Colon cancer is cancer of the large intestine (colon), the lower part of your digestive system.

Cancer of the colon is thought to arise sporadically in about 80% of those who develop the disease. 20% of cases are thought to have genetic predisposition that ranges from familial syndromes affecting 50% of the off-spring of a mutation carrier, to a risk of 6% when there is just a family history of colon cancer occurring in a first degree relative. Development of colon cancer at an early age, or at multiple sites, or recurrent colon cancer suggests a genetically transmitted form of the disease as opposed to the sporadic form. Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps become colon cancers. Polyps may be small and produce few, if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying polyps before they become colon cancer. The stages of colon cancer are:

Stage 0. Your cancer is in the earliest stage. It hasn't grown beyond the inner layer (mucosa) of your colon or rectum. This stage of cancer may also be called carcinoma in situ. Stage I. Your cancer has grown through the mucosa but hasn't spread beyond the colon wall or rectum. Stage II. Your cancer has grown into or through the wall of the colon or rectum but hasn't spread to nearby lymph nodes. Stage III. Your cancer has invaded nearby lymph nodes but isn't affecting other parts of your body yet. Stage IV. Your cancer has spread to distant sites, such as other organs for instance to your liver or lung. Recurrent. This means your cancer has come back after treatment. It may recur in your colon, rectum or other part of your body.

Pathophysiology With continuous unhealthy lifestyle cancer of the colon may develop in one of two ways In the cecum & ascending colon,the lesions tend to develop as polyps that grow as caulifloerlike masses portuding into the lumens of the colon. These lesions may ulcerate, but obstruction of the colon is uncommon. Eventually the lesions penetrate the colon wall and extend into surrounding tissues. In the descending colon, especially the rectosigmoid portion, an annular lesion is more common. The early lesion is a small mass that becomes plaque like. The plaque grows circumferentially, encircling the colon wall, then contracts, causing narrowing of the lumen. These lesions also eventually penetrate the colon wall and extend into adjacent tissue. Cancer of the

colon may spread by direct extension as through the lymphatic in circulatory systems, needing at distant points in the peritoneum or at distant points in the colon. The liver is the major organ of metastasis because the colonic blood vessel empty into the portal vein leading to the liver.

Signs and symptoms of colon cancer include: Colon cancer causes symptoms related to its local presence in the large bowel or by its effect on other organs if it has spread. These symptoms may occur alone or in combination:

a change in bowel habit blood in the stool bloating, persistent abdominal distention constipation a feeling of fullness even after having a bowel movement narrowing of the stoolso-called ribbon stools persistent, chronic fatigue abdominal discomfort unexplained weight loss and, very rarely, nausea and vomiting

Many of the symptoms are understood by remembering that the colon is a tubular conduit. If a tumor develops, as it reaches a certain size it will begin to cause symptoms related to the obstruction of that conduit. In addition, the tumor commonly oozes blood that is lost in the stool. (Often, this blood is not visible.) This phenomenon results in anemia and chronic fatigue. Weight loss is a late symptom, often implying substantial obstruction or the presence of systemic disease. Cause Factors that may increase your risk of colon cancer include:

Older age. About 90 percent of people diagnosed with colon cancer are older than 50. Colon cancer can occur in younger people, but it occurs much less frequently. African-American race. African-Americans have a greater risk of colon cancer than do people of other races. A personal history of colorectal cancer or polyps. If you've already had colon cancer or adenomatous polyps, you have a greater risk of colon cancer in the future. Inflammatory intestinal conditions. Long-standing inflammatory diseases of the colon, such as ulcerative colitis and Crohn's disease, can increase your risk of colon cancer.

Inherited syndromes that increase colon cancer risk. Genetic syndromes passed through generations of your family can increase your risk of colon cancer. These syndromes include familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, which is also known as Lynch syndrome. Family history of colon cancer and colon polyps. You're more likely to develop colon cancer if you have a parent, sibling or child with the disease. If more than one family member has colon cancer or rectal cancer, your risk is even greater. In some cases, this connection may not be hereditary or genetic. Instead, cancers within the same family may result from shared exposure to an environmental carcinogen or from diet or lifestyle factors. Low-fiber, high-fat diet. Colon cancer and rectal cancer may be associated with a diet low in fiber and high in fat and calories. Research in this area has had mixed results. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat and processed meats. A sedentary lifestyle. If you're inactive, you're more likely to develop colon cancer. Getting regular physical activity may reduce your risk of colon cancer. Diabetes. People with diabetes and insulin resistance may have an increased risk of colon cancer. Obesity. People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight. Smoking. People who smoke cigarettes may have an increased risk of colon cancer. Alcohol. Heavy use of alcohol may increase your risk of colon cancer. Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat previous cancers may increase the risk of colon cancer.

Diagnosing colon cancer If your signs and symptoms indicate that you could have colon cancer, your doctor may recommend one of more tests and procedures, including:

Fecal occult blood tests are chemical tests that are performed on samples of stool to detect the presence of "occult" blood (amounts of blood that are so small that they cannot be seen with the naked eye). These tests usually are begun at age 40 and then are repeated annually along with a digital rectal examination that is performed by a doctor. The use of fecal occult blood tests is based on the observation that slow bleeding from colon polyps or cancers can cause small amounts of blood to mix with the colonic contents. (This sometimes can lead to an iron deficiency anemia .) Since the small amounts of blood are not visible to the naked eye, sensitive chemical tests are needed to detect the traces of blood in the stool. Using a scope to examine the inside of your colon. Colonoscopy uses a long, flexible and slender tube attached to a video camera and monitor to view your entire colon and rectum. If any suspicious areas are found, your doctor can pass surgical tools through the tube to take tissue samples (biopsies) for analysis.

Using dye and X-rays to make a picture of your colon. A barium enema allows your doctor to evaluate your entire colon with an X-ray. Barium, a contrast dye, is placed into your bowel in an enema form. During a double-contrast barium enema, air also is added. The barium fills and coats the lining of the bowel, creating a clear silhouette of your rectum, colon and sometimes a small portion of your small intestine. Using multiple CT images to create a picture of your colon. Virtual colonoscopy combines multiple computerized tomography (CT) images to create a detailed picture of the inside of your colon. If you're unable to undergo colonoscopy, your doctor may recommend virtual colonoscopy.

Treatments and drugs

Surgery for early-stage colon cancer If your cancer is small, localized in a polyp and in a very early stage, your doctor may be able to remove it completely during a colonoscopy. If the pathologist determines that the cancer in the polyp doesn't involve the base where the polyp is attached to the bowel wall then there's a good chance that the cancer has been completely eliminated. Some larger polyps may be removed using laparoscopic surgery. In this procedure, your surgeon performs the operation through several small incisions in your abdominal wall, inserting instruments with attached cameras that display your colon on a video monitor. He or she may also take samples from lymph nodes in the area where the cancer is located. Surgery for invasive colon cancer If your colon cancer has grown into or through your colon, your surgeon may recommend a colectomy to remove the part of your colon that contains the cancer, along with a margin of normal tissue on either side of the cancer. Nearby lymph nodes are usually also removed and tested for cancer. Your surgeon is often able to reconnect the healthy portions of your colon or rectum. But when that's not possible, for instance if the cancer is at the outlet of your rectum, you may need to have a permanent or temporary colostomy. This involves creating an opening in the wall of your abdomen from a portion of the remaining bowel for the elimination of body waste into a special bag. Sometimes the colostomy is only temporary, allowing your colon or rectum time to heal after surgery. In some cases, however, the colostomy may be permanent. Surgery for advanced cancer If your cancer is very advanced or your overall health very poor, your surgeon may recommend an operation to relieve a blockage of your colon or other conditions in order to improve your symptoms. This type of surgery is referred to as palliative surgery. The goal of palliative surgery isn't to cure your cancer, but to relieve signs and symptoms, such as bleeding and pain.

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. Chemotherapy may be used before or after this type of surgery. This treatment may improve your prognosis. Chemotherapy Chemotherapy uses drugs to destroy cancer cells. Chemotherapy can be used to destroy cancer cells after surgery, to control tumor growth or to relieve symptoms of colon cancer. Your doctor may recommend chemotherapy if your cancer has spread beyond the wall of the colon or if your cancer has spread to the lymph nodes. In people with rectal cancer, chemotherapy is typically used along with radiation therapy. Radiation therapy Radiation therapy uses powerful energy sources, such as X-rays, to kill any cancer cells that might remain after surgery, to shrink large tumors before an operation so that they can be removed more easily, or to relieve symptoms of colon cancer and rectal cancer. Radiation therapy is rarely used in early-stage colon cancer, but is a routine part of treating rectal cancer, especially if the cancer has penetrated through the wall of the rectum or traveled to nearby lymph nodes. Radiation therapy, usually combined with chemotherapy, may be used after surgery to reduce the risk that the cancer may recur in the area of the rectum where it began. .Prognosis Prognosis is the long-term outlook or survival after therapy. Overall, about 50% of patients treated for colon cancer survive the disease. As expected, the survival rates are dependent upon the stage of the cancer at the time of diagnosis, making early detection a very worthwhile endeavor. About 15% of patients present with stage I disease and 85-90% survive. Stage II represents 20-30% of cases and 65-75% survive. 30-40% comprise the stage III presentation of which 55% survive. The remaining 20-25% present with stage IV disease and are very rarely cured. Website: http://www.mayoclinic.com/health/colon-cancer/DS00035/DSECTION=coping-andsupport http://www.medicinenet.com/colon_cancer_screening/page4.htm Books: Pathophysiology Made Incredibly Easy p22. 2002 by Lippincott Williams & Wilkins