Symptoms
The possible initial symptoms of colon cancer include:
- Change in bowel habits, diarrhea or constipation.
- Bleeding, blood in the stool, black colored stool.
- Frequent urge to defecate, discharge of small and thin portions.
- Abdominal pain, flatulence, cramps.
- Weight loss, weakness, anemia
Because the cancer grows slowly, it takes years before clinical symptoms finally appear. Colorectal cancer is the second to third most common cancer. In many countries, several thousand, in Germany several tens of thousands of people are diagnosed each year. Different stages are distinguished. Colon cancer can spread locally, grow through the intestinal wall, affect the lymph nodes and, in the final stage, finally form metastases, especially in the liver or lungs. The more advanced the cancer, the worse the prognosis.
Causes
Colon cancer is a cancer of the colon (small intestine) or rectum. It is caused by uncontrolled cell growth, usually originating in the mucus-forming glandular cells of the mucosa. It is referred to as adenocarcinoma. The cancer develops in the majority of cases from initially benign mucosal polyps. Known risk factors include:
- Age: Most cases occur in individuals over the age of 50.
- Heredity
- History of colon cancer in the family or patient history.
- Gender: men are more often affected
- Ethnicity
- Intestinal polyps
- Inflammatory bowel disease: Crohn’s disease, ulcerative colitis
- Diabetes mellitus
- Lifestyle: smoking, alcohol, diet (red meat, sausage), obesity, lack of exercise.
Diagnosis
Diagnosis is made based on patient history, clinical presentation, with colonoscopy, biopsy, imaging and laboratory methods. The best way to treat colon cancer is to detect it as early as possible. For this reason, people over the age of 50 are recommended to have regular examinations. This is possible, among other things, with a colonoscopy or with the detection of occult blood in the stool. Blood is released from the fine blood vessels surrounding the adenoma/carcinoma. However, in the early stages this is in such small quantities that it is not visible to the eye.
Non-drug treatment
- Removal of intestinal polyps or carcinoma by surgical methods.
- Radiotherapy (irradiation)
Drug treatment
Cell toxic chemotherapy is used to destroy cancer cells. The following agents are used. They are also combined:
- Capecitabine (Xeloda, generic), a prodrug of 5-fluorouracil.
- 5-Fluorouracil (generic) / folinic acid (Leucovorin).
- Oxaliplatin (Eloxatin, generics).
- Irinotecan (Campto, generics)
Newer cancer drugs and biologics are more specific than traditional chemotherapy drugs. They are administered in advanced disease: anti-VEGF antibodies, VEGF inhibitors:
- Bevacizumab (Avastin).
- Aflibercept (Zaltrap)
Anti-EGFR antibody:
- Cetuximab (Erbitux).
- Panitumumab (Vectibix)
Kinase inhibitors:
- Regorafenib (Stivarga)
Prevention
Screening:
- Regular screening starting at age 50 (see above), earlier for at-risk groups.
For prevention, a healthy lifestyle is recommended:
- Healthy diet, such as dietary fiber, whole grains, cereals, fruits, vegetables, little red meat, few sausages.
- Do not smoke
- No excessive consumption of alcohol
- Sufficient physical exercise, avoid excess weight
Medication prevention:
- NSAIDs such as low-dose acetylsalicylic acid and COX-2 inhibitors such as celexocib may reduce the risk of colorectal cancer. However, potential adverse effects pose a problem, so general use is not recommended. The drugs are not approved for this indication.
- Protective properties are attributed to vitamin D.
