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Clinical Description
Colon cancer is cancer that develops in the large intestine. The colon is the longest part of the large intestine and receives partially digested food from the small intestine. It helps to absorb water and additional nutrients. It is between the small intestine and rectum.
Symptoms of Colon Cancer
Risk Factors of Colon Cancer
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Previous history of colorectal (colon or rectal) cancer or advanced polyps
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Family history of colorectal cancer
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Inflammatory bowel disease (such as Crohn’s or Ulcerative colitis)
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Diets high in fat and red meat and low in fiber, fruits and vegetables.
How Colon Cancer is Diagnosed
There are a variety of methods to diagnose colon cancer.
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Fecal occult blood tests can identify trace amounts of blood in stool suggesting the presence of cancer.
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Sigmoidoscopy is a scope that is inserted into the anus that allows the doctor to view the rectum and only the lower part of the colon. The doctor may sample or remove tissue suspicious that looks suspicious for cancer during this test.
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Colonoscopy is a scope that is inserted into the anus but allows the doctor to view the rectum AND the entire colon. The doctor may sample or remove tissue that looks suspicious for cancer during this test.
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Double contrast barium enema is done by giving an enema with contrast material and then pushing air into the rectum. Several detailed x-rays are obtained for the purpose of showing evidence of cancer.
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Virtual colonoscopy is a test that uses a CT scanner to take a series of detailed x-rays imaging the entire large intestine and may identify cancer.
Treatment Options for Colon Cancer at Tufts Medical Center
The type of treatment for colon cancer depends on the stage or extent of the cancer and its spread.
Colon cancer diagnosed at early stages, such as stage I and most stage II cancers, is treated with surgical removal of the cancer and may not need further chemotherapy treatment.
More advanced stages of colon cancer may be treated with chemotherapy with or without surgery to eliminate colon cancer cells that may have spread elsewhere in the body. For some stage II and most stage III cancers it is recommended to remove the cancer by surgery and then treat with chemotherapy. The chemotherapy helps reduce the chance of the cancer returning.
For patients with metastatic, or stage IV colon cancer, surgery followed by chemotherapy may still be possible if there are only a few metastasis. Most patients, however, will receive chemotherapy alone. Chemotherapy usually consists of one or more of the following agents: 5-fluorouracil, leucovorin, capecitabine, oxaliplatin and irinotecan. More recently biologic agents such as bevacizumab, cetuximab and panitumumab have been used in combination with chemotherapy or on their own.
For more advanced stages of colon cancer, radiation therapy may also be given in addition to chemotherapy. Adding radiation as part of the treatment of colon cancer is typically considered when the tumor has penetrated through the wall of the colon and has grown into another structure within the abdomen that is fixed (for example: the abdominal wall). This therapy is started after recovery from surgery and chemotherapy is typically given during this same treatment period.
The radiation is delivered using 3D conformal external beam irradiation. This allows us to target the tumor precisely and avoid and protect the unaffected bowel as much as possible. The radiation is given in small fractions of dose each day, Monday through Friday, over a period of about 5-6 weeks. Side effects are usually mild and include fatigue, decrease in appetite and loose stools. Our patients have close monitoring by our physicians, nurses and nutritionists while on this daily therapy to be sure to minimize these side effects.
In selected patients with a small number of liver or lung metastasis, localized treatment to these sites may be offered. When possible, surgical removal of the metastatic tumors is performed. In cases where surgery is not able to be done, highly focused radiation, called stereotactic body radiation, can be offered for treatment. In this treatment, higher doses of radiation are delivered over a few days (3-5) rather then over several weeks.
Clinical Trials Available for Patients
Our patients have access to novel therapies through participation in both Tufts Medical Center clinical trials and national clinical trials.
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Our Experts
For more information about Tufts Medical Center’s Gastrointestinal and Colorectal Cancer Program and our expert medical resources
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