INITIAL DIAGNOSIS

Cancer is a frightening diagnosis for anyone to receive. Just the word cancer produces fear and anxiety. If you have been diagnosed with colon cancer, you need as much information as you can find about your disease. Knowledge and education about cancer can be a powerful tool in combating colon cancer. Arming yourself with knowledge about colon cancer, its effects, and its treatments is a wise way to prepare for the challenges and choices the illness often brings. This quick reference guide is designed to be a first stop on the road to self-education about colon cancer.

The Facts
Colon cancer begins in the digestive, or gastrointestinal, system. Apart from skin cancer, colon and rectal cancer (or colorectal cancers) together are the third most common type of cancer found in men and women in Texas and in the United States as a whole. The American Cancer Society estimates there will be about 112,000 new cases of colon cancer in 2007 in the United States.

Causes
While the exact causes of colon cancer are not clear, a number of risk factors have been identified by the medical community. They include:

Age: the chances of developing colon cancer sharply increase over the age of 50.
Personal History of Colon Cancer: if you have had colorectal cancer in the past there is a greater likelihood you will develop it again.
Personal History of Inflammatory Bowel Disease (IBD): having a history of ulcerative colitis or Crohn’s disease, which involve long-term inflammation of the colon, is associated with having a higher risk of developing colorectal cancer.
Heredity: 15% of people who develop colon cancer have disease that is familial.
Ethnicity: Jews of Eastern European descent have the highest colorectal cancer risk of any ethnic group; this is likely due to certain genetic mutations carried by some members of this group.
Race: African Americans have the highest incidence and mortality rates of colorectal cancer.
Other Factors: a number of other factors, such as having a diet mostly from animal sources, physical inactivity, being overweight, having diabetes, and being a heavy drinker or smoker have been shown to increase the risk of contracting colorectal cancer.

Types of Colon Cancer
There are five main types of colon cancer.

Adenocarcinomas are by far the most common type of colon cancer, comprising about 95% of all colorectal cancer cases. This type originates in the glands around the colon and has two sub-types: mucinous and signet ring cell cancer.

Leiomyosarcomas occur in the smooth muscle of the colon and account for only 2% colorectal cancers. These have a fairly high chance of metastasizing, or spreading to other parts of the body.

Lymphomas are rare and are more likely to start in the rectum than in the colon. However, lymphomas that start elsewhere in the body are more likely to spread to the colon than to the rectum. Non-Hodgkin lymphoma accounts for about 0.5% of colon cancers.

Melanomas make up about 2% of colorectal cancers. They usually start somewhere else in the body and spread to the colon or rectum.

Neuroendocrine tumors are broken into two types: aggressive and indolent. Large and small cell neuroendocrine tumors are considered aggressive, while carcinoid tumors are considered indolent.

Key Terminology (Initial Diagnosis)

Adenocarcinoma: Cancer in the cells that line the inside of the wall of the colorectum

Adenomatous polyp (also called adenoma): A growth that is usually benign and that protrudes from the mucous membranes

Anal verge: The distal end of the anal canal, forming a transitional zone between the skin of the anal canal and the perianal skin.

Ascending colon: That portion of the colon on the right side of the body that connects to the small intestine

Barium enema, double-contrast barium enema: An enema containing a white, chalky substance that contains barium; used to highlight the contours of the intestines on a series of x-rays to reveal abnormalities

Biopsy: Removal of a tissue sample for examination

Carcinoembryonic antigen (CEA): A blood chemical that is measured after treatments as a way to determine the presence of cancer cells

Colonic stent: An expandable tube that is placed in the colon to open up a blocked bowel

Colonoscopy: Visual examination of the inner surface of the colon by means of a colonoscope.

Colostomy: A procedure in which an opening is made through the abdomen to allow waste to pass out of the body

Descending colon: The part of the colon where stool is stored. Located on the left side of the abdomen between the transverse colon and the sigmoid colon.

Endoscope: A tube that is inserted into openings in the body to allow an internal examination without the need for surgery

Pancolitis: Inflammation of the entire colon

Proctoscopy: A rectal examination with a type of endoscope called a proctoscope

Sigmoid colon: The lower part of the colon just above the rectum. It is curved somewhat like the letter S.

Staging: Colon cancer is staged according to the extent to which it has spread. Stages include Stage 0, I, IIA, IIB, IIIA, IIIB, IIIC and IV, with Stage 0 being least severe and Stage IV being most severe.

Transverse colon: The middle portion of the colon, which extends horizontally across the body

Virtual colonoscopy: A developing technology in which the colorectum can be examined with a CT scan

TREATMENT AND POST-TREATMENT SUPPORT

Typical Treatments and their Side Effects
There are three main types of treatment for colon cancer: surgery, radiation therapy, chemotherapy and monoclonal antibody therapy. In addition, biologic therapy is a new type of treatment being tested in clinical trials.

Surgery is the primary treatment for most colon cancer patients. It involves the physical removal of part or all of the affected areas through incisions in the abdomen or other areas of the body.

Radiation therapy employs a beam of focused radiation designed to stop cancer cells from dividing. It is an effective treatment because it preferentially treats the more rapidly-dividing cells, such as cancer cells, in the body of the patient.

Chemotherapy kills rapidly dividing cells through the infusion of drugs directly into the bloodstream. There are various types of drugs used in chemotherapy, and many times a combination of drugs is used to treat a particular type of cancer.

Links to Support Resources

American Cancer Society:
www.cancer.org

Cancer Care:
www.cancercare.org

Cancer Consultants - Cancer Topics
http://www.texasoncology.com/cancer-blood-disorders.aspx

Colorectal Cancer Network:
www.colorectal-cancer.net

Colon Cancer Alliance:
www.ccalliance.org

Managing Treatment
Chemotherapy is a commonly-prescribed systemic therapy for treating cancer. While chemotherapy is a powerful technique, it is usually accompanied by a number of side effects. Here is a list of common chemotherapy side effects and some strategies for managing them:

Weakened Immune System:

Avoid crowds, especially those with children.
Wash your hands as frequently as possible.
Prevent breaks in the skin.

Nausea and Vomiting:

Eat smaller meals more frequently.
Avoid sweets and fatty, fried foods.
Eat foods only when they are at room temperature.
Avoid strong odors.
Take anti-emetic drugs.

Diarrhea:

Drink plenty of fluids.
Avoid dairy products.
Try foods that are low in fiber such as bananas, rice, and mashed potatoes.

Constipation:

Drink plenty of fluids.
Eat high fiber foods.

Sore Mouth:

Drink plenty of fluids.
Suck on ice chips.
Chew sugarless gum or eat hard candy.
Moisten dry foods before chewing.

Fatigue:

Plan fewer activities.
Rest whenever you can.

Hair Loss:

Try cooling your scalp during chemotherapy, as this may reduce hair loss.
Ask your cancer nurse about wigs and hairpieces, if you are interested in wearing one.

Key Terminology (Treatment)

Abdominoperineal resection: Surgery that involves cutting through the abdomen and the perineum

Brachytherapy: A radiation treatment that implants radiation directly into a tumor site

Chemoembolization: Administration of chemotherapy mixed with material to slow blood flow through the liver, allowing the drugs to stay in contact with the liver longer

Colectomy: Surgery to remove part or all of the colon

HAI (hepatic arterial infusion): Delivering chemotherapy drugs directly into the liver via a main artery

Hemicolectomy: Surgical removal of part of the colon

Interstitial radiation therapy: Radiation treatment in which radioactive material contained in needles, seeds, wires, or catheters is placed directly into the tumor site

Radiofrequency ablation: A procedure in which a special electrode is placed in a tumor that uses a radiofrequency current to heat and destroy it

Resection: Surgery in which cancer is removed along with healthy tissue around it

Sigmoid colectomy: Surgery to remove part of the sigmoid colon