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The Colon

The colon (together with the rectum) are part of the large intestine (bowel). The colon is a muscular tube that is about five feet long. It absorbs water and nutrients from food passing through. The rectum, the lower six inches of the digestive tract, serves as a holding place for stool, which then passes out of the body through the anus. The colon is divided into four sections: the ascending colon, transverse colon, descending colon, and sigmoid colon. Most colorectal cancers arise in the sigmoid colon -- the portion just above the rectum. They usually start in the innermost layer and can grow through some or all of the several tissue layers that make up the colon and rectum. Cancer can, however, develop in any portion of the colon. The extent to which a cancer penetrates the various tissue layers of the colon determines the stage of the disease.

What is Colon Cancer?

Colon and rectal cancers are the second most prevalent cancer after lung cancer among men, and the third most prevalent cancer after breast cancer and lung cancer in women. Most colorectal cancers grow slowly over a period of several years, often beginning as small benign growths called polyps. Removing these polyps early, before they become malignant, is an effective means of preventing colorectal cancer. If the epithelia cells (the cells in the mucous membrane of the colon) turn cancerous and begin to grow and replicate in an abnormal and uncontrolled way, the body cannot organize these cells for normal function and the cells form a mass that is called a tumor. Malignant tumors in the colon can eventually penetrate through the colon and spread to other parts of the body, crowding and destroying normal cells.

Everyone is potentially at risk of developing colon cancer at some point in their lifetime. Although colon cancer occurs mostly in mature individuals, it can also occur in younger men and women as well. Some of the risk factors include a personal history of colonic or rectal polys, a personal or family history of colon or rectal cancer, and certain conditions, such as chronic ulcerative colitis (CUC) and Crohn's disease. Diet also appears to be a factor in the development of colon cancer. There are symptoms or warning symptoms that should raise the suspicion that one has colon cancer. These include:

  • Obstruction
    As the colon cancer grows, particularly if it is located in the transverse colon or in the descending and sigmoid colons, it may cause obstruction, leading to a build-up of pressure. This can result in pain and in swelling of the abdomen. In more extreme cases of obstruction, there may also be nausea and vomiting.
  • Bleeding
    As tumors expand, they can be traumatized by the fecal stream, causing them to bleed. The blood is often hidden in the stool and not readily visible. In some cases bleeding may be visible on the stool or there is rectal bleeding.
  • Anemia
    In some cases, as the tumor bleeds, it causes iron deficiency anemia to occur.
  • Pain
    Once the tumor penetrates the wall of the colon and begins to invade adjacent tissue, it can cause pain, together with additional symptoms. For example, if the cancer spreads to the bladder, it may cause urinary problems.
  • Wasting Syndrome
    In some cases, tumors colon cancer can cause a loss of appetite, weight, and strength.

While the above warning signs can occur even in individuals without colon cancer, if someone does exhibit these symptoms, appropriate diagnostic procedures should be recommended in order to rule out colon cancer.

Colon cancer generally grows slowly over a period of years. Once the cancer breaks through the colon, it can enter blood or the lymphatic system grow and spread very rapidly. As the cancer grows, it often spreads into the liver and the lungs. It can also spread to the bones, especially in the pelvis. Depending on the location of the tumor, it can also spread to the clavicle.

The American Cancer Society recommends that screening for colon cancer in individuals without any symptoms commence at age 50. Screening should consist of a yearly digital rectal examination (DRE) and a fecal occult bloot test (FOBT). Sigmoidoscopies, preferably flexible endoscopic sigmoidoscopies, should occur every three to five years. For anyone with a first-degree relative (parent, sibling, or child) who has had colon cancer under the age of 55, screening should start by age 40.






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