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Revision as of 15:11, 14 July 2015
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Colorectal cancer Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Colorectal cancer natural history On the Web |
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American Roentgen Ray Society Images of Colorectal cancer natural history |
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Risk calculators and risk factors for Colorectal cancer natural history |
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.
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.
Natural history
- Colorectal cancer arises from a precursor lesion, the adenomatous polyp[1]
- The progression from an adenomatous polyp to colorectal cancer may take 10-15 years[1]
- 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 of colorectal cancer include[2]:
- Intestinal obstruction
- Intestinal Perforation
- Fistula formation
- Gastrointestinal bleeding
- Metastasis - usually is seen 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)
- 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
- Metachronous colon cancer (development of a second primary cancer) - develops six or more months after the primary tumor and is often in another site
- Death
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.
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.
Normal CEA levels are:
- 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.
| Stage | 5-year Relative Survival Rate |
| I | 92% |
| IIA | 87% |
| IIB | 63% |
| IIIA | 89% |
| IIIB | 69% |
| IIIC | 53% |
| IV | 11% |
The numbers below come from the National Cancer Institute's SEER database, looking at people diagnosed with rectal cancer between 2004 and 2010.
| Stage | 5-year Relative Survival Rate |
| I | 87% |
| IIA | 80% |
| IIB | 49% |
| IIIA | 84% |
| IIIB | 71% |
| IIIC | 58% |
| IV | 12% |
Poor prognostic factors of patients with liver 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
- High blood levels of the tumor marker, carcino-embryonic antigen (CEA), in the patient prior to resection
- Large-sized metastatic lesions
References
- ↑ 1.0 1.1 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.