liver, and abdominal/pelvic MRI are appropriate for imaging abdomen and liver, for the purpose of staging.
  • Colon Cancer, Adenocarcinoma: Differential Diagnoses & Workup - eMedicine Oncology 10 February 2010 13:36 UTC emedicine.medscape.com [Source type: Academic]

^ MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones.

^ The CT scan can help determine if cancer has spread to the lungs or liver.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

.Lesions confined to the right lobe are amenable to en bloc removal with a right hepatectomy (liver resection) surgery.^ In specific cases where the cancer has spread only to the liver and if your overall health is otherwise good, your doctor may recommend surgery to remove the cancerous lesion from your liver.

^ Surgery to remove parts of other organs, such as the liver, lungs, and ovaries, where the cancer may have recurred or spread.
  • Colon Cancer Treatment PDQ®: Treatment - Patient Information NCI - MSN Health & Fitness - Cancer 10 February 2010 13:36 UTC health.msn.com [Source type: Academic]
  • Colon cancer: Treatment - Patient Information [NCI PDQ] | NYU Cancer Institute 10 February 2010 13:36 UTC ci.med.nyu.edu [Source type: Academic]

^ In some cases, surgery may also be performed to remove tumors in areas that the cancer has spread, such as the liver, ovaries, or lung.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

.Smaller lesions of the central or left liver lobe may sometimes be resected in anatomic "segments", while large lesions of left hepatic lobe are resected by a procedure called hepatic trisegmentectomy.^ Hepatic tumors also called Liver cancer.

^ In specific cases where the cancer has spread only to the liver and if your overall health is otherwise good, your doctor may recommend surgery to remove the cancerous lesion from your liver.

^ Local regional approaches to treating liver metastases include hepatic resection and/or intraarterial administration of chemotherapy with implantable infusion ports or pumps.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

.Treatment of lesions by smaller, non-anatomic "wedge" resections is associated with higher recurrence rates.^ Hepatic intra-arterial chemotherapy with floxuridine has produced a higher overall response rate but no consistent improvement in survival, even when combined with resection of hepatic metastases.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

^ Folic acid ingestion was associated with higher risks of having three or more adenomas and of non-CRCs.
  • Colon cancer: Prevention - Health Professional Information [NCI PDQ] - AOL Health 10 February 2010 13:36 UTC www.aolhealth.com [Source type: Academic]

^ After looking at data from over 15,000 Americans the researchers found that vitamin D deficiency was associated with higher death rates among all subjects.
  • Colon Cancer - Kosmix : Reference, Videos, Images, News, Shopping and more... 10 February 2010 13:36 UTC www.kosmix.com [Source type: Academic]

.Some lesions which are not initially amenable to surgical resection may become candidates if they have significant responses to preoperative chemotherapy or immunotherapy regimens.^ It may be given either before or after surgery, but recently doctors have begun to favor preoperative treatment, along with chemotherapy.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ Steady Gains Made Against Digestive Cancers (14-MAY-2005) Researchers tweaking chemotherapy regimens with good results .
  • Health news, discussions, articles, and resources 10 February 2010 13:36 UTC news.healingwell.com [Source type: Academic]

^ Surgical resection/anastomosis or bypass of obstructing primary lesions in selected cases.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

.Lesions which are not amenable to surgical resection for cure can be treated with modalities including radio-frequency ablation (RFA), cryoablation, and chemoembolization.^ Surgical resection/anastomosis or bypass of obstructing primary lesions in selected cases.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

^ There are several non-surgical options for palliative treatment of inoperable primary or secondary liver cancer including percutaneous cryosurgery and percutaneous radiofrequency ablation.

^ Colon resection for larger lesions not amenable to local excision.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

.Patients with colon cancer and metastatic disease to the liver may be treated in either a single surgery or in staged surgeries (with the colon tumor traditionally removed first) depending upon the fitness of the patient for prolonged surgery, the difficulty expected with the procedure with either the colon or liver resection, and the comfort of the surgery performing potentially complex hepatic surgery.^ Hepatic ischemia-reperfusion promotes liver metastasis of colon cancer.
  • Warm Hepatic Ischemia-Reperfusion Promotes Growth of Colorectal Carcinoma Micrometastases in Mouse Liver via Matrix Metalloproteinase-9 Induction -- Nicoud et al. 67 (6): 2720 -- Cancer Research 25 September 2009 0:48 UTC cancerres.aacrjournals.org [Source type: Academic]

^ Half of patients with both colon and endometrial cancer present with endometrial cancer first.
  • Hereditary Colorectal Cancer: eMedicine Gastroenterology 10 February 2010 13:37 UTC emedicine.medscape.com [Source type: Academic]

^ What is the stage of my colon cancer?

Aspirin

.A study published in 2009 found that Aspirin reduces risk of colorectal neoplasia in randomized trials and inhibits tumor growth and metastases in animal models.^ The stage is a combination of the size of tumor growth, the number of lymph nodes involved, and the spread to other sites (metastases).
  • Colon Cancer Symptoms, Diagnosis, and Treatment- Mass General Hospital 10 February 2010 13:36 UTC www2.massgeneral.org [Source type: Academic]

^ According to the results of a Cochrane Systematic Review in the Annals of Internal Medicine, in cohort studies, regular use of aspirin was associated with a 22% reduced risk of colorectal cancer, while two randomized controlled trials of low-dose aspirin failed to show any protective effect.
  • WHFoods: Colorectal Cancer 10 February 2010 13:36 UTC www.whfoods.com [Source type: Academic]

^ Riethmuller G, Holz E, Schlimok G, et al.: Monoclonal antibody therapy for resected Dukes' C colorectal cancer: seven-year outcome of a multicenter randomized trial.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

.The influence of aspirin on survival after diagnosis of colorectal cancer is unknown [68].^ Chan AT, Ogino S, Fuchs CS. Aspirin use and survival after diagnosis of colorectal cancer.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ They work closely with pathologists and radiologists in the diagnosis and staging of patients with colorectal cancer and with medical oncologists and radiation oncologists in the coordinated multidisciplinary management of these patients.
  • Colon & Rectal Cancer Program - Hartford Hospital, Connecticut 10 February 2010 13:36 UTC www.harthosp.org [Source type: Academic]

^ These findings provide strong evidence in support of the diagnosis of hereditary nonpolyposis colorectal cancer.
  • NEJM -- Hereditary Colorectal Cancer 10 February 2010 13:37 UTC content.nejm.org [Source type: Academic]

.Several reports including a prospective cohort of 1,279 people diagnosed with stages I-III (non-metastatic) colorectal cancer[69] have suggested a significant improvement in cancer-specific survival in a subset of patients using aspirin[70].^ It is used as a tumor marker for colorectal cancer.

^ There are several methods for staging colorectal cancer.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ Chan AT, Ogino S, Fuchs CS. Aspirin use and survival after diagnosis of colorectal cancer.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

Support therapies

.Cancer diagnosis very often results in an enormous change in the patient's psychological wellbeing.^ Talking With Your Doctor About Your Colon Cancer Diagnosis The stress of a colon cancer diagnosis can feel overwhelming, so it's very important to have a support system to help you with questions and decisions.

^ Researchers in Holland determined the effects of SJW on the metabolism of irinotecan in 5 patients and reported their results in the August 20, 2002 issue of the Journal of the National Cancer Institute .

^ A doctor makes a diagnosis of colorectal cancer based on results of several types of tests.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

.Various support resources are available from hospitals and other agencies which provide counseling, social service support, cancer support groups, and other services.^ These findings provide strong evidence in support of the diagnosis of hereditary nonpolyposis colorectal cancer.
  • NEJM -- Hereditary Colorectal Cancer 10 February 2010 13:37 UTC content.nejm.org [Source type: Academic]

^ Patient-to-patient networks and cancer support groups can allow patients to talk about living with cancer with others who have had similar experiences.
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ There are also support groups for the families of cancer survivors.
  • OhioHealth - Colon cancer 10 February 2010 13:36 UTC www.ohiohealth.com [Source type: General]

.These services help to mitigate some of the difficulties of integrating a patient's medical complications into other parts of their life.^ Improving preventive care at a medical clinic: How can the patient help?
  • Implementing Colorectal Cancer Screening: Workshop Summary 10 February 2010 13:37 UTC www.nap.edu [Source type: Academic]

^ For some patients, taking part in a clinical trial may be the best treatment choice.
  • Colon Cancer Treatment PDQ®: Treatment - Patient Information NCI - MSN Health & Fitness - Cancer 10 February 2010 13:36 UTC health.msn.com [Source type: Academic]
  • Colon cancer: Treatment - Patient Information [NCI PDQ] | NYU Cancer Institute 10 February 2010 13:36 UTC ci.med.nyu.edu [Source type: Academic]
  • Colon Cancer Treatment - National Cancer Institute 10 February 2010 13:36 UTC healthpromotionresearch.cancer.gov [Source type: Academic]

^ The Cancer Information Service can provide information to help patients and their families locate programs, services, and publications.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

Prognosis

.Survival is directly related to detection and the type of cancer involved.^ Targeting Liver Extends Metastatic Colon Cancer Survival (02-Mar-2006) Delivery system pumps drug directly to the organ, researchers say .
  • Health news, discussions, articles, and resources 10 February 2010 13:36 UTC news.healingwell.com [Source type: Academic]

^ Various types of imaging tests can help detect the presence of cancer or find out how far the cancer has spread.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ Tests or procedures that detect specific types of cancer.
  • Colon cancer: Prevention - Health Professional Information [NCI PDQ] - AOL Health 10 February 2010 13:36 UTC www.aolhealth.com [Source type: Academic]

.Survival rates for early stage detection is about 5 times that of late stage cancers.^ C. presenting information about cancer on a stage.
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ In its early stages, colorectal cancer usually .
  • NIHSeniorHealth: Colorectal Cancer (Print Version) 10 February 2010 13:37 UTC nihseniorhealth.gov [Source type: Academic]

^ Colon cancer survival rates* Stage Survival Rate .
  • Colorectal Cancer 10 February 2010 13:36 UTC www.metrohealth.org [Source type: FILTERED WITH BAYES]

.CEA level is also directly related to the prognosis of disease, since its level correlates with the bulk of tumor tissue.^ The prognosis of colon cancer is clearly related to the degree of penetration of the tumor through the bowel wall and the presence or absence of nodal involvement.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

^ However,TS levels at the primary tumor site do not appear to correlate with RR or survival in patients with metastatic disease.
  • Metastatic Colorectal Cancer: Systemic Treatment: Biological Markers 10 February 2010 13:37 UTC www.medscape.com [Source type: Academic]

^ Cellular deficiency of TP correlates with relative resistance to 5-FU. Levels of TP are higher in tumor cells than in normal tissue.
  • Metastatic Colorectal Cancer: Systemic Treatment: Biological Markers 10 February 2010 13:37 UTC www.medscape.com [Source type: Academic]

Follow-up

Micrograph of a colorectal villous adenoma. .These lesions are considered pre-cancerous.^ Non-Polyp Colon Lesions Hard to Detect (04-Mar-2008) These flat growths are relatively common and tend to be cancerous, study finds .
  • Health news, discussions, articles, and resources 10 February 2010 13:36 UTC news.healingwell.com [Source type: Academic]

H&E stain.
.The aims of follow-up are to diagnose in the earliest possible stage any metastasis or tumors that develop later but did not originate from the original cancer (metachronous lesions).^ Follow-up: Rectal Cancer .

^ Your cancer is in the earliest stage.
  • OhioHealth - Colon cancer 10 February 2010 13:36 UTC www.ohiohealth.com [Source type: General]

^ Follow-up: Hereditary Colorectal Cancer .
  • Hereditary Colorectal Cancer: eMedicine Gastroenterology 10 February 2010 13:37 UTC emedicine.medscape.com [Source type: Academic]

.The U.S. National Comprehensive Cancer Network and American Society of Clinical Oncology provide guidelines for the follow-up of colon cancer.^ Proceedings of the American Society of Clinical Oncology 17: A-1, 1a, 1998.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

^ American Cancer Society (2008).
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

^ The American Cancer Society's recommendations for colorectal cancer screening are provided in Table 5.
  • Update on Colorectal Cancer - March 15, 2000 - American Academy of Family Physicians 10 February 2010 13:37 UTC www.aafp.org [Source type: Academic]

[71][72] .A medical history and physical examination are recommended every 3 to 6 months for 2 years, then every 6 months for 5 years.^ One group recommends combining a stool test every 3 years with a sigmoidoscopy every 5 years.
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

^ The doctor asks about personal and family medical history and may do a physical exam.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

^ Flexible sigmoidoscopy is recommended every 5-10 years, depending on the individual organization.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

.Carcinoembryonic antigen blood level measurements follow the same timing, but are only advised for patients with T2 or greater lesions who are candidates for intervention.^ Carcinoembryonic antigen (CEA) assay : A test that measures the level of CEA in the blood.

^ Carcinoembryonic antigen (CEA) assay: A test that measures the level of CEA in the blood.
  • Colon Cancer Treatment PDQ®: Treatment - Patient Information NCI - MSN Health & Fitness - Cancer 10 February 2010 13:36 UTC health.msn.com [Source type: Academic]

^ A carcinoembryonic antigen (CEA) blood test to see if the cancer has returned after treatment.
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

.A CT-scan of the chest, abdomen and pelvis can be considered annually for the first 3 years for patients who are at high risk of recurrence (for example, patients who had poorly differentiated tumors or venous or lymphatic invasion) and are candidates for curative surgery (with the aim to cure).^ Patients should have a colonoscopy 1 year after surgery.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ Patients at high risk for cancer recurrence should receive an annual computerized tomography (CT) scan of the chest, abdomen, and pelvis for the first 3 years after treatment.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ The third patient survived for over 5 years without sign of tumor recurrence.

.A colonoscopy can be done after 1 year, except if it could not be done during the initial staging because of an obstructing mass, in which case it should be performed after 3 to 6 months.^ Patients should have a colonoscopy 1 year after surgery.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

^ In Western countries, cancers of the colon and rectum account for more new cancer cases each year than any other site except the lung.

^ Another died after 3 years and 7 months and did not respond to treatments, except for the initial series.

.If a villous polyp, polyp >1 centimeter or high grade dysplasia is found, it can be repeated after 3 years, then every 5 years.^ These people, many of which live well over 120 years in excellent health, are almost exclusively found in high altitudes of 2000 m (7000 ft) and above.

^ Your FOBT result is negative if no blood is found in your samples and it is recommended that you repeat a FOBT at least every two years.

^ One study showed that physical activity in men, 2 hours or more per week, was more strongly associated with reduced risk for advanced adenomas (adenomas =10.0 mm in diameter, a villous adenoma, or an adenoma with high-grade dysplasia) versus nonadvanced adenomas.
  • Colon cancer: Prevention - Health Professional Information [NCI PDQ] - AOL Health 10 February 2010 13:36 UTC www.aolhealth.com [Source type: Academic]

.For other abnormalities, the colonoscopy can be repeated after 1 year.^ Colonoscopy : If colonoscopy was not performed for diagnosis, the doctor examines the entire length of the colon and rectum with a colonoscope to check for other abnormal areas.
  • Colon & Rectal Cancer 10 February 2010 13:36 UTC www.hoptechno.com [Source type: Academic]

.Routine PET or ultrasound scanning, chest X-rays, complete blood count or liver function tests are not recommended.^ A complete blood count , which is a blood test.
  • Colorectal Cancer | NYU Cancer Institute 10 February 2010 13:37 UTC ci.med.nyu.edu [Source type: FILTERED WITH BAYES]

^ Blood tests may include a complete blood count and organ-function tests.
  • OhioHealth - Colon cancer 10 February 2010 13:36 UTC www.ohiohealth.com [Source type: General]

^ PET scans are not routinely recommended.
  • Colon and rectal cancers - Western Baptist 10 February 2010 13:37 UTC westernbaptist.adam.com [Source type: Academic]

[71][72] .These guidelines are based on recent meta-analyses showing that intensive surveillance and close follow-up can reduce the 5-year mortality rate from 37% to 30%.^ Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence.
  • Hereditary Colorectal Cancer: eMedicine Gastroenterology 10 February 2010 13:37 UTC emedicine.medscape.com [Source type: Academic]

^ In an attempt to reduce morbidity and mortality, surveillance measures may then be instituted that reflect the natural history of the disorder.
  • NEJM -- Hereditary Colorectal Cancer 10 February 2010 13:37 UTC content.nejm.org [Source type: Academic]

^ Thus, yearly screening would reduce the mortality rate by 53.5 percent.
  • Update on Colorectal Cancer - March 15, 2000 - American Academy of Family Physicians 10 February 2010 13:37 UTC www.aafp.org [Source type: Academic]

[73][74][75]

Epidemiology

Age-standardized death from colorectal cancer per 100,000 inhabitants in 2004.[76]
     no data      less than 2.5      2.5-5      5-7.5      7.5-10      10-12.5      12.5-15      15-17.5      17.5-20      20-22.5      22.5-25      25-27.5      more than 27.5

Society and culture

Notable patients

.

Research

Mathematical modeling

.Colorectal cancer has been the subject of mathematical modeling for many years.^ Riethmuller G, Holz E, Schlimok G, et al.: Monoclonal antibody therapy for resected Dukes' C colorectal cancer: seven-year outcome of a multicenter randomized trial.
  • Colon Cancer Risk | Metastatic Colon Cancer Signs | Colon Cancer Surgery | Colon Cancer Treatment 25 September 2009 0:48 UTC www.meds.com [Source type: Academic]

^ For example, two siblings may have colorectal cancer of the proximal colon before the age of 30 years in the absence of multiple colonic adenomas.
  • NEJM -- Hereditary Colorectal Cancer 10 February 2010 13:37 UTC content.nejm.org [Source type: Academic]

^ Based on this model, annual screening for fecal occult blood would reduce the annual incidence of colorectal cancer by about 50 percent, from 4,988 to 2,610 cases.
  • Update on Colorectal Cancer - March 15, 2000 - American Academy of Family Physicians 10 February 2010 13:37 UTC www.aafp.org [Source type: Academic]

[82][83]

See also

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External links


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