Involve. Supporting you. Supporting your patients with cancer
As a healthcare provider, you participate in every aspect of care for patients facing a cancer diagnosis. Use this section to refresh your knowledge of colorectal cancer or share the information with patients who are facing a colorectal cancer diagnosis.
- Facts and Statistics
- Risk Factors
- Screening and Early Detection
- Diagnosis and Staging
- Colorectal Cancer Treatment Options
Facts and Statistics
According to the American Cancer Society:
- Excluding skin cancer, colorectal cancer is the third most common cancer diagnosed in men and women in the US.
- In 2009, approximately 106,100 new cases of colon cancer and 40,870 new cases of rectal cancer are expected to be diagnosed.
- The lifetime risk of developing colorectal cancer is approximately 1 in 19, with the risk slightly higher in men than in women.
- Colorectal cancer is the second leading cause of cancer-related death among both men and women in the US, with an estimated 49,920 deaths expected in 2009.
Risk Factors
Multiple factors contribute to the risk of developing colorectal cancer. Some of the risk factors below can be avoided, while others, like family history, are unavoidable.
- Diet: A diet high in fat, especially from animal sources, increases the risk of colorectal cancer. It is recommended that individuals consume plenty of fruits, vegetables, and whole grain foods, and limit intake of high-fat foods.
- Physical Activity: People who lead a sedentary lifestyle or are very overweight are more likely to develop colorectal cancer.
- Cigarette Smoking and Alcoholism: Smokers and people with a history of alcoholism may be at an increased risk of developing colorectal cancer.
- Age: More than 90% of people diagnosed with colon or rectal cancer are older than age 50.
- Family History: People with a close relative (parent, brother, sister, or child) who had colorectal cancer before age 60 or 2 or more close relatives who had the disease at any age are at higher risk of developing colorectal cancer.
- Personal History: People who have already had colorectal cancer are at risk of developing recurrent disease.
- Intestinal Polyps: Having large or many polyps increases the risk of developing colorectal cancer.
- Genetic Alterations: People with changes in certain genes are more likely to develop colorectal cancer. Common types of inherited (genetic) colorectal cancer are:
- Hereditary Nonpolyposis Colon Cancer (HNPCC): The most common type. HNPCC accounts for about 2% of all colorectal cancer cases and is caused by changes in a specific gene.
- Familial Adenomatous Polyposis (FAP): FAP is caused by a change in a specific gene called APC and accounts for less than 1% of all colorectal cancer cases.
- Family Members of People With HNPCC or FAP: Can have genetic testing to check for specific genetic changes.
Screening and Early Detection
Identifying colorectal cancer early improves overall survival. It is recommended that starting at the age of 50 years (or younger in patients with a family history of colorectal cancer or in patients with high risk), men and women begin screening regularly for colorectal cancer, or as often as their healthcare provider suggests. Colorectal cancer screening may be used to detect abnormal cell growth, such as polyps and nonpolypoid lesions, and other conditions. Removal of abnormal cells is one of the most effective ways to prevent colon and rectal cancer from developing. As a nurse, discussing risk factors and screening with patients is crucial to improving the potential for early detection and survival.
Diagnosis and Staging
Several options are available for the diagnosis of colorectal cancer:
- Biopsy: If an abnormal growth is identified during a colonoscopy or sigmoidoscopy, a biopsy of the abnormal tissue may be taken. A biopsy may be taken from the colon and/or rectum or nearby lymph nodes.
- Blood Tests: Specific indicators in the blood, such as carcinoembryonic antigen (CEA), may be measured to evaluate the potential presence of colorectal cancer.
- Colonoscopy: A long, flexible tube is placed in the rectum and up into the colon. The entire length of the color is checked for abnormal growths. A colonoscopy is recommended every 10 years.
- Computed Tomography (CT) Scan: A CT scan uses X-rays to create a visual image of specific areas inside the body. An injectable dye may be used in conjunction with the X-rays to help visualize tumors.
- Digital Rectal Exam (DRE): During a DRE, a healthcare provider inserts a lubricated, gloved finger into the rectum to feel for abnormal areas. A digital rectal exam is limited to the lower part of the rectum and is not sensitive enough to detect small polyps. Thus, a DRE is not recommended as a stand-alone test for colorectal cancer.
- Double-contrast Barium Enema (DCBE): Also known as a barium enema with air contrast (or just a barium enema). The patient receives an enema with a barium solution, air is pumped into the rectum, and a series of rectum X-rays are taken. The barium and air outline the colon and rectum on the X-rays and may allow visualization of polyps.
- Endorectal Ultrasound (EUS): An ultrasound probe is inserted into the rectum. The probe sends out sound waves (out of range of human hearing) that bounce off the rectum and nearby tissues, and a computer-generated picture is created from the echoes. An EUS may show how deep a rectal tumor has grown or if the cancer has spread to lymph nodes or other nearby tissues.
- Fecal Occult Blood Test (FOBT): During an FOBT, a stool sample is examined for blood. An FOBT is recommended once per year, with any positive test results followed by a colonoscopy.
- Flexible Sigmoidoscopy: During a sigmoidoscopy, a lighted tube is placed in the rectum, allowing a healthcare provider to observe abnormal growths. A flexible sigmoidoscopy is recommended every 5 years, with all positive tests followed by a colonoscopy.
Once colorectal cancer is diagnosed, the disease is staged:
| Colon and Rectal Cancer Stages | |||||
|---|---|---|---|---|---|
| Stage | Primary Tumor (T) |
Lymph Nodes (N) | Metastasis (M) | Dukes | MAC |
| 0 | Tis | N0 | M0 | – | – |
| I | T1 | N0 | M0 | A | A |
| T2 | N0 | M0 | A | B1 | |
| IIA | T3 | N0 | M0 | B | B2 |
| IIB | T4 | N0 | M0 | B | B3 |
| IIIA | T1-T2 | N1 | M0 | C | C1 |
| IIIB | T3-T4 | N1 | M0 | C | C2/C3 |
| IIIC | Any T | N2 | M0 | C | C1/C2/C3 |
| IV | Any T | Any N | M1 | – | D |
| Colon and Rectal Cancer TNM Staging Guide | |
|---|---|
| Primary Tumor (T) | |
| TX | Primary tumor cannot be assessed |
| T0 | No evidence of primary tumor |
| Tis | Carcinoma in situ: intraepithelial or invasion of lamina propria. (Tis includes cancer cells confined within the glandular basement membrane [intraepithelial] or lamina propria [intramucosal] with no extension through the muscularis mucosae into the submucosa.) |
| T1 | Tumor invades submucosa |
| T2 | Tumor invades muscularis propria |
| T3 | Tumor invades through the muscularis propria into the subserosa, or into non-peritonealized paracolic or perirectal tissues |
| T4 | Tumor directly invades other organs or structures, and/or perforates visceral peritoneum. (Direct invasion in T4 includes invasion of other segments of the colorectum by way of the serosa; for example, invasion of the sigmoid colon by a carcinoma of the cecum. Tumor that is adherent to other organs or structures, macroscopically, is classified T4. However, if no tumor is present in the adhesion microscopically, the classification should be pT3. The V and L substaging should be used to identify the presence or absence of vascular or lymphatic invasion.) |
| Colon and Rectal Cancer TNM Staging Guide | |
|---|---|
| Regional Lymph Nodes (N) | |
| NX | Regional lymph node metastases cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis in 1 to 3 regional lymph nodes |
| N2 | Metastasis in ≥4 regional lymph nodes |
| Colon and Rectal Cancer TNM Staging Guide | |
|---|---|
| Distant Metastases (M) | |
| MX | Distant metastasis cannot be assessed |
| M0 | No distant metastasis |
| M1 | Distant metastasis present |
| Dukes and MAC Staging | |
|---|---|
| Dukes | A composite of better (T3, N0, M0) and worse (T4, N0, M0) prognostic groups |
| MAC | The modified Astler-Coller classification |
Colorectal Cancer Treatment Options
- Surgery: Surgical removal of the cancer is the most common treatment for colorectal cancer. Factors that may affect the type of surgery include whether the cancer is located in the colon or rectum, the stage of the cancer, and the risks and benefits of surgery. The types of surgery available for the treatment of colorectal cancer include:
- Polypectomy – Recommended for Stage I colorectal cancer, a polypectomy is used to remove the polyp or tumor.
- Laparoscopic surgery – During laparoscopic surgery, a laparoscope attached to a video camera is inserted through a small cut or incision in the abdomen. The laparoscope is used to guide surgical instruments that are inserted through other small abdominal incisions.
- Colostomy – If the tumor has invaded the bowel wall or surrounding tissue, it may be necessary to remove the diseased part of the bowel. Once the tumor is removed, the 2 healthy ends of the bowl are sewn back together. Sometimes the bowel tissue needs more time to heal before the reattachment, and a temporary colostomy is needed. Sometimes the entire lower colon or rectum is removed because it is diseased. In those cases, the colostomy will be permanent.
- Chemotherapy: Oral, intravenous, and injectable chemotherapeutic agents are available to destroy and prevent further growth of cancer cells.
- Liver Resection: Liver resection is recommended typically for stage IV or advanced colorectal cancer.
- Radiation Therapy: A local therapy that utilizes high–energy rays to target cells in the affected area. Radiation therapy is often used to kill the cancer cells that remain after surgery. The 2 main types of radiation therapy are external radiation, which comes from a machine outside the body, and internal radiation, which comes from radioactive material inside thin tubes or pellets placed directly next to or in the tumor.
- Immunotherapy: An outside agent is introduced to stimulate the body's own immune system.
- Clinical Trials: Clinical trials give patients access to investigational approaches and treatments that often are not otherwise available. There are both benefits and drawbacks to participation in clinical trials that patients and healthcare providers should discuss.
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