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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Cancer, Colon


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Duration Trends | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
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
153.6 - 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
211.3 - Polyp of Colon
230.3 - Carcinoma in Situ of Colon, Appendix, Cecum, Ileocecal Valve, Large Intestine NOS
235.2 - Neoplasm of Uncertain Behavior of Stomach, Intestines and Rectum

Related Terms

  • Bowel Cancer
  • Cancer of the Colon
  • Cancer of the Large Intestine
  • Colorectal Cancer

Overview

Colon cancer is a cancer of the lower gastrointestinal tract characterized by development of cancerous (malignant) tumors in the large intestine (colon). It is the third most commonly diagnosed cancer in both men and women in the US; the majority of colon cancers are primary adenocarcinoma, a type of cancer arising from cells of the glandular epithelium (Hassan).

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 by wave-like motions of the muscular intestinal wall (peristalsis) 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 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 composed of similar types of tissue, but cancers affecting them can behave differently, depending on the location. Please refer to Cancer, Rectum, for more details about cancer of 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, but polyps may become cancerous (primary adenocarcinoma). Colorectal screening is an important tool in finding cancer early before it has spread to other organs (metastasis). Studies have shown that early detection and the removal of adenomatous polyps has the potential to improve the 5-year survival rate, which is shown to be about 90% in those diagnosed in an early stage ("Cancer"). Because polyps are uncommon in individuals younger than 50, screening is recommended for individuals over the age of 50. The American Cancer Society recommends more frequent screening in individuals with a history of colorectal polyps or inflammatory bowel disease, or in those with a family history of colorectal cancer or other cancers. 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 from early adulthood, since their risk of developing cancer is extremely high (Hassan).

If colon cancer is discovered, it is staged and then treated according to the degree of invasiveness. The more recent staging system is the tumor/node/metastasis (TNM) system from the American Joint Committee on Cancer (AJCC), which corresponds almost exactly to the older Duke's classification system. The TNM system defines the following stages: stage 0 is a localized tumor found only in the lining of the colon (carcinoma in situ); stage I (Duke's A) is cancer that has grown into the inner wall of the colon; stage II (Duke's B) is cancer that extends through the layers of the colon wall and may have invaded nearby tissue; stage III (Duke's C) is cancer that has also spread to nearby lymph nodes; and stage IV (Duke's D) is cancer that has spread to distant organs (metastasized), most commonly the lungs, liver, or bone. 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.

Incidence and Prevalence: Colon cancer is the most commonly diagnosed gastrointestinal (GI) cancer and the third most common malignancy found in men and women (Hassan). The American Cancer Society estimated that 102,900 cases of colon and rectum cancer would be diagnosed in the US in 2010, compared to 105,000 cases of colon cancer diagnosed in 2005 (“Cancer”). 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 (Hassan).
The world incidence of colon cancer is highest in westernized regions and countries such as North America, northern Europe, Australia, and New Zealand and is believed to be a factor of the high-fat, low-fiber diet in developed countries. The 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



Causation and Known Risk Factors

Risk factors for colon cancer include a diet high in calories, red meat, and saturated fat and low in fiber; a family history of the disease; a prior diagnosis of colon polyps or cancer, or inflammatory bowel disease; and a sedentary lifestyle (“Colorectal Cancer”).

The risk of colon cancer increases with age: 90% of individuals diagnosed with colon cancer are over the age of 50. Although men and women are generally equally affected, men over 50 years of age have a slightly higher risk of colon cancer than women (Hassan), with 1 in 17 men and 1 in 18 women likely to be diagnosed with colorectal cancer in their lifetime (“Cancer”). The risk varies among racial and ethnic groups in the US: Alaska natives have the greatest likelihood of developing the disease, second are whites and African Americans, and least likely are Hispanics and Filipinos (“Colorectal Cancer”).

A personal history of abnormal tissue masses (polyps), prior malignancy in the colon, or a family history of colorectal cancer increases an individual's risk of developing this cancer. Some individuals may have a genetic predisposition to colorectal cancer associated with the genes for familial adenomatous polyposis (Gardner syndrome, Turcot syndrome) and hereditary nonpolyposis syndromes. Individuals who have inflammatory bowel disease (e.g., ulcerative colitis and Crohn's disease) or other cancers (e.g., breast, ovarian, and endometrial cancer) are also at increased risk of developing colorectal cancer.

Source: Medical Disability Advisor



Diagnosis

History: Individuals are usually asymptomatic in the early stages of colon cancer, some for up to five years, 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 blood in the feces, changed bowel habits (diarrhea or constipation lasting more than a few days), cramping or abdominal pain 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.

A complete history of personal and family illness is usually obtained as an aid in diagnosis.

Physical exam: Examination of the abdomen by touch (palpation) may reveal a colonic mass. Abdominal palpation may also reveal an enlarged liver (hepatomegaly), which suggests that the cancer has spread from the colon to other nearby organs (metastasized). Digital rectal examination may be done and a stool sample obtained for occult blood determination. Signs of general health status are observed.

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 a chemical test done annually on a stool sample (fecal occult blood test, or FOBT), flexible sigmoidoscopy every 5 years, double-contrast barium enema every 5 to 10 years, and colonoscopy every 10 years. Double-contrast barium enema is able to detect about 90% of colon tumors (Hassan).

FOBT can identify blood that may be hidden (occult blood) within the fecal material. 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 fiber-optic 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 (60- to 180-cm) flexible colonoscope, 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 (histopathological 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); a special CT scan staging system includes stages T1 through T4, ranging from intraluminal polypoid mass with no thickening of the bowel wall to gradations of thickening, thickening with invasion outside the intestinal wall, and distant metastases. Positron emission tomography (PET scan) with fluorodeoxyglucose (FDG) is of value in detecting recurrent disease and to visualize colon cancer that may have metastasized. Angiography may be useful to evaluate the potential spread of cancer to the liver and to diagnose metastasis to the liver and other organs. Ultrasound from within the colon (endoluminal ultrasound) can provide important information about how far colorectal cancers have invaded into or through the bowel wall. Ultrasound may also be used to determine if colorectal cancer has metastasized to the liver and other organs.

Source: Medical Disability Advisor



Treatment

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 (resect) 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 (anastomosis) to reestablish the intestinal channel. In more extensive surgery in which more of the rectum is excised (abdominoperineal resection), 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. An ileal pouch/anal anastomosis surgery allows passage of waste through a pouch made from a piece of small intestine when the colon and rectum have had to be removed. In rare cases of metastatic colon cancer, the rectum, bladder, prostate, uterus, or other organs to which cancer has spread may require resection (pelvic exenteration); this aggressive surgery will require a colostomy as well as drainage for urine.

Other surgical approaches for early-stage cancer confined to the colon include radiofrequency (RF) ablation and cryosurgery. RF ablation 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 cancer cells left behind from surgery. Radioisotopes may sometimes be implanted into the area of the tumor to minimize the possibility of recurrence.

Chemotherapeutic drugs administered after surgery can help improve survival rates, more effectively manage metastatic colorectal cancer, and help prevent recurrence of the disease. Certain newer chemotherapeutic agents inhibit the formation of blood vessels that maintain a tumor (antiangiogenic drugs), resulting in destruction of the tumor. The choice of advanced chemotherapeutic and immunologic agents has expanded in recent years, making a significant difference in survival rates for colon cancer patients. 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 obstruction that can occur with advanced stage colon cancer. Obstruction may also be treated with stent placement to improve the patient’s condition temporarily and possibly to avoid emergency surgery.

Other colon cancer treatment options that are being used in large hospitals and specialty treatment centers include minimally invasive laparoscopic surgery and intraoperative electron radiation therapy (IOERT), which allows radiation to specifically target cancerous tumors during surgery. Clinical trials are under way to study the enhancement of the individual's immune response in fighting cancer (immunotherapy).

Source: Medical Disability Advisor



Prognosis

Prognosis depends on the stage of the cancer at diagnosis, the histologic grade of the tumor, and the individual’s response to initial treatment. The 5-year survival rate for individuals with colon cancer is as follows: Stage I (Duke’s A): 83% (Hassan), and with early detection, 90% (“Cancer”); stage II (Duke’s B): 70%; stage III (Duke’s C): 30%; stage IV (Duke’s D): 10% (Hassan). Individuals with stage IV rarely live beyond 5 years (Hassan).

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Colon and Rectal Surgeon
  • Gastroenterologist
  • General Surgeon
  • Oncologist
  • Radiology Oncologist

Source: Medical Disability Advisor



Rehabilitation

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



Comorbid Conditions

  • Crohn's disease
  • Disease of the pancreas
  • Disease of the spleen
  • Irritable bowel disease
  • Liver disease
  • Ulcerative colitis

Source: Medical Disability Advisor



Complications

Complications of colon cancer include bowel obstruction, perforation, telescoping of the intestine into itself (intussusceptions), and fistula formation in the small bowel, bladder, or vaginal wall. 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 (perforation). Slow-growing carcinoid tumors, which may develop without producing symptoms, often secrete excessive amounts of compounds that activate blood vessels (vasoactive substances). They are likely to metastasize and can have effects on the circulatory system. Colonic tumors may enter the lymphatic tissue in the wall of the gut, damaging the intestinal wall and nearby lymph nodes and 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



Factors Influencing Duration

Factors that may influence the length of disability include the stage at which the cancer was detected, the length of colon that was removed during surgery, the presence of a temporary or permanent colostomy, the effectiveness of treatment (radiation, chemotherapy, or immunotherapy), and the individual's response to these treatments. Advanced age may also be a factor because older individuals often require longer recovery times. The presence of comorbid illness may also increase duration.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

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 colostomy 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



Failure to Recover

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:

  • Was occult blood detected in the stool?
  • Is individual anemic due to blood loss?
  • Was there obstruction or rupture of the intestine?
  • Has individual suffered from nutrition problems due to malabsorption of food?
  • Were other conditions, such as irritable bowel syndrome (IBS), diverticular disease, ischemic colitis, inflammatory bowel disease (IBD), infectious colitis, or hemorrhoids, ruled out?
  • Was a biopsy performed? Diagnostic imaging?
  • Was the diagnosis of colon cancer confirmed?
  • Was the cancer staged by CT scan and/or histopathologic examination of tumor cells?
  • At what stage of the disease was diagnosis made?

Regarding treatment:

  • Did colectomy remove all the cancerous tissue and surrounding lymph nodes?
  • Was more extensive surgery required to resect a portion of the colon and/or rectum?
  • Was colostomy performed? Temporary or permanent? If temporary, what is the time frame for reconstruction? Is individual capable of appropriate colostomy care?
  • Assuming bowel resection was performed, is postoperative chemotherapy or radiation therapy needed?
  • Are adjuvant therapies a part of the treatment plan?
  • 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?
  • Was condition diagnosed in an early stage?
  • Was treatment prompt and appropriate for that stage?
  • How well did individual respond to treatment?
  • Has the tumor metastasized into other organ systems?
  • Did colonic tumor recur?
  • Does individual have an underlying condition that may affect recovery?
  • Has individual experienced any complications of the disease or treatment?
  • Is individual depressed or anxious? If so, was a referral made for counseling?

Source: Medical Disability Advisor



References

Cited

"Cancer: Colon and Rectum, SEER Stat Fact Sheets." Natonal Cancer Institute. Dec. 2007. U.S. National Institutes of Health. 20 Aug. 2009 <http://seer.cancer.gov/statfacts/html/colorect.html>.

"Colon and Rectal Cancer." National Cancer Institute. New Media Systems, LLC. 2 Jun. 2011 <http://www.cancer.gov/cancertopics/types/colon-and-rectal>.

"Colorectal Cancer." InteliHealth. 24 Aug. 2008. 20 Aug. 2009 <http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/31560.html#diagnosis>.

Hassan, Isaac. "Colon, Adenocarcinoma." eMedicine. Eds. Eugene C. Lin, et al. 3 May. 2009. Medscape. 20 Aug. 2009 <http://emedicine.medscape.com/article/367061-overview>.

Source: Medical Disability Advisor