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colon cancer, colon cancer, adenocarcinoma, carcinoma

Colon cancer: an overview...

Colon cancer is one of the most common cancers in Italy; 30,000 new cases of this disease are diagnosed in our country every year.

The colon is one of the organs that make up thegastroenteric system. As a whole, the organs of the gastroenteric system are concerned with digesting food and absorbing the nutrients and liquids it contains, and eliminating the products that cannot be assimilated with feces. The colon is primarily concerned with absorbing fluids and conducting the stool that results from this process to the rectum, from where it is eliminated.

Colon cancer arises from normal cells that transform into malignant cells. The uncontrolled multiplication of such a group of cells results in the formation of a tumor, that is, a mass in the wall of the viscera, which can bleed, completely occupy its cavity giving rise tointestinal obstruction, and invade neighboring tissues. In addition, malignant cells can spread distantly through lymphatic vessels or the bloodstream, resulting in metastasis

Colon cancer is the third leading cause of cancer death in Western countries; however, if it is diagnosed early, the chance of curing it today is very high.

How does colon cancer develop?

colon cancer, adenoma - carcinoma sequence

Colon cancer arises from a small benign tumor, called a polyp, that can develop in the mucosa of the colon.

The likelihood of a polyp becoming a malignant tumor varies according to its histological features. In this sense, three types of polyps are recognized:

  • Adenomatous polyps: these are precancerous lesions; in turn, they are divided, in ascending order of malignancy, into tubular, tubulo-villous and villous adenomas.
  • Hyperplastic polyps: these lesions are considered benign
  • Inflammatory polyps: benign.

Polyps can be identified and removed by colonoscopy: this is sufficient to prevent the growth of cancer. The transformation of a polyp into cancer is a slow process, which can take more than 10 years of time: therefore, the use, according to protocols well-defined, colonoscopy is the best way to prevent the onset ofcolon cancer .

About 90 percent of polyps are identified and removed during colonoscopy; the remaining 10 percent are flat lesions that are difficult to identify and remove, and therefore have a high risk of giving rise to colon cancer.

The leading International Societies of Gastroenterology and Colorectal Surgery recommend that patients who do not have a positive family history or other specific risk factors forcolon cancer begin prevention by undergoing periodic colonoscopies starting at age 50.

Risk factors for colon cancer

  • Age greater than 60 years
  • African American or Eastern European ethnicity
  • Personal history of neoplasia in other parts of the body
  • Family history of colon cancer
  • Colon polyps
  • Ulcerative rectocolitis
  • Smoking cigarette
  • Obesity
  • Alcohol use
  • Diet high in animal fat and low in fiber
  • Familial adenomatous polyposis
  • Hereditary colon and rectal cancer non-polyposis (HNPCC)
  • Muir-Torre Syndrome
  • Turcot's syndrome
  • Peutz-Jeghers syndrome
  • Juvenile polyposis syndrome

Prevention of colon cancer

Adopting proper lifestyles can significantly reduce the risk of developing colon cancer. The main recommendations are:
  • Modify the diet, enriching it with fruits, vegetables, fiber and water. This facilitates transit and stool elimination, reducing contact of the colon mucosa with potentially carcinogenic substances. In addition, vegetables and fruits are an important source of vitamins and antioxidants. Insufficient intake of vitamins C, E, D and A is correlated with an increased risk of developing colon cancer. Similarly, excessive consumption of red meat and animal fats appears to be correlated with an increased risk of developing cancer.
  • Exercise. This increases the rate of transit of the products of digestion in the colon, and reduces the exposure of the colic mucosa to potentially carcinogenic substances, as well as improving blood flow to the organ itself. TheAmerican Cancer Society recommends at least 30 minutes of physical activity a day.
  • Limit the use of alcohol 
  • Quitting smoking
  • Undergo colonoscopy regularly, starting at age 50 if there is no family history of colon cancer. If there is a family history, one should undergo the first colonoscopy at an age 10 years younger than the age of the family member with cancer at the time of first diagnosis.

Both polyps and colon cancer are absolutely asymptomatic in the early stages of the disease, when their radical cure is easiest. It is a disease that can be prevented or cured if diagnosed early, which is achieved by undergoing screening programs.

colon cancer, diverticulosis, diverticulitis, virtual colonoscopyThe most effective tests for the diagnosis of tumor colon are the colonoscopy and the virtual colonoscopy.

- Colonoscopy is performed by introducing a thin, flexible tube through the anus, which, almost always, allows the endoscopist to visualize the entire colon and, if polyps are visualized, to remove them. The examination usually takes about 20 minutes, involves preparation and is somewhat uncomfortable, so much so that it is often performed with the patient sedated. Sometimes, in cases of special anatomical conformations of the colon, the examination cannot be completed.

- Virtual colonoscopy is a radiological examination: the patient takes a CT scan of the abdomen and, with special software, a three-dimensional image of the colon is reconstructed. It is a very detailed examination that allows visualizing polyps from 6 mm in diameter (definitely benign). It is, moreover, a very fast examination, and not limited, unlike traditional colonoscopy, by the presence of particular anatomical conformations of the colon. It, too, requires preparation and is not uncomfortable for the patient.

Occult blood in the stool is one of the common screening examinations and involves looking for the presence of blood in the stool. If blood is present, the patient is referred for a colonoscopy. This is an unspecific and insensitive test: if, in fact, blood is present, it can result from many causes (e.g., diverticula or hemorrhoids); if, on the contrary, it is absent, it does not rule out the possibility of polyps or even a colon tumor that does not bleed.

colon cancer, DNA, fecal DNA testingTests that search for the Tumor DNA in stool; they are based on the principle that the mucosa of the colon undergoes rapid turnover, and that the shedding cells mix with the feces: if they are present cells from a colon tumor, even in small amounts, it is possible to assay their DNA, which is different from that of normal cells. This is a very sensitive and extremely specific test.

Both occult blood and fecal DNA testing are absolutely noninvasive tests.

The staging of colon cancer

If colon cancer is present, it is important to know what stage it is, that is, to what extent it invades the colon wall and neighboring organs, and whether or not it has spread to other distrtects of the body. Colon cancer staging is usually performed with a CT scan of the abdomen with contrast medium.

Four stages of increasing disease severity are recognized:

  • - Stage I: cancer is limited to the innermost layers of the colon wall
  • - Stage II: Cancer extends to the muscular, outer layers of the colon wall
  • - Stage III: cancer has reached the lymph nodes
  • - Stage IV: cancer has metastasized to other organs
Colon cancer surgery

Treatment depends on the stage, but surgery is always contemplated. Surgery may be preceded and/or followed by radio- or chemotherapy, and involves the removal of a section of the colon containing the tumor, the length of which varies depending on the severity of the cases. The surgeons at Cuccomarino, MD perform many dozens of colon cancer surgeries each year, and are specifically trained in the treatment of this disease. Surgery is performed, except for exceptional contraindications, laparoscopically and using all the latest technologies, so that the operative trauma for the patient is minimal and discharge can be as early as possible. The approach to the patient is always multidisciplinary, in collaboration with radiologists, gastroenterologists, anatomic pathologists, radiation oncologists and oncologists, so that an integrated network of professionals ready to follow the patient through all stages of treatment is available to those suffering from colon cancer.



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