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

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).

Colorectal cancer, also called colon cancer or large bowel cancer, includes cancerous growths in the colon, rectum and appendix. It is the third most common form of cancer and the second leading cause of cancer-related death in the Western world. Colorectal cancer causes 655,000 deaths worldwide per year, including about 16,000 in the UK, where it is the second most common site (after lung) to cause cancer death.^[1] Many colorectal cancers are thought to arise from adenomatous polyps in the colon. These mushroom-like growths are usually benign, but some may develop into cancer over time. The majority of the time, the diagnosis of localized colon cancer is through colonoscopy. Therapy is usually through surgery, which in many cases is followed by chemotherapy. Image File history File links Stomach_colon_rectum_diagram. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // C00-D48 - Neoplasms (C00-C14) Malignant neoplasms, lip, oral cavity and pharynx (C00) Malignant neoplasm of lip (C01) Malignant neoplasm of base of tongue (C02) Malignant neoplasm of other and unspecified parts of tongue (C03) Malignant neoplasm of gum (C04) Malignant neoplasm of floor of mouth (C05) Malignant neoplasm of... // C00-D48 - Neoplasms (C00-C14) Malignant neoplasms, lip, oral cavity and pharynx (C00) Malignant neoplasm of lip (C01) Malignant neoplasm of base of tongue (C02) Malignant neoplasm of other and unspecified parts of tongue (C03) Malignant neoplasm of gum (C04) Malignant neoplasm of floor of mouth (C05) Malignant neoplasm of... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The International Classification of Diseases for Oncology (ICD-O) is a domain specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. ... The International Classification of Diseases for Oncology (ICD-O) is a domain specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Gross examination or grossing is the process by which pathology specimens are inspected with the naked eye to obtain diagnostic information, while being processed for further microscopic examination. ... Colectomy is the surgical procedure by means of which part of the colon is removed. ... Gross examination or grossing is the process by which pathology specimens are inspected with the naked eye to obtain diagnostic information, while being processed for further microscopic examination. ... Colectomy is the surgical procedure by means of which part of the colon is removed. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... It has been suggested that this article or section be merged with Large intestine. ... The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. ... In human anatomy, the vermiform appendix (or appendix, pl. ... An adenoma is a collection of growths (-oma) of glandular origin. ... Look up Benign in Wiktionary, the free dictionary. ... Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. ... Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer. ...

Symptoms

The first symptoms of colon cancer are usually vague, like weight loss and fatigue (tiredness). Local (bowel) symptoms are rare until the tumor has grown to a large size. Generally, the nearer the tumor is to the anus, the more bowel symptoms there will be. This article is about the bodily orifice. ...

Symptoms and signs are divided into local, constitutional and metastatic.

Local symptoms

• Change in bowel habits
  • Change in frequency (constipation and/or diarrhea),
  • Feeling of incomplete defecation (tenesmus) and reduction in diameter of stool, both characteristic of rectal cancer,
  • Change in the appearance of stools :
    • Bloody stools or rectal bleeding
    • Stools with mucus
    • Black, tar-like stool (melena), more likely related to upper gastrointestinal eg stomach or duodenal disease
• Bowel obstruction causing bowel pain, bloating and vomiting of stool-like material.
• A tumor in the abdomen, felt by patients or their doctors.
• Symptoms related to invasion by the cancer of the bladder causing hematuria (blood in the urine) or pneumaturia (air in the urine), or invasion of the vagina causing smelly vaginal discharge. These are late events, indicative of a large tumor.

Constipation, costiveness, or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest. ... In medicine, diarrhea, also spelled diarrhoea (see spelling differences), refers to frequent loose or liquid bowel movements. ... Tenesmus is the constant feeling of the need to empty the bowel, accompanied by pain, cramping, and involuntary straining efforts. ... Hematochezia is the passage of bloody stools from the rectum. ... Mucus cells. ... In medicine, melena or melaena refers to the black, tarry feces that are associated with gastrointestinal hemorrhage. ... Bowel obstruction is a mechanical blockage of the intestines, preventing the normal transit of the products of digestion. ... For malignant tumors specifically, see cancer. ... A bladder is a pouch or other flexible enclosure with waterproof or gasproof walls. ... In medicine, hematuria (or haematuria) is the presence of blood in the urine. ... The vagina, (from Latin, literally sheath or scabbard ) is the tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. ...

Constitutional (systemic) symptoms

• Unexplained weight loss, probably the most common symptom, caused by lack of appetite
• Anemia, causing dizziness, fatigue and palpitations. Clinically, there will be pallor and blood tests will confirm the low hemoglobin level.

This article is about the symptom of decreased appetite. ... This article discusses the medical condition. ... Exhaustion redirects here. ... A palpitation is an abnormal awareness of the beating of the heart, whether it is too slow, too fast, irregular, or at its normal frequency. ... Pallor is a reduced amount of oxyhemoglobin in skin or mucous membrane, a pale color which can be caused by illness, emotional shock or stress, avoiding excessive exposure to sunlight, anaemia or genetics. ...

Metastatic symptoms

• Liver metastases, causing :
  • Jaundice.
  • Pain in the abdomen, more often the upper part (epigastrium or right side of the abdomen
  • liver enlargement, usually felt by a doctor.
• Blood clots in the veins and arteries, a paraneoplastic syndrome related to hypercoagulability of the blood (the blood is "thickened")

For the musical composition, see Metastasis (Xenakis composition). ... Look up jaundice in Wiktionary, the free dictionary. ... The abdomen in a human and an ant. ... The epigastrium is the upper central region of the abdomen. ... Hepatomegaly is the condition of having an enlarged liver. ... A thrombus is the final product of blood coagulation, through the aggregation of platelets and the activation of the humoral coagulation system. ... A paraneoplastic phenomenon is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells. ... Thrombophilia is the propensity to develop thrombosis (blood clots) due to an abnormality in the system of coagulation. ...

Risk factors

This article does not cite any references or sources. (February 2008) Please help improve this article by adding citations to reliable sources. Unverifiable material may be challenged and removed.

The lifetime risk of developing colon cancer in the United States is about 7%. Certain factors increase a person's risk of developing the disease.^[2] These include:

• Age. The risk of developing colorectal cancer increases with age. 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.
• Polyps of the colon, particularly adenomatous polyps, are a risk factor for colon cancer. The removal of colon polyps at the time of colonoscopy reduces the subsequent risk of colon cancer.
• History of cancer. Individuals who have previously been diagnosed and treated for colon cancer are at risk for developing colon cancer in the future. 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
  • 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
• Long-standing ulcerative colitis or Crohn's disease of the colon, approximately 30% after 25 years if the entire colon is involved
• Smoking. Smokers are more likely to die of colorectal cancer than non-smokers. 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. Male smokers had more than a 30% increase in risk of dying from the disease compared to men who never had smoked."^[3]
• Diet. Studies show that a diet high in red meat^[4] and low in fresh fruit, vegetables, poultry and fish increases the risk of colorectal cancer. 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. Individuals who frequently eat fish showed a decreased risk.[1] 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.^[5] The nature of the relationship between dietary fiber and risk of colorectal cancer remains controversial.
• Physical inactivity. People who are physically active are at lower risk of developing colorectal cancer.
• Virus. 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 selenium.
• Inflammatory Bowel Disease. ^{[6] [7]} About one percent of colorectal cancer patients have a history of chronic ulcerative colitis. 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. Patients with colorectal Crohn's disease have a more than average risk of colorectal cancer, but less than that of patients with ulcerative colitis. ^[8]
• Environmental Factors. ^[6] Industrialized countries are at a relatively increased risk compared to less developed countries or countries that traditionally had high-fiber/low-fat diets. Studies of migrant populations have revealed a role for environmental factors, particularly dietary, in the etiology of colorectal cancers.
• Exogenous Hormones. The differences in the time trends in colorectal cancer in males and females could be explained by cohort effects in exposure to some sex-specific risk factor; one possibility that has been suggested is exposure to estrogens ^[9]. There is, however, little evidence of an influence of endogenous hormones on the risk of colorectal cancer. In contrast,there is evidence that exogenous estrogens such as hormone replacement therapy (HRT), tamoxifen, or oral contraceptives might be associated with colorectal tumors. ^[10]
• Alcohol. Drinking, especially heavily, may be a risk factor.

Familial adenomatous polyposis (FAP) is an inherited condition in which numerous polyps form mainly in the epithelium of the large intestine. ... Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is characterized by an increased risk of colorectal cancer and other cancers of the endometrium, ovary, stomach, small intestine, hepatobiliary tract, upper urinary tract, brain, and skin. ... Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory bowel disease (IBD) and is generally classified as an autoimmune disease. ... The American Cancer Society (ACS) is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy and service. ... The European Prospective Investigation into Cancer and Nutrition (EPIC) study is a Europe-wide prospective cohort study of the relationships between diet and cancer, as well as other chronic diseases, such as cardiovascular disease. ... Human papillomavirus (HPV) is a virus which affects humans. ... Primary sclerosing cholangitis (PSC) is a form of cholangitis due to an autoimmune reaction. ... For other uses, see Selenium (disambiguation). ...

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.^[11] Considerable evidence suggests a connection between heavy alcohol consumption and increased risk for cancer, with an estimated 2 to 4 percent of all cancer cases thought to be caused either directly or indirectly by alcohol[1] indicates the NIAAA.[2] 3. ...

The NIAAA reports that: "Epidemiologic studies have found a small but consistent dose-dependent association between alcohol consumption and colorectal cancer^[12][13]even when controlling for fiber and other dietary factors.^[14][15] Despite the large number of studies, however, causality cannot be determined from the available data."^[16]

"Heavy alcohol use may also increase the risk of colorectal cancer" (NCI). 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."^[17][18] 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."^[19][20][21]

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. 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.".^[22]

Other research suggests that "to minimize your risk of developing colorectal cancer, it's best to drink in moderation."^[16]

On its colorectal cancer page, the National Cancer Institute does not list alcohol as a risk factor^[23]: however, on another page it states, "Heavy alcohol use may also increase the risk of colorectal cancer" ^[24] The National Cancer Institute (NCI) is part of the United States Federal governments National Institutes of Health. ...

Drinking may be a cause of earlier onset of colorectal cancer.^[25]

Diagnosis, screening and monitoring

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. Therefore, screening for the disease is recommended in individuals who are at increased risk. There are several different tests available for this purpose. Image File history File linksMetadata Colorectal_cancer_endo_2. ... Image File history File linksMetadata Colorectal_cancer_endo_2. ... Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. ... It has been suggested that this article or section be merged with Large intestine. ... Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. ... Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory bowel disease (IBD) and is generally classified as an autoimmune disease. ...

• Digital rectal exam (DRE): The doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas. 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. 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. ^[26]
• 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. A colonoscopy has the advantage that if polyps are found during the procedure they can be immediately removed. Tissue can also be taken for biopsy.

In the United States, colonoscopy or FOBT plus sigmoidoscopy are the preferred screening options. A rectal examination or rectal exam is an internal examination of the rectum by a physician. ... Fecal occult blood is a term for blood present in the feces that is not visibly apparent. ... Endoscopic images of a duodenal ulcer A flexible endoscope. ... Sigmoidoscope inserted through the anus and rectum and into the sigmoid colon. ... Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. ... Polyp of sigmoid colon as revealed by colonoscopy. ... Polyp of sigmoid colon as revealed by colonoscopy. ... Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ...

Other screening methods

• Double contrast barium enema (DCBE): First, an overnight preparation is taken to cleanse the colon. An enema containing barium sulfate is administered, then air is insufflated into the colon, distending it. The result is a thin layer of barium over the inner lining of the colon which is visible on X-ray films. A cancer or a precancerous polyp can be detected this way. 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. This technique is approaching colonoscopy in sensitivity for polyps. 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. 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. In particular, high levels of carcinoembryonic antigen (CEA) in the blood can indicate metastasis of adenocarcinoma. 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. Because cancer cells often have very high metabolic rate, this can be used to differentiate benign and malignant tumors. 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. 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. 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. Capture, followed by PCR amplifies the DNA to detectable levels for assay. Clinical studies have shown a cancer detection sensitivity of 71%-91%.^[27]

This 2qt (about 1. ... Granulated Barium Sulfate Barium sulfate (or barium sulphate) is the white crystalline solid with the formula BaSO4. ... Virtual colonoscopy (VC) is a Medical imaging procedure which uses x-rays and computers to produce two- and three-dimensional images of the colon (large intestine) from the lowest part, the rectum, all the way to the lower end of the small intestine and display them on a screen. ... negron305 Cat scan redirects here. ... Radiology is the branch of medical science dealing with the medical use of x-ray machines or other such radiation devices. ... Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. ... CT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... A representation of the 3D structure of myoglobin, showing coloured alpha helices. ... Carcinoembryonic antigen (CEA) is a glycoprotein involved in cell adhesion. ... For the musical composition, see Metastasis (Xenakis composition). ... Adenocarcinoma is a form of carcinoma that originates in glandular tissue. ... Type I errors (or α error, or false positive) and type II errors (β error, or a false negative) are two terms used to describe statistical errors. ... Type I errors (or α error, or false positive) and type II errors (β error, or a false negative) are two terms used to describe statistical errors. ... Genetic counseling is the process by which patients or relatives, at risk of an inherited disorder, are advised of the consequences and nature of the disorder, the probability of developing or transmitting it, and the options open to them in management and family planning in order to prevent, avoid or... Genetic testing allows the genetic diagnosis of vulnerabilities to inherited diseases, and can also be used to determine a persons ancestry. ... Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is characterized by an increased risk of colorectal cancer and other cancers of the endometrium, ovary, stomach, small intestine, hepatobiliary tract, upper urinary tract, brain, and skin. ... Familial adenomatous polyposis (FAP) is an inherited condition in which numerous polyps form mainly in the epithelium of the large intestine. ... Image of a typical positron emission tomography (PET) facility Positron emission tomography (PET) is a nuclear medicine medical imaging technique which produces a three-dimensional image or map of functional processes in the body. ... “PCR” redirects here. ...

Pathology

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 pathology report will usually contain a description of cell type and grade. The most common colon cancer cell type is adenocarcinoma which accounts for 95% of cases. Other, rarer types include lymphoma and squamous cell carcinoma. Image File history File linksMetadata Download high-resolution version (2040x1536, 548 KB) Histopathologic image of colonic carcinoid stained by hematoxylin and eosin. ... Image File history File linksMetadata Download high-resolution version (2040x1536, 548 KB) Histopathologic image of colonic carcinoid stained by hematoxylin and eosin. ... A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... For malignant tumors specifically, see cancer. ... A thin section of lung tissue stained with hematoxylin and eosin. ... Adenocarcinoma is a form of carcinoma that originates in glandular tissue. ... This article is about lymphoma in humans. ... Biopsy of a highly differentiated squamous cell carcinoma of the mouth. ...

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. This very rarely causes obstruction of feces, and presents with symptoms such as anemia. Left-sided tumours tend to be circumferential, and can obstruct the bowel much like a napkin ring. The cecum or caecum (from the Latin caecus meaning blind) is a pouch connected to the ascending colon of the large intestine and the ileum. ... Horse feces Feces, faeces, or fæces (see spelling differences) is a waste product from an animals digestive tract expelled through the anus (or cloaca) during defecation. ... This article discusses the medical condition. ...

Histopathology: Adenocarcinoma is a malignant epithelial tumor, originating from glandular epithelium of the colorectal mucosa. It invades the wall, infiltrating the muscularis mucosae, the submucosa and thence the muscularis propria. Tumor cells describe irregular tubular structures, harboring pluristratification, multiple lumens, reduced stroma ("back to back" aspect). 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. If the mucus remains inside the tumor cell, it pushes the nucleus at the periphery - "signet-ring cell." Depending on glandular architecture, cellular pleomorphism, and mucosecretion of the predominant pattern, adenocarcinoma may present three degrees of differentiation: well, moderately, and poorly differentiated. ^[28] Section of mucous membrane of human rectum. ... In the gastrointestinal tract. ...

Staging

Colon cancer staging is an estimate of the amount of penetration of a particular cancer. It is performed for diagnostic and research purposes, and to determine the best method of treatment. The systems for staging colorectal cancers largely depend on the extent of local invasion, the degree of lymph node involvement and whether there is distant metastasis. The stage of a cancer is a descriptor (usually numbers I to IV) of how much the cancer has spread. ... For the musical composition, see Metastasis (Xenakis composition). ...

Definitive staging can only be done after surgery has been performed and pathology reports reviewed. An exception to this principle would be after a colonoscopic polypectomy of a malignant pedunculated polyp with minimal invasion. Preoperative staging of rectal cancers may be done with endoscopic ultrasound. Adjuncts to staging of metastasis include Abdominal Ultrasound, CT, PET Scanning, and other imaging studies. Colectomy is the surgical procedure by means of which part of the colon is removed. ... Endoscopic ultrasound is an ultrasound that is placed into the stomach and duodenum via the upper GI tract. ... Sonography redirects here. ... negron305 Cat scan redirects here. ... Image of a typical positron emission tomography (PET) facility Positron emission tomography (PET) is a nuclear medicine medical imaging technique which produces a three-dimensional image or map of functional processes in the body. ...

Dukes system

Dukes classification, first proposed by Dr Cuthbert E. Dukes in 1932, identifies the stages as:^[29]

• A - Tumour confined to the intestinal wall
• B - Tumour invading through the intestinal wall
• C - With lymph node(s) involvement
• D - With distant metastasis

TNM system

Main article: TNM

The most common current staging system is the TNM (for tumors/nodes/metastases) system, though many doctors still use the older Dukes system. The TNM system assigns a number^[30]: TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ...

• T - The degree of invasion of the intestinal wall
  • T0 - no evidence of tumor
  • Tis- cancer in situ (tumor present, but no invasion)
  • T1 - invasion through submucosa into lamina propria (basement membrane invaded)
  • T2 - invasion into the muscularis propria (i.e. proper muscle of the bowel wall)
  • T3 - invasion through the subserosa
  • T4 - invasion of surrounding structures (e.g. bladder) or with tumour cells on the free external surface of the bowel
• N - the degree of lymphatic node involvement
  • N0 - no lymph nodes involved
  • N1 - one to three nodes involved
  • N2 - four or more nodes involved
• M - the degree of metastasis
  • M0 - no metastasis
  • M1 - metastasis present

In the gastrointestinal tract. ... The muscular coat (or muscular layer, or muscular fibers, or muscularis externa) is a region of smooth muscle in many organs in the vertebrate body, adjacent to the mucous membrane. ... A serous membrane is a very thin layer of cells (usually one row) covering internal body cavity. ... In mammals including humans, the lymphatic vessels (or lymphatics) are a network of thin tubes that branch, like blood vessels, into tissues throughout the body. ... Lymph nodes are components of the lymphatic system. ... For the musical composition, see Metastasis (Xenakis composition). ...

AJCC stage groupings

The 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 0
  • Tis, N0, M0
• Stage I
  • T1, N0, M0
  • T2, N0, M0
• Stage IIA
  • T3, N0, M0
• Stage IIB
  • T4, N0, M0
• Stage IIIA
  • T1, N1, M0
  • T2, N1, M0
• Stage IIIB
  • T3, N1, M0
  • T4, N1, M0
• Stage IIIC
  • Any T, N2, M0
• Stage IV
  • Any T, Any N, M1

Pathogenesis

Colorectal cancer is a disease originating from the epithelial cells lining the gastrointestinal tract. Hereditary or somatic mutations in specific DNA sequences, among which are included DNA replication or DNA repair genes^[31], and also the APC, K-Ras, NOD2 and p53 genes, lead to unrestricted cell division. The exact reason why (and whether) a diet high in fiber might prevent colorectal cancer remains uncertain. Chronic inflammation, as in inflammatory bowel disease, may predispose patients to malignancy. This article is about the epithelium as it relates to animal anatomy. ... Gut redirects here. ... A genetic disorder, or genetic disease is a disease caused, at least in part, by the genes of the person with the disease. ... This article does not cite any references or sources. ... For linguistic mutation, see Apophony. ... The structure of part of a DNA double helix Deoxyribonucleic acid, or DNA, is a nucleic acid molecule that contains the genetic instructions used in the development and functioning of all known living organisms. ... DNA replication. ... DNA damage resulting in multiple broken chromosomes DNA repair refers to a collection of processes by which a cell identifies and corrects damage to the DNA molecules that encode its genome. ... For other uses, see Gene (disambiguation). ... Familial adenomatous polyposis (FAP) is an inherited condition in which numerous polyps form mainly in the epithelium of the large intestine. ... In molecular biology, Ras is the name of a protein, the gene that encodes it, and the family and superfamily of proteins to which it belongs. ... NOD2 (nucleotide-binding oligomerization domain containing 2) is a protein, also known as the caspase recruitment domain family, member 15 (CARD15), which plays an important role in the immune system. ... TP53 bound to a short DNA fragment. ... In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. ...

Treatment

The treatment depends on the staging of the cancer. When colorectal cancer is caught at early stages (with little spread) it can be curable. However when it is detected at later stages (when distant metastases are present) it is less likely to be curable. For the musical composition, see Metastasis (Xenakis composition). ...

Surgery remains the primary treatment while chemotherapy and/or radiotherapy may be recommended depending on the individual patient's staging and other medical factors.

Surgery

Surgeries can be categorised into curative, palliative, bypass, fecal diversion, or open-and-close.

Curative Surgical treatment can be offered if the tumor is localized. “Surgeon” redirects here. ...

• 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). If possible, the remaining parts of colon are anastomosed together to create a functioning colon. 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. 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. Anatomy of a coral polyp. ... Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. ... In anatomy, a mesentery is a part of the peritoneum that connects an internal organ, such as the small intestine, to the abdominal wall. ... Lymph nodes are components of the lymphatic system. ... // Anastomosis (plural anastomoses) refers to a form of network in which streams both branch out and reconnect. ... In medicine, a stoma (Greek - plr. ... Total Mesorectal Excision (or TME) is a standard technique for treatment of colorectal cancer, devised some 20 years ago. ... Resection has multiple meanings: Resectioning involves enlarging the cross-section of a river channel by deepening or widening the river to increase its hydraulic efficiency. ... In medicine, epidemiology and actuarial science, the term morbidity can refer to the state of being diseased (from Latin morbidus: sick, unhealthy), the degree or severity of a disease, the prevalence of a disease: the total number of cases in a particular population at a particular point in time, the... Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer. ...

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. Excision means to remove as if by cutting. It can be a euphemism for Female circumcision. ... In medicine, a stoma (Greek - plr. ...

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. 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.

Laparoscopic-assisted colectomy is a minimally-invasive technique that can reduce the size of the incision and may reduce post-operative pain. Laparoscopic surgery, also called keyhole surgery (when natural body openings are not used), bandaid surgery, or minimally invasive surgery (MIS), is a surgical technique. ... Colectomy is the surgical procedure by means of which part of the colon is removed. ... Minimally invasive surgical procedures avoid open invasive surgery in favor of closed or local surgery with less trauma. ...

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 (especially small bowel)
• adjacent organ injury; most commonly to the small intestine, ureters, spleen, or bladder
• Cardiorespiratory complications such as myocardial infarction, pneumonia, arrythmia, pulmonary embolism etc

An infection is the detrimental colonization of a host organism by a foreign species. ... Hematoma on thigh, 6 days after a fall down stairs, 150ml of blood drained a few days later A hematoma, or haematoma, is a collection of blood, generally the result of hemorrhage, or, more specifically, internal bleeding. ... An adhesion is a fibrous band of scar tissue that binds together normally separate anatomical structures. ... Bowel obstruction is a mechanical blockage of the intestines, preventing the normal transit of the products of digestion. ... Heart attack redirects here. ... This article is about human pneumonia. ... Cardiac arrhythmia is a group of conditions in which the muscle contraction of the heart is irregular or is faster or slower than normal. ...

Chemotherapy

Chemotherapy is used to reduce the likelihood of metastasis developing, shrink tumor size, or slow tumor growth. Chemotherapy is often applied after surgery (adjuvant), before surgery (neo-adjuvant), or as the primary therapy (palliative). 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. In colon cancer, chemotherapy after surgery is usually only given if the cancer has spread to the lymph nodes (Stage III). Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer. ... This box:      In health care, a clinical trial is a comparison test of a medication or other medical treatment (such as a medical device), versus a placebo (inactive look-a-like), other medications or devices, or the standard medical treatment for a patients condition. ... The United States Food and Drug Administration is the government agency responsible for regulating food, dietary supplements, drugs, cosmetics, medical devices, biologics and blood products in the United States. ...

• Adjuvant (after surgery) chemotherapy. One regimen involves the combination of infusional 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX)
  • 5-fluorouracil (5-FU) or Capecitabine (Xeloda)
  • Leucovorin (LV, Folinic Acid)
  • Oxaliplatin (Eloxatin)

• Chemotherapy for metastatic disease. Commonly used first line chemotherapy regimens involve the combination of infusional 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) with bevacizumab or infusional 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI) with bevacizumab
  • 5-fluorouracil (5-FU) or Capecitabine
  • UFT or Tegafur-uracil
  • Leucovorin (LV, Folinic Acid)
  • Irinotecan (Camptosar)
  • Oxaliplatin (Eloxatin)
  • Bevacizumab (Avastin)
  • Cetuximab (Erbitux)
  • Panitumumab (Vectibix)

• In clinical trials for treated/untreated metastatic disease. [2]
  • Bortezomib (Velcade)
  • Oblimersen (Genasense, G3139)
  • Gefitinib and Erlotinib (Tarceva)
  • Topotecan (Hycamtin)

Fluorouracil (5-FU) is a drug that is used in the treatment of cancer. ... Folinic acid, generally administered as calcium folinate, is an adjuvant used in cancer chemotherapy involving the drug methotrexate. ... Oxaliplatin is a platinum-based chemotherapy drug in the same family as cisplatin and carboplatin. ... FOLFOX is a chemotherapy regimen for treatment of advanced colorectal cancer, consisting of concurrent treatment with fluorouracil, leucovorin (folinic acid), and oxaliplatin. ... Fluorouracil (5-FU) is a drug that is used in the treatment of cancer. ... Capecitabine (INN) (IPA: ) is an orally-administered chemotherapeutic agent used in the treatment of metastatic breast and colorectal cancers. ... Folinic acid, generally administered as calcium folinate, is an adjuvant used in cancer chemotherapy involving the drug methotrexate. ... Oxaliplatin is a platinum-based chemotherapy drug in the same family as cisplatin and carboplatin. ... Chemotherapy regimens are often identified with acronyms, identifying the agents used in combination. ... Fluorouracil (5-FU) is a drug that is used in the treatment of cancer. ... Folinic acid, generally administered as calcium folinate, is an adjuvant used in cancer chemotherapy involving the drug methotrexate. ... Oxaliplatin is a platinum-based chemotherapy drug in the same family as cisplatin and carboplatin. ... FOLFOX is a chemotherapy regimen for treatment of advanced colorectal cancer, consisting of concurrent treatment with fluorouracil, leucovorin (folinic acid), and oxaliplatin. ... Bevacizumab (trade name Avastin) is a monoclonal antibody against vascular endothelial growth factor. ... Fluorouracil (5-FU) is a drug that is used in the treatment of cancer. ... Folinic acid, generally administered as calcium folinate, is an adjuvant used in cancer chemotherapy involving the drug methotrexate. ... Irinotecan is a chemotherapy agent that is a topoisomerase 1 inhibitor. ... FOLFIRI is a chemotherapy regimen for treatment of advanced colorectal cancer, consisting of concurrent treatment with irinotecan, leucovorin (folinic acid), and fluorouracil. ... Bevacizumab (trade name Avastin) is a monoclonal antibody against vascular endothelial growth factor. ... Fluorouracil (5-FU) is a drug that is used in the treatment of cancer. ... Folinic acid, generally administered as calcium folinate, is an adjuvant used in cancer chemotherapy involving the drug methotrexate. ... Irinotecan is a chemotherapy agent that is a topoisomerase 1 inhibitor. ... Oxaliplatin is a platinum-based chemotherapy drug in the same family as cisplatin and carboplatin. ... Bevacizumab (trade name Avastin) is a monoclonal antibody against vascular endothelial growth factor. ... Cetuximab (Erbitux®) is a chimeric monoclonal antibody given by intravenous injection for treatment of colorectal cancer. ... It is proposed that this article be deleted, because of the following concern: No references or indication of notability. ... Bortezomib (originally PS-341 and marketed as Velcade by Millennium Pharmaceuticals) is the first therapeutic proteasome inhibitor to be tested in humans. ... Gefitinib is a new drug used in the treatment of certain types of cancer. ... Erlotinib hydrochloride (trade name Tarceva, Genentech/OSIP, originally coded as OSI-774) is a drug used to treat non-small cell lung cancer, pancreatic cancer and several other types of cancer. ... Topotecan (Hycamtin®) is a chemotherapy agent that is a topoisomerase 1 inhibitor. ...

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. 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. Indications include: Radiation enteropathy or radiation enteritis is the syndrome that develops after the intestine is exposed to radiation. ...

• 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. For the musical composition, see Metastasis (Xenakis composition). ...

Immunotherapy

Bacillus Calmette-Guérin (BCG) is being investigated as an adjuvant mixed with autologous tumor cells in immunotherapy for colorectal cancer.^[32] An apparatus (4-5 cm length, with nine short needles) used for BCG vaccination in Japan. ...

Vaccine

In November 2006, it was announced that a vaccine had been developed and tested with very promising results.^[33] The new vaccine, called TroVax, works in a totally different way to existing treatments by harnessing the patient's own immune system to fight the disease. Experts say this suggests that gene therapy vaccines could prove an effective treatment for a whole range of cancers. Oxford BioMedica is a British spin-out from Oxford University specialising in the development of gene-based treatments. Phase III trials are underway for renal cancers and planned for colon cancers.^[34] A vaccine is an antigenic preparation used to establish immunity to a disease. ... TroVax is a cancer immunotherapy product produced by Oxford BioMedica. ... Gene therapy is the insertion of genes into an individuals cells and tissues to treat a disease, and hereditary diseases in which a defective mutant allele is replaced with a functional one. ... The University of Oxford, located in the city of Oxford in England, is the oldest university in the English-speaking world. ...

Treatment of liver metastases

According to the American Cancer Society statistics in 2006,[3] 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. Lesions which undergo curative resection have demonstrated 5-year survival outcomes now exceeding 50%.^[35]

Resectability of a liver metastasis is determined using preoperative imaging studies (CT or MRI), intraoperative ultrasound, and by direct palpation and visualization during resection. Lesions confined to the right lobe are amenable to en bloc removal with a right hepatectomy (liver resection) surgery. 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. Treatment of lesions by smaller, non-anatomic "wedge" resections is associated with higher recurrence rates. Some lesions which are not initially amenable to surgical resection may become candidates if they have significant responses to preoperative chemotherapy or immunotherapy regimens. Lesions which are not amenable to surgical resection for cure can be treated with modalities including radio-frequency ablation (RFA), cryoablation, and chemoembolization.

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.

Poor pronostic factors of patients with liver metastasis include:^{[citation needed]}

• Synchronous (diagnosed simultaneously) liver and primary colorectal tumors
• A short time between detecting the primary cancer and subsequent development of liver mets
• Multiple metastatic lesions
• High blood levels of the tumor marker, carcino-embryonic antigen (CEA), in the patient prior to resection
• Larger size metastatic lesions

Support therapies

Cancer diagnosis very often results in an enormous change in the patient's psychological wellbeing. Various support resources are available from hospitals and other agencies which provide counseling, social service support, cancer support groups, and other services. These services help to mitigate some of the difficulties of integrating a patient's medical complications into other parts of their life. The word counseling or counselling comes from the Middle English counseil, from Old French conseil, from Latin cōnsilium; akin to cōnsulere, to take counsel, consult. ... Cancer support groups provide a setting in which cancer patients can talk about living with cancer with others who may be having similar experiences. ...

Prognosis

Survival is directly related to detection and the type of cancer involved. Survival rates for early stage detection is about 5 times that of late stage cancers. CEA level is also directly related to the prognosis of disease, since its level correlates with the bulk of tumor tissue.

Follow-up

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).

The U.S. National Comprehensive Cancer Network and American Society of Clinical Oncology provide guidelines for the follow-up of colon cancer.^[36][37] A medical history and physical examination are recommended every 3 to 6 months for 2 years, then every 6 months for 5 years. 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. 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). 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. If a villous polyp, polyp >1 centimeter or high grade dysplasia is found, it can be repeated after 3 years, then every 5 years. For other abnormalities, the colonoscopy can be repeated after 1 year. National Comprehensive Cancer Network is an alliance of twenty-one cancer centers from across the United States. ... American Society of Clinical Oncology, or ASCO, is an organization that represents all clinical oncologists. ... The medical history of a patient (sometimes called anamnesis [1][2] ) is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called heteroanamnesis). ... In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ... Carcinoembryonic antigen (CEA) is a glycoprotein involved in cell adhesion. ... negron305 Cat scan redirects here. ... Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. ...

Routine PET or ultrasound scanning, chest X-rays, complete blood count or liver function tests are not recommended.^[36][37] 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%.^[38][39][40] Image of a typical positron emission tomography (PET) facility Positron emission tomography (PET) is a nuclear medicine medical imaging technique which produces a three-dimensional image or map of functional processes in the body. ... Sonography redirects here. ... Frontal chest X-ray. ... Schematics of shorthand for complete blood count commonly used by physicians. ... Liver function tests (LFTs or LFs), which include liver enzymes, are groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patients liver. ...

Prevention

The neutrality or factuality of this section may be compromised by weasel words, which can allow the implication of unsourced information. You can help Wikipedia by removing weasel worded statements.

Most colorectal cancers should be preventable, through increased surveillance, improved lifestyle, and, probably, the use of dietary chemopreventative agents.

Surveillance

Most colorectal cancer arise from adenomatous polyps. These lesions can be detected and removed during colonoscopy. 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.^[41]

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). National Comprehensive Cancer Network is an alliance of twenty-one cancer centers from across the United States. ... Adenoma refers to a collection of growths (-oma) of glandular origin. ... IBD redirects here. ...

Lifestyle & 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. In contrast, a healthy body weight, physical fitness, and good nutrition decreases cancer risk in general. Accordingly, lifestyle changes could decrease the risk of colorectal cancer as much as 60-80%.^[42]

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. 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. ^[43] A 2005 meta-analysis study further supports these findings.^[44]

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. Despite what many people may think, however, fiber probably has little, if any effect on colon cancer risk." ^[45]

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. Other studies show strong inhibition of spontaneous intestinal polyps in mutated mice (Min mice). Chemoprevention clinical trials in human volunteers have shown smaller prevention, but few intervention studies have been completed today. Calcium, aspirin and celecoxib supplements, given for 3 to 5 years after the removal of a polyp, decreased the recurrence of polyps in volunteers (by 15-40%).^{[citation needed]} The "chemoprevention database" shows the results of all published scientific studies of chemopreventive agents, in people and in animals.^[46] Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ... Activities that need to be performed and results to be obtained a before a clinical trial in humans can begin. ...

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 (300mg or more) outweigh the possible benefits.^[47]

A clinical practice guideline by the U.S. Preventive Services Task Force (USPSTF) recommended against taking aspirin (grade D recommendation).^[48] 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".^[49] However, long-term doses over 81 mg per day may increase bleeding events.^[50] Clinical practice guidelines are collections of practical information for use by doctors and other medical professionals. ... This article is about the drug. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ...

Calcium

A 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.".^[51] Subsequently, one randomized controlled trial by the Women's Health Initiative (WHI) reported negative results.^[52] A second randomized controlled trial reported reduction in all cancers, but had insufficient colorectal cancers for analysis.^[53] A meta-analysis is a statistical practice of combining the results of a number of studies. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicine, used because of its record of reliability. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ... The Womens Health Initiative (WHI) was initiated by the National Institutes of Health (NIH) in 1991. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ...

Mathematical modeling

Colorectal cancer has been for years subject of mathematical modeling.^[54] For a comprehensive overview of current computational approaches on colorectal cancer see the Integrative Biology web page.

Famous people diagnosed with colorectal cancer

• Ruth Bader Ginsburg
• Tammy Faye Messner died July 20, 2007
• Audrey Hepburn [4]
• H. P. Lovecraft, horror writer
• Harold Wilson [5]
• Pope John Paul II [6]
• Ronald Reagan [7]
• Elizabeth Montgomery, American Actress (died at age 62; died 8 weeks after being diagnosed with colon cancer. see [8])
• Charles Schulz, Creator of Peanuts (died at age 77; died 60 days after being diagnosed with colon cancer) [9].
• Lillian Board, British athlete
• Malcolm Marshall, Legendary West Indian and Hampshire Cricketer [10]
• Achille-Claude Debussy, Famous French composer [11]
• Bobby Moore, 1966 England World cup winning captain (died at age 51; died 2 years after being diagnosed with colon cancer) [12]
• Babe Didrikson Zaharias, Legendary American athlete [13]
• Joel Siegel, movie critic and Host of Good Morning America (died between ages 63-65; died 10 years after being diagnosed with colon cancer)
• Eric Turner, second player taken in the 1991 NFL Draft
• Walter Matthau died from metastatic colon cancer on July 1, 2000
• Vince Lombardi, legendary coach of the Green Bay Packers, died of metastatic colon cancer
• Rod Roddy, previous announcer for The Price Is Right (died at age 66; died 2 years after being diagnosed with colon cancer)
• George David Low, American aerospace executive and a former NASA astronaut; died 2008
• Corazon Aquino, Former president of the Philippines. [14]

Ruth Joan Bader Ginsburg (born March 15, 1933, Brooklyn, New York) is an Associate Justice on the U.S. Supreme Court. ... Tammy Faye Bakker Messner (born March 7, 1942) is the former wife of televangelist and later convicted felon Jim Bakker. ... Audrey Hepburn (May 4, 1929) – January 20, 1993) was an English Academy Award-, Tony Award-, Grammy Award-, and Emmy Award-winning film and stage actress, fashion icon, and humanitarian. ... This article is about the author. ... For other persons named Harold Wilson, see Harold Wilson (disambiguation). ... John Paul II (Latin: , Italian: , Polish: ) born   IPA: ; 18 May 1920 – 2 April 2005) reigned as the 264th Pope of the Roman Catholic Church and Sovereign of the State of the Vatican City from 16 October 1978, until his death, almost 27 years later. ... Reagan redirects here. ... Elizabeth Victoria Montgomery (April 15, 1933 – May 18, 1995) was an American film and television actress whose career spanned five decades. ... Charles Monroe Schulz (November 26, 1922 - February 12, 2000) was a 20th-century American cartoonist best known for his Peanuts comic strip. ... For other uses, see Peanut (disambiguation). ... Lillian Board (born December 13, 1948 in Durban, South Africa – died December 26, 1970 in Munich) was an athlete from Great Britain, who won the silver medal in the 400 metres at the 1968 Summer Olympics in Mexico City, and two gold medals at the 1969 European Championships in Athletics... Malcolm Denzil Marshall (April 18, 1958 - November 4, 1999) was a West Indian cricketer, regarded as one of the finest fast bowlers ever to have played Test cricket; some have suggested he was the finest of all. ... Claude Debussy, photo by Félix Nadar, 1908. ... Robert Frederick Chelsea Bobby Moore, OBE (born Barking, England, 12 April 1941 - died London, 24 February 1993) was an English footballer. ... Babe Didrikson in the 1932 Olympic javelin competition Mildred Ella Babe Didrikson Zaharias (June 26, 1911-September 27, American athlete, who excelled in many sports. ... Joel Siegel (July 7, 1943 – June 29, 2007) was an American film critic for the ABC morning news show Good Morning America for over 25 years. ... Good Morning America is a weekday morning news show that is broadcast on the ABC television network. ... Eric Turner was a hard hitting, former first round draft choice, at defensive back for the Browns. ... The 1991 NFL Draft Categories: | ... Walter Matthau (October 1, 1920 – July 1, 2000) was an Academy Award-winning American comedy actor best known for his role as Oscar Madison in The Odd Couple and his frequent collaborations with fellow Odd Couple star Jack Lemmon. ... Vincent Thomas Lombardi (June 11, 1913 – September 3, 1970) was an American football coach. ... Robert Ray (Rod) Roddy (September 28, 1937 – October 27, 2003) was an American radio and television announcer. ... This article is about the current version of the U.S. game show. ... For other uses, see NASA (disambiguation). ... Maria Corazon Sumulong Cojuangco Aquino (born January 25, 1933), widely known as Cory Aquino, was President of the Philippines from 1986 to 1992. ... Judiciary Supreme Court Chief Justice Reynato Puno Court of Appeals · Sandiganbayan Court of Tax Appeals · Ombudsman Elections Commission on Elections Chairman: Resurreccion Z. Borra 2013 | 2010 | 2007 | 2004 | 2001 | 1998 1995 | 1992 | 1987 | 1986 | All Foreign relations Government Website Human rights Other countries Atlas  Politics Portal      The President of the...

References

Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 144th day of the year (145th in leap years) in the Gregorian calendar. ... Year 2000 (MM) was a leap year starting on Saturday. ... is the 340th day of the year (341st in leap years) in the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Common Era (or Anno Domini), in accordance with the Gregorian calendar. ... is the 16th day of the year in the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Common Era (or Anno Domini), in accordance with the Gregorian calendar. ... is the 16th day of the year in the Gregorian calendar. ... The National Institute on Alcohol Abuse and Alcoholism (NIAAA), as part of the U.S. National Institutes of Health, supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. ... The National Cancer Institute (NCI) is part of the United States Federal governments National Institutes of Health. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 317th day of the year (318th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 225th day of the year (226th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... The New England Journal of Medicine (NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ... The British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA)which published its first issue in 1845. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... {| style=float:right; |- | |- | |} is the 235th day of the year (236th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... This article is about the day. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 127th day of the year (128th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

See also

• Hereditary nonpolyposis colorectal cancer
• Diet and cancer
• Bowel & Cancer Research

Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is characterized by an increased risk of colorectal cancer and other cancers of the endometrium, ovary, stomach, small intestine, hepatobiliary tract, upper urinary tract, brain, and skin. ... The methionine metabolism pathway. ...

External links

• Bowel & Cancer Research UK
• Colon Cancer Alliance
• Colorectal Cancer Coalition
• National Cancer Institute (Cancer.gov) colorectal cancer
• Current clinical trials
• europacolon Pan European Not for Profit dedicated to colorectal cancer
• Complementary medical clinical trials
• Photos at: Atlas of Pathology
• Bowel Cancer UK (charity)
• Tackle Colon Cancer
• Cancer.Net: Colorectal Cancer
• Beating Bowel Cancer (UK charity)
• Colorectal cancer screening - the World Gastroenterology Organisation (WGO)