Colorectal Cancer

Aka: Colorectal Cancer, Colon Cancer, Colon Carcinoma, Colorectal Carcinoma

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II. Epidemiology

  1. Accounts for 8.5% of all new cancer cases
    1. Third most common cancer in the U.S.
  2. In U.S. (2014)
    1. Prevalence: 1.2 Million
    2. Incidence: 137,000/year
    3. Mortality: 50,000/year
  3. Highest Incidence of Colon Cancer
    1. North America
    2. Western Europe
    3. Australia and New Zealand
    4. Japan

III. Risk Factors

  1. See Colon Cancer Risk Factors

IV. Management: Non-resectable hepatic metastases

  1. Radiofrequency Ablation
    1. Small trials suggest prolonged survival or cure
    2. Wong (2001) Am J Surg 182:552-7 [PubMed]

V. Prevention

  1. Primary prevention
    1. See Colorectal Cancer Prevention
    2. See Colorectal Cancer Screening
  2. Secondary prevention
    1. Routine screening for other cancers
    2. Tobacco Cessation
    3. Obesity Management and Healthy Diet (Colorectal Cancer risk factors)
    4. Exercise improves quality of life and decreases overall mortality (goal: 150 min/week)
    5. Daily low dose Aspirin

VI. Course

  1. Five-year survival: 65%
  2. Recurrence risk
    1. Highest risk within first 5 years post-resection (17 to 42%)

VII. Complications: General

  1. Colorectal Cancer recurrence (typically in first 5 years after treatment)
  2. Second primary Colorectal Cancer
  3. Urinary symptoms
    1. Stress Incontinence
    2. Urge Incontinence
    3. Urology Consultation indications
      1. Persistent Urinary Retention (pelvic nerve injury is common in initial post-operative period)
      2. Persistent Hematuria
  4. Neuropsychiatric
    1. Cognitive dysfunction (Chemotherapy associated)
      1. Typically mild and transient
    2. Major Depression
    3. Anxiety Disorder
    4. Insomnia
    5. Sexual Dysfunction
      1. Vaginal Dryness and Dyspareunia in women
      2. Erectile Dysfunction (pelvic radiation, platinum-based Chemotherapy)
      3. Ostomy-related concerns
    6. Neuropathy (esp. platinum-based Chemotherapy such as oxaliplatin)
      1. Duloxetine (Cymbalta)
      2. Gabapentin (Neurontin) or Pregabalin (Lyrica)
      3. Tricyclic Antidepressant
    7. Fatigue
      1. Common in Colorectal Cancer survivors
      2. Consider evaluating for alternative Fatigue cause (e.g Anemia, Hypothyroidism)

VIII. Complications: Gastrointestinal adverse effects

  1. Ostomy care
  2. Diarrhea
    1. Dietary Fiber supplementation
    2. Probiotic supplementation
    3. Periodic Loperamide (Imodium) use
  3. Fecal Incontinence
    1. Periodic Loperamide (Imodium) use
    2. Methylcellulose and Dietary Fiber
    3. Biofeedback
  4. Radiation Proctitis (Diarrhea, bleeding)
    1. Endoscopic argon plasma coagulation
    2. Sucralfate enemas
    3. Hanson (2012) Dis Colon Rectum 55(10): 1081-95 [PubMed]
  5. Abdominal Pain
    1. Acute pain (esp. RUQ Pain, Pelvic Pain)
      1. Evaluate for cancer recurrence
    2. Chronic Pain
      1. Radiation Proctitis
      2. Incisional Hernia
  6. Pelvic Fracture
    1. Higher risk in women who undergo pelvic radiation

IX. Protocol: Monitoring post-resection

  1. See Cancer Survivor Care
  2. Oncology may often establish a survivorship care plan
  3. Follow-up visits (starting 4-5 weeks after curative resection)
    1. Visit every 3-6 months for 2-3 years, then every 6 months until 5 years post-resection
    2. Focus areas
      1. Ostomy problems or Stool Incontinence
      2. Radiation Proctitis
      3. Bowel adhesions
  4. Carcinoembryonic Antigen (CEA-125)
    1. Perform at each visit (every 3-6 months for 2-3 years, then every 6 months until 5 years post-resection)
    2. May avoid in Stage I at low risk of recurrence
    3. Other labs (e.g. CBC, Comprehensive panel) are not routinely indicated (unless other concerns)
  5. Colonoscopy
    1. Perform at one year post resection and resect new polyps
    2. Normal Colonoscopy
      1. Repeat at 3 years post-resection, and then every 5 years
    3. Advanced adenomatous polyp (>1 cm, high grade dysplasia or villous component)
      1. Repeat Colonoscopy in 1 year
    4. Rectal cancer at risk of recurrence
      1. Flexible Sigmoidoscopy every 3-6 months for first 2-3 years post-resection
  6. Imaging
    1. PET scan is not recommended for recurrence monitoring
    2. CT Chest, Abdomen and Pelvis Indications (every 12 months for 5 years post-resection)
      1. Stage I or II if high risk for recurrence
      2. Stage III disease
      3. Stage IV disease (CT interval may be increased to coincide with CEA and visit timing)

X. References

  1. Burgers (2018) Am Fam Physician 97(5):331-6 [PubMed]
  2. Short (2014) Am Fam Physician 91(2): 93-100 [PubMed]
  3. Sunga (2005) Am Fam Physician 71:699-714 [PubMed]
  4. Wilbur (2014) Am Fam Physician 91(1):29-36 [PubMed]

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Related Studies

Ontology: Colorectal Carcinoma (C0009402)

Definition (NCI) A malignant epithelial neoplasm that arises from the colon or rectum and invades through the muscularis mucosa into the submucosa. The vast majority are adenocarcinomas.
Definition (NCI_NCI-GLOSS) Cancer that develops in the colon (the longest part of the large intestine) and/or the rectum (the last several inches of the large intestine before the anus).
Concepts Neoplastic Process (T191)
MSH D015179
English Carcinoma, Colorectal, Carcinomas, Colorectal, Colorectal Carcinomas, carcinoma of large intestine, carcinoma of large intestine (diagnosis), Colorectal carcinoma, carcinoma colorectal, Carcinoma;bowel;large, colorectal carcinoma, Colorectal Carcinoma, CRC, Large intestine carcinoma, Colorectal cancer, NOS, colorectal cancer, Colorectal Cancer, Large Bowel Cancer, Large Bowel Carcinoma, Large Intestine Cancer, Large Intestine Carcinoma, Cancer of Large Bowel, Cancer of Large Intestine, Cancer of the Large Bowel, Cancer of the Large Intestine, Carcinoma of Large Bowel, Carcinoma of Large Intestine, Carcinoma of the Large Bowel, Carcinoma of the Large Intestine, Carcinoma;intestine;large, carcinoma of the large bowel, carcinoma of the large intestine
Dutch colorectaalcarcinoom, dikkedarmcarcinoom
German Kolorektalkarzinom, Kolorektales Karzinom, Dickdarmkarzinom
Italian Carcinoma di colon e retto, Carcinoma del colon e del retto, Carcinoma dell'intestino crasso
Portuguese Carcinoma colorrectal, Carcinoma do intestino grosso
Spanish Carcinoma colorrectal, Carcinoma del intestino grueso
Japanese 結腸直腸癌, ｹｯﾁｮｳﾁｮｸﾁｮｳｶﾞﾝ, ﾀﾞｲﾁｮｳｶﾞﾝ, 大腸癌
French Carcinome colorectal, Carcinome du gros intestin, Carcinome du colorectum, Carcinomes colorectaux, Carcinome colo-rectal, Carcinome recto-colique, Carcinome rectocolique, Carcinomes colo-rectaux
Czech Karcinom kolorekta, kolorektální karcinom, Karcinom tlustého střeva
Hungarian Colorectalis carcinoma, Vastagbél carcinoma
Norwegian Kolorektalt karsinom
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Colon Carcinoma (C0699790)

Definition (NCI_NCI-GLOSS) Cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).
Definition (NCI) A malignant epithelial neoplasm that arises from the colon and invades through the muscularis mucosa into the submucosa. The vast majority are adenocarcinomas.
Concepts Neoplastic Process (T191)
SnomedCT 154454005, 269533000
English CARCINOMA OF COLON, COLON CARCINOMA, CARCINOMA COLON, Colon cancer, COLON CANCER, Carcinoma colon, Colon carcinoma, Carcinoma;colon, bowel carcinoma large, carcinoma colon, colon carcinoma, carcinoma colon cancer, carcinoma intestine large, carcinoma of colon, colon cancer, Carcinoma of colon, Carcinoma of colon (disorder), Colon Carcinoma, Colon Cancer, Colonic Carcinoma, Carcinoma of Colon, Carcinoma of the Colon, carcinoma of the colon
Dutch coloncarcinoom, carcinoom colon
French Carcinome du côlon, CANCER COLIQUE, CARCINOME COLIQUE
German Kolonkarzinom, Karzinom, Kolon, COLONKARZINOM, DARMKARZINOM
Italian Carcinoma del colon
Portuguese Carcinoma do cólon, CARCINOMA DO COLON
Spanish Carcinoma de colon, CARCINOMA DE COLON, carcinoma del colon (trastorno), carcinoma del colon
Japanese 結腸癌, ｹｯﾁｮｳｶﾞﾝ
Czech Karcinom tračníku
Hungarian Colon carcinoma, Vastagbél-carcinoma
Derived from the NIH UMLS (Unified Medical Language System)

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