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Colorectal Cancer

Colorectal cancer is the third leading cause of cancer-related deaths in the United States among both men and women. For men, only lung and prostate cancer show higher numbers than colorectal cancer. In women, only lung and breast cancers outrank colorectal cancer. The survival rate after five years is 45%.

Colorectal cancer affects the digestive system, including the large and small intestines. The main section of the large intestine is known as the colon.
The intestines break down and absorb food and water and carry away the body's digestive waste products. Genetic screening can help determine if patients may have a genetic predisposition for developing colorectal cancer. The
GenRISKŪ Program at Cedars-Sinai can assess a person's risk of developing colorectal and related cancers.

Risk Factors

There is no single cause of intestinal cancer, but several risk factors may contribute to its development. Colorectal cancer has been linked with foods, such as red meat, spices, salt preserved or smoked foods and alcohol. Certain genes may also play an important role in developing colorectal cancer. Brothers, sisters and children of those already diagnosed with colorectal cancer have a greater chance of developing the disease later in life.

The GenRISK Program at Cedars-Sinai offers complete genetic risk assessment, counseling and genetic testing to determine whether an individual has the genetic mutations that lead to an inherited predisposition for colorectal cancer. The results of such an assessment can help provide an individual with valuable information on how to manage the risk of getting colorectal cancer or options to consider if he or she is diagnosed as having colorectal cancer.

Colorectal cancer also often occurs when other diseases of the colon, such as ulcerative colitis (ulcers in the lining of the large intestines) and Crohn's disease, are present.

Signs and Symptoms

During the early stages of disease, symptoms may not show up. Signs of the disease may involve a minor change in bowel pattern, rectal bleeding and abdominal tenderness. Symptoms of advanced disease include:

• Anorexia, a feeling of being full very quickly while eating
• Weakness and pain in the abdominal area

Diagnosis

Patients at high risk for getting the disease (having large-intestine ulcers or family history of colon cancer) might think about having screening tests, including:

• Digital rectal exam. The doctor inserts a gloved finger into the rectum to feel for lumps and check for blood in the material that comes from the rectum.
• Sigmoidoscopy. An instrument called a sigmoidoscope is inserted into the rectum and part of the colon to look inside.
• Colonoscopy. An instrument called colonoscope is used to examine the rectum and the entire colon.
• CT scan. A special X-ray creates a computerized picture of the colon and rectum.
• Barium enema. The patient drinks a special liquid, which travels through the intestines and allows doctors to look for abnormal growths in the colon and rectum.
• Biopsy. If test results are abnormal, the doctor may remove and examine under the microscope a small piece of the tumor.

Screening has been highly effective for detecting early stage colorectal cancer. It is recommended that individuals not considered at risk and without symptoms should have an annual digital rectal exam beginning at age 40. Persons older than 50 years of age should have additional screening tests, such as:

• Annual occult blood test. A sample of stool is tested in the laboratory for any blood that may be mixed with the stool.
• Sigmoidoscopy. Exam of the rectum and sigmoid colon using a viewing instrument (sigmoidoscope) and given every three to five years.

Treatment

• Surgery is the primary treatment for colon and rectal cancers. Different surgical procedures can be performed, depending on the size and location of the tumor and the spread of the disease through the abdominal cavity or other sites. In cases where the disease has spread extensively, surgery may not be possible.
• Radiation and chemotherapy. Currently undergoing clinical trials is the use of high-dose X-rays and chemotherapy drugs to kill cancer cells. These may be given before and/or after surgery.

For more information, visit the Colorectal Cancer Program website.