Colorectal cancer, also called 

colon cancer or large bowel cancer, includes cancerous growths in

the colon, rectum and appendix. With 655,000 deaths worldwide per year, it is the fourth most common form of
cancer in the United States and the third leading cause of cancer-related death in the Western world.[1]
[2]
 Colorectal cancers arise from adenomatous polyps in the colon. These mushroom-shaped growths are
usually benign, but some develop into cancer over time. Localized colon cancer is usually diagnosed
through colonoscopy.
Invasive cancers that are confined within the wall of the colon (TNM stages I and II) are curable with surgery. If
untreated, they spread to regional lymph nodes (stage III), where up to 73% are curable by surgery and
chemotherapy. Cancer that metastasizes to distant sites (stage IV) is usually not curable, although
chemotherapy can extend survival, and in rare cases, surgery and chemotherapy together have seen patients
through to a cure.[3] Radiation is used with rectal cancer.
On the cellular and molecular level, colorectal cancer starts with a mutation to the Wnt signaling pathway.
When Wnt binds to a receptor on the cell, that sets in motion a chain of molecular events that ends with β-
catenin moving into the nucleus and activating a gene on DNA. In colorectal cancer, genes along this chain are
damaged. Usually, a gene called APC, which is a "brake" on the Wnt pathway, is damaged. Without a working
APC brake, the Wnt pathway is stuck in the "on" position.[3]

Colorectal cancer is cancer that occurs in the colon or rectum. Sometimes it is called colon
cancer, for short. As the drawing shows, the colon is the large intestine or large bowel. The
rectum is the passageway that connects the colon to the anus.
Colon cancer, when discovered early, is highly treatable. Even if it spreads into nearby lymph
nodes, surgical treatment followed by chemotherapy is highly successful. In the most difficult
cases — when the cancer has metastasized to the liver, lungs or other sites — treatment can
prolong and add to the quality of life.

Most colorectal cancers develop first as colorectal polyps, which are growths inside the colon or
rectum that may later become cancerous.

Colorectal cancer affects both men and women of all racial and ethnic groups, and is most often
found in people aged 50 years or older. For men, colorectal cancer is the third most common
cancer after prostate and lung cancers. For women, colorectal cancer is the third most common
cancer after breast and lung cancers.
Colorectal cancer is the second leading cancer killer in the United States, but it doesn't have to
be. If everybody aged 50 or older has regular screening test, as many as 80% of deaths from
colorectal cancer could be prevented.
Colorectal cancer screening saves lives. Screening can find precancerous polyps—abnormal
growths in the colon or rectum—so that they can be removed before turning into cancer.
Screening also helps find colorectal cancer at an early stage, when treatment often leads to a
cure.
Facts About Colon Cancer
About 150,000 new cases of colorectal (colon and rectal) cancer are diagnosed each year in the
U.S., making it the second most common type of cancer and the second leading cause of cancer
death in the U.S.
One-third of all colorectal cancers are found in the rectum; the rest are found in other parts of the
colon.
Screening for colorectal cancer should begin at the age of 40 in healthy adults. Seventy to 80 percent
of colorectal cancer cases occur in adults without specific risk factors.
Widespread screening for colorectal cancer could save up to many lives each year.
Early detection reduces the probability of major surgery and increases chances of cure.
Risk increases after age 40.
Both men and women are equally at risk for colorectal cancer.
In the U.S. the death rate for colorectal cancer is declining. This may be due to a higher rate of
screening for the disease.
Colon cancer may affect any racial or ethnic group; however, some studies suggest that Americans of
northern European heritage have a higher-than-average risk of colon cancer.

Colon cancer symptoms aren't always obvious, but you can learn what these symptoms look and feel like.
Understanding colon cancer symptoms is important, because you can use this knowledge to work with your
doctor to find out the cause and take care of your long-term health.
Symptoms
By Mayo Clinic staff
Top of Form
Bottom of Form
Signs and symptoms of colon cancer include:
A change in your bowel habits, including diarrhea or constipation or a change in the
consistency of your stool for more than a couple of weeks
Rectal bleeding or blood in your stool
Persistent abdominal discomfort, such as cramps, gas or pain
A feeling that your bowel doesn't empty completely
Weakness or fatigue
Unexplained weight loss
Many people with colon cancer experience no symptoms in the early stages of the disease. When
symptoms appear, they'll likely vary, depending on the cancer's size and location in your large
intestine.
When to see a doctor 
If you notice any symptoms of colon cancer, such as blood in your stool or a persistent change
in bowel habits, make an appointment with your doctor.
Talk to your doctor about when you should begin screening for colon cancer. Guidelines
generally recommend colon cancer screenings begin at age 50. Your doctor may recommend
more frequent or earlier screening if you have other risk factors, such as a family history of the
disease.

Local Colon Cancer Symptoms

Local colon cancer symptoms affect your bathroom habits and the colon itself. Some of the more common local
symptoms of colon cancer include:
Changes in your bowel habits, such as bowel movements that are either more or less frequent than normal
Constipation (difficulty having a bowel movement or straining to have a bowel movement)
Diarrhea (loose or watery stools)
Intermittent (alternating) constipation and diarrhea
Bright red or dark red blood in your stools or black, dark colored, "tarry" stools
Stools that are thinner than normal ("pencil stools") or feeling as if you cannot empty your bowels completely
Abdominal (midsection) discomfort, bloating, frequent gas pains, or cramps
If you experience any of these for two or more weeks, call your doctor right away to discuss your concerns and
arrange for tests to get to the bottom of your symptoms.
Signs and symptoms
The symptoms of colorectal cancer depend on the location of tumor in the bowel, and whether it has spread
elsewhere in the body (metastasis). Most of the symptoms may occur in other diseases as well, and hence
none of the symptoms mentioned here is diagnostic of colorectal cancer. Symptoms and signs are divided into
local, constitutional (affecting the whole body) and metastatic (caused by spread to other organs).
[edit]Local
Local symptoms are more likely if the tumor is located closer to the anus. There may be a change in bowel
habit (new-onset constipation or diarrhea in the absence of another cause), and a feeling of incomplete
defecation (rectal tenesmus) and reduction in diameter of stool; tenesmus and change in stool shape are both
characteristic of rectal cancer. Lower gastrointestinal bleeding, including the passage of bright red blood in the
stool, may indicate colorectal cancer, as may the increased presence of mucus. Melena, black stool with a
tarry appearance, normally occurs in upper gastrointestinal bleeding (such as from a duodenal ulcer), but is
sometimes encountered in colorectal cancer when the disease is located in the beginning of the large bowel.
A tumor that is large enough to fill the entire lumen of the bowel may cause bowel obstruction. This situation is
characterized by constipation, abdominal pain, abdominal distension andvomiting. This occasionally leads to
the obstructed and distended bowel perforating and causing peritonitis. A large left colonic tumor may
compress the left ureter and cause hydronephrosis.
Certain local effects of colorectal cancer occur when the disease has become more advanced. A large tumor is
more likely to be noticed on feeling the abdomen, and it may be noticed by a doctor on physical examination.
The disease may invade other organs, and may cause blood or air in the urine (invasion of the bladder)
or vaginal discharge (invasion of the female reproductive tract).
[edit]Constitutional
If a tumor has caused chronic occult bleeding, iron deficiency anemia may occur; this may be experienced
as fatigue, palpitations and noticed as pallor (pale appearance of the skin). Colorectal cancer may also lead
to weight loss, generally due to a decreased appetite.
More unusual constitutional symptoms are an unexplained fever and one of several paraneoplastic syndromes.
The most common paraneoplastic syndrome is thrombosis, usually deep vein thrombosis.
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