Colorectal Cancer | Dr Meenu Walia | DNB Medical Oncologist


## Colorectal cancer (also known as colon cancer, rectal cancer or bowel cancer) is the development of cancer in the colon or rectum (parts of the large intestine). It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Signs and symptoms may include blood in the stool, a change in bowel movements, weight loss, and feeling tired all the time.
## Risk factors for colorectal cancer include lifestyle, older age, and inherited genetic disorders. Other risk factors include diet, smoking, alcohol, lack of physical activity, family history of colon cancer and colon polyps, presence of colon polyps, race, exposure to radiation, and even other diseases such as diabetes and obesity. Genetic disorders only occur in a small fraction of the population. A diet high in red, processed meat, while low in fiber increases the risk of colorectal cancer. Other diseases such as inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis, can increase the risk of colorectal cancer. Some of the inherited genetic disorders that can cause colorectal cancer include familial adenomatous polyposis and hereditary non-polyposis colon cancer; however, these represent less than 5% of cases. It typically starts as a benign tumor, often in the form of a polyp, which over time becomes cancerous.
## Treatments used for colorectal cancer may include some combination of surgery, radiation therapy, chemotherapy and targeted therapy. Cancers that are confined within the wall of the colon may be curable with surgery while cancer that has spread widely are usually not curable, with management focusing on improving quality of life and symptoms. Five year survival rates in the United States are around 65%. This, however, depends on how advanced the cancer is, whether or not all the cancer can be removed with surgery, and the person’s overall health. Globally, colorectal cancer is the third most common type of cancer making up about 10% of all cases. In 2012 there were 1.4 million new cases and 694,000 deaths from the disease. It is more common in developed countries, where more than 65% of cases are found. It is less common in women than men
Types of Colorectal Cancer
## Adenocarcinoma is the most common type of colorectal cancer. Other colorectal cancers include gastrointestinal carcinoid tumours, gastrointestinal stromal tumours, primary colorectal lymphoma, leiomyosarcoma, melanoma and squamous cell carcinoma.
Colorectal adenocarcinoma
A cancer of the intestinal gland cells, adenocarcinomas represent more than 95 percent of colon and rectal cancers. “Adeno” is the prefix for gland, and adenocarcinomas typically start within the intestinal gland cells that line the inside of the colon and/or rectum. They tend to start in the inner layer and then spread deeper to other layers. There are two main subtypes of adenocarcinoma:
Mucinous adenocarcinoma is made up of approximately 60 percent mucus. The mucus can cause cancer cells to spread faster and become more aggressive than typical adenocarcinomas. Mucinous adenocarcinomas account for 10 to 15 percent of all colon and rectal adenocarcinomas.
Signet ring cell adenocarcinoma accounts for less than one percent of adenocarcinomas. Named for its appearance under a microscope, signet ring cell adenocarcinoma is typically aggressive and may be more difficult to treat.
Other types of colorectal cancer
There are many other types of rare colorectal cancers, and combined these types account for just 5 percent of all cases. Below are examples of other colorectal types:
Gastrointestinal carcinoid tumors: This slow-growing cancer forms in the neuroendocrine cell (a nerve cell that also creates hormones) in the lining of the gastrointestinal tract. These tumors account for just 1 percent of all colorectal cancers, but half of all of the cancers found in the small intestine.
Primary colorectal lymphomas: A type of non-Hodgkin lymphoma (NHL), lymphomas are cancers that develop in the lymphatic system from cells called lymphocytes. Lymphocytes are a type of white blood cell that helps the body fight infections. NHL can develop in many parts of the body, including the lymph nodes, bone marrow, spleen, thymus and the digestive tract. Primary colorectal lymphomas account for just 0.5 percent of all colorectal cancers, and about 5 percent of all lymphomas. The disease usually occurs later in life, and is more common in men than women.
Gastrointestinal stromal tumors: Also known as GISTs, this is a rare type of colorectal cancer that starts in a special cell found in the lining of the gastrointestinal (GI) tract called interstitial cells of Cajal (ICCs). More than 50 percent of GISTs start in the stomach. While most of the others start in the small intestine, the rectum is the third most common location. GISTs are classified as sarcomas, cancers that begin in the connective tissues, which include fat, muscle, blood vessels, deep skin tissues, nerves, bones and cartilage.
Leiomyosarcomas: Another form of sarcoma, leiomyosarcomas essentially means “cancer of smooth muscle.” The colon and rectum have three layers of the type of muscle that can be affected, which all work together to guide waste through the digestive tract. This rare type of colorectal cancer accounts for about 0.1 percent of all colorectal cases.
Melanomas: Though most commonly associated with the skin, melanomas can occur anywhere, including the colon or rectum.
Squamous cell carcinomas: Some parts of the GI tract, like the upper part of the esophagus and the end of the anus, are lined with flat cells called squamous cells. These are the same type of cells that are found on the surface of the skin. Cancers starting in these cells are called squamous cell carcinoma.

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