Colorectal cancer natural history: Difference between revisions
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{{Colon cancer}} | {{Colon cancer}} | ||
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> | ||
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.; Elliot B. Tapper, M.D.; {{RAK}} | |||
==Overview== | ==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== | ==Natural history== | ||
*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> | |||
==Complications== | ==Complications== | ||
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 [[perforation]] | |||
*[[Fistula]] formation | |||
*[[Gastrointestinal bleeding]] | |||
*[[Metastasis]] | |||
**Usually in the [[liver]] and [[lungs]] but may occur in other sites | |||
*Cancer recurrence | |||
**Local: site of the original tumor | |||
**Regional: in [[lymph nodes]] near the [[primary tumor]] | |||
**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 | |||
==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:<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''' | |||
| style="background:#f0f0f0;" align="center" |'''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:<ref name=":0" /> | |||
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" | |||
| style="background:#f0f0f0;" align="center" |'''Stage''' | |||
== | | style="background:#f0f0f0;" align="center" |'''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:''' | |||
*[[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 | |||
*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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[[Category:Disease]] | [[Category:Disease]] | ||
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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
- 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/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 in hands/feet, itchiness, jaundice, and/or dark-colored urine.[1]
Complications
Common complications of colorectal cancer include:[2]
- Intestinal obstruction
- Intestinal perforation
- Fistula formation
- Gastrointestinal bleeding
- Metastasis
- Cancer recurrence
- Local: site of the original tumor
- Regional: in lymph nodes near the primary tumor
- 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
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:
- Synchronous (diagnosed simultaneously) liver and primary colorectal tumors
- A short time between detecting the primary cancer and subsequent development of liver metastasis
- Multiple metastatic lesions
- Large-sized metastatic lesions, which can be measured by a high concentration of carcino-embryonic antigen (CEA)
References
- ↑ Winawer SJ (1999). "Natural history of colorectal cancer". Am J Med. 106 (1A): 3S–6S, discussion 50S-51S. PMID 10089106.
- ↑ 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.
- ↑ 3.0 3.1 Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 978-3-319-40617-6.