Colon cancer is a common and lethal disease. It is estimated that approximately
141,210 new cases of large bowel cancer will be diagnosed in the United States
in 2011, including about 101,000 colon and 40,000 rectal cancers. Colon cancer mortality has been
progressively declining since 1990 at a rate of about 3 percent per year.
Screening with fecal occult blood testing, colonoscopy, or
radiology can lead to diagnosis at an earlier stage of disease and therefore
reduce mortality.
Symptoms of colon cancer are typically due to growth of the tumor
into the lumen of the colon or adjacent structures. As a result, symptomatic
presentation is often a manifestation of relatively advanced colon cancer. The
majority of patients presenting with symptomatic colon cancer have blood in the
stool, abdominal pain, otherwise unexplained iron deficiency anemia and/or a
change in bowel habits
Staging of Colon Cancer:
Preoperative clinical staging is best
accomplished by physical examination (with particular attention to ascites,
hepatomegaly and lymphadenopathy), CT scan of the abdomen and pelvis, and chest
imaging. Although frequently obtained preoperatively, liver enzymes may be
normal in the setting of small hepatic metastases and are not a reliable marker
for exclusion of liver involvement. The single most common liver test
abnormality associated with liver metastases is an elevation in the serum
alkaline phosphatase level.
Serum
CEA levels should be obtained preoperatively in patients with demonstrated
colorectal cancer to aid surgical treatment planning, assessment of prognosis
and follow-up. Elevated preoperative CEA levels that do not normalize following
surgical resection imply the presence of persistent disease and the need for
further evaluation.
Treatment
of Colon Cancer:
Surgical resection is the primary treatment modality for colon
cancer, and outcome is most closely related to the extent of disease at
presentation.
If the tumor is considered “high risk”, despite not having any
cancer spread to the lymph nodes surrounding the tumor, your medical oncologist
could recommend chemotherapy. If there
are lymph nodes that are involved with cancer, then the standard of care
currently is chemotherapy following surgical resection.
Survival
Rates of Colon Cancer Based on Staging:
Five-year survival rates according to tumor stage at diagnosis
(using the older 2002 AJCC staging criteria for 119,363 patients with colon
cancer reported to the SEER (Surveillance, Epidemiology and End Results)
database between 1991 and 2000 were as follows:
Stage I (T1-2 N0) — 93 percent
Stage IIA (T3N0) — 85 percent
Stage IIB (T4N0) —
72 percent
Stage IIIA (T1-2 N1) — 83
percent
Stage IIIB (T3-4 N1) — 64
percent
Stage IIIC (N2 disease) — 44
percent
These
are simply statistics and do not imply how you as the patient will do with the
same stage of cancer. It is always best
to remain hopeful and optimistic.
TNM staging for colorectal cancer
Primary tumor (T)
TX
Primary tumor cannot be assessed
T0
No evidence of primary tumor
Tis
Carcinoma in situ: intraepithelial or invasion of lamina propria*
T1
Tumor invades submucosa
T2
Tumor invades muscularis propria
T3
Tumor invades through the muscularis propria into pericolorectal tissues
T4a
Tumor penetrates to the surface of the visceral peritoneum•
T4b
Tumor directly invades or is adherent to other organs or structures•Δ
Regional lymph node (N)◊
NX
Regional lymph nodes cannot be assessed
N0
No regional lymph node metastasis
N1
Metastasis in 1-3 regional lymph nodes
N1a
Metastasis in one regional lymph node
N1b
Metastasis in 2-3 regional lymph nodes
N1c
Tumor deposit(s) in the subserosa, mesentery, or nonperitonealized pericolic or perirectal tissues without regional nodal metastasis
N2
Metastasis in four or more regional lymph nodes
N2a
Metastasis in 4-6 regional lymph nodes
N2b
Metastasis in seven or more regional lymph nodes
Distant metastasis (M)
M0
No distant metastasis
M1
Distant metastasis
M1a
Metastasis confined to one organ or site (eg, liver, lung, ovary, nonregional node)
M1b
Metastases in more than one organ/site or the peritoneum
Anatomic stage/prognostic groups§
Stage
T
N
M
Dukes¥
MAC¥
0
Tis
N0
M0
-
-
I
T1
N0
M0
A
A
T2
N0
M0
A
B1
IIA
T3
N0
M0
B
B2
IIB
T4a
N0
M0
B
B2
IIC
T4b
N0
M0
B
B3
IIIA
T1-2
N1/N1c
M0
C
C1
T1
N2a
M0
C
C1
IIIB
T3-T4a
N1/N1c
M0
C
C2
T2-T3
N2a
M0
C
C1/C2
T1-T2
N2b
M0
C
C1
IIIC
T4a
N2a
M0
C
C2
T3-T4a
N2b
M0
C
C2
T4b
N1-N2
M0
C
C3
IVA
Any T
Any N
M1a
-
-
IVB
Any T
Any N
M1b
-
-
Here, Dr. Tony Talebi discusses general concepts of colon cancer
with Dr. Caio Rocha Lima, professor of medicine at the University of Miami
including chemotherapy for colon cancer, colon cancer awareness
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Dr. Caio Rocha Lima
Credentials:
Board Certifications
American Board of Internal Med-Medical Oncology
Practice Locations
University of Miami Sylvester Comprehensive Cancer Center