Colorectal cancer natural history: Difference between revisions
(Mahshid) |
|||
Line 6: | Line 6: | ||
==Overview== | ==Overview== | ||
The progression from an | 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 | *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> | ||
*The progression from an [[adenomatous]] | *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 that involves genetics, abnormalities of cell regulation, and environmental triggers | *It is a multistep process that involves [[genetics]], abnormalities of cell regulation, and environmental triggers | ||
*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 | *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/vomiting, unexplained weight loss, unexplained loss of appetite, weakness, fatigue, dizziness may develop to suggest colorectal cancer | *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 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 | *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 of the ankles|swelling in hands/feet]], [[itchiness]], [[jaundice]], and/or [[Dark urine|dark-colored urine]] | ||
*Once the cancer spreads to the other organs, it is most likely fatal | *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> | 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]] - 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 - local (site of the original tumor), regional (in the [[lymph nodes]] near the [[primary tumor]]) or distal (in another part of the body) | ||
*Common [[radiation therapy]] adverse effects - skin discoloration, skin burns, [[headache]], [[fatigue]], [[hair loss]], [[nausea]], [[vomiting]], and/or [[confusion]] | *Common [[radiation therapy]] adverse effects - [[skin discoloration]], skin burns, [[headache]], [[fatigue]], [[hair loss]], [[nausea]], [[vomiting]], and/or [[confusion]] | ||
*Common [[chemotherapy]] adverse effects - [[hair loss]], [[fatigue]], [[weakness]], [[nausea]], [[vomiting]], risk of [[infection]], and/or [[diarrhea]] | *Common [[chemotherapy]] adverse effects - [[hair loss]], [[fatigue]], [[weakness]], [[nausea]], [[vomiting]], risk of [[infection]], and/or [[diarrhea]] | ||
*Common post-surgical complications - colon leakage, organ damage, [[hematoma]], [[bleeding]], [[infection]] | *Common post-surgical complications - colon leakage, organ damage, [[hematoma]], [[bleeding]], [[infection]] | ||
Line 32: | Line 32: | ||
==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. | 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. | |||
The 5 year survival rates depending upon the stage of colorectal cancer are as follows: | * The [[Survival rates|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. | * The numbers below come from the National Cancer Institute's SEER database, looking at people diagnosed with colon cancer between 2004 and 2010. | ||
{| {{table}} | {| style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" cellspacing="0" cellpadding="4" {{table}} | ||
| | | style="background:#f0f0f0;" align="center" |'''Stage''' | ||
| | | style="background:#f0f0f0;" align="center" |'''5-year Relative Survival Rate''' | ||
|- | |- | ||
Line 73: | Line 74: | ||
The numbers below come from the National Cancer Institute's SEER database, looking at people diagnosed with rectal cancer between 2004 and 2010. | The numbers below come from the National Cancer Institute's SEER database, looking at people diagnosed with rectal cancer between 2004 and 2010. | ||
{| {{table}} | {| style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" cellspacing="0" cellpadding="4" {{table}} | ||
| | | style="background:#f0f0f0;" align="center" |'''Stage''' | ||
| | | style="background:#f0f0f0;" align="center" |'''5-year Relative Survival Rate''' | ||
|- | |- | ||
Line 108: | Line 109: | ||
|} | |} | ||
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== |
Revision as of 20:24, 15 December 2017
Colorectal cancer Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Colorectal cancer natural history On the Web |
American Roentgen Ray Society Images of Colorectal cancer natural history |
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 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 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 that involves genetics, abnormalities of cell regulation, and environmental triggers
- 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/vomiting, unexplained weight loss, unexplained loss of appetite, weakness, fatigue, dizziness may develop to suggest colorectal cancer
- 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 of colorectal cancer include:[2]
- 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 the lymph nodes near the primary tumor) or distal (in another part of the body)
- Common radiation therapy adverse effects - skin discoloration, skin burns, headache, fatigue, hair loss, nausea, vomiting, and/or confusion
- Common chemotherapy adverse effects - hair loss, fatigue, weakness, nausea, vomiting, risk of infection, and/or diarrhea
- Common post-surgical complications - colon leakage, organ damage, hematoma, 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 the detection and the type of cancer involved.
- Survival rates for early stage detection is approximately 5 times that of late stage cancers.
- 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% |
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
- ↑ 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.