How does right-sided colon cancer differ from left-sided. What are the unique characteristics of ascending colon cancer. Why is early detection crucial for right-sided colon tumors. How does the location of colon cancer impact treatment approaches. What screening methods are most effective for right-sided colon cancer.

The Significance of Colon Cancer Location: Left vs. Right Side

The location of colon cancer plays a crucial role in its development, symptoms, and treatment. Dr. Anthony Dakwar, a colon and rectal surgeon at Roswell Park Comprehensive Cancer Center, emphasizes the importance of understanding the differences between left-sided and right-sided colon cancers. These distinctions can significantly impact patient outcomes and treatment strategies.

Key Differences Between Left-Sided and Right-Sided Colon Cancers

• Development process and speed
• Symptom presentation
• Aggressiveness of the cancer
• Response to chemotherapy
• Genetic factors

Understanding these differences is crucial for both patients and healthcare providers in developing effective treatment plans and improving overall outcomes.

Characteristics of Left-Sided Colon Cancer

Left-sided colon cancers, which occur in the descending and sigmoid parts of the colon, are often considered more conventional in their development and behavior. What are the typical characteristics of left-sided colon cancer?

• Develops through a traditional pathway
• Often starts as simple colon polyps
• Slow-growing, taking several years to develop
• More likely to cause noticeable symptoms earlier
• Generally responds well to standard chemotherapy regimens

The slow development of left-sided colon cancers makes them more amenable to detection through regular screening procedures, such as colonoscopies. This characteristic underscores the importance of adhering to recommended screening guidelines.

Understanding Right-Sided Colon Cancer: Focus on Ascending Colon

Right-sided colon cancers, particularly those in the ascending colon, present unique challenges in terms of detection and treatment. How do these cancers differ from their left-sided counterparts?

• More likely to occur in individuals with genetic predispositions
• Often develop from flat polyps rather than mushroom-shaped ones
• Tend to grow more rapidly
• Higher risk of metastasis
• May be resistant to standard chemotherapy treatments

The genetic makeup of right-sided colon cancers, including those in the ascending colon, often contributes to their aggressive nature and treatment resistance. This genetic distinction necessitates a more tailored approach to treatment.

Genetic Factors in Ascending Colon Cancer

The genetic landscape of ascending colon cancer plays a significant role in its development and behavior. What are the key genetic factors associated with right-sided colon cancers?

• Lynch Syndrome
• Microsatellite instability
• Atypical genetic mutations

These genetic factors not only increase the risk of developing right-sided colon cancer but also influence its growth rate and response to treatment. Understanding these genetic components is crucial for developing targeted therapies and personalized treatment plans.

Challenges in Detecting Right-Sided Colon Cancer

One of the significant challenges in managing right-sided colon cancers, including those in the ascending colon, is their often asymptomatic nature in early stages. Why are right-sided colon cancers frequently diagnosed at later stages?

• Lack of early symptoms
• Location in the larger, more expansive part of the colon
• Symptoms may only appear when the tumor is large or advanced

The absence of early symptoms in right-sided colon cancers underscores the critical importance of regular screening, even in the absence of noticeable symptoms. Early detection through screening can significantly improve treatment outcomes and survival rates.

Innovative Treatment Approaches for Ascending Colon Cancer

Given the unique characteristics of right-sided colon cancers, including those in the ascending colon, innovative treatment approaches are crucial. What strategies are being employed to address the challenges posed by these cancers?

• Personalized treatment plans based on genetic profiling
• Targeted therapies addressing specific genetic mutations
• Immunotherapy approaches
• Combination therapies tailored to individual tumor characteristics

Dr. Dakwar emphasizes the importance of a multidisciplinary approach in treating colon cancer, regardless of its location. This collaborative effort ensures that patients receive comprehensive care that addresses all aspects of their condition.

The Role of Screening in Preventing Ascending Colon Cancer

Given the challenges in detecting right-sided colon cancers early, screening plays a pivotal role in prevention and early intervention. What are the most effective screening methods for right-sided colon cancer?

• Colonoscopy
• Virtual colonoscopy (CT colonography)
• Stool-based tests (FIT, gFOBT, multi-target stool DNA test)

Dr. Dakwar emphasizes that colonoscopy remains the gold standard for colon cancer screening, as it can detect polyps and early cancers throughout the entire colon. The ability to remove precancerous polyps during the procedure makes colonoscopy both a diagnostic and preventive tool.

Updated Screening Guidelines

Recent updates to screening guidelines reflect the increasing incidence of colon cancer in younger individuals. What are the current recommendations for colon cancer screening?

• Begin regular screening at age 45 for average-risk individuals
• Earlier screening for high-risk groups (e.g., African Americans, those with family history)
• Personalized screening schedules based on individual risk factors

Adhering to these guidelines is crucial for early detection and prevention of colon cancer, particularly for right-sided tumors that may not present symptoms until advanced stages.

Emerging Research in Ascending Colon Cancer

The field of colon cancer research is rapidly evolving, with new insights emerging regularly. What are some of the latest areas of research focusing on right-sided colon cancers?

• Molecular profiling to identify new therapeutic targets
• Development of more sensitive screening techniques
• Investigation of microbiome influences on cancer development
• Exploration of novel immunotherapy approaches

These research efforts aim to improve our understanding of right-sided colon cancers and develop more effective prevention, detection, and treatment strategies. The ongoing studies hold promise for improving outcomes for patients with ascending colon cancer and other right-sided colon malignancies.

Living with Ascending Colon Cancer: Patient Perspectives

Understanding the patient experience is crucial in providing comprehensive care for those with ascending colon cancer. How does living with right-sided colon cancer impact patients’ daily lives?

• Coping with treatment side effects
• Adapting to dietary changes
• Managing emotional and psychological impacts
• Navigating follow-up care and surveillance

Patient experiences highlight the importance of a holistic approach to care that addresses not only the physical aspects of the disease but also the emotional and practical challenges faced by individuals living with ascending colon cancer.

Support Systems and Resources

A robust support system is essential for patients navigating the challenges of ascending colon cancer. What resources are available to support patients and their families?

• Support groups (both in-person and online)
• Nutritional counseling
• Psychological services
• Patient education programs
• Financial assistance resources

Accessing these resources can significantly improve the quality of life for patients and their caregivers, providing practical support and emotional comfort throughout the treatment journey.

The Future of Ascending Colon Cancer Treatment

As our understanding of colon cancer continues to evolve, so do the treatment approaches. What future developments can we anticipate in the management of ascending colon cancer?

• Precision medicine approaches tailored to individual genetic profiles
• Advanced imaging techniques for earlier detection
• Minimally invasive surgical innovations
• Novel combination therapies targeting specific tumor characteristics

These advancements hold promise for improving outcomes and quality of life for patients with ascending colon cancer. The integration of cutting-edge research into clinical practice is expected to revolutionize the approach to right-sided colon cancers in the coming years.

The Role of Artificial Intelligence in Colon Cancer Care

Artificial intelligence (AI) is increasingly playing a role in various aspects of healthcare, including cancer diagnosis and treatment. How might AI impact the future of ascending colon cancer management?

• Enhanced image analysis for more accurate polyp detection during colonoscopies
• Predictive models for treatment response based on genetic and clinical data
• Automated systems for monitoring patient symptoms and side effects
• AI-assisted surgical planning and navigation

The integration of AI technologies has the potential to improve detection rates, personalize treatment plans, and enhance overall patient care in the context of ascending colon cancer and other colorectal malignancies.

Global Perspectives on Ascending Colon Cancer

Colon cancer incidence and mortality rates vary significantly across different regions of the world. How do global perspectives inform our understanding of ascending colon cancer?

• Variations in dietary patterns and their impact on cancer risk
• Differences in screening practices and healthcare access
• Genetic variations among different populations
• Environmental factors influencing cancer development

Studying these global variations provides valuable insights into risk factors, prevention strategies, and potential therapeutic approaches for ascending colon cancer. International collaborations and data sharing are crucial for advancing our understanding and improving outcomes worldwide.

Cultural Considerations in Colon Cancer Care

Cultural factors can significantly influence healthcare decisions and outcomes. How do cultural considerations impact the management of ascending colon cancer?

• Attitudes towards screening and preventive care
• Cultural beliefs about health, illness, and treatment
• Language barriers in healthcare settings
• Traditional medicine practices and their integration with modern treatments

Addressing these cultural considerations is essential for providing culturally competent care and improving outcomes for diverse patient populations affected by ascending colon cancer.

Empowering Patients: Knowledge and Advocacy in Ascending Colon Cancer

Patient empowerment through education and advocacy plays a crucial role in improving outcomes for those affected by ascending colon cancer. How can patients take an active role in their care?

• Educating themselves about their specific type of colon cancer
• Participating in shared decision-making with their healthcare team
• Advocating for access to cutting-edge treatments and clinical trials
• Sharing their experiences to raise awareness and support others

Empowered patients are better equipped to navigate the complexities of their diagnosis and treatment, potentially leading to improved outcomes and quality of life. Healthcare providers play a crucial role in fostering this empowerment through open communication and comprehensive patient education.

The Role of Patient Advocacy Groups

Patient advocacy groups serve as valuable resources for those affected by ascending colon cancer. What are the key functions of these organizations in supporting patients and advancing research?

• Providing educational resources and support services
• Facilitating connections between patients and healthcare providers
• Advocating for policy changes to improve cancer care and research funding
• Supporting and promoting participation in clinical trials

These organizations play a vital role in amplifying the patient voice and driving progress in the field of colon cancer research and care. Collaboration between advocacy groups, healthcare providers, and researchers is essential for advancing the field and improving patient outcomes.

Does it matter if colon cancer is on the left or right side? | Roswell Park Comprehensive Cancer Center

Roswell Park’s new colon and rectal surgeon, Anthony Dakwar, MD, explains the differences between colon cancers that arise in the right side of the colon compared to those in the left side.

Yes, it does. Several differences can be seen in the colon cancers that begin on the left side, in the descending and sigmoid parts of the colon, compared to those that occur on the right side, in the ascending and cecum portions of the colon, explains Roswell Park Comprehensive Cancer Center’s new colon and rectal surgeon Anthony Dakwar, MD. (Cancers can also develop in the middle, transverse section of the colon, although less commonly.)

The location in the colon where cancer develops is one of the factors that’s considered when developing your customized treatment plan.

The differences between left-sided and right-sided colon cancers include why and how the cancer developed, whether it produces noticeable symptoms, and the cancer’s aggressiveness and how well it responds to usual chemotherapy regimens. “While polyps can occur anywhere in the entire colon, their incidence and their predisposition to turn into cancer can differ depending on where in the colon they arise,” says Dr. Dakwar

Left-sided colon cancers are often ordinary

The cancers that develop on the colon’s left side are more likely to be unremarkable, garden-variety colorectal cancers. These tend to develop in a traditional pathway, Dr. Dakwar explains. “Simple colon polyps, abnormal growths of tissue, experience a sporadic chromosomal change in their cells that, in time, can convert into a cancerous tumor. This process is slow and can take several years, which is why screening with colonoscopy can be performed at several-year intervals.”

Right-sided colon cancers are more unusual

Polyps that develop in the right side of the colon are more likely to occur in people with a genetic predisposition for developing cancer, such as Lynch Syndrome and microsatellite instability. Right-sided polyps are more likely to develop into cancers — which often grow rapidly and have a higher risk for metastasis, spreading to distant body areas.

Right-sided colon cancers also tend to develop from flat polyps rather than the usual mushroom-shaped ones, and are genetically atypical, too. “Differences in the genetic makeup of these tumors often means these cancers are more aggressive and can be resistant to current chemotherapy treatment regimens,” he says.

Both types need multidisciplinary care

The location of your cancer is just one aspect of it that’s contemplated in developing your treatment plan. “For both left- and right-sided colon cancers, unless they are metastatic, upfront surgery is the typical first-line treatment,” says Dr. Dakwar. “However, the key to having successful treatment is a multidisciplinary approach with regards to obtaining personalized and individualized cancer care.” At Roswell Park, your care team will include physicians from various medical disciplines — surgical, medical and radiation oncologists, plus gastroenterologists and pathologists — each bringing their respective expertise to the table.

“Our team ensures that every patient gets evaluated systematically and receives a customized treatment plan. We are able to get patients on cutting-edge clinical trials in order to enhance their treatment plan and provide opportunity for being cancer-free.”

Don’t wait for symptoms — get your screening!

Screening tests look for signs of cancer before it progresses to the point where symptoms may arise. Abdominal symptoms such as pain, bloating or rectal bleeding are often signs of an abnormal process in the left side of your colon. “Right-sided colon cancers tend to be asymptomatic or cause these symptoms only when they are at an advanced stage and fairly large. Right-sided cancers are more likely to be diagnosed at a later stage and this alone makes for a poorer prognosis,” Dr. Dakwar says.

The good news is that screening with colonoscopy can detect polyps and early cancers anywhere in the colon. Getting a colonoscopy screening on time, according to the recommended guidelines, can find and treat precancerous polyps and prevent cancer from forming. “There is no other screening test that can substitute for a colonoscopy,” says Dr. Dakwar.

What is “on time” for your colonoscopy? Most people at average risk should begin regular colon and rectal screening at age 45. But several factors mean you should begin sooner, such as being African American or having a family history of gastrointestinal cancer. Talk to your healthcare provider to learn when you need to schedule your screening.

Colon cancer screening

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Most Common and Rare Forms

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science.

This page was updated on August 11, 2022.

Colorectal cancer develops in the colon or in the rectum. If it starts in the colon, it may be referred to as colon cancer. If it starts in the rectum, it may be called rectal cancer. Regardless of where they start, however, these cancers share a lot in common, which is why they’re together known as colorectal cancer.

The most common type of colorectal cancer is adenocarcinoma. Adenocarcinomas of the colon and rectum make up 95 percent of all colorectal cancer cases. In the gastrointestinal tract, rectal and colon adenocarcinomas develop in the cells of the lining inside the large intestine. These adenocarcinomas typically start as a growth of tissue called a polyp. A particular type of polyp called an adenoma may develop into cancer. Colorectal polyps are often removed during a routine colonoscopy before they may turn cancerous.

While other types of tumors may develop in the colon or rectum, they’re much more rare. Less common types of colorectal cancer include:

• Primary colorectal lymphomas
• Gastrointestinal stromal tumors
• Leiomyosarcomas
• Carcinoid tumors
• Melanomas

This article will cover:

• Types of colorectal cancer
• Rare types of colorectal cancer
• Genetic risks

Types of colorectal cancer

Colorectal adenocarcinoma

“Adeno” is a prefix meaning gland. “Carcinoma” is a type of cancer that grows in epithelial cells, which line the surfaces inside and outside the body. Adenocarcinomas develop in the lining of the large intestine (colon) or the end of the colon (rectum). They often start in the inner lining and spread to other layers.

There are two less common subtypes of adenocarcinomas:

• Mucinous adenocarcinoma is made up of about 60 percent mucus. The mucus may cause cancer cells to spread more quickly and become more aggressive than typical adenocarcinomas. Mucinous adenocarcinomas account for 10 percent to 15 percent of all rectal and colon adenocarcinomas.
• Signet ring cell adenocarcinoma accounts for fewer than 1 percent of all colon cancers. Named for its appearance under a microscope, signet ring cell adenocarcinoma is typically aggressive and may be more difficult to treat.

Most information about colorectal cancer refers to colorectal adenocarcinoma, the most common type. Estimates suggest that 4. 1 percent of people may develop colorectal cancer during their life, according to the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program.

Colorectal adenocarcinoma symptoms generally include:

• Abdominal pain and tenderness
• Blood in stool
• Changes in bowel habits, such as diarrhea or constipation
• Thin stools
• Unexplained weight loss

Getting screened for colon cancer may detect the disease before it starts causing symptoms. The American Cancer Society (ACS) and the U.S. Preventive Services Task Force both recommend adults start colon cancer screening at age 45.

Diagnosing colorectal cancer starts with a colonoscopy, which lets doctors see inside the rectum and colon. If signs of colorectal cancer are discovered during a colonoscopy, other tests will follow. A biopsy may be performed, which involves removing a small piece of potentially cancerous tissue (sometimes during a colonoscopy) and analyzing the sample for the presence of cancer. Once a diagnosis is confirmed by a colonoscopy and a biopsy, blood tests and imaging tests, such as computed tomography (CT) scans and magnetic resonance imaging (MRI) scans, may be used to help learn more about the cancer and whether it’s spread.

Common treatment options for colorectal adenocarcinomas include:

• Surgery
• Chemotherapy
• Radiation therapy
• Targeted therapy

Gastrointestinal carcinoid tumors

Carcinoid tumors develop in nerve cells called neuroendocrine cells, which help regulate hormone production. These tumors are among a group of cancers called neuroendocrine tumors (NETs). Carcinoid tumor cells are slow-growing and may develop in the lungs and/or gastrointestinal tract. They account for about 1 percent of all colorectal cancers and half of all cancers found in the small intestine.

Potential symptoms differ depending on where the tumor grows. A carcinoid tumor in the appendix typically doesn’t cause symptoms, unless it begins to block the pathway from the appendix to the intestine, leading to appendicitis symptoms such as fever, nausea and vomiting.

Tumors in the small intestine or colon may cause stomach cramps and pain, weight loss, tiredness, bloating and other stomach problems. Carcinoid tumors in the rectum may cause pain, bleeding and constipation. In the stomach, carcinoid tumors typically don’t cause symptoms.

Carcinoid tumors also sometimes produce hormones that may lead to various symptoms, depending on the type of hormone. For example, 10 percent of people with these tumors may experience flushing in the face, diarrhea, wheezing and rapid heartbeat due to certain hormone-like substances that are released by the tumor, according to the ACS.

Depending on where they develop, gastrointestinal carcinoid tumors may be discovered in various ways. For example, a tumor in the appendix may be found after it causes appendicitis, and the appendix is removed. Rectal tumors may be detected during routine checkups.

Several tests are used to diagnose carcinoid tumors in the abdominal tract, including blood tests, urine tests, imaging scans, endoscopy and colonoscopy.

Gastrointestinal carcinoid tumor treatment options include:

• Surgery
• Radiation therapy
• Chemotherapy
• Hormone therapy

Rare types of colorectal cancer

Other types of rare colorectal cancers combined account for less than 5 percent of all cases:

Primary colorectal lymphomas

A type of non-Hodgkin lymphoma, this cancer type develops in the lymphatic system, specifically in cells called lymphocytes. Lymphocytes are a type of white blood cell that helps the body fight infections. Lymphoma may develop in many parts of the body, including the lymph nodes, bone marrow, spleen, thymus and the digestive tract. Primary colorectal lymphomas account for 0.5 percent of all colorectal cancers and about 5 percent of lymphomas. This colorectal cancer type usually develops later in life and is more common in men.

Symptoms may include indigestion, bloating, unexplained weight loss, stomach pain, vomiting, diarrhea and other stomach issues. Diagnosis may involve biopsy and endoscopy.

Treatment options vary but may include:

• Chemotherapy
• Radiation therapy
• Surgery

Gastrointestinal stromal tumors

Gastrointestinal stromal tumors are a rare type of colorectal cancer that forms in special cells found in the lining of the gastrointestinal (GI) tract called interstitial cells of Cajal (ICCs). More than 50 percent of GISTs develop in the stomach. While most other GISTs form in the small intestine, the rectum is the third most common location. GISTs are classified as sarcomas, or cancers that begin in the connective tissues, which include fat, muscle, blood vessels, deep skin tissues, nerves, bones and cartilage.

While estimates are uncertain, about 4,000 to 6,000 cases of GIST are diagnosed in the United States every year, according to the ACS. These tumors tend to take a while to grow large enough to start causing symptoms. However, they may cause bleeding in the gastrointestinal tract. Depending on the location of the tumor, blood may show up in vomit or bowel movements. Over time, slow bleeding may lead to a decrease in the amount of red blood cells, a condition called anemia, which causes fatigue and weakness.

Other potential symptoms include:

• Abdominal pain
• Abdominal mass or lump
• Nausea
• Vomiting
• Poor appetite
• Weight loss
• Swallowing problems

The diagnostic process may involve an endoscopy, colonoscopy, biopsy and various imaging tests.

Some smaller GISTs may not need to be treated right away, while others are typically treated with surgery and targeted therapy.

 Colon and rectal leimyosarcomas

Another form of sarcoma, leiomyosarcoma essentially means “cancer of smooth muscle.” The colon and rectum have three layers of the type of muscle affected by leiomyosarcoma, and all three 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.

In the early stages, leiomyosarcomas in the colon or rectum may not cause symptoms. As the cancer progresses, symptoms may include fatigue, weight loss, vomiting blood, changes in stools and other stomach problems. Diagnosis generally includes standard measures, such as a biopsy, blood tests and imaging tests. Treatment typically starts with surgery to remove the tumor. Other treatment options include radiation therapy and chemotherapy.

Colon and rectal melanomas

Most commonly associated with skin cancer, these may start to develop anywhere, including in the colon or rectum, or may spread to the GI tract from the primary melanoma site. Melanomas account for 1 percent to 3 percent of all cancers that develop in the digestive system, according to research published in BMJ Case Reports. How melanomas develop in the colon isn’t well understood, as it’s extremely rare. Diagnosis may involve a biopsy and other tests to determine whether the cancer spread from elsewhere in the body or started in the colon or rectum.

Colorectal melanoma treatment may include:

• Surgery
• Immunotherapy
• Chemotherapy
• Radiation therapy

Colorectal squamous cell carcinoma

This cancer, also known as SCC, is extremely rare in the colon, with fewer than 100 cases reported in the literature as of a 2017 case report in the Journal of Community Hospital Internal Medicine Perspectives. Squamous cell carcinoma is typically associated with skin cancer—it’s the second most common type of skin cancer. Squamous cells are a particular type of cell present in many areas of the body. Squamous cell carcinoma occurs when these cells start growing uncontrollably and become cancerous. The reason why this rarely occurs in the colon and rectum isn’t well understood.

Symptoms may resemble colorectal adenocarcinoma, including stomach issues and changes in stool or bowel habits. Colonoscopy and other tests are used to diagnose this cancer. It’s important to determine whether the cancer started in the colon or rectum, or whether it spread to this region from another area of the body. Treatment isn’t standardized but may include surgery, chemotherapy and radiation therapy.

Familial adenomatous polyposis (FAP)

This accounts for about 1 percent of all cancers in the colon or rectum, according to the ACS. People with this syndrome may develop hundreds or even thousands of colon or rectal polyps. These polyps tend to occur when people with this syndrome are 10 to 12 years old. Nearly all people with FAP develop colorectal cancer during their lifetime, and as a result, some people have their colon removed as a preventative measure.

Genetic risks

If an inherited syndrome associated with colorectal cancer is suspected, the patient may consider undergoing genetic testing. Genetic testing involves taking a sample of blood, hair or other bodily fluids to analyze for DNA mutations linked to cancer or a genetic syndrome. The patient also may be advised to get regular colonoscopies to look for colorectal cancer and to begin screening early.

Peutz-Jeghers syndrome (PJS): This condition causes a particular type of polyp to develop in the gastrointestinal tract, called a hamartoma. This syndrome is inherited from one’s parents and is caused by mutations in a particular gene (STK11). It comes with an increased risk of colorectal cancer and others including breast cancer, ovarian cancer and pancreatic cancer. If colorectal cancer does occur in individuals with PJS, it tends to develop at a younger than average age.

Familial colorectal cancer: Some people inherit genetic syndromes from their parents that increase their risk of getting colorectal cancer. These syndromes come with mutations—in particular, genes that make it more likely that cancer will develop. Examples include Lynch syndrome, familial adenomatous polyposis and other rarer syndromes. Lynch syndrome is associated with about 2 percent to 4 percent of all cancers in the colon or rectum, according to the ACS. People with Lynch syndrome have a high risk of getting colorectal cancer at some point in their lifetime—up to 50 percent. Those who have Lynch syndrome and go on to develop colorectal cancer tend to get the cancer at an earlier than average age.

symptoms and treatment of cancerous tumors in the Federal Scientific and Practical Center of the Federal Medical and Biological Agency

Colon cancer is the most common type of malignant tumor of the gastrointestinal tract. This is a multifactorial disease, which is based on genetic factors, environmental factors, as well as inflammatory pathology of the gastrointestinal tract.

Colon cancer often develops in older patients, against the background of polyps and other changes in the large intestine. In the presence of certain provoking factors, polyps can eventually transform into a malignant tumor. The recommendation to undergo an annual medical examination is due to the timely diagnosis of polyps and other benign neoplasms before their malignancy.

In the treatment of colon cancer, surgical methods, radiation and drug therapy are used. Drug treatment includes chemotherapy, targeted therapy, immunotherapy.

Departments and functions of the colon

The colon, together with the rectum, forms the large intestine, the last section of the digestive tract. In turn, the colon consists of several sections: the caecum with the appendix, the ascending colon, the transverse colon, the descending colon, and the sigmoid colon.

The wall of the colon consists of three layers: mucous, muscular and serous. The growth of the polyp begins from the innermost shell – the mucous layer.

From the small intestine, the digested food bolus enters the colon. The job of the colon is to form stool. At this stage, the bacteria living in the large intestine complete the chemical process of digestion.

Colon cancer symptoms

Colon cancer often causes no symptoms in the early stages. As it progresses, it is accompanied by the following symptoms:

• Prolonged diarrhea or constipation
• Change in character, color, shape of stools, band-like stools, dark brown or black bloody stools
• Bleeding from the rectum
• Persistent abdominal pain, gas, bloating, cramps
• Nausea, vomiting
• Persistent urge to defecate after defecation
• Feeling of incomplete emptying of the bowels after going to the toilet
• Rapid weight loss
• Anemia due to intestinal bleeding
• Fatigue, weakness (symptoms of anemia and tumor intoxication)

Tumor metastases that spread to other organs can give characteristic symptoms of the lesion. Thus, colon cancer metastases to the liver cause jaundice.

Cancer that grows large can close the colon and cause an obstruction. Intestinal obstruction is a life-threatening emergency. If you suspect an obstruction, it is recommended to immediately call an ambulance or consult a doctor.

Obstruction symptoms include:

• Severe, cramping pains in the abdomen that bother regardless of eating
• Absence of stool and passing flatus
• Sharp, sudden swelling, rumbling in the abdomen
• Multiple vomiting

Tumor stages

It is possible to determine the stage of colon cancer only after examining the patient.

Doctors use the TNM staging system, where T (tumor) is the size of the tumor, N (nodus) is spread to the lymph nodes, M (metastasis) is the presence of metastases in other organs and structures of the body. The stage of the cancer indicates the extent of spread and size of the tumor.

There are five stages of colon cancer:

• Stage 0 (carcinoma in situ) . This stage identifies abnormal or precancerous cells in the mucosal layer, the innermost layer of the colon.
• Stage 1. The tumor has invaded the mucosa but has not spread beyond the muscle layer or to nearby lymph nodes.
• Stage 2. The cancer has spread beyond the muscle layer to the outer serous layer of the colon wall, and possibly to adjacent organs.
• Stage 3. Growth of a cancerous tumor through all layers with spread to the lymph nodes.
• Stage 4. Metastasis of a cancerous tumor to the liver, lungs, ovaries.

Causes

Colon cancer occurs when abnormal (abnormal) cells grow and divide uncontrollably. In this case, the process of programmed cell death is disrupted. Cancer is growing steadily. Until the end, the causes of the appearance of abnormal cells and precancerous polyps, from which cancer is formed, remain unclear. Certain factors increase the risk of polyps turning into cancer. These factors include certain diseases, including hereditary, as well as lifestyle.

Lifestyle factors:

• Smoking. Tobacco use, including e-cigarettes, increases the risk of developing cancer
• Alcohol. Alcohol abuse increases the risk of colon cancer
• Obesity. Obese people have a higher risk of developing cancer and dying from colon cancer
• Insufficient physical activity. Regular physical activity reduces the risk of colon cancer
• Low fiber diet , high fat, red meat.

Medical factors in the development of cancer:

• Inflammatory bowel disease. It includes ulcerative colitis, Crohn’s disease, conditions that increase the risk of developing cancer. The risk increases if the duration of the inflammatory disease in history is seven years or more.
• Hereditary syndromes that increase the risk of developing a tumor of the colon, such as familial adenomatous polyposis, Lynch syndrome (hereditary non-polyposis colorectal cancer). A small percentage of cancers are associated with gene mutations.
• Diabetes mellitus. People with diabetes have an increased risk of developing cancer.
• Cases of bowel cancer in a relative of the first line – mother, father, brother, sister
• Radiation therapy. Radiation therapy for previously diagnosed abdominal cancer increases the risk of colon cancer

Colon cancer diagnostics

If colon cancer is suspected, the doctor conducts a survey, performs a standard physical examination. The examination also includes performing a digital rectal examination, as well as palpation of the abdomen for seals.

The doctor orders laboratory blood tests, such as a complete and biochemical analysis, to determine or rule out iron deficiency anemia. Anemia occurs as a result of bleeding from the tumor.

Laboratory tests also include the study of feces for occult blood, the determination of the level of cancer embryonic antigen (CEA). Cancer embryonic antigen is a protein-based chemical that is synthesized in colon cancer. It is a marker of cancer. Controlling the level of CEA over time helps to assess the prognosis and understand how the cancerous tumor responds to treatment.

Flexible sigmoidoscopy

Flexible sigmoidoscopy – examination of the anus, rectum and sigmoid using a sigmoidoscope. The device is a flexible endoscope equipped with a video camera for visualizing the mucous layer, no more than sixty centimeters long.

Colonoscopy

Colonoscopy is an invasive endoscopic examination of the inside of the large intestine using a flexible, thin endoscope. The endoscope is equipped with a camera for examining the mucosa. If any suspicious areas are found, the doctor inserts surgical instruments, takes a tissue sample for histological examination, and also removes polyps. Colonoscopy requires careful preparation, taking medications to cleanse the intestines. It is performed both at the screening stage and when a malignant tumor of the colon is suspected.

Colonoscopy is a highly effective diagnostic and treatment method. Unlike sigmoidoscopy, colonoscopy examines all parts of the large intestine.

CT colonography

CT colonography, also known as “virtual colonoscopy”. The method is based on the use of a CT scanner to create a three-dimensional image of the colon and rectum. During the test, gas is used to inflate the intestines with a thin, flexible tube. Then perform computed tomography in different projections. As before a colonoscopy, you need preparation in the form of bowel cleansing. This study is indicated for patients who, for whatever reason, are contraindicated in performing a colonoscopy.

Prevention

Knowing about cases of colon cancer in the family is important for timely screening. If risk factors are present, doctors recommend screening at age 45, or 10 years younger than the age at which a relative was diagnosed with colon cancer. People at increased risk, such as those with a history of familial polyposis, should consider screening earlier. Screening includes performing a colonoscopy, taking a stool test for occult blood. Colonoscopy is recommended every 10 years. The study of feces for occult blood is carried out 1 time in 2 years.

Lifestyle recommendations include:

• Complete, balanced nutrition. Inclusion in the diet of fiber, vegetables, fruits, whole grains
• Smoking cessation
• Drinking a reasonable amount of alcohol
• Active lifestyle with regular moderate to vigorous exercise
• Maintaining a healthy weight

Colon cancer treatment at FNCC

The Federal Research and Clinical Center for the treatment of colon cancer uses surgical methods and drug therapy. Drug treatment includes chemotherapy, targeted therapy, immunotherapy. When choosing a method, a multidisciplinary team of doctors takes into account the location, stage of the tumor, the aggressiveness of the cancer, the degree of spread, general health, and also takes into account chronic comorbidities.

Early treatment

Surgery at an early stage of cancer involves a minimally invasive procedure:

• Removal of polyps during colonoscopy. Cancer localized in the polyper at an early stage and without spread is removed completely during endoscopy.
• Endoscopic mucosal resection. The procedure involves the removal of a larger polyp and part of the submucosa using endoscopic instruments.
• Laparoscopic intervention. During laparoscopy, polyps are removed that are difficult to remove endoscopically

Treatment of common forms

If a cancerous tumor grows through all layers, an operation is performed to remove a section of the large intestine – resection of a part of the large intestine with a tumor:

• Open colon resection. During the operation, the surgeon makes an incision on the anterior abdominal wall and removes the area of ​​the colon affected by the tumor, with certain groups of lymph nodes.
• Laparoscopic colon resection. The difference with the open type of operation is only in online access. Laparoscopy involves the creation of several accesses – incisions with the introduction of laparoscopic surgical instruments and a video camera. During the operation, in both cases, nearby lymph nodes are removed. Laparoscopy is currently the preferred surgical method, routine in most medical organizations. It is less painful, provides faster patient recovery compared to open surgery.

The operation to remove a section of the colon is completed either by suturing the two ends of a healthy intestine, or by creating a stoma. The formation of a stoma involves the creation of an opening in the abdominal wall and the opening of the intestinal lumen into the opening to preserve the passage of the stool. The stoma may be temporary until it heals, or permanent if stitching is not possible.

Chemotherapy

Chemotherapy for bowel cancer, which consists in taking drugs against cancer cells, is performed at different stages of treatment:

• Before surgery in combination with radiotherapy to reduce the initial size of the tumor
• After surgery to reduce the risk of recurrence
• Palliative chemotherapy to slow the progression of advanced cancer, reduce symptoms

Chemotherapy can be oral, intravenous, or combined. It is carried out in courses lasting 2-3 weeks, depending on the stage of the disease.

Side effects of chemotherapy include:

• Fatigue, weakness
• Diarrhea
• Nausea, vomiting
• Mouth ulcers
• Hair loss
• Numbness, tingling, burning sensation in arms and legs
• Weakening of the immune system, increased susceptibility to infectious diseases

These symptoms disappear gradually after the completion of the course of treatment.

Radiotherapy

Radiation therapy is based on energy sources, such as X-rays, that can destroy a cancerous tumor. Radiotherapy is used before surgery to reduce the size of the tumor. When surgery is not possible, radiation therapy is given as palliative care to relieve symptoms.

Targeted therapy

Targeted therapy involves taking drugs that affect the biological processes of cancer cells, blocking their spread in the body. The drugs target receptors located on the surface of cancer cells. Blocking the receptors stops tumor growth.

Immunotherapy

Immunotherapy involves the administration of drugs that act on the immune system to stimulate the fight against cancer. Cancer cells synthesize substances that make the tumor “invisible” to the immune system. Immunotherapy stimulates antibodies to recognize molecules on the surface of cancer cells and bind to them.

In the Department of Surgery No. 1 of the Federal Research and Clinical Center of the Federal Medical and Biological Agency of Russia, all types of surgical treatment of colon cancer are performed, including the minimally invasive method. The employees of the department are certified in the specialty “oncology” and “coloproctology”, they are proficient in all methods of surgical treatment. For the development and introduction into clinical practice of new minimally invasive methods in oncology, in 2018, the staff of the department was awarded the Prize of the Government of the Russian Federation in the field of science and technology.

Treatment prices

Chemotherapy

Surgery

Primary appointment (examination, consultation) with an oncologist

2,250 ₽

Repeated appointment (examination, consultation) with an oncologist

1,950 ₽

Medical colonoscopy. Endoscopic resection of the mucous membrane

47 450 ₽

This article is informational material and is not intended for self-diagnosis and self-treatment. If signs of discomfort appear, you should contact your doctor.

Colon cancer – symptoms and signs, diagnosis

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Colon cancer is an oncological disease that affects part of the intestine, the functions of which include reabsorption of fluid and the formation of feces.

Colon cancer is classified into adenocarcinoma, neuroendocrine and squamous cell tumors. It is possible to determine the histological form of the disease only after the diagnosis of the neoplasm using endoscopy and surgery.

Colon cancer – stages

Colon cancer is classified by a single international methodology that determines the course of the disease depending on the symptoms and signs of the development of the disease. A common designation for the development of colon cancer is used to predict effective treatment among physicians and scientific research.

The staging of the disease depends on the spread of cancer cells in the body. From the site of the tumor to its metastasis to other organs.

Stage 1 – a neoplasm is diagnosed only in the tissues of the colon,

Stage 2 – germination of cancer cells in the intestinal cavity,

Stage 3 – the tumor spreads to the lymphatic vessels and nodes,

Stage 4 – metastasis to other organs.

Colon cancer – symptoms

This dangerous disease in the early stages is asymptomatic. Signs of colon cancer appear as early as stages 3 and 4. Symptoms include pain in the middle of the abdomen, indigestion, and discharge of blood and mucus. The general well-being of a person is also deteriorating. Intoxication of the body with cancer cells is detected by such signs as fever, weakness, fatigue, loss of appetite and, as a result, weight loss.

Diagnosing the general condition of the body and conducting preventive examinations allows you to identify colon cancer before the onset of symptoms and signs, which helps to organize the correct treatment regimen.

Colon cancer – causes of development

The causes of colon cancer are:

• genetic heredity,

0024

• chronic inflammatory intestinal diseases,
• bad habits,
• sedentary lifestyle.

Colon cancer – diagnosis

The patient’s complaints and symptoms of the disease usually begin with intestinal colic. At a consultation with a specialist, the reasons for the occurrence of signs of disruption of the internal organs and general condition are clarified.

Colon cancer in some cases can be identified at the initial examination by palpation of the abdominal cavity. After that, endoscopic examinations are prescribed with the taking of biomaterial. This study allows the doctor to determine the size, nature and stage of the tumor, which is extremely important for the percentage of possible recovery.

If it is impossible to use the endoscopic method of treatment, irrigoscopy is prescribed, which also helps to assess the nature of the neoplasm. Computer diagnostics allows you to determine the stage of the disease and the spread of cancer cells in the body. Colon cancer can be complicated by concomitant pathologies, so it is necessary to prescribe examinations of blood vessels, lymph nodes, lungs and heart, as well as blood and urine tests.

Colon cancer – treatment

Colon cancer is treated by available combined methods, with the use of surgery and chemotherapy.

Depending on the signs of the tumor and the symptoms of the patient, several types of treatment are selected. The staging of colon cancer allows you to either immediately perform a radical removal of the tumor site, or to carry out a complex of supporting procedures.

In the first and second stages, only part of the intestinal cavity can be removed. If the colon cancer has progressed to the lymph nodes, then they are removed too. After resection of part of the intestine, chemotherapeutic treatment is performed. Taking specialized drugs reduces the risk of relapse, and also helps to relieve a large number of symptoms of the disease. But after taking chemotherapy, side effects may occur. Inflammatory processes in the oral cavity, reactions on the skin, digestive disorders and a decrease in blood sprouts. Such side effects are corrected by changing drugs to reduce symptoms.

Colon cancer is also treated with modern treatments such as HiFu therapy. This is an improved analog of radiation therapy, which allows high-frequency ultrasound exposure to the intestinal cavity through the peritoneum.

A feature of the rehabilitation period of colon cancer is the setting of an intestinal stoma. Such a measure is necessary for the healing of the resection site and is removed after 3-6 months from the date of the operation.

Colon cancer treatment has a favorable outcome that can be maintained for many years.