The term colon cancer or colon carcinoma is used to describe cancers that are localized in the area of the colon. The malignant tumors arise primarily from the intestinal mucosa.
What is colon cancer?
Malignant tumors in the area of the colon are called colon cancer (colon carcinoma). The colon, in turn, begins in the area of the right lower abdomen. There it joins the small intestine and finally ends at the anus. This form of cancer as a malignant proliferation of cells develops predominantly from the mucous membrane of the intestine. In some cases, the degeneration of initially benign growths develops on the intestinal mucosa. Mostly this disease appears after the age of 40. Thus, 90% of all those affected are older than 50 years. In western industrialized countries, this cancer is relatively common. In men and women, colon cancer is the second most common cancer. Within Germany, there are approximately 39,000 new male patients and 33,000 new female patients each year. In contrast, colon cancer rarely occurs in emerging and developing countries.
Causes
There are many causes of colon cancer. It can be favored by various risk factors. For example, hereditary defects exist in the genetic makeup that can increase the likelihood of colon cancer. These include the following diseases: familial adenomatous polyposis, Gardner syndrome, Peutz-Jeghers syndrome and Lynch syndrome. Chronic intestinal diseases are another risk factor. These include diseases such as ulcerative colitis and Crohn’s disease. Both diseases are similar in terms of symptoms, complications, and treatments. They usually occur in childhood or during adolescence. Furthermore, dietary habits can have an influence. For example, being overweight, eating a diet rich in meat as well as fat, smoking for many years, regular and high alcohol consumption, and a low-fiber diet increase the risk of developing colon cancer.
Symptoms, complaints, and signs
Unfortunately, as with many other cancers, colorectal carcinoma lacks characteristic early symptoms. Especially in the early stages, the disease is often completely asymptomatic. The first signs of colorectal cancer may be changes in bowel habits. Any sudden change in bowel movements in patients under 40 years of age should therefore be investigated more closely. There may be an alternation between constipation and diarrhea. Frequent, foul-smelling or pencil-thin stools may also indicate malignant bowel disease. In order to overcome the constriction, the intestinal muscles have to exert considerably more force, which can lead to massive colic-like abdominal pain. In the course of the disease, blood is regularly found on or in the stool. The permanent blood loss thus leads to iron deficiency and anemia. Less specific for colorectal carcinoma, but indicative of a general malignant disease, are symptoms such as unwanted weight loss, night sweats, fever, loss of performance and general fatigue. In later stages of the disease and with increasing size of the tumor, it may also become palpable as a hardening in the abdominal cavity. If the tumor has grown so large that it obstructs the intestinal lumen, intestinal obstruction occurs. Physicians refer to this obstruction as ileus. It manifests as stool retention, nausea and vomiting, a distended abdomen and cramping pain.
Diagnosis
Physicians have a variety of methods at their disposal to diagnose colon cancer. Since about half of all growths are localized in the rectum, the doctor can feel them with the help of a palpation examination. Deeper areas, on the other hand, require a rectoscopy. To examine the entire colon, however, a colonoscopy is necessary. With this method, the physician can also take a tissue sample from regions suspected of cancer at the same time. This is analyzed under the microscope in the further course. Special X-ray examinations with a colon contrast enema are also possible. Early detection is crucial for a successful course of the disease. Thus, 95% of all patients survive the following five years if they have been diagnosed with this cancer at an early stage. If the colon cancer is already far advanced, the chances of a cure are greatly minimized.
Complications
Depending on the location and size of the tumor, partial removal of the bowel may be appropriate. In these cases, the respective ends of the bowel are sutured together. The utilization of food and the regulation of bowel movements may be problematic afterwards. In individual cases, the creation of an artificial anus may be necessary. The associated psychological consequences for the patient usually subside after the stoma has been repositioned. In addition, there are the general surgical risks (thrombosis, pulmonary embolism and postoperative wound healing disorders). The most frequent complications in the course of chemotherapy are severe malaise with vomiting, dizziness and temporary hair loss. Depending on the tumor classification and location, pre- or postoperative radiation therapy may be appropriate. Many patients experience the following complications during the course of radiation therapy: Diarrhea, skin irritation, abdominal pain, and increased susceptibility to urinary tract infections. If the disease is not treated or if therapy is started too late, the tumor will continue to grow and form distant metastases in the liver and lungs. The tumor may break through the intestinal walls if it grows aggressively, causing intestinal contents to leak into the abdomen and cause inflammation. A cure is no longer possible at this stage of the disease.
When should you see a doctor?
Characteristic of a tumor infestation of the colon usually remains a long period of symptomlessness in the early stages. In most cases, patients suffer only from nonspecific pain. For this reason, doctors detect growths in the last section of the digestive tract only thanks to routine checks. If massive symptoms occur, the colorectal cancer is usually already very advanced. Nevertheless, there are some warning signs for early detection that can prevent the spread of cancerous growths by timely clarification with a physician. Only a colonoscopy can provide absolute certainty regarding the condition of the colon. This method clarifies very reliably whether there are growths in the colon. Typical warning signs that prompt the physician to perform a detailed examination are regular blood deposits on the stool. Especially a dark discoloration indicates an origin in the inner part of the intestine. Canker sores impair bowel function and provoke occasional alternations of diarrhea and constipation with no plausible explanation for sufferers. Bottlenecks also favor the formation of very thin pencil stools. Excessive mucus accumulation with relatively few bowel movements in the morning hours indicates disease in the rectum. General indications of involvement of the colon are provided by pain a few hours before the next visit to the toilet. However, isolated abdominal pain and cramps are not a specific symptom of cancer. Nevertheless, it is considered advisable to seek examination by a specialist if the condition is regular and mild. Family histories of colon cancer, especially before the age of 45, should definitely be brought up by patients at presentation.
Treatment and therapy
Treatment of colon cancer is usually surgical. Thus, the surgical procedure is to remove the tumor completely. Furthermore, the treatment depends on the extent and type of cancer. Thus, metastases may also need to be eliminated. In an advanced stage, surgery is often supplemented by radiation therapy and chemotherapy. Prior to surgery, these treatment methods serve to shrink the growths. This makes the surgery easier. After surgery, chemotherapy and radiation therapy serve to kill any remaining cancer cells. Radiation therapy affects only the local area of the radiation field. Chemotherapy also covers settled pathological cells in the whole organism. It is also combined with newly developed preparations that allow a better quality of life. Thus, pain is efficiently relieved, mobility persists for a longer period of time and the cancer can be stabilized for a while by this form of therapy. Patients with colon cancer not only feel better physically as a result, but also improve their psychological state.
Outlook and prognosis
Colon cancer is one of the cancers whose prognosis is initially quite good, but unfortunately the disease is often discovered late.This naturally worsens the prospects of a complete cure and a cancer-free life down the line. If stage I or II colon cancer is detected, the chances are often still good that it can be removed completely or at least in large parts by surgery. It is possible that the patient will need chemotherapy afterwards, because there is a risk that the colon cancer has already spread. However, if it has not and can be completely removed, then a patient can hope for a cure. Colon cancer discovered later, on the other hand, already has no such prognosis. Often it has already spread to other organs and can only be removed in part or not at all by surgery. The prognosis then depends on the outcome of chemotherapy, and its success in turn depends on a number of other factors, such as the patient’s general health, individual tolerance of chemotherapy, and age. Colon cancer also affects the absorption of nutrients, so malnutrition can quickly occur, especially with this type of cancer. Furthermore, it may be necessary to insert an artificial anus after surgery. This is reversed, but this may be accompanied by adjustment problems due to a weakened sphincter muscle.
Prevention
The risk of developing colon cancer can be reduced by eating a healthy diet. In particular, a diet rich in fiber can prevent various colon and stomach cancers. Furthermore, a life with a lot of exercise and sport is advisable. In old age, however, early detection is essential as a preventive measure. This improves the prognosis decisively. Men and women should be screened for colorectal cancer from the age of 50. From the age of 55, a colonoscopy is recommended at intervals of 10 years in order to detect any colon carcinoma at an early stage.
Follow-up
A diagnosis of colon cancer comes with some challenges after treatment is complete. The body is regenerating. Those affected must find their way back into everyday life. For example, doctors order rehabilitation measures if necessary or arrange help for a social and psychological suffering. Treatment sometimes also results in secondary complaints such as incontinence and digestive disorders. In addition to remedying the acute signs, follow-up care also has a preventive character. It is to prevent cancer cells from forming again, metastases from developing or a tumor from arising at another site in the colon. Depending on the intensity of the infestation, various follow-up examinations have become established. If the prognosis is favorable, doctors perform a colonoscopy in addition to a physical examination. If the prospects of cure deteriorate, a number of additional checks are carried out. Among other things, the determination of the tumor marker CEA provides clarity about the progress. Sonography of the abdomen and X-rays of the chest are also performed regularly. The higher the probability of a relapse, the more frequent the follow-up examinations. If the course is unfavorable, six-month intervals are indicated.
What you can do yourself
Patients with colorectal cancer also have options apart from medical treatments in everyday life to alleviate discomfort triggered by the disease itself or even the therapies. It is important that self-help measures are always discussed with the treating physician. It is crucial that the intestinal remnant in the body after the operation is supported in its function and not exposed to any avoidable stress. This is achieved by avoiding overly sumptuous meals, foods that are difficult to digest or foods that cause flatulence. Fiber-rich foods are also suitable for supporting the intestines in their natural digestive activity. In this context, it is also important to drink sufficient amounts of fluids to ensure that the intestines are sufficiently hydrated. Patients who have lost a lot of weight due to the intestinal disease and the therapy can regain weight and strength by eating special food. For mental regeneration, self-help groups for cancer patients, relaxation methods, or yoga are all available. Exercise in the fresh air or meetings with friends also help to create a positive mood and thus a better quality of life.
Stoma carriers can contribute a lot to their well-being by caring for their artificial bowel outlet according to the instructions of the stoma therapist.To do this, it is also helpful to learn to consciously accept the stoma and not struggle with the restriction on a daily basis by talking to experts, such as a psycho-oncologist or stoma therapist.
