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To view the natural history of familial adenomatous polyposis (FAP), click [[Familial adenomatous polyposis natural history|'''here''']]<br>
To view the natural history of familial adenomatous polyposis (FAP), click [[Familial adenomatous polyposis natural history|'''here''']]<br>
To view the natural history of hereditary nonpolyposis colorectal cancer (HNPCC), click [[Hereditary nonpolyposis colorectal cancer natural history|'''here''']]<br><br>
To view the natural history of hereditary nonpolyposis colorectal cancer (HNPCC), click [[Hereditary nonpolyposis colorectal cancer natural history|'''here''']]<br><br>
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D., Elliot B. Tapper, M.D.
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.; Elliot B. Tapper, M.D.; {{RAK}}


==Overview==
==Overview==
The progression from an edematous poly to colorectal cancer may take 10-15 years. Complication may arise is the cancer is not eradicated or from the treatment itself. Complications include [[intestinal obstruction]], gastrointestinal bleeding, [[metastasis]], cancer recurrence, [[radiation therapy]] side effects, [[chemotherapy]] side effects, post-surgical complications, metachronous colon cancer, and death. The 5 year survival rates depending upon the stage of colorectal cancer.
The progression from an [[adenomatous polyp]] to colorectal cancer may take 10-15 years. Complications may arise if the cancer is not eradicated or from the treatment itself. Complications include [[intestinal obstruction]], [[gastrointestinal bleeding]], [[metastasis]], cancer recurrence, [[radiation therapy]] adverse effects, [[chemotherapy]] adverse effects, post-surgical complications, metachronous colon cancer, and death. The 5 year survival rates depend upon the stage of colorectal cancer.


==Natural history==
==Natural history==
*Colorectal cancer arises from a precursor lesion, the adenomatous polyp<ref name="pmid10089106">{{cite journal| author=Winawer SJ| title=Natural history of colorectal cancer. | journal=Am J Med | year= 1999 | volume= 106 | issue= 1A | pages= 3S-6S; discussion 50S-51S | pmid=10089106 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10089106  }} </ref>
*Colorectal cancer usually arises from a precursor lesion, the [[adenomatous polyp]].
*The progression from an [[adenomatous polyp]] to colorectal cancer may take 10-15 years.
*The symptoms of colorectal cancer usually develop in the 6th decade of life, and start with symptoms such as change in bowel habits, [[hematochezia]] or [[bleeding]] per [[rectum]], [[abdominal cramps]] or [[discomfort]], rectal pain, [[tenesmus]], and/or diminished caliber of stools.
*Constitutional symptoms such as [[Nausea and vomiting|nausea/vomiting]], [[Weight loss|unexplained weight loss]], unexplained [[loss of appetite]], [[weakness]], [[fatigue]], [[dizziness]] may develop to suggest colorectal cancer.
*If the disease advances and spreads to other organs, the patient may present with [[dyspnea]], [[cough]] with blood-stained [[sputum]], persistent pain or discomfort in the chest, [[Swelling of the ankles|swelling in hands/feet]], [[itchiness]], [[jaundice]], and/or [[Dark urine|dark-colored urine]].<ref name="pmid10089106">{{cite journal| author=Winawer SJ| title=Natural history of colorectal cancer. | journal=Am J Med | year= 1999 | volume= 106 | issue= 1A | pages= 3S-6S; discussion 50S-51S | pmid=10089106 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10089106  }} </ref>


*The progression from an adenomatous polyp to colorectal cancer may take 10-15 years<ref name="pmid10089106">{{cite journal| author=Winawer SJ| title=Natural history of colorectal cancer. | journal=Am J Med | year= 1999 | volume= 106 | issue= 1A | pages= 3S-6S; discussion 50S-51S | pmid=10089106 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10089106  }} </ref>
*It is a multistep process involves genetics, abnormalities of cell regulation, and environmental triggers
*Once the patient is diagnosed with CRC and appropriate treatment is administered, the patient may develop the following side effects from treatment
:*[[Radiation therapy]] side effects - skin discoloration, skin burns, [[headache]], [[fatigue]], [[hair loss]], [[nausea]], [[vomiting]], and/or [[confusion]]
:*[[Chemotherapy]] side effects - [[hair loss]], [[fatigue]], [[weakness]], [[nausea]], [[vomiting]], risk of [[infection]], and/or [[diarrhea]]
:*Post-surgical complications - colon leakage, organ damage, blood clots, bleeding, infection
*If the cancer is not eradicated after treatment, the following complications may develop:
:*[[Intestinal obstruction]]
:*Intestinal Perforation
:*Fistula formation
:*[[Metastasis]]
:*Gastrointestinal bleeding
:*Cancer recurrence
:*Metachronous colon cancer (development of a second primary cancer)
:*Death
==Complications==
==Complications==
Complications of colorectal cancer include<ref name="Tebbutt2003">{{cite journal|last1=Tebbutt|first1=N C|title=Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases|journal=Gut|volume=52|issue=4|year=2003|pages=568–573|issn=00175749|doi=10.1136/gut.52.4.568}}</ref>:
Common complications of colorectal cancer include:<ref name="Tebbutt2003">{{cite journal|last1=Tebbutt|first1=N C|title=Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases|journal=Gut|volume=52|issue=4|year=2003|pages=568–573|issn=00175749|doi=10.1136/gut.52.4.568}}</ref>
*[[Intestinal obstruction]]
*[[Intestinal obstruction]]
*Intestinal Perforation
*Intestinal [[perforation]]
 
*[[Fistula]] formation
*Fistula formation
*[[Gastrointestinal bleeding]]
*Gastrointestinal bleeding
*[[Metastasis]]
*[[Metastasis]] - usually is seen in the liver and lungs but may occur in other sites
**Usually in the [[liver]] and [[lungs]] but may occur in other sites
*Cancer recurrence - local (site of the original tumor), regional (in the lymph nodes near the primary tumor) or distal (in another part of the body)
*Cancer recurrence  
*[[Radiation therapy]] side effects - skin discoloration, skin burns, [[headache]], [[fatigue]], [[hair loss]], [[nausea]], [[vomiting]], and/or [[confusion]]
**Local: site of the original tumor
*[[Chemotherapy]] side effects - [[hair loss]], [[fatigue]], [[weakness]], [[nausea]], [[vomiting]], risk of [[infection]], and/or [[diarrhea]]
**Regional: in [[lymph nodes]] near the [[primary tumor]]
:*Post-surgical complications - colon leakage, organ damage, hematoma, bleeding, infection
**Distal: in another part of the body
*Metachronous colon cancer (development of a second primary cancer) - develops six or more months after the primary tumor and is often in another site
*[[radiation therapy]] adverse effects including [[skin discoloration]], skin burns, [[headache]], [[fatigue]], [[hair loss]], [[nausea]], [[vomiting]], and/or [[confusion]]
*[[chemotherapy]] adverse effects including [[hair loss]], [[fatigue]], [[weakness]], [[nausea]], [[vomiting]], risk of [[infection]], and/or [[diarrhea]]
*Death
*Death


==Prognosis==
==Prognosis==
Survival is directly related to detection and the type of cancer involved.  Survival rates for early stage detection is about 5 times that of late stage cancers.  CEA level is also directly related to the prognosis of disease, since its level correlates with the bulk of tumor tissue.
Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor.


The [[CEA]] should return to normal levels with treatment.  There may be temporary rise in CEA levels when [[chemotherapy]] or [[radiotherapy]] are given because of the death of the cancer cells which release CEA.
The 5 year survival rate at diagnosis of colon cancer:<ref name=":0">{{cite book | last = Amin | first = Mahul | title = AJCC cancer staging manual | publisher = Springer | location = Switzerland | year = 2017 | isbn = 978-3-319-40617-6 }}</ref>
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
| style="background:#f0f0f0;" align="center" |'''Stage'''


Normal CEA levels are:
| style="background:#f0f0f0;" align="center" |'''5-year Relative Survival Rate'''
* Non-smokers - <3 micrograms per liter (mcg/L)
* Smokers - <5 micrograms per liter (mcg/L)


The 5 year survival rates depending upon the stage of colorectal cancer are as follows:
|-


The numbers below come from the National Cancer Institute's SEER database, looking at people diagnosed with colon cancer between 2004 and 2010.
| '''I'''||74.0%
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Stage'''
 
| align="center" style="background:#f0f0f0;"|'''5-year Relative Survival Rate'''


|-
|-


| '''I'''||92%
| '''IIA'''||66.5%


|-
|-


| '''IIA'''||87%
| '''IIB'''||58.6%


|-
|-


| '''IIB'''||63%
| '''IIC'''||37.3%


|-
|-


| '''IIIA'''||89%
| '''IIIA'''||73.1%


|-
|-


| '''IIIB'''||69%
| '''IIIB'''||46.3%


|-
|-


| '''IIIC'''||53%
| '''IIIC'''||28.0%


|-
|-


| '''IV'''||11%
| '''IV'''||5.7%


|}
|}


The numbers below come from the National Cancer Institute's SEER database, looking at people diagnosed with rectal cancer between 2004 and 2010.
The 5 year survival rate at diagnosis of rectal cancer:<ref name=":0" />
{| {{table}}
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
| align="center" style="background:#f0f0f0;"|'''Stage'''
| style="background:#f0f0f0;" align="center" |'''Stage'''


| align="center" style="background:#f0f0f0;"|'''5-year Relative Survival Rate'''
| style="background:#f0f0f0;" align="center" |'''5-year Relative Survival Rate'''


|-
|-


| '''I'''||87%
| '''I'''||74.1%


|-
|-


| '''IIA'''||80%
| '''IIA'''||64.5%


|-
|-


| '''IIB'''||49%
| '''IIB'''||51.6%


|-
|-


| '''IIIA'''||84%
| '''IIC'''||32.3%


|-
|-


| '''IIIB'''||71%
| '''IIIA'''||74.0%


|-
|-


| '''IIIC'''||58%
| '''IIIB'''||45.0%


|-
|-


| '''IV'''||12%
| '''IIIC'''||33.4%
 
|-
 
| '''IV'''||6.0%


|}
|}
'''Poor prognostic factors of patients with liver metastasis include the following:'''
 
*[[Synchronous]] (diagnosed simultaneously) liver and primary colorectal tumors
[[CEA]] level may also be directly related to the prognosis of disease, since its concentration correlates with the bulk of tumor tissue.
*A short time between detecting the primary cancer and subsequent development of liver metastasis
 
'''Poor prognostic factors of patients with hepatic metastasis include the following:'''
*[[Synchronous]] (diagnosed simultaneously) [[liver]] and [[Cardiac tumors|primary colorectal tumors]]
*A short time between detecting the [[Primary tumor|primary cancer]] and subsequent development of [[Metastases|liver metastasis]]
*Multiple metastatic lesions
*Multiple metastatic lesions
*High [[blood]] levels of the tumor marker, [[carcino-embryonic antigen]] (CEA), in the patient prior to resection
*Large-sized metastatic lesions, which can be measured by a high concentration of [[Carcinoembryonic antigen|carcino-embryonic antigen]] ([[CEA]])
*Large-sized metastatic lesions


==References==
==References==
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Latest revision as of 20:08, 28 January 2019

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To view the natural history of familial adenomatous polyposis (FAP), click here
To view the natural history of hereditary nonpolyposis colorectal cancer (HNPCC), click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.; Elliot B. Tapper, M.D.; Roukoz A. Karam, M.D.[2]

Overview

The progression from an adenomatous polyp to colorectal cancer may take 10-15 years. Complications may arise if the cancer is not eradicated or from the treatment itself. Complications include intestinal obstruction, gastrointestinal bleeding, metastasis, cancer recurrence, radiation therapy adverse effects, chemotherapy adverse effects, post-surgical complications, metachronous colon cancer, and death. The 5 year survival rates depend upon the stage of colorectal cancer.

Natural history

Complications

Common complications of colorectal cancer include:[2]

Prognosis

Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor.

The 5 year survival rate at diagnosis of colon cancer:[3]

Stage 5-year Relative Survival Rate
I 74.0%
IIA 66.5%
IIB 58.6%
IIC 37.3%
IIIA 73.1%
IIIB 46.3%
IIIC 28.0%
IV 5.7%

The 5 year survival rate at diagnosis of rectal cancer:[3]

Stage 5-year Relative Survival Rate
I 74.1%
IIA 64.5%
IIB 51.6%
IIC 32.3%
IIIA 74.0%
IIIB 45.0%
IIIC 33.4%
IV 6.0%

CEA level may also be directly related to the prognosis of disease, since its concentration correlates with the bulk of tumor tissue.

Poor prognostic factors of patients with hepatic metastasis include the following:

References

  1. ↑ Winawer SJ (1999). "Natural history of colorectal cancer". Am J Med. 106 (1A): 3S–6S, discussion 50S-51S. PMID 10089106.
  2. ↑ Tebbutt, N C (2003). "Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases". Gut. 52 (4): 568–573. doi:10.1136/gut.52.4.568. ISSN 0017-5749.
  3. ↑ 3.0 3.1 Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 978-3-319-40617-6.


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