Colorectal cancer natural history
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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.
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.
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.