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Sporadic Nonhereditary Colorectal Cancer

Benign to malignant polyp progression
Benign to malignant polyp progression. (Click to Enlarge)

Colorectal cancer may start anywhere on the colon or rectum. It affects about 5 percent of the population in the United States. This means that the average adult has about a 1 in 19 chance of getting colon cancer in their lifetime. Each year, up to 150,000 new cases are diagnosed.

Colorectal Cancer Symptoms

Colorectal cancer does not usually produce symptoms early in the disease. Later as the tumor grows, the symptoms you experience depend on where in the intestine the primary tumor is located.

Symptoms include:

  • Blood in stool; sometimes, the blood is not obvious, called occult (hidden) blood

  • Anemia

  • Abdominal distension and pain

  • Nausea and vomiting

  • Pelvic pain

  • Loss of appetite, weight and strength

  • A change in bowel habits (new-onset constipation)

Colorectal Cancer Diagnosis at Johns Hopkins

Because you may not experience symptoms during the early stages of the disease, it is crucial to undergo regular exams to screen for colon cancer. This way, if cancer is present, it can be caught and treated early. Polyps are pre-cancerous growths that start in the colon. Some types of polyps have the potential to enlarge and become cancerous.

Polyps are found in 1 in 4 people who undergo colonoscopy. Polyps or cancers found early can often be removed without having to undergo surgery; the cure rate in these cases is close to 100 percent. Removing polyps from the colon may reduce your risk of developing colon cancer in the future.

The combination of screening and prevention is important in the fight against colorectal cancer. Talk to your doctor about your risk factors and when you should begin screening. For Americans, screening for colorectal cancer should start no later than age 50. Depending on your personal or family history, your doctor might recommend that you start screening for colorectal cancer at an earlier age.

Screening tests for colorectal cancer include:

Fecal Occult Blood Test

This blood test looks for occult (hidden) blood in the stool. For this test:

  • You receive three small cards and place a sample on each from three consecutive bowel movements.

  • A small amount of the stool is placed on a special test strip.

  • The stool is analyzed for traces of blood.

Barium Enema

A barium enema is an X-ray of the rectum and colon. Before the procedure, you will need to clear your colon of any stool. Preparations may include a liquid diet, enema or laxative. During a barium enema:

  • A barium preparation (contrast material) is inserted through a rectal tube.

  • The barium outlines the colon, highlighting any abnormalities.

  • An X-ray is taken.

  • Your doctor can see the entire colon and see if polyps or cancer are present.

Flexible Sigmoidoscopy

A flexible sigmoidoscopy is a type of endoscopic diagnosis. An endoscope is a thin, flexible lighted tube that your doctor inserts inside you to see the affected area.

A flexible sigmoidoscopy examines the rectum and lower colon. During the procedure:

  • Your colon must be clear of stool so your doctor has good visibility. Preparations may include a liquid diet, enema and laxatives.

  • Your doctor inserts the sigmoidoscope through the rectum and into the anus and large intestine, and checks to see if cancer or polyps are present.

  • Biopsy forceps may be inserted through the scope in order to remove a small sample of tissue for further analysis.

Colonoscopy

Colonoscopy is the most widely used diagnostic test to study the colon. It has the highest sensitivity of all tests. Doctors can examine 90 to 95 percent of the colon during most colonoscopies.

During a colonoscopy:

  • Your colon must be clear of stool so your doctor has good visibility. Preparations may include a liquid diet, enema and laxatives.

  • Typically you will receive medication to sedate you for this procedure.

  • Your doctor inserts the colonoscope through the rectum and into the anus and large intestine, and checks to see if cancer or polyps are present.

  • A biopsy forceps may be inserted through the scope in order to remove a small sample of tissue for further analysis.

  • A polyp can be removed through the colonoscope.

Virtual Colonoscopy (also called CT Colonography)

Virtual colonoscopy is a way to screen for colorectal cancer using computed tomography (CT) imaging. This procedure is done in the radiology department. Virtual colonoscopy does not involve sedation, but does require that your colon be clear of stool.

  • You will be asked to take a laxative preparation the night before, similar to what is required for the other kind of colonoscopy.

  • Air will be pumped into your colon for this exam, which might cause some cramping.

  • If a polyp is identified, you will be referred for a traditional colonoscopy since no polyps can be biopsied or removed during virtual colonoscopy.

Stool DNA Test

There is a commercial kit that your doctor must first prescribe for use as a colorectal cancer screening test. Special DNA testing is done on a stool sample that you provide to detect the presence of abnormal cells that are shed from large colorectal polyps or cancers.

  • The test is shipped to your home and you collect the stool sample at home before sending it back to the company.

  • Your doctor will receive the results and communicate those to you.

  • If the test is positive, you will likely need to have a colonoscopy to confirm the findings.

Sporadic (Nonhereditary) Colorectal Cancer Treatment at Johns Hopkins

Treatment will depend on how early the cancer is caught. Sometimes, your doctor can remove polyps during a colonoscopy and no further treatment is necessary. Other times, you may need surgery and/or chemotherapy. Learn more about sporadic (nonhereditary) colorectal cancer treatment at Johns Hopkins.

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