Colon Cancer

(Colorectal Cancer)

Medical Reviewing Editor: Jay Marks, MD

 What is cancer?
 What is cancer of the colon and rectum?
 What are the causes of colon cancer?
 What are the symptoms of colon cancer?
 What tests can be done to detect colon cancer?
 How can colon cancer be prevented?
 What are the treatments and survival for colon cancer?
 What is the follow-up care for colon cancer?
 What does the future hold for patients with colorectal cancer?
 Colon Cancer At A Glance
 Pictures of Colorectal (Colon) Cancer - Slideshow
 Pictures of Digestive Disease Myths - Slideshow
 Patient Discussions: Colon Cancer - Symptoms
 Patient Discussions: Colon Cancer - How Was Diagnosis Established
 Find a local Oncologist in your town

A Surprising Colon Cancer

From diagnosis to treatment, a fighting tale.

An Unexpected Challenge
Wed., Dec. 7, 2005

At the time, I had no idea anything at all was wrong. I just knew it was time for a
colonoscopy. In fact it was past time, since I was 61 years old.

I don't remember the procedure itself. What I do remember is waking up at home and
Kim, my husband, telling me that they'd found a tumor at the very far end of my
colon and that the doctor wanted to speak to me when I was awake and ready to talk.
I called the doc right away. The doctor told me that he was totally surprised when he
found the tumor, that it was being biopsied, and that he asked them to rush the results.
No matter what the outcome of the biopsy; the tumor had to be removed, the doc said. He asked
who I wanted to do the surgery. I somehow remembered that a lady I play golf with is a nurse for a
gastro practice. I called her and found out who she'd ask for if she needed colon surgery. Once I
got a name, I called my gastroenterologist back, told him who I wanted, and asked for an
appointment.

Patti deals with her diagnosis »

Top Searched Colon Cancer Terms:

family history, polyps, stages, risks, prevention, signs, screening, genetics, lymph nodes, warning
signs, Lynch, rectum cancer, rectal cancer, ibs

What is cancer?

Cancer is a group of more than 100 different diseases. They affect the body's basic unit, the cell.
Cancer occurs when cells become abnormal and divide without control or order. Like all other
organs of the body, the colon and rectum are made up of many types of cells. Normally, cells
divide to produce more cells only when the body needs them. This orderly process helps keep us
healthy.

If cells keep dividing when new cells are not needed, a mass of tissue forms. This mass of extra
tissue, called a growth or tumor, can be benign or malignant.

Benign tumors are not cancer. They can usually be removed and, in most cases, they do not come
back. Most important, cells from benign tumors do not spread to other parts of the body. Benign
tumors are rarely a threat to life.

Malignant tumors are cancer. Cancer cells can invade and damage tissues and organs near the
tumor. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or
lymphatic system. This is how cancer spreads from the original (primary) tumor to form new
tumors in other parts of the body. The spread of cancer is called metastasis.

When cancer spreads to another part of the body, the new tumor has the same kind of abnormal
cells and the same name as the primary tumor. For example, if colon cancer spreads to the liver,
the cancer cells in the liver are colon cancer cells. The disease is metastatic colon cancer (it is not
liver cancer).

What is cancer of the colon and rectum?

The colon is the part of the digestive system where the waste material is stored. The rectum is the
end of the colon adjacent to the anus. Together, they form a long, muscular tube called the large
intestine (also known as the large bowel). Tumors of the colon and rectum are growths arising
from the inner wall of the large intestine. Benign tumors of the large intestine are called polyps.
Malignant tumors of the large intestine are called cancers. Benign polyps do not invade nearby
tissue or spread to other parts of the body. Benign polyps can be easily removed during
colonoscopy and are not life-threatening. If benign polyps are not removed from the large
intestine, they can become malignant (cancerous) over time. Most of the cancers of the large
intestine are believed to have developed from polyps. Cancer of the colon and rectum (also
referred to as colorectal cancer) can invade and damage adjacent tissues and organs. Cancer cells
can also break away and spread to other parts of the body (such as liver and lung) where new
tumors form. The spread of colon cancer to distant organs is called metastasis of the colon
cancer. Once metastasis has occurred in colorectal cancer, a complete cure of the cancer is
unlikely.

Globally, cancer of the colon and rectum is the third leading cause of cancer in males and the
fourth leading cause of cancer in females. The frequency of colorectal cancer varies around the
world. It is common in the Western world and is rare in Asia and Africa. In countries where the
people have adopted western diets, the incidence of colorectal cancer is increasing.

What are the causes of colon cancer?

Doctors are certain that colorectal cancer is not contagious (a person cannot catch the disease
from a cancer patient). Some people are more likely to develop colorectal cancer than others.
Factors that increase a person's risk of colorectal cancer include high fat intake, a family history
of colorectal cancer and polyps, the presence of polyps in the large intestine, and chronic
ulcerative colitis.

Diet and colon cancer

Diets high in fat are believed to predispose humans to colorectal cancer. In countries with high
colorectal cancer rates, the fat intake by the population is much higher than in countries with low
cancer rates. It is believed that the breakdown products of fat metabolism lead to the formation
of cancer-causing chemicals (carcinogens). Diets high in vegetables and high-fiber foods such as
whole-grain breads and cereals may rid the bowel of these carcinogens and help reduce the risk
of cancer.

Colon polyps and colon cancer

Doctors believe that most colon cancers develop in colon polyps. Therefore, removing benign
colon polyps can prevent colorectal cancer. Colon polyps develop when chromosome damage
occurs in cells of the inner lining of the colon. Chromosomes contain genetic information
inherited from each parent. Normally, healthy chromosomes control the growth of cells in an
orderly manner. When chromosomes are damaged, cell growth becomes uncontrolled, resulting
in masses of extra tissue (polyps). Colon polyps are initially benign. Over years, benign colon
polyps can acquire additional chromosome damage to become cancerous.

Ulcerative colitis and colon cancer

Chronic ulcerative colitis causes inflammation of the inner lining of the colon. For further
information, please read the Ulcerative Colitis article. Colon cancer is a recognized complication
of chronic ulcerative colitis. The risk for cancer begins to rise after eight to 10 years of colitis.
The risk of developing colon cancer in a patient with ulcerative colitis also is related to the
location and the extent of his or her disease.

Current estimates of the cumulative incidence of colon cancer associated with ulcerative colitis
are 2.5% at 10 years, 7.6% at 30 years, and 10.8% at 50 years. Patients at higher risk of cancer
are those with a family history of colon cancer, a long duration of colitis, extensive colon
involvement, and those with primary sclerosing cholangitis (PSC).

Since the cancers associated with ulcerative colitis have a more favorable outcome when caught
at an earlier stage, yearly examinations of the colon often are recommended after eight years of
known extensive disease. During these examinations, samples of tissue (biopsies) can be taken to
search for precancerous changes in the lining cells of the colon. When precancerous changes are
found, removal of the colon may be necessary to prevent colon cancer.

Genetics and colon cancer

A person's genetic background is an important factor in colon cancer risk. Among first-degree
relatives of colon cancer patients, the lifetime risk of developing colon cancer is 18% (a threefold
increase over the general population in the United States).

Even though family history of colon cancer is an important risk factor, majority (80%) of colon
cancers occur sporadically in patients with no family history of colon cancer. Approximately
20% of cancers are associated with a family history of colon cancer. And 5 % of colon cancers
are due to hereditary colon cancer syndromes. Hereditary colon caner syndromes are disorders
where affected family members have inherited cancer-causing genetic defects from one or both
of the parents.

Chromosomes contain genetic information, and chromosome damages cause genetic defects that
lead to the formation of colon polyps and later colon cancer. In sporadic polyps and cancers
(polyps and cancers that develop in the absence of family history), the chromosome damages are
acquired (develop in a cell during adult life). The damaged chromosomes can only be found in
the polyps and the cancers that develop from that cell. But in hereditary colon cancer syndromes,
the chromosome defects are inherited at birth and are present in every cell in the body. Patients
who have inherited the hereditary colon cancer syndrome genes are at risk of developing large
number of colon polyps, usually at young ages, and are at very high risk of developing colon
cancer early in life, and also are at risk of developing cancers in other organs.

FAP (familial adenomatous polyposis) is a hereditary colon cancer syndrome where the
affected family members will develop countless numbers (hundreds, sometimes thousands) of
colon polyps starting during the teens. Unless the condition is detected and treated (treatment
involves removal of the colon) early, a person affected by familial polyposis syndrome is almost
sure to develop colon cancer from these polyps. Cancers usually develop in the 40s. These
patients are also at risk of developing other cancers such as cancers in the thyroid gland,
stomach, and the ampulla (the part where the bile ducts drain into the duodenum just beyond the
stomach).

AFAP (attenuated familial adenomatous polyposis) is a milder version of FAP. Affected

members develop less than 100 colon polyps. Nevertheless, they are still at very high risk of
developing colon cancers at young ages. They are also at risk of having gastric polyps and
duodenal polyps.

HNPCC (hereditary nonpolyposis colon cancer) is a hereditary colon cancer syndrome where
affected family members can develop colon polyps and cancers, usually in the right colon, in
their 30s to 40s. Certain HNPCC patients are also at risk of developing uterine cancer, stomach
cancer, ovarian cancer, and cancers of the ureters (the tubes that connect the kidneys to the
bladder), and the biliary tract (the ducts that drain bile from the liver to the intestines).

MYH polyposis syndrome is a recently discovered hereditary colon cancer syndrome. Affected
members typically develop 10-100 polyps occurring at around 40 years of age, and are at high
risk of developing colon cancer.

What are the symptoms of colon cancer?

Symptoms of colon cancer are numerous and nonspecific. They include fatigue, weakness,
shortness of breath, change in bowel habits, narrow stools, diarrhea or constipation, red or dark
blood in stool, weight loss, abdominal pain, cramps, or bloating. Other conditions such as
irritable bowel syndrome (spastic colon), ulcerative colitis, Crohn's disease, diverticulosis, and
peptic ulcer disease can have symptoms that mimic colorectal cancer. For more information on
these conditions, please read the following articles: Irritable Bowel Syndrome, Ulcerative Colitis,
Crohn's Disease, Diverticulosis, and Peptic Ulcer Disease.
Colon cancer can be present for several years before symptoms develop. Symptoms vary
according to where in the large bowel the tumor is located. The right colon is spacious, and
cancers of the right colon can grow to large sizes before they cause any abdominal symptoms.
Typically, right-sided cancers cause iron deficiency anemia due to the slow loss of blood over a
long period of time. Iron deficiency anemia causes fatigue, weakness, and shortness of breath.
The left colon is narrower than the right colon. Therefore, cancers of the left colon are more
likely to cause partial or complete bowel obstruction. Cancers causing partial bowel obstruction
can cause symptoms of constipation, narrowed stool, diarrhea, abdominal pains, cramps, and
bloating. Bright red blood in the stool may also indicate a growth near the end of the left colon or
rectum.

What tests can be done to detect colon cancer?

When colon cancer is suspected, either a lower GI series (barium enema x-ray) or colonoscopy is
performed to confirm the diagnosis and to localize the tumor.

A barium enema involves taking x-rays of the colon and the rectum after the patient is given an
enema with a white, chalky liquid containing barium. The barium outlines the large intestines on
the x-rays. Tumors and other abnormalities appear as dark shadows on the x-rays. For more
information, please read the Lower Gastrointestinal Series (Barium Enema) article.

Colonoscopy is a procedure whereby a doctor inserts a long, flexible viewing tube into the
rectum for the purpose of inspecting the inside of the entire colon. Colonoscopy is generally
considered more accurate than barium enema x-rays, especially in detecting small polyps. If
colon polyps are found, they are usually removed through the colonoscope and sent to the
pathologist. The pathologist examines the polyps under the microscope to check for cancer.
While the majority of the polyps removed through the colonoscopes are benign, many are
precancerous. Removal of precancerous polyps prevents the future development of colon cancer
from these polyps. For more information, please read the Colonoscopy article.

If cancerous growths are found during colonoscopy, small tissue samples (biopsies) can be
obtained and examined under the microscope to confirm the diagnosis. If colon cancer is
confirmed by a biopsy, staging examinations are performed to determine whether the cancer has
already spread to other organs. Since colorectal cancer tends to spread to the lungs and the liver,
staging tests usually include chest x-rays, ultrasonography, or a CAT scan of the lungs, liver, and
abdomen.

Sometimes, the doctor may obtain a blood test for CEA (carcinoembyonic antigen). CEA is a
substance produced by some cancer cells. It is sometimes found in high levels in patients with
colorectal cancer, especially when the disease has spread.

How can colon cancer be prevented?

Unfortunately, colon cancers can be well advanced before they are detected. The most effective
prevention of colon cancer is early detection and removal of precancerous colon polyps before
they turn cancerous. Even in cases where cancer has already developed, early detection still
significantly improves the chances of a cure by surgically removing the cancer before the disease
spreads to other organs. Multiple world health organizations have suggested general screening
guidelines.

Digital rectal examination and stool occult blood testing

It is recommended that all individuals over the age of 40 have yearly digital examinations of the
rectum and their stool tested for hidden or "occult" blood. During digital examination of the
rectum, the doctor inserts a gloved finger into the rectum to feel for abnormal growths. Stool
samples can be obtained to test for occult blood (see below). The prostate gland can be examined
at the same time.

An important screening test for colorectal cancers and polyps is the stool occult blood test.
Tumors of the colon and rectum tend to bleed slowly into the stool. The small amount of blood
mixed into the stool is usually not visible to the naked eye. The commonly used stool occult
blood tests rely on chemical color conversions to detect microscopic amounts of blood. These
tests are both convenient and inexpensive. A small amount of stool sample is smeared on a
special card for occult blood testing. Usually, three consecutive stool cards are collected. A
person who tests positive for stool occult blood has a 30% to 45% chance of having a colon
polyp and a 3% to 5% chance of having a colon cancer. Colon cancers found under these
circumstances tend to be early and have a better long-term prognosis.

It is important to remember that having stool tested positive for occult blood does not necessarily
mean the person has colon cancer. Many other conditions can cause occult blood in the stool.
However, patients with a positive stool occult blood should undergo further evaluations
involving barium enema x-rays, colonoscopies, and other tests to exclude colon cancer, and to
explain the source of the bleeding. It is also important to realize that stool which has tested
negative for occult blood does not mean the absence of colorectal cancer or polyps. Even under
ideal testing conditions, at least 20% of colon cancers can be missed by stool occult blood
screening. Many patients with colon polyps are tested negative for stool occult blood. In patients
suspected of having colon tumors, and in those with high risk factors for developing colorectal
polyps and cancer, flexible sigmoidoscopies or screening colonoscopies are performed even if
the stool occult blood tests are negative.

Flexible sigmoidoscopy and colonoscopy

Beginning at age 50, a flexible sigmoidoscopy screening tests is recommended every three to
five years. Flexible sigmoidoscopy is an exam of the rectum and the lower colon using a viewing
tube (a short version of colonoscopy). Recent studies have shown that the use of screening
flexible sigmoidoscopy can reduce mortality from colon cancer. This is a result of the detection
of polyps or early cancers in people with no symptoms. If a polyp or cancer is found, a complete
colonoscopy is recommended. The majority of colon polyps can be completely removed by
colonoscopy without open surgery. Recently doctors are recommending screening colonoscopies
instead of screening flexible sigmoidoscopies for healthy individuals starting at ages 50-55.
Please read the Colon Cancer Screening article.
Patients with a high risk of developing colorectal cancer may undergo colonoscopies starting at
earlier ages than 50. For example, patients with family history of colon cancer are recommended
to start screening colonoscopies at an age 10 years before the earliest colon caner diagnosed in a
first-degree relative, or five years earlier than the earliest precancerous colon polyp discovered in
a first-degree relative. Patients with hereditary colon cancer syndromes such as FAP, AFAP,
HNPCC, and MYH are recommended to begin colonoscopies early. The recommendations differ
depending on the genetic defect, for example in FAP; colonoscopies may begin during teenage
years to look for the development of colon polyps. Patients with a prior history of polyps or
colon cancer may also undergo colonoscopies to exclude recurrence. Patients with a long history
(greater than 10 years) of chronic ulcerative colitis have an increased risk of colon cancer, and
should have regular colonoscopies to look for precancerous changes in the colon lining.

Genetic counseling and testing

Blood tests are now available to test for FAP, AFAP, MYH, and HNPCC hereditary colon cancer
syndromes. Families with multiple members having colon cancers, members with multiple colon
polyps, members having cancers at young ages, and having other cancers such as cancers of the
ureters, uterus, duodenum, etc., should be referred for genetic counseling followed possibly by
genetic testing. Genetic testing without prior counseling is discouraged because of the extensive
family education that is involved and the complicated nature of interpreting the test results.

The advantages of genetic counseling followed by genetic testing include: (1) identifying family
members at high risk of developing colon cancer to begin colonoscopies early; (2) identifying
high risk members so that screening may begin to prevent other cancers such as ultrasound tests
for uterine cancer, urine examinations for ureter cancer, and upper endoscopies for stomach and
duodenal cancers; and (3) alleviating concern for members who test negative for the hereditary
genetic defects.

Diet and colon cancer to prevent colon cancer

People can change their eating habits by reducing fat intake and increasing fiber (roughage) in
their diet. Major sources of fat are meat, eggs, dairy products, salad dressings, and oils used in
cooking. Fiber is the insoluble, nondigestible part of plant material present in fruits, vegetables,
and whole-grain breads and cereals. It is postulated that high fiber in the diet leads to the creation
of bulky stools which can rid the intestines of potential carcinogens. In addition, fiber leads to
the more rapid transit of fecal material through the intestine, thus allowing less time for a
potential carcinogen to react with the intestinal lining. For additional information, please read the
Colon Cancer Prevention article.

What are the treatments and survival for colon cancer?

Surgery is the most common treatment for colorectal cancer. During surgery, the tumor, a small
margin of the surrounding healthy bowel, and adjacent lymph nodes are removed. The surgeon
then reconnects the healthy sections of the bowel. In patients with rectal cancer, the rectum is
permanently removed. The surgeon then creates an opening (colostomy) on the abdomen wall
through which solid waste in the colon is excreted. Specially trained nurses (enterostomal
therapists) can help patients adjust to colostomies, and most patients with colostomies return to a
normal lifestyle.

The long-term prognosis after surgery depends on whether the cancer has spread to other organs
(metastasis). The risk of metastasis is proportional to the depth of penetration of the cancer into
the bowel wall. In patients with early colon cancer which is limited to the superficial layer of the
bowel wall, surgery is often the only treatment needed. These patients can experience long-term
survival in excess of 80%. In patients with advanced colon cancer, wherein the tumor has
penetrated beyond the bowel wall and there is evidence of metastasis to distant organs, the five-
year survival rate is less than 10%.

In some patients, there is no evidence of distant metastasis at the time of surgery, but the cancer
has penetrated deeply into the colon wall or reached adjacent lymph nodes. These patients are at
risk of tumor recurrence either locally or in distant organs. Chemotherapy in these patients may
delay tumor recurrence and improve survival.

Chemotherapy is the use of medications to kill cancer cells. It is a systemic therapy, meaning that
the medication travels throughout the body to destroy cancer cells. After colon cancer surgery,
some patients may harbor microscopic metastasis (small foci of cancer cells that cannot be
detected). Chemotherapy is given shortly after surgery to destroy these microscopic cells.
Chemotherapy given in this manner is called adjuvant chemotherapy. Recent studies have shown
increased survival and delay of tumor recurrence in some patients treated with adjuvant
chemotherapy within five weeks of surgery. Most drug regimens have included the use of 5-
flourauracil (5-FU). On the other hand, chemotherapy for shrinking or controlling the growth of
metastatic tumors has been disappointing. Improvement in the overall survival for patients with
widespread metastasis has not been convincingly demonstrated.

Chemotherapy is usually given in a doctor's office, in the hospital as a outpatient, or at home.

Chemotherapy is usually given in cycles of treatment periods followed by recovery periods. Side
effects of chemotherapy vary from person to person, and also depend on the agents given.
Modern chemotherapy agents are usually well tolerated, and side effects are manageable. In
general, anticancer medications destroy cells that are rapidly growing and dividing. Therefore,
red blood cells, platelets, and white blood cells are frequently affected by chemotherapy.
Common side effects include anemia, loss of energy, easy bruising, and a low resistance to
infections. Cells in the hair roots and intestines also divide rapidly. Therefore, chemotherapy can
cause hair loss, mouth sores, nausea, vomiting, and diarrhea.

Radiation therapy in colorectal cancer has been limited to treating cancer of the rectum. There is
a decreased local recurrence of rectal cancer in patients receiving radiation either prior to or after
surgery. Without radiation, the risk of rectal cancer recurrence is close to 50%. With radiation,
the risk is lowered to approximately 7%. Side effects of radiation treatment include fatigue,
temporary or permanent pelvic hair loss, and skin irritation in the treated areas.

Other treatments have included the use of localized infusion of chemotherapeutic agents into the
liver, the most common site of metastasis. This involves the insertion of a pump into the blood
supply of the liver which can deliver high doses of medicine directly to the liver tumor.
Response rates for these treatments have been reported to be as high as eighty percent. Side
effects, however, can be serious. Additional experimental agents considered for the treatment of
colon cancer include the use of cancer-seeking antibodies bound to cancer-fighting drugs. Such
combinations can specifically seek and destroy tumor tissues in the body. Other treatments
attempt to boost the immune system, the bodies' own defense system, in an effort to more
effectively attack and control colon cancer. In patients who are poor surgical risks, but who have
large tumors which are causing obstruction or bleeding, laser treatment can be used to destroy
cancerous tissue and relieve associated symptoms. Still other experimental agents include the use
of photodynamic therapy. In this treatment, a light sensitive agent is taken up by the tumor which
can then be activated to cause tumor destructio

What is the follow-up care for colon cancer?

Follow-up exams are important after treatment for colon cancer. The cancer can recur near the
original site or in a distant organ such as the liver or lung. Follow-up exams include a physical
examination by the doctor, blood tests of liver enzymes, chest x-rays, CAT scans of the abdomen
and pelvis, colonoscopies, and blood CEA levels. Abnormal liver enzymes may indicate growth
of liver metastasis. CEA levels may be elevated before surgery and become normal shortly after
the cancer is removed. Slowly rising CEA level may indicate cancer recurrence. A CAT scan of
the abdomen and pelvis can show tumor recurrence in the liver, pelvis, or other areas.
Colonoscopy can show recurrence of polyps or cancer in the large intestine.

In addition to checking for cancer recurrence, patients who have had colon cancer may have an
increased risk of cancer of the prostate, breast, and ovary. Therefore, follow-up examinations
should include these areas.

What does the future hold for patients with colorectal cancer?

Colon cancer remains a major cause of death and disease, especially in the western world. A
clear understanding of the causes and course of the disease is emerging. This has allowed for
recommendations regarding screening for and prevention of this disease. The removal of colon
polyps helps prevent colon cancer. Early detection of colon cancer can improve the chances of a
cure and overall survival. Treatment remains unsatisfactory for advanced disease, but research in
this area remains strong and newer treatments continue to emerge. New and exciting preventive
measures have recently focused on the possible beneficial effects of aspirin or other anti-
inflammatory agents. In trials, the use of these agents has markedly limited colon cancer
formation in several experimental models. Other agents being evaluated to prevent colon cancer
include calcium, selenium, and vitamins A, C, and E. More studies are needed before these
agents can be recommended for widespread use by the public to prevent colon cancer.

Colon Cancer At A Glance

 Colorectal cancer is a malignant tumor arising from the inner wall of the large intestine.
 Colorectal cancer is the third leading cause of cancer in males and fourth in females in the U.S.
 Risk factors for colorectal cancer include heredity, colon polyps, and long-standing ulcerative
colitis.
  Most colorectal cancers develop from polyps. Removal of colon polyps can prevent colorectal
cancer.
 Colon polyps and early cancer can have no symptoms. Therefore regular screening is important.
 Diagnosis of colorectal cancer can be made by barium enema or by colonoscopy with biopsy
confirmation of cancer tissue.
 Treatment of colorectal cancer depends on the location, size, and extent of cancer spread, as
well as the age and health of the patient.
 Surgery is the most common treatment for colorectal cancer.

What is colonoscopy?

Colonoscopy is a procedure that enables an examiner (usually a gastroenterologist) to evaluate

the inside of the colon (large intestine or large bowel). The colonoscope is a four foot long,
flexible tube about the thickness of a finger with a camera and a source of light at its tip. The tip
of the colonoscope is inserted into the anus and then is advanced slowly, under visual control,
into the rectum and through the colon usually as far as the cecum, which is the first part of the
colon.

Why is colonoscopy done?

Colonoscopy may be done for a variety of reasons. Most often it is done to investigate the cause
of blood in the stool, abdominal pain, diarrhea, a change in bowel habit, or an abnormality found
on colonic X-rays or a computerized tomographic (CT) scan. Individuals with previous history of
polyps or colon cancer and certain individuals with a family history of some types of non-colonic
cancers or colonic problems that may be associated with colon cancer (such as ulcerative colitis
and colonic polyps) may be advised to have periodic colonoscopies because their risks are
greater for polyps or colon cancer. How often should one undergo colonoscopy depends on the
degree of the risks and the abnormalities found at previous colonoscopies. More recently, it has
been recommended that even healthy people at normal risk for colon cancer should undergo
colonoscopy at age 50 and every 10 years thereafter, for the purpose of removing colonic polyps
before they become cancerous.

What bowel preparation is needed for colonoscopy?

If the procedure is to be complete and accurate, the colon must be completely

cleaned, and there are several colonoscopy preparations . Patients are given
detailed instructions about the cleansing preparation. In general, this consists of
drinking a large volume of a special cleansing solution or several days of a clear
liquid diet and laxatives or enemas prior to the examination. These instructions
should be followed exactly as prescribed or the procedure may be unsatisfactory,
and may have to be repeated, or a less accurate alternative test may be
performed in its place. What about current medications or diet before
colonoscopy?
Most medications should be continued as usual, but some may interfere with the examination. It
is best that the physician is informed of all current prescriptions or over-the-counter medications.
Aspirin products, blood thinners (warfarin [Coumadin], etc.), arthritis medications, insulin, and
iron preparations are examples of medications that may require special instructions. The
colonoscopist will also want to be aware of a patient's allergies and any other major illnesses.
The colonoscopist should be alerted if, in the past, patients have required antibiotics prior to
surgical or dental procedures to prevent infections. Instructions may also be given to avoid
certain foods for a couple of days prior to the procedure, such as stringy foods, foods with seeds,
or red Jello.

What should I expect during colonoscopy?

Prior to colonoscopy, intravenous fluids are started, and the patient is placed on a monitor for
continuous monitoring of heart rhythm and blood pressure as well as oxygen in the blood.
Medications (sedatives) usually are given through an intravenous line so the the patient becomes
sleepy and relaxed, and to reduce pain. If needed, the patient may receive additional doses of
medication during the procedure. Colonoscopy often produces a feeling of pressure, cramping,
and bloating in the abdomen; however, with the aid of medications, it is generally well-tolerated
and infrequently causes severe pain.

Patients will lay on their left side or back as the colonoscope is slowly advanced. Once the tip of
the colon (cecum) or the last portion of the small intestine (terminal ileum) is reached, the
colonoscope is slowly withdrawn, and the lining of the colon is carefully examined.
Colonoscopy usually takes 15 to 60 minutes. If the entire colon, for some reason, cannot be
visualized, the physician may decide to try colonoscopy again at a later date with or without a
different bowel preparation or may decide to order an X-ray or CT of the colon.

What if there are abnormalities detected during colonoscopy?

If an abnormal area needs to be better evaluated, a biopsy forceps is passed through a channel in
the colonoscope and a biopsy (a sample of the tissue) is obtained. The biopsy is submitted to the
pathology laboratory for examination under a microscope by a pathologist. If infection is
suspected, a biopsy may be obtained for culturing of bacteria (and occasionally viruses) or
examination under the microscope for parasites. If colonoscopy is performed because of
bleeding, the site of bleeding can be identified, samples of tissue obtained (if necessary), and the
bleeding controlled by several means. Should there be polyps, (benign growths that can become
cancerous) they almost always can be removed through the colonoscope. Removal of these
polyps is an important method of preventing colorectal cancer, although the great majority of
polyps are benign. None of these additional procedures typically produce pain. Biopsies are
taken for many reasons and do not necessarily mean that cancer is suspected.

What should I expect post colonoscopy?

Patients will be kept in an observation area for an hour or two post-colonoscopy, until the effects
of medications that have been given adequately wear off. If patients have been given sedatives
before or during colonoscopy, they may not drive, even if they feel alert. Someone else must
drive them home. The patient's reflexes and judgment may be impaired for the rest of the day,
making it unsafe to drive, operate machinery, or make important decisions. Should patients have
some cramping or bloating, this can be relieved quickly with the passage of gas, and they should
be able to eat upon returning home. After the removal of polyps or certain other manipulations,
the diet or activities of patients may be restricted for a brief period of time.

Prior to the patient's departure from the coloscopic unit, the findings can be discussed with the
patient. However, at times, a definitive diagnosis may have to wait for a microscopic analysis of
biopsy specimens, which usually takes a few days.

What is the hematocrit?

The hematocrit is the proportion, by volume, of the blood that consists of red blood cells. The
hematocrit (hct) is expressed as a percentage. For example, an hematocrit of 25% means that
there are 25 milliliters of red blood cells in 100 milliliters of blood.

How is the hematocrit measured?

The hematocrit is typically measured from a blood sample by an automated machine that makes
several other measurements at the same time. Most of these machines in fact do not directly
measure the hematocrit, but instead calculate it based on the determination of the amount of
hemoglobin and the average volume of the red blood cells. The hematocrit can also be
determined by a manual method using a centrifuge. When a tube of blood is centrifuged, the red
cells will be packed into the bottom of the tube. The proportion of red cells to the total blood
volume can be visually measured.

What is a normal hematocrit?

The normal ranges for hematocrit are dependent on age and, after adolescence, the sex of the
individual. The normal ranges are:

 Newborns: 55%-68%

 One (1) week of age: 47%-65%

 One (1) month of age: 37%-49%

 Three (3) months of age: 30%-36%

 One (1) year of age: 29%-41%

 Ten (10) years of age: 36%-40%

 Adult males: 42%-54%

 Adult women: 38%-46%

These values may vary slightly between laboratories.

What does a low hematocrit mean?

A low hematocrit is referred to as being anemic. There are many reasons for anemia. Some of the
more common reasons are loss of blood (traumatic injury, surgery, bleeding colon cancer),
nutritional deficiency (iron, vitamin B12, folate), bone marrow problems (replacement of bone
marrow by cancer, suppression by chemotherapy drugs, kidney failure), and abnormal hematocrit
(sickle cell anemia).

What does a high hematocrit mean?

Higher than normal hematocrit levels can be seen in people living at high altitudes and in chronic
smokers. Dehydration produces a falsely high hematocrit that disappears when proper fluid
balance is restored. Some other infrequent causes of elevated hematocrit are lung disease, certain
tumors, a disorder of the bone marrow known as polycythemia rubra vera, and abuse of the drug
erythropoietin (Epogen) by athletes for blood doping purposes.
What is chemotherapy?

Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to destroy cancer
cells.

How does chemotherapy work?

Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide
quickly. But it can also harm healthy cells that divide quickly, such as those that line your mouth
and intestines or cause your hair to grow. Damage to healthy cells may cause side effects. Often,
side effects get better or go away after chemotherapy is over.

What does chemotherapy do?

Depending on your type of cancer and how advanced it is, chemotherapy can:

 Cure cancer - when chemotherapy destroys cancer cells to the point that your doctor can
no longer detect them in your body and they will not grow back.

 Control cancer - when chemotherapy keeps cancer from spreading, slows its growth, or
destroys cancer cells that have spread to other parts of your body.

 Ease cancer symptoms (also called palliative care) - when chemotherapy shrinks tumors
that are causing pain or pressure.

How is chemotherapy used?

Sometimes, chemotherapy is used as the only cancer treatment. But more often, you will get
chemotherapy along with surgery, radiation therapy, or biological therapy. Chemotherapy can:

 Make a tumor smaller before surgery or radiation therapy. This is called neo-adjuvant
chemotherapy.

 Destroy cancer cells that may remain after surgery or radiation therapy. This is called
adjuvant chemotherapy.

 Help radiation therapy and biological therapy work better.

  Destroy cancer cells that have come back (recurrent cancer) or spread to other parts of
your body (metastatic cancer).

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Chemotherapy (cont.)
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 What is chemotherapy?