Dr. M.J. Bazos, MD Patient Handout


About Your Diagnosis
Colon cancer, colorectal cancer, and adenocarcinoma of the large intestine (bowel) are the same thing. Colon cancer is the most common cancer of the gastrointestinal tract. The cancer commonly involves the lower rectum and sigmoid portion of the colon but also can be found at the beginning of the colon (the cecum). Approximately 160,000 people will be found to have colon cancer this year. Although not completely understood, environmental and hereditary factors are believed to lead to colon cancer. A high consumption of saturated fat (animal fat) and a lowfiber diet are leading theories of a dietary cause of colon cancer. The main risk factors for colorectal cancer are age older than 50 years, long-standing inflammatory bowel disease (ulcerative colitis, Crohn’s disease), genital or breast cancer, and a family history of colon cancer or familial polyposis. Colon cancer is usually detectable by means of colonoscopy (a scope is passed through the rectum to visualize the entire colon). Biopsies are easily performed on any suspicious areas, and any polyps (growths from the surface of the colon that can transform into malignant cancer) can be removed. Colon cancer can be cured if detected early, before it has had the chance to spread (metastasize). The best way to detect colon cancer early is by means of screening (see below).
Living With Your Diagnosis
Signs and symptoms to be aware of are change in bowel habits, such as constipation; change in the caliber of stools (e.g., pencil-thin stools); black tarry stools; frank rectal bleeding; and abdominal pain. Sometimes you may not have any symptoms but may be found to have iron deficiency anemia. This usually necessitates evaluation to exclude colon cancer. Colon cancer if undetected or untreated usually spreads through the wall of the intestine into the surrounding areas and also into the liver. Sometimes it can spread to the lungs and bone.
The best treatment is prevention by means of screening. Screening guidelines include the following: a digital rectal examination annually after 40 years of age; testing of stools for occult blood annually after 50 years of age; and flexible sigmoidoscopy every 3 to 5 years after the age of 50 years. Once the diagnosis of colon cancer is made, treatment depends on the extent of spread of the cancer. Abdominal and pelvic computed tomography (CT) is performed to determine whether the tumor has spread to the liver or outside the colon to regional lymph nodes. This information is important because it is used to decide whether chemotherapy is needed. Surgical intervention is the best therapy for complete removal of the tumor and the best chance for cure if there is no evidence of spread. Also with surgical treatment, additional information is found about local extension of the tumor within the layers of the wall of the colon and within regional lymph nodes. This information is important because chemotherapy and radiation therapy may be recommended after surgical treatment. Side effects and complications of surgical treatment include pain and infection. Radiation therapy may cause colitis with diarrhea and bloody stools. Chemotherapy can lead to bone marrow suppression making one prone to infection, bleeding, and anemia. Other side effects of chemotherapy include nausea, vomiting, diarrhea, hair loss, and mucositis (pain and redness) of the eyes and mouth.

The DOs
• Understand the importance of colon screening for all persons older than 50 years and for all family members of patients with colon cancer.
• Make sure your diet is high in fiber and low in animal fat.
• Make sure that once your cancer is diagnosed and you are treated and cured, you undergo colonoscopy 1 year postoperatively and every 3 years thereafter.
• Understand that there is a blood test called carcinoembryonic antigen (CEA) measurement that is usually performed once the diagnosis of colon cancer is made and after surgical treatment to detect recurrence.

The DON’Ts
• Do not forget the importance of screening.
• Do not miss follow-up appointments with your primary care physician, oncologist, radiation oncologist if radiation therapy was provided, and general surgeon for wound care and colostomy care if you have a colostomy.
• Do not be afraid to ask your primary care physician about emotional support groups.
• Do not forget the importance of nutrition after surgical treatment.

When to Call Your Doctor
• If you have change in bowel habits, bloody or black stools, diarrhea, or constipation.
• If you have new abdominal pain or back pain with lower leg weakness.
• If you note skin color change such as jaundice.
• If you have a fever during chemotherapy.
• If you note abnormal drainage from within or around the colostomy site.
• If you continue to have no appetite and weight loss.
• If nausea and vomiting persist.