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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 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.
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<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.
*It is a multistep process that involves genetics, abnormalities of cell regulation, and environmental triggers
*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.
*The patient may present with 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.
*Constitutional symptoms such as nausea/vomiting, 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>
*If the diseases 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 in hands/feet, [[itchiness]], [[jaundice]], and/or dark-colored urine
*Once the cancer spreads to the other organs, it is most likely fatal


==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]] - usually in the liver and lungs but may occur in other sites
*[[Metastasis]]
*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)
**Usually in the [[liver]] and [[lungs]] but may occur in other sites
*Common [[radiation therapy]] adverse effects - skin discoloration, skin burns, [[headache]], [[fatigue]], [[hair loss]], [[nausea]], [[vomiting]], and/or [[confusion]]
*Cancer recurrence  
*Common [[chemotherapy]] adverse effects - [[hair loss]], [[fatigue]], [[weakness]], [[nausea]], [[vomiting]], risk of [[infection]], and/or [[diarrhea]]
**Local: site of the original tumor
*Common post-surgical complications - colon leakage, organ damage, [[hematoma]], [[bleeding]], [[infection]]
**Regional: in [[lymph nodes]] near the [[primary tumor]]
*Metachronous colon cancer (development of a second primary cancer) - develops six or more months after the primary tumor and is often in another site
**Distal: in another part of the body
*[[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 the detection and the type of cancer involved. Survival rates for early stage detection is approximately 5 times that of late stage cancers.
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 rates depending upon the stage of colorectal cancer are as follows:
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'''


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


| align="center" style="background:#f0f0f0;"|'''5-year Relative Survival Rate'''
|-
 
| '''I'''||74.0%


|-
|-


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


| align="center" style="background:#f0f0f0;"|'''5-year Relative Survival Rate'''
| '''I'''||74.1%


|-
|-


| '''I'''||87%
| '''IIA'''||64.5%


|-
|-


| '''IIA'''||80%
| '''IIB'''||51.6%


|-
|-


| '''IIB'''||49%
| '''IIC'''||32.3%


|-
|-


| '''IIIA'''||84%
| '''IIIA'''||74.0%


|-
|-


| '''IIIB'''||71%
| '''IIIB'''||45.0%


|-
|-


| '''IIIC'''||58%
| '''IIIC'''||33.4%


|-
|-


| '''IV'''||12%
| '''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.
[[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:'''
'''Poor prognostic factors of patients with hepatic metastasis include the following:'''
*[[Synchronous]] (diagnosed simultaneously) liver and primary colorectal tumors
*[[Synchronous]] (diagnosed simultaneously) [[liver]] and [[Cardiac tumors|primary colorectal tumors]]
*A short time between detecting the primary cancer and subsequent development of liver metastasis
*A short time between detecting the [[Primary tumor|primary cancer]] and subsequent development of [[Metastases|liver metastasis]]
*Multiple metastatic lesions
*Multiple metastatic lesions
*Large-sized metastatic lesions, which can be measured by a high concentration of carcino-embryonic antigen (CEA)
*Large-sized metastatic lesions, which can be measured by a high concentration of [[Carcinoembryonic antigen|carcino-embryonic antigen]] ([[CEA]])


==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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