| ICD-9-CM: |
| 153 - | Neoplasm, Colon, Malignant |
| 153.0 - | Neoplasm, Hepatic Flexure of Colon, Malignant |
| 153.1 - | Neoplasm, Transverse Colon, Malignant |
| 153.2 - | Neoplasm, Descending Colon, Malignant; Left Colon |
| 153.3 - | Neoplasm, Sigmoid Colon, Malignant; Sigmoid Flexure |
| 153.4 - | Neoplasm, Cecum, Malignant |
| 153.5 - | Neoplasm, Appendix, Malignant |
| 153.6 - | Malignant Neoplasm, Ascending Colon, Right Colon |
| 153.7 - | Neoplasm, Splenic Flexure of Colon, Malignant |
| 153.8 - | Neoplasm, Other Specified Sites of Large Intestine, Malignant |
| 153.9 - | Neoplasm, Colon, Malignant, Unspecified Site; Large Intestine NOS |
| 197.5 - | Secondary Malignant Neoplasm of Respiratory and Digestive Systems; Large Intestine and Rectum |
| 230.3 - | Carcinoma in Situ of Colon, Appendix, Cecum, Ileocecal Valve, Large Intestine NOS |
| Colon cancer is the third most commonly diagnosed cancer in both men and women in the US ("Overview"). It is a cancer of the lower gastrointestinal tract, characterized by development of cancerous tumors in the large intestine (colon). The large intestine normally receives partially digested food from the small intestine and functions to extract water and nutrients from the food before storing the rest as waste; the waste is then moved from the colon into the rectum, and passed out of the body through the anus. The large intestine consists of four sections: The ascending colon, transverse colon, descending colon, and the sigmoid colon, before ending at the rectum. The term "colorectal cancer" is frequently used to refer to malignancies within these organs. Colorectal cancer can start in any of the four sections of colon, or in the rectum itself. The large intestine and the rectum are comprised of comparable types of tissue, but cancers affecting them can behave differently depending on the location. Please refer to Cancer, Rectum for more details about the distal portion of the GI tract.
Most colorectal cancers begin as polyps, which are growths on the inner wall of the colon or rectum. Many polyps are benign; however, polyps may become cancerous (adenocarcinoma, or cancer arising from cells of the glandular epithelium). Colorectal screening is an important tool in finding cancer early before it has spread to other organs (metastasis), as early detection and treatment helps to increase survival. Studies have shown that early screening and treatment can prevent mortality from colon cancer in up to 90% of cases ("Colon/Rectal Cancer"). A personal history of abnormal tissue masses (polyps) in the colon or a family history of colorectal cancer increases an individual's chances of getting this cancer. Other risk factors include a genetic predisposition (familial adenomatous polyposis and hereditary nonpolyposis syndromes); the presence of inflammatory bowel disease (ulcerative colitis, Crohn's disease); and the presence of other cancers such as breast, ovarian, and endometrial cancer.
Since colon cancer is highly preventable though identification and removal of colon polyps, routine colorectal screening is important to reduce mortality. As polyps are uncommon in individuals younger than 50, screening is recommended for individuals over the age of 50. The American Cancer Society recommends that individuals with history of colorectal polyps or inflammatory bowel disease, or those with a family history of colorectal cancer or other cancers should be screened more frequently. The familial adenomatous polyposis (FAP) gene is rare but predisposes individuals to colorectal cancer; individuals who are positive for this gene should be regularly screened for colon cancer beginning at 15 years of age.
If colon cancer is discovered, it is staged and then treated according to the degree of invasiveness: stage 0, known as carcinoma in situ, is a localized tumor found only in the lining of the colon; stage I is cancer that has grown into the inner wall of the colon; stage II is cancer that extends through the layers of the colon wall and may have invaded nearby tissue; stage III is cancer that has also spread to nearby lymph nodes; and stage IV is cancer that has spread to distant organs (metastasized). Cancers of the ascending colon (on the right side of the abdomen) tend to grow larger than in other sections of the colon before symptoms occur, and may present with occult bleeding. Cancers of the descending or sigmoid colon (on the left side of the abdomen) may show earlier symptoms, may initially present as a bowel obstruction, and may present with overt rectal bleeding.Risk: Risk factors for colon cancer include a diet high in calories, red meat, fat, saturated fat, and low fiber intake. Smoking, alcohol use, and a sedentary lifestyle are also associated with an increased risk of colon cancer; those that smoke have a 30% to 40% increased risk of dying from colorectal cancers than nonsmokers ("Overview").
The risk of colon cancer increases with age; 90% of individuals diagnosed with colon cancer are over the age of 50; men over 50 years of age have a slightly higher risk of colon cancer than women, with 1 in 17 men and 1 in 18 women likely to be diagnosed with colorectal cancer in their lifetime ("Colon/Rectal Cancer"). Jews of Eastern European descent, blacks, and Hispanics have a higher rate of colorectal cancer ("Colorectal Cancer"). Incidence and Prevalence: An estimated 105,000 cases of colon cancer will be diagnosed in the US in 2005 ("Overview"). More than 56,000 people will die from the disease ("Colorectal Cancer"). Colon cancer is by far the most common type of intestinal cancer, and it is the third most commonly occurring malignancy in both men and women in the US ("Overview"). In the US, the highest rates of colon cancer are found in the northeastern and north-central states, the San Francisco Bay Area, and Hawaii; the lowest rates are found in the remaining western and southern states. World incidence of colon cancer is highest in westernized countries such as North America, Northern Europe, Australia, and New Zealand. Rates of colon cancer are 60 times lower in Africa, Asia, and South America, in part reflecting dietary differences in fat and fiber intake (Hassan). |
Source: Medical Disability Advisor
| History: Individuals are usually asymptomatic in the early stages of colon cancer, and often will discover cancer through screening tests. Occasionally, the individual will report no symptoms at all until the tumor grows so large that it causes a bowel obstruction or rupture of the intestine.
However, individuals with colon cancer may report rectal bleeding, changed bowel habits (diarrhea or constipation lasting more than a few days), abdominal pain or cramping that radiates toward the middle of the abdomen (umbilicus) or around the anus (perianal), loss of appetite (anorexia), weakness and fatigue, and nausea and/or vomiting. These symptoms tend to vary depending upon the location of the tumor. In general, if the tumor is located in the segment of colon closest to the small intestine (right or ascending colon), individuals often report abdominal pain, nausea, and vomiting. Tumors in the segment of colon that is farthest from the small intestine and closest to the rectum (left or descending colon) are more likely to cause passage of blood or mucus, an alteration in bowel habits, and a feeling that the bowel is not empty after defecation. Regardless of the tumor's location, weakness and fatigue may be reported due to chronic blood loss, and constipation may alternate with increased frequency and loose stools. Physical exam: Examination with the hands of the abdomen (palpation) may reveal a colonic mass. Abdominal palpation may also reveal an enlarged liver, which suggests that the cancer has spread from the colon to other nearby organs (metastasized). Tests: The most important tests for detection of colon cancer are routine screening tests. Screening tests for average-risk individuals over 50 years of age may include yearly fecal occult blood testing, flexible sigmoidoscopy every 5 years, double-contrast barium enema every 5 to 10 years, and colonoscopy every 10 years.
A chemical test done on a stool sample (fecal occult blood test, or FOBT) can identify blood that may be hidden within the fecal material (occult blood). Diagnostic tests for colon cancer may include an x-ray procedure to visualize the colon (barium enema) or visualization of the entire colon (full colonoscopy) using a flexible viewing instrument (endoscope) that is inserted through the rectum. Flexible sigmoidoscopy can help view the rectum and lower half of the colon, and colonoscopy, which uses a longer type of sigmoidoscope, allows visualization of the entire colon. Colonoscopy also allows a small sample of tissue (biopsy) to be taken from the tumor, which can then be examined microscopically to confirm that it is cancerous (pathological confirmation).
A complete blood count (CBC) can be done to rule out anemia. Additional blood tests, including measurement of a molecule that is associated with cancer cells (carcinoembryonic antigen, or CEA test), a liver enzyme test, and a kidney function test, may indicate the extent of disease spreading (metastasis) from the colon to other organs. A chest x-ray may be used to look for evidence of metastasis into the lungs. The extent of cancer growth (staging) can be determined using harmless, low-energy radio waves (MRI) or computer analysis of x-ray data (CT). Positron emission tomography (PET scan) can be used to visualize colon cancer that may have metastasized. Angiography may be useful to visualize the potential spread of cancer to the liver. Ultrasound from within the colon (endoluminal ultrasound) can provide important information about the depth that colorectal cancers have invaded into or through the bowel wall. |
Source: Medical Disability Advisor
| An evaluation of the degree to which the cancer has spread (staging) is important to determine the type of treatment that the individual should receive and to estimate the individual's long-term survival possibilities. Surgery to remove the cancerous tissue and a small amount of the surrounding normal tissue (partial colectomy) and nearby lymph nodes is the primary treatment for colon cancer. After removal of the tumor, the cut ends of the bowel are sewn together to re-establish the intestinal channel. The individual may require an artificial opening (stoma) of the colon through the abdominal wall for the purpose of bowel elimination (colostomy). A colostomy may be temporary or permanent, depending upon the portion of bowel that was surgically removed. However, a permanent colostomy is seldom needed by individuals who have been surgically treated for colon cancer.
Other surgical approaches include radiofrequency (RF) ablation and cryosurgery. RF may be performed locally under local anesthesia, or through an abdominal incision under general anesthesia. The thermal probe is heated to a specific temperature, and kills the colon cancer cells directly. Cryosurgery uses an instrument to destroy cancer cells by freezing them; this method is commonly used for carcinoma in situ, or stage 0 colon cancer.
Other adjuvant therapies may be performed in addition to surgery, including radiation therapy and chemotherapy. Radiation therapy administered before surgery may reduce tumor size and make it easier to remove the cancerous tissue. Radiation used after surgery helps kill any remaining cancer cells left behind from surgery. Also, radioisotopes implanted into the area of the tumor may minimize the possibility of recurrence.
Chemotherapeutic drugs administered after surgery can help improve survival rates and may be beneficial in preventing recurrence of the disease. Other drugs (analgesics) can be used for pain relief following surgery. Chemotherapy or radiation therapy may also be used to decrease symptoms of bleeding, pain, or intestinal blockage that can occur with advanced stage colon cancer.
Other colon cancer treatment options that are being used in large hospitals and specialty treatment centers include minimally invasive laparoscopic surgery, intraoperative electron radiation therapy (IOERT) that allows radiation to specifically target cancerous tumors during surgery, and ileal pouch/anal anastamosis surgery that allows passage of waste through a pouch made from a piece of small intestine when the colon and rectum have had to be removed. Clinical trials are underway to study the enhancement of the individual's immune response in fighting cancer (immunotherapy). |
Source: Medical Disability Advisor
| Stage I cancer, or cancer that is contained and detected early, has a 5-year survival rate of 90%. If colon cancer does not recur after 5 years, it is considered cured. Individuals with stage II cancer have a survival rate of 75% to 85%, and individuals with stage III cancer have an estimated 40% to 60% survival rate. These three stages of cancer are considered potentially curable; individuals with stage IV cancer rarely live beyond 5 years (Green). |
Source: Medical Disability Advisor
| A regular exercise routine may be useful in reducing the risk of recurrence of colon cancer.
Following abdominal surgery, intermittent positive pressure breathing exercises may help prevent postoperative pulmonary complications. Also, certain exercises may be performed to reduce postoperative pain and speed recovery, including progressive relaxation and deep breathing techniques. Individuals may continue with these exercises until recovery from surgery is complete and pain is no longer noticeable while walking or breathing. |
Source: Medical Disability Advisor
| The stage the disease has reached by the time of diagnosis affects the possible complications of colon cancer. Chronic blood loss at the site of the tumor may result in low concentrations of iron in the blood (iron deficiency anemia). In some cases, the tumor can grow so large that it causes bowel obstruction or rupture of the intestine. A certain type of colonic tumor may occur (carcinoid tumor) that is slow growing and usually without symptoms. However, carcinoid tumors often secrete excessive amounts of compounds that activate blood vessels (vasoactive substances). They can metastasize widely and have effects on the circulatory system. Colonic tumors may enter the lymphatic tissue in the wall of the gut. This can damage the intestinal wall and nearby lymph nodes, causing malabsorption of food. Further metastasis through the lymph system may allow the cancer to spread to neighboring tissues such as the liver and spleen. After treatment there is a chance that the cancer may recur in the colon. |
Source: Medical Disability Advisor
| In the absence of other medical complications, individuals who have had surgery for colon cancer should be able to return to their previous duties. However, those with colostomies may need frequent breaks and emotional support. Some individuals, especially those performing heavy physical labor, may require more sedentary work for a period of time to recover from the weakness and fatigue following surgery, radiation therapy, or chemotherapy. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Is there blood in the stool?
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Is individual anemic due to blood loss?
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Was there obstruction or rupture of the intestine?
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Has individual suffered from nutrition problems due to malabsorption of food?
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Were other conditions, such as irritable bowel syndrome (IBS), diverticular disease, ischemic colitis, inflammatory bowel disease (IBD), infectious colitis, or hemorrhoids, ruled out?
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Was the diagnosis of colon cancer confirmed?
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At what stage of the disease was diagnosis made?
Regarding treatment:
- Did colectomy remove all the cancerous tissue?
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Was colostomy performed? Temporary or permanent? If temporary, what is the time frame for reconstruction? Is individual capable of appropriate colostomy care?
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Assuming bowel resection was performed, are different postoperative drug or radiation therapy treatments needed?
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Are adjuvant therapies a part of the treatment plan?
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What options (radiation therapy, chemotherapy, immunotherapy, or implantation of radioisotopes) would now be appropriate to include?
Regarding prognosis:
- What was the location of the cancer?
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Was condition diagnosed in an early stage?
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Was treatment prompt and appropriate for that stage?
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Has the tumor metastasized into other organ systems?
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Did colonic tumor recur?
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Does individual have an underlying condition that may affect recovery?
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Has individual experienced any complications?
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Is individual depressed or anxious? If so, was a referral made for counseling?
|
Source: Medical Disability Advisor
| "Colon/Rectal Cancer Screening Test." PotentHerbs. 17 Jan. 2005 <http://www.potentherbs.com/shop/colon.cancer.test.html>. "Colorectal Cancer." InteliHealth. 18 Feb. 2004. 19 Sep. 2004 <http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/31560.html#diagnosis>. Green, Robert J. "Colon Cancer." MedlinePlus. National Library of Medicine. 19 Sep. 2004 <http://www.nlm.nih.gov/medlineplus/ency/article/000262.htm>. Hassan, Isaac. "Colon, Adenocarcinoma." eMedicine. Eds. Ludwig G. Strauss, et al. 21 Oct. 2002. Medscape. 17 Jan. 2005 <http://emedicine.com/radio/topic182.htm>. "Overview: Colon and Rectum Cancer." American Cancer Society. 19 Sep. 2004 <http://www.cancer.org/docroot/CRI/CRI_2_1x.asp?rnav=criov&dt=10>. |
Source: Medical Disability Advisor
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