Contact Hours: 3
This educational activity is credited for 3 contact hours at completion of the activity.
Course Purpose
The purpose of this course is to provide healthcare professionals with a brief overview of colon cancer types, stages, and various treatment options.
Overview
Colon cancer is an abnormal, unregulated growth within the lining of the colon or rectum, both parts of the large intestine. The colon is the longest part of the large intestine and is divided into four sections: the ascending colon, the transverse colon, the descending colon, and the sigmoid colon. The innermost layer of the colon, the mucosa, is lined with a single cell layer of epithelial cells. A genetic mutation in these cells can result in a polyp, which can become cancerous, leading to the development of colon cancer. This course provides an overview of colon cancer, its characteristics, risk factors, preventative testing, early signs and symptoms, and treatment options
Course Objectives
Upon completion of the independent study, the learner will be able to:
- Describe the large intestine and how abnormalities can lead to colon cancer.
- Summarize the various types of colon cancer and their treatment options.
- Identify common risk factors, early signs, and symptoms of colon cancer.
- Review the stages of colon cancer.
- Summarize preventative testing to reduce the risk of colon cancer.
Policy Statement
This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.
Disclosures
Fast CE For Less, Inc and its authors have no disclosures. There is no commercial support.
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| Adenocarcinoma | A type of cancer that starts in the gland cells that make mucus to lubricate and protect the inside of the colon and rectum. |
| Anaplastic Carcinoma | A general term for a malignant neoplasm arising from the uncontrolled proliferation of transformed cells of epithelial origin, or showing some epithelial characteristics, but that reveal no cytological or architectural features associated with more differentiated tumors, such as the glandular formation or special cellular junctions that are typical of adenocarcinoma and squamous cell carcinoma, respectively. |
| Anastomosis | A connection between blood vessels or between two loops of the intestine. |
| Ascending Colon (Right Colon) | The first part of the large intestine. |
| Carcinoid Tumors | A type of slow-growing cancer that can arise in several places throughout the body. |
| Chromatin | A complex of DNA and protein found in eukaryotic cells. |
| Colectomy | A surgical procedure to remove all or part of the colon. |
| Colon Adenocarcinoma | Malignant tumors that overtake healthy tissue inside an organ and may spread to other parts of the body. |
| Colon Cancer | Cancer that starts in the large colon (large intestine), the long tube that helps carry digested food to the rectum and out of the body. |
| Colonic Crypts | Contains a dedicated stem cell compartment, and several molecular markers of colon stem cells |
| Colonoscopy | An imaging test of colon for detection of abnormalities using a colonoscope. |
| Colorectal Lymphoma | A rare type of colorectal cancer; the most common type of colorectal lymphoma is non-Hodgkin’s lymphoma. |
| Computed Tomography (CT) Colonoscopy | Uses special x-ray equipment to examine the large intestine for cancer and growths called polyps. |
| Computerized Tomography (CT) | Combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels and soft tissues inside your body. |
| Crohn’s Disease | A chronic disease that causes inflammation and irritation in the digestive tract. |
| Cytoplasmic Vacuoles | Observed after the exposure of human and animal cells to many bacterial pathogens. |
| Defecation | The discharge of feces from the body. |
| Deoxyribonucleic Acid (DNA) | A polymer composed of two polynucleotide chains that coil around each other to form a double helix. |
| Descending Colon | The part of the colon extending from the left colic flexure to the level of the iliac crest (whereupon it transitions into the sigmoid colon). |
| Digestive Tract (Gastrointestinal Tract) | A long twisting tube that starts at the mouth and ends at the anus. |
| Enterochromaffin Cells | A type of enteroendocrine cell, and neuroendocrine cell. They reside alongside the epithelium lining the lumen of the digestive tract and play a crucial role in gastrointestinal regulation, particularly intestinal motility, and secretion. |
| Epidermal Growth Factor Receptor (EGFR) Inhibitors | Are medicines that bind to certain parts of the EGFR and slow down or stop cell growth. |
| Familial Adenomatous Polyposis (FAP) | A rare, inherited condition caused by a defect in the adenomatous polyposis coli (APC) gene. |
| Fecal Immunochemical Test (FIT) | A screening test for colon cancer. It tests for hidden blood in the stool, which can be an early sign of cancer. |
| Guaiac-Based Fecal Occult Blood Test (gFOBT) | Used to find occult blood (or blood that can’t be seen with the naked eye) in stool. |
| Gut Microbiota | The microorganisms including bacteria, archaea, fungi, and viruses that live in the digestive tract. |
| Ileostomy | An opening in the belly (abdominal wall) that’s made during surgery. |
| Ileum | The third portion of the small intestine, between the jejunum and the cecum. |
| Intestinal Glands | Are found in the epithelia of the small intestine, namely the duodenum, jejunum, and ileum, and in the large intestine (colon), where they are sometimes called colonic crypts. |
| Large Intestine | Where food waste is formed into poop, stored, and finally excreted. |
| Inflammatory Bowel Diseases (IBD) | The common name used to describe two chronic diseases of the intestinal tract; Crohn’s disease and ulcerative colitis, that cause inflammation in the intestines. |
| Lymphadenectomy | A surgical procedure to dissect and remove lymph nodes. |
| Lymphoma | A cancer of the lymphatic system of the body involving immune cells. |
| Lynch Syndrome | An inherited genetic condition which increases the risk of developing cancers such as colon cancer, endometrial cancer, and other cancers. |
| Magnetic Resonance Imaging (MRI) | Provides precise details of your body parts, especially soft tissues, with the help of magnetic fields and radio waves. |
| Malignancies | The tendency of a medical condition to become progressively worse; the term is most familiar as a characterization of cancer. |
| Mucinous Adenocarcinoma | A histological subtype of colorectal adenocarcinoma. They constitute about 10% of all colorectal adenocarcinomas. |
| Mucosa | A membrane that lines the digestive tract. |
| Neoadjuvant Chemotherapy | Chemotherapy that a person with cancer receives before their primary course of treatment. |
| Neuropathy | A group of diseases resulting from damaged or malfunctioning of nerves that causes weakness, numbness and pain in hands and feet. |
| Ostomy | A life-saving procedure that allows bodily waste to pass through a surgically created stoma on the abdomen into a prosthetic known as a ‘pouch’ or ‘ostomy bag’ on the outside of the body. |
| Polyp | An abnormal clump of cells that grow inside the body. |
| Positron Emission Tomography (PET) | An imaging test that uses radiotracers to assess organ and tissue functions. |
| Rectal Bleeding (Hematochezia) | Refers to fresh, red blood in the stool. |
| Serosa | A membrane that lines an internal cavity to protect the contents and secretes serum. |
| Sigmoid Colon | The part of the large intestine that is closest to the rectum and anus. |
| Signet Ring Cell Carcinoma | A rare form of highly malignant adenocarcinoma that produces mucin. |
| Smooth Muscle Layer (Muscularis Propria) | Layers of smooth muscle are used for peristalsis to move food down through the gut. |
| Squamous Cell Carcinoma | A type of skin cancer caused by an overproduction of squamous cells in your epidermis, the top layer of skin. |
| Stool DNA Test | A stool sample test to look for signs of colon cancer. |
| Submucosa | A thin layer of tissue in various organs of the gastrointestinal, respiratory, and genitourinary tracts. |
| TGF-Β Signaling Pathway | Is involved in many cellular processes including cell growth, cell differentiation, cell migration, apoptosis, cellular homeostasis, and other cellular functions. |
| Transverse Colon | The lengthy, upper part of the large intestine. |
| Tumor Mutational Burden (TMB) | A genetic characteristic of tumorous tissue that can be informative to cancer research and treatment. |
| Tumor, Node, Metastasis (TNM) Classification | A notation system that describes the stage of a cancer, which originates from a solid tumor, using alphanumeric codes. |
| Ulcerative Colitis | An inflammatory bowel disease that causes irritation, inflammation, and ulcers in the lining of the large intestine. |
| Undifferentiated Carcinomas | A type of cancer that lacks clear indicators of its origin and tissue type. |
| Vascular Endothelial Growth Factor (VEGF) Inhibitors | Agents that inhibit the activity of VEGF and VEGFR (tyrosine kinase receptor). |
| Visceral Peritoneum | An inner layer that lines the abdominal organs. |
| Wnt Signaling Pathway | A group of signal transduction pathways which begin with proteins that pass signals into a cell through cell surface receptors. |
Colon cancer is a slow-growing malignancy that originates in the lining of the colon or the rectum and is indicated by the uncontrolled growth of abnormal cells.1 Colon cancer is a type of colorectal cancer that is grouped with rectal cancer because of its numerous similarities in presentation, characteristics, and treatment.1 In the United States, more than 150,000 new cases of colon cancer were diagnosed in the last year alone, accounting for almost 8% of all new cancer cases and making it the fourth most commonly diagnosed form of cancer in the country.2 Despite the significant reduction in rate of diagnosis in people over the age of 50, rates are increasing in those under 50.1,2 More concerning, colon cancer is the second deadliest type of cancer for men and women, accounting for more than 50,000 deaths last year.2 It is estimated that nearly 4% of men and women will be diagnosed with colon or colorectal cancer at some point in their lifetime, which is why early detection and immediate management of colon cancer is the key to improving prognosis and quality of life.2
This course thoroughly examines colon cancer, discussing its characteristics, risk factors, early signs and symptoms, and treatment options. Additionally, it discusses preventative testing and important nursing considerations to better recognize, prevent, and manage this malignancy.
Colon cancer is an abnormal, unregulated growth within the lining of the colon or rectum, both parts of the large intestine. The colon is the longest part of the large intestine, averaging between 61 – 65 inches in adults, and is divided into four sections: the ascending colon, the transverse colon, the descending colon, and the sigmoid colon.3 It is the final organ component of the digestive tract with two main functions, reabsorption of water and salt from the solid waste and fermentation of unabsorbed material by the gut microbiota. From here, waste moves to the rectum, the final straight segment of the large intestine, for elimination via defecation.
The walls of the colon and rectum consist of four layers: mucosa, submucosa, smooth muscle layer (muscularis propria), and serosa. The innermost layer, the mucosa, is lined with a single cell layer of epithelial cells with invaginations called the colonic crypts or intestinal glands.1 These structures are shaped like thick-walled test tubes with holes down the central length of the tube. A genetic mutation in these cells can result in small benign growths, often in the form of a polyp, which can become cancerous over the course of 10 – 15 years, leading to the development of colon cancer.4 This mutation can be acquired or inherited, and genome analysis of tissue samples from colorectal carcinomas has shown gene abnormalities that in some way affect the Wnt signaling pathway and TGF-β signaling pathway within the colon, making it a point of interest to researchers.5,6
The Wnt signaling pathway aids in regulating the normal function of the colon’s epithelial cells and colonic crypts and the TGF-β signaling pathway, which is associated with cell growth.5,7 Research continues to study these mutated genes and other bio-proteins found in tissue samples to develop more accurate screening and diagnostics tests to identify non-cancerous growth that have the potential to become cancerous over time.
Up to 90% of cases of colon cancer are caused by lifestyle factors and old age, with only 5 – 10% caused by inherited genetic disorders.8 Key external risk factors that can increase the likelihood of developing this disease and even quicken cancerous growth are explained below.
Age and Sex
Age is one of the most noteworthy risk factors associated with colon cancer. Most cases occur in individuals over 50, with the median age at diagnosis being 66.2 While younger people can develop colon cancer, it is more likely later in life as cell damage builds up, increasing the chances of mutation.9 Additionally, men have a higher risk of developing colon cancer, with research showing higher incidence rates per 100,000 in men (42.1) than women (32.0).2
Race and Ethnicity
Certain racial and ethnic groups, such as Non-Hispanic Black and Non-Hispanic American Indian/Alaska Native, have a documented higher risk of colon cancer than other populations.2 The exact reason for this racial link is unknown, but it has been linked to polyps being located deeper in the colon, poorer lifestyle choices, and lower screening. Incidence rates for men and women per 100,000 are given in the table below.
| Race | Male | Female |
| Non-Hispanic American Indian/Alaska Native | 52.3 | 45.1 |
| Non-Hispanic Black | 50.4 | 37.2 |
| Non-Hispanic White | 42.3 | 32.5 |
| Hispanic | 39.6 | 28.4 |
| Non-Hispanic Asian/Pacific Islander | 35.3 | 25.0 |
Genetics, Medical, and Family History
Certain genetic disorders, such as Lynch syndrome (hereditary non-polyposis colorectal cancer), significantly elevate the risk of colon cancer. Other disorders like familial adenomatous polyposis (FAP) have a 100% lifetime risk of colorectal cancer if left untreated.10,11 It is estimated that 5% of all colorectal cancers are attributed to Lynch syndrome and FAP syndromes.1 If an individual has previously had colorectal polyps, been diagnosed with colon cancer, or has a first-degree relative such as a child, sibling, or parent with a similar medical history, they have a higher risk of colon cancer. Up to 20% of colon cancer is due to familial clustering without any identifiable inherited condition.1
Diet, Smoking, and Alcohol
Research has shown that certain lifestyle choices, such as diet, smoking, and alcohol consumption, have a strong link to colon cancer. A diet rich in processed or red meats and low in dietary fiber and whole grains increases the risk of colon cancer.1 Smoking is well-known in increasing the risk of multiple cancers, including colon cancer. Smoking introduces harmful substances into the body that can trigger mutation leading to abnormal growths.12 Heavy and regular alcohol consumption has also been shown to increase the risk of colon cancer.13
Obesity and Physical Inactivity
Excessive body fat, particularly around the abdominal area, has been linked to a 30-70% increased risk of colon cancer in men.12 It is believed that obesity promotes inflammation, thus contributing to cancer development. A sedentary lifestyle that lacks regular physical activity also increases the risk of this disease.1,12
Underlying Conditions
Chronic conditions that cause inflammation in the colon and rectum, like inflammatory bowel diseases (IBD), ulcerative colitis and Crohn’s disease, raise the risk of colon cancer significantly.15 Moreover, individuals with type 2 diabetes may have an elevated risk of developing colon cancer, possibly due to factors related to insulin resistance and inflammation.16
Colon cancer is categorized into distinct stages based on the extent of tumor growth, local invasion, and potential metastasis using the Tumor, Node, Metastasis(TNM) Classification. This universally adopted methodology for cancer staging categorizes tumor extent using three parameters tumor (T), node (N), and metastasis (M), as given in the table below.17
| Tumor (T) | Tx | Primary tumor cannot be assessed |
| T0 | No evidence of a primary tumor | |
| Tis | Carcinoma in situ; abnormal cells present but confined to the epithelium | |
| T1-T4 | Progressive invasion of nearby tissues or structures as the tumor increase in size and extent | |
| Node (N) | Nx | Regional lymph nodes cannot be assessed |
| N0 | No regional lymph node involvement | |
| N1-N3 | Gradations of lymph node involvement, reflecting the number, size, and extent of affected nodes | |
| Metastasis (M) | Mx | Presence of distant metastasis cannot be assessed |
| M0 | No distant metastasis | |
| M1 | Presence of distant metastasis, indicating cancer spread beyond the primary site |
Various diagnostic techniques, including computerized tomography (CT), Magnetic Resonance Imaging (MRI), and positron emission tomography (PET) scans, endoscopy, and pathological evaluation of tissue samples, are used to assess the extent of the cancer accurately.1
Stage 0 (Tis): Carcinoma in Situ
At this initial stage, cancerous cells are confined to the mucosa, the innermost layer of the colon lining, with no penetration into deeper layers or spread to lymph nodes.18
Stage I (T1 – T2, N0, M0): Localized Invasion
In stage I, the cancer has grown beyond the mucosa into the submucosa (T1) or muscular layer (T2) of the colon wall. Lymph nodes remain unaffected (N0), and distant metastasis is absent (M0). 18
Stage II (T3-T4a, N0, M0): Limited Spread
Cancerous cells have advanced into the outer layers of the colon wall (T3) or penetrated through the visceral peritoneum (T4a) but have not reached nearby organs. Lymph nodes are still uninvolved (N0), and metastasis has not occurred (M0). 18
Stage III (Any T, N1-N2, M0): Lymph Node Involvement
At stage three, cancer has infiltrated nearby lymph nodes (N1-N2) but hasn’t spread to distant sites (M0). At this point, the tumor size is less relevant than the nodal involvement as it can now spread further. 18
Stage IV (Any T, Any N, M1): Distant Metastasis
Stage four is the most advanced and indicates the cancer has spread out to distant structures or organs (M1), such as the liver, lungs, or peritoneum. Lymph node involvement (N) and the primary tumor’s size (T) may vary. 18
Recurrence of Colon Cancer
Recurrence refers to cancer’s reappearance after initial treatment. It can happen locally, in nearby tissues, or distantly in organs. Recurrence may occur months or years after treatment and be at a lower or higher stage than when it was first diagnosed.18
There are several types of colon cancer. The most common type of colon cancer is adenocarcinoma. Other rarer types of colon cancer include squamous cell carcinoma, carcinoid tumors, anaplastic carcinoma, and lymphoma.1
Colon adenocarcinoma arises from abnormal growths in the colonic crypt lining of the mucosa and can be further differentiated into mucinous and signet-ring cells.1
Mucinous adenocarcinoma is a subtype characterized by abundant extracellular mucin production, contributing to its gelatinous appearance. The tumor cells are scattered within pools of mucin, often leading to a “signet ring” appearance. These tumors may have distinct biological behavior and treatment response.19
Signet ring cell carcinoma is characterized by tumor cells with cytoplasmic vacuoles (holes in the cytoplasm) and a nucleus displaced to the periphery which resembles signet rings. The holes in the cytoplasm contain mucin for a distinctive appearance. Signet ring cell carcinomas are often considered aggressive.20
Squamous cell carcinoma arises from squamous epithelial cells rather than glandular cells. These tumors show squamous differentiation with a buildup of keratin (keratinization), resembling squamous cells in other epithelial tissues. Squamous cell carcinomas are often diagnosed at advanced stages and tend to exhibit aggressive behavior.21
Carcinoid tumors are neuroendocrine tumors arising from specialized neuroendocrine cells in the digestive tract called enterochromaffin cells. These cells typically occur in the appendix or rectum. These tumors exhibit characteristic “nested” growth patterns, with well-defined nuclei and finely granular chromatin. While most carcinoid tumors are symptomless, their prognosis depends on factors like size, grade, and presence of metastasis.22
Anaplastic carcinoma, also known as undifferentiated carcinoma, exhibits poor differentiation, lacking the typical glandular or mucin-producing features, making this type of colon cancer an accurate diagnosis. Undifferentiated carcinomas are generally associated with aggressive behavior, rapid growth, and poorer outcomes.23
Colorectal lymphoma is extremely rare, accounting for less than 1% of all colon malignancies. Typically, lymphoma originates in the lymph nodes spreading to other parts of the body. However, lymph tissue is naturally present throughout the body. Colorectal lymphoma can mutate and affect the colon or rectum. This type of cancer is often diagnosed at a later stage, making treatment more difficult.24
Colon cancer manifests various clinical signs and symptoms stemming from the tumor’s location, growth pattern, and potential local and systemic effects. Recognizing these indications is pivotal for early diagnosis, treatment planning, and patient care.1
Altered Bowel Habits: The earliest signs and symptoms of colon cancer are altered bowel movements, which include unexplained constipation, diarrhea, or alternating between the two. As the tumor increases in size it can obstruct the colon’s lumen, leading to changes in stool consistency and frequency. Constipation can result from partial obstruction, while diarrhea may occur due to stool bypassing the obstructed area.25
Change in Stool Appearance: Tumor growth within the colon lumen can lead to constriction, resulting in stools that have a narrower form like a ribbon, often called “pencil-thin” stools. Moreover, the stool may change in color, appearing darker, even black, in some cases. 25
Rectal Bleeding (Hematochezia): Rectal bleeding is another common sign of colon cancer, as it typically indicates lower gastrointestinal bleeding. Rectal bleeding is noted as the presence of bright red blood in the stool or blood on toilet tissue after wiping and is caused by ulceration or erosion of the mucosal lining.25
Abdominal Pain or Discomfort: This symptom arises from inflammation and pressure the growth puts on adjacent structures. Pain location and severity may vary depending on the tumor’s location within the colon.25
Unintended Weight Loss: Weight loss can occur despite no changes in diet or activity. Colon cancer causes metabolic changes, increasing the energy demand in the body. Also, systemic inflammation can contribute to unintended weight loss.25
Anemia: A low red blood cell count and reduced hemoglobin levels that results from chronic bleeding from the tumor site, which can lead to gradual, progressive blood loss.25
Abdominal Mass or Palpable Lump: As the tumor grows, it may become palpable through the abdominal wall, especially in advanced stages. During a physical examination, a healthcare provider can feel a lump or mass in the abdomen.25
Bowel Obstruction: Advanced tumors can cause mechanical obstruction, impairing the flow of stool and gas through the colon. This can cause a complete or partial blockage of the bowel, resulting in vomiting, severe abdominal pain, and inability to gas or pass stool.25
Fatigue and Weakness: The tumor’s metabolic demands, anemia, and systemic effects of cancer can contribute to fatigue and weakness. This persistent fatigue and weakness is not alleviated by rest.25
Systemic Symptoms: The tumor will trigger an immune response in the body which will cause other systemic symptoms such as frequent night sweats, unexplained fever, and generalized malaise.25
Treatment options and decisions are based on thoroughly evaluating the patient’s overall health, disease characteristics, stage, and individual preferences. A personalized approach often involving a combination of treatments is often used to achieve the best possible outcomes for individuals with colon cancer.1
The first-line treatment for localized, non-metastatic colon cancer is surgical resection. This treatment involves removing the cancerous segment of the colon along with nearby lymph nodes.1 The extent of resection depends on the tumor’s location and stage. Prevalent procedures may include colectomy (partial or total colon removal), lymphadenectomy, and anastomosis (rejoining of colon segments). Major complications of resection include perforation with bleeding.1,26
After surgical resection, if the two ends of the colon can be anastomosed, bowel movements generally return to normal. However, in cases where the colon cannot be anastomosed, a temporary ostomy is created. An ostomy connects the bowel to an opening in the abdomen, allowing for stool to be diverted from the area of healing and eliminated from the body into an ostomy bag. If this procedure connects the colon to the abdominal wall, it is called a colostomy, and if it connects the ileum (part of the small intestine), it is called an ileostomy.27
Surgery alone can cure patients with stage 1 colon cancer, with a five-year survival rate estimated at 90 – 95%. However, surgery is insufficient to improve survival rates for more advanced stages. With surgical resection alone, five-year survival for stage II colon cancer is 50 – 65%, and for Stage III, it is 20 – 50%.1,28 Therefore, adjuvant therapy is recommended. Adjuvant chemotherapy is the primary option and is administered following surgery to eradicate any remaining cancer cells, thus reducing the risk of recurrence. The standard recommended length is six months, but the treatment can vary as it depends on the tumor characteristics, medications, and patient’s condition.1
Neoadjuvant chemotherapy (chemotherapy before surgery) may be used to shrink tumors, facilitating the resection, but this is generally reserved for stage II with high-risk factors and stage III.26
Radiation therapy is less commonly used for colon cancer due to the colon’s mobility. However, it may be considered in specific cases to shrink tumors before surgery or as palliative treatment for symptom relief.
More than 50% of colon cancer cases metastasize, with 80 – 90% of cancers that metastasize affecting the liver. Even with the best supportive care, the prognosis is poor with a five-year survival of 15%. As a result, treatment options often focus on systemic therapies that alleviate symptoms. This approach can improve quality of life and prolong survival, and often includes a combination of the following interventions:26
Targeted therapy: Can occur with Epidermal growth factor receptor (EGFR) inhibitors (cetuximab, panitumumab) and Vascular endothelial growth factor (VEGF) inhibitors (bevacizumab, ramucirumab).1
Immunotherapy: Stimulates and enhances the immune system to recognize and attack cancer cells. Immune checkpoint inhibitors (pembrolizumab, nivolumab) have shown promise in treating certain types of colon cancer that exhibit Deoxyribonucleic acid (DNA) instability (microsatellite instability – MSI-H) or high levels of tumor mutational burden (TMB).1
Palliative chemotherapy: Used to shrink or slow down the cancer’s progression.1
Palliative treatments: Manage pain, relieve symptoms, and provide nutritional, psychological, and emotional support for patients and their families.1
Clinical trials: A treatment option that may be the only treatment available for patients unresponsive to other treatments. Clinical trials can provide new approaches, all while advancing the field of oncology.1 Regardless of the treatment option, patient surveillance and monitoring are critical to ensure early detection of potential cancer recurrence. This includes physical examinations, imaging, and laboratory tests.1
Given the curability of stage 1 colon cancer, preventive testing, also known as screening, plays a pivotal role in detecting precursor lesions, such as polyps before they progress to malignancy.1 Individuals at the highest risk are advised to undergo regular screening tests to reduce their chances of developing colon cancer. The most common preventative tests are colonoscopy, flexible sigmoidoscopy, double-contrast barium enema, stool-based tests, computed tomography (CT) colonoscopy, and genetic tests.29
Colonoscopy is regarded as the standard for colon cancer screening. Research has shown that mortality rates were drastically lower in people who have had at least one screening colonoscopy than those who did not. 30 A colonoscopy uses a flexible, lighted tube with a camera (colonoscope) to examine the large intestines. Any precancerous polyps detected can be removed (polypectomy) or biopsied for further investigation, greatly decreasing the likelihood of cancer developing.29 Similarly, flexible sigmoidoscopy may also be performed to detect and remove precancerous growths. However, this procedure is less comprehensive than a colonoscopy and focuses on the left side of the colon.29
For less invasive screening, a double-contrast barium enema or CT colonoscopy can also be done to visualize the colon. A double-contrast barium enema involves filling the colon with barium and air, followed by X-rays to create images of the colon. While it was once a common screening test, it is quickly being replaced with CT colonoscopy, which can provide much more detailed images.29 In the case of positive findings with either procedure, a follow-up with a colonoscopy is required for definitive diagnosis and treatment.1
There are also several stool-based tests for detecting colon cancer, such as guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), and stool DNA test. A gFOBT can identify blood hidden in stool samples, which may be indicative of bleeding from tumors or polyps. A FIT is more specific for human hemoglobin and is more sensitive than a FOBT. Stool DNA tests detect specific genetic markers to identify mutations or abnormalities associated with colon cancer. It is important to note that while all these stool tests are non-invasive, they are less reliable than a colonoscopy.29
Genetic tests are also another important screening tool. They can assess hereditary factors that might increase an individual’s risk of developing colon cancer, such as those for Lynch syndrome or familial adenomatous polyposis (FAP). While genetic testing is an option for everyone, it is highly recommended for individuals with a family history of colorectal diseases or colon cancer.29
When caring for a patient with colon cancer, several considerations must be kept at the forefront by the team of multidisciplinary healthcare providers and social workers coordinating care, managing treatment, and facilitating patient and family education.1 For patients with positive screening results, a comprehensive assessment of the patient’s medical history, treatment plan, and individual needs is paramount. This is followed by educating the patient and family regarding the disease, treatment options, and expectations while providing emotional support.31
By addressing patients’ fears, concerns, and coping mechanisms, healthcare professionals can assist patients and their families in coming to terms with their diagnosis and ensure that patients understand the importance of following treatment regimens.32 Once treatment has started, patients must be taught how to recognize adverse reactions such as signs of infection, thrombosis, bleeding, and other complications, ensuring prompt intervention and minimizing risks of further health problems.1,31 During treatment, healthcare providers should monitor and manage treatment-related symptoms and adverse effects such as pain, nausea, vomiting, diarrhea, constipation, fatigue, and neuropathy. Prompt intervention alleviates distress and improves patients’ quality of life.31,32
In the event of surgical resection and ostomy, healthcare providers must educate patients about managing temporary or permanent ostomies, including ostomy care, appliance management, skin integrity, and dietary considerations. It is also important to address psychological and body image concerns after an ostomy.31,32 During and after treatment, healthcare professionals must discuss lifestyle changes patients should make to reduce the risk of reoccurrence. This includes following a well-balanced diet, exercising regularly, losing and maintaining a healthy body weight, reducing alcohol consumption, and not smoking.1
Outside of medical support, psychosocial support is needed to promote mental well-being. Healthcare providers must be aware of psychological distress and facilitate access to counseling, support groups, or psychosocial services.32 In the case of advanced colon cancer, healthcare professionals must provide compassionate end-of-life care and support for patients and their families. This may include facilitating communication between patients, families, and the healthcare team and guiding discussions about end-of-life wishes and advance directives.33
Colon cancer is a slow-growing disease that sees uncontrolled irregular cell growth within the lining of the colon and rectum. While it is highly curable in its earliest stages, it has no typical clinical manifestations. Colon cancer often exhibits non-specific signs that are either overlooked or misdiagnosed for other medical issues. Classic symptoms usually present when the cancer has progressed to more advanced stages, and by this time, the prognosis becomes much poorer. Not only is more aggressive treatment required, but there is also a significant drop in survival rates, resulting in higher mortality. For this reason, early and regular screening is crucial, especially among those at a higher risk. By enhancing awareness and knowledge about colon cancer, individuals can seek prompt treatment and radical lifestyle changes to improve their long-term survival.
- Duan, B., Zhao, Y., Bai, J., Wang, J., Duan, X., Luo, X., Zhang, R., Pu, Y., Kou, M., Lei, J., & Yang, S. (2022). Colorectal Cancer: An Overview (J. A. Morgado-Diaz, Ed.). PubMed; Exon Publications. https://www.ncbi.nlm.nih.gov/books/NBK586003/
- National Cancer Institute. (2018). Cancer of the Colon and Rectum – Cancer Stat Facts. SEER. https://seer.cancer.gov/statfacts/html/colorect.html
- Kahai, P., Mandiga, P., Wehrle, C. J., & Lobo, S. (2020). Anatomy, Abdomen and Pelvis, Large Intestine. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470577/
- Cernat, L., Blaj, C., Jackstadt, R., Brandl, L., Engel, J., Hermeking, H., Jung, A., Kirchner, T., & Horst, D. (2014). Colorectal Cancers Mimic Structural Organization of Normal Colonic Crypts. PLoS ONE, 9(8), e104284. https://doi.org/10.1371/journal.pone.0104284
- Tabibzadeh, A., Tameshkel, F. S., Moradi, Y., Soltani, S., Moradi-Lakeh, M., Ashrafi, G. H., Motamed, N., Zamani, F., Motevalian, S. A., Panahi, M., Esghaei, M., Ajdarkosh, H., Mousavi-Jarrahi, A., & Niya, M. H. K. (2020). Signal transduction pathway mutations in gastrointestinal (GI) cancers: a systematic review and meta-analysis. Scientific Reports, 10(1), 18713. https://doi.org/10.1038/s41598-020-73770-1
- The Cancer Genome Atlas Network. (2012). Comprehensive molecular characterization of human colon and rectal cancer. Nature, 487(7407), 330–337. https://doi.org/10.1038/nature11252
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