Topic Overview

Is this topic for you?

This topic will tell you about the initial testing, diagnosis, and treatment of colorectal cancer.

If you want to learn about colorectal cancer that has come back or has spread, see the topic Colorectal Cancer, Metastatic or Recurrent.

What is colorectal cancer?

Colorectal cancer happens when cells that are not normal grow in your colon or rectum . These cells grow together and form tumors.

This cancer is also called colon cancer or rectal cancer. It is the third most common cancer in the United States. And it occurs most often in people older than 50.

When it is found early, it is easily treated and often cured. But because it usually is not found early, it is the second leading cause of cancer deaths in the United States. ¹ Screening tests can prevent this cancer, but fewer than half of people older than 50 are screened. According to the American Cancer Society, if everyone were tested, tens of thousands of lives could be saved each year.

What causes colorectal cancer?

Most cases begin as polyps , which are small growths inside the colon or rectum. Colon polyps are very common, and most of them do not turn into cancer. But doctors cannot tell ahead of time which polyps will turn into cancer. This is why people older than 50 need regular tests to find out if they have any polyps and then have them removed. And some people who are younger than 50 need regular tests if their medical history puts them at increased risk for colorectal cancer.

What are the symptoms?

Colorectal cancer usually does not cause symptoms until after it has begun to spread. See your doctor if you have any of these symptoms:

• Pain in your belly
• Blood in your stool or very dark stools
• A change in your bowel habits, such as more frequent stools or a feeling that your bowels are not emptying completely

How is colorectal cancer diagnosed?

If your doctor thinks that you may have this cancer, you will need a test, called a colonoscopy , that lets the doctor see the inside of your entire colon and rectum. During this test, your doctor will remove polyps or take tissue samples from any areas that don't look normal. The tissue will be looked at under a microscope to see if it contains cancer.

Sometimes another test, such as a sigmoidoscopy , is used to diagnose colorectal cancer.

How is it treated?

Surgery is almost always used to treat colon and rectal cancer. The cancer is easily removed and often cured when it is found early.

If the cancer has spread into the wall of the colon or farther, you may also need radiation or chemotherapy . These treatments have side effects, but most people can manage the side effects with medicines or home care.

Learning that you have cancer can be upsetting. It may help to talk with your doctor or with other people who have had cancer. Your local American Cancer Society chapter can help you find a support group.

How can you screen for colorectal cancer?

Screening tests can prevent many cases of colon and rectal cancer. They look for a certain disease or condition before any symptoms appear. Experts recommend routine colon cancer testing for everyone age 50 and older who has a normal risk for colon cancer. People who have a higher risk, such as African Americans and people with a strong family history of colon cancer, should be tested sooner. Talk to your doctor about when you should be tested.

These are the most common screening tests:

• Stool tests that check for signs of cancer:
  • Fecal occult blood test (FOBT).
  • Fecal immunochemical test (FIT).
  • Stool DNA test (sDNA).
• Sigmoidoscopy. A doctor puts a flexible viewing tube into your rectum and into the first part of your colon. This lets the doctor see the lower portion of the intestine, which is where most colon cancers grow. Doctors can remove polyps during this test also.
• Colonoscopy. A doctor puts a long, flexible viewing tube into your rectum and colon. The tube is usually linked to a video monitor similar to a TV screen. With this test, the doctor can see the entire large intestine.
• Computed tomographic colonography (CTC). This test is also called a virtual colonoscopy. A computer and X-rays make a detailed picture of the colon to help the doctor look for polyps.

Frequently Asked Questions

Learning about colorectal cancer:	What is colorectal cancer? What causes it? How can I prevent it? What are the symptoms? What increases my risk? What else could be causing my symptoms? Who gets this cancer?
Being diagnosed:	How is colorectal cancer diagnosed? What are the stages of colorectal cancer? What is a colonoscopy? What is a sigmoidoscopy? What is a fecal occult blood test?
Getting treatment:	How is colorectal cancer treated? Will I need surgery? What medicines are used to treat this cancer? What is radiation therapy?
Ongoing concerns:	How often will I need to see my doctor? When should I call my doctor?
Living with colorectal cancer:	What can I do at home to relieve symptoms of the cancer or cancer treatment?

Health Tools 

Health Tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Colon cancer: Which screening test should I have?
	Actionsets are designed to help people take an active role in managing a health condition.
	Bowel disease: Caring for your ostomy
	Cancer: Controlling nausea and vomiting from chemotherapy

Cause

The exact cause of colorectal cancer is not known. Most cases begin as small growths, or polyps, inside the colon or rectum.

Colon polyps are very common. Very few of them turn into cancer. If they are found early, usually through routine screening tests, they can be removed before they turn into cancer.

Symptoms

Colorectal cancer in its early stages usually doesn't cause any symptoms. Symptoms occur later, when the cancer may be more difficult to treat. The most common symptoms include:

• Pain in the belly.
• Blood in your stool or very dark stools.
• A change in your bowel habits (such as more frequent stools or a feeling that your bowels are not emptying completely).
• Fatigue.
• In rare cases, unexplained weight loss.

Colon cancer may cause no symptoms. When there are symptoms, they may depend on where in the colon the cancer is. ²

• The cecum and ascending colon , the first and second parts of the colon, are on the right side of your abdomen. Cancer in this area may bleed, causing blood in the stool and symptoms of anemia , including fatigue and weakness. The amount of blood may be small and so well mixed with stool that your stool may look normal. Sometimes cancer in this area does not cause many symptoms.
• The transverse colon , the third part, goes across your body from right to left. Cancer here may cause abdominal cramps.
• The descending colon , the fourth part, and the S-shaped sigmoid colon , the fifth part, are on the left side of your abdomen and join the rectum. Cancer here may cause narrower stools and bright red blood in the stool. Sometimes this blood is mistakenly thought to come from hemorrhoids .

Having these symptoms does not mean you have cancer. A number of other medical problems could cause similar symptoms, including:

• Irritable bowel syndrome , a common digestive problem that causes periods of stomach pain, cramping or bloating, and diarrhea or constipation.
• Other growths ( polyps ) in the large intestine that are not cancer.
• Diverticulitis , a condition in which pouches form in the wall of the colon and become painful, swollen, or infected.
• Infections that cause diarrhea, such as salmonella .
• Inflammatory bowel disease , such as Crohn's disease and ulcerative colitis , which cause swelling and sores in the intestines.
• Bleeding hemorrhoids .
• Ulcers of the rectum.

What Happens

Cancer is the growth of abnormal cells in the body. These extra cells grow together and form masses, called tumors. In colorectal cancer , these growths usually start as polyps in the large intestine (colon or rectum). Colon polyps are quite common and most do not cause problems. But if they are not detected and removed, some of them can turn into cancer.

Cancers in the colon or rectum usually grow very slowly. It takes most of them years to become large enough to cause symptoms. If the cancer is allowed to grow, it eventually will invade and destroy nearby tissues and then spread farther. Colorectal cancer spreads first to nearby lymph nodes . From there it may spread to other parts of the body, usually the liver. It may also spread to the lungs, and less often, to the bones and the brain.

The long-term outcome, or prognosis, for colorectal cancer depends on how much the cancer has grown and spread. Experts talk about prognosis in terms of "5-year survival rates." The 5-year survival rate means the percentage of people who are still alive 5 years or longer after their cancer was discovered. It is important to remember that these are only averages. Everyone's case is different, and these numbers do not necessarily show what will happen to you. The estimated 5-year survival rate for colorectal cancer is: ¹

• 90% or more if cancer is found early and treated before it has spread.
• 67% if the cancer has spread to nearby organs and lymph nodes.
• 10% if the cancer has spread to the liver, lungs, or bones.

What Increases Your Risk

Colorectal cancer occurrence rates are highest among blacks; intermediate among whites, Asians, and Pacific Islanders; and lowest among American Indians, Alaskan Natives, and Hispanics. ¹

A risk factor is anything that increases your chance of getting a disease such as cancer. Risk factors for getting colorectal cancer include:

Your age

Everyone who is older than 50 has a risk of getting colorectal cancer and the older you are, the greater the risk. Most cases of colorectal cancer are diagnosed in people older than 50. Most people who get colorectal cancer have no other risk factors besides being older than 50.

Your family's medical history

You are more likely to get colorectal cancer if one of your parents, brothers, sisters, or children has had the disease. Your risk depends on how old your family member was when he or she was diagnosed and on how many members of your family have had the disease. ¹

If you have a strong family history of colorectal cancer, you may want to have a blood test to look for changed genes. Genetic mutations are more common in certain ethnic groups, such as Ashkenazi Jews (Jews whose ancestors were from Eastern Europe).

You have a strong family history if all of the following are true:

• You have at least three relatives who have had colon cancer, and at least one of them is a parent, brother, or sister.
• Those relatives are spread over two generations in a row (for example, a grandparent and a parent).
• One of those relatives got cancer before age 50.

The most common gene changes occur in two conditions: familial adenomatous polyposis (FAP) and hereditary nonpolyposis colon cancer (HNPCC) . Many people with these changed genes will develop colorectal cancer if they are not carefully watched. Genetic testing can tell you whether you carry a changed, or mutated, gene that can cause FAP or HNPCC.

Most people who get colorectal cancer do not have a personal or family history of the disease.

Your medical history

Your chances of getting colorectal cancer are higher if you have had:

• Colorectal cancer in the past.
• Another type of cancer, such as cancer of the ovary or cancer of the endometrium .
• Polyps removed from your colon, especially if you had large polyps or a large number of polyps.
• Ulcerative colitis or Crohn's disease for more than 10 years.
• Radiation therapy in your abdomen or pelvis.
• Type 2 diabetes. ^{3 4}

What you eat

Your chances of getting colorectal cancer may be higher if your diet is high in calories, protein, and fat—especially animal fat—and if your diet is low in calcium.

Whether you smoke

Studies show that smokers have a greater chance of getting colorectal cancer. ²

How much you exercise

If you are not physically active, you have a greater chance of getting colorectal cancer.

How much you weigh

If you are very overweight, your chances of getting colorectal cancer are higher. Having extra fat in the waist area is a greater risk than having extra fat in the hips or thighs.

How much alcohol you drink

People who drink more than 2 alcoholic drinks a day—and especially those who drink more than 3 drinks a day—have a slightly higher risk for colorectal cancer. ⁵

When To Call a Doctor

Call your doctor if you have any symptoms of colorectal cancer , such as:

• A change in bowel habits.
• Bleeding from your rectum, including bright red or dark blood in your stools or stools that look black.
• Constant or frequent diarrhea, constipation, or a feeling that your bowel doesn't empty completely.
• Stools that are narrow (may be as narrow as a pencil).
• Abdominal pain or problems with gas or bloating.
• Unexplained weight loss.
• Constant fatigue .

Because colorectal cancer often does not cause any symptoms, talk with your doctor about screening tests. Screening helps doctors find a certain disease or condition before any symptoms appear. Some screening tests for colorectal cancer can find and remove small precancerous growths in the colon and rectum called adenomatous polyps . If these are found and removed early, they cannot turn into cancer.

Watchful Waiting

Watchful waiting refers to a period of time in which your doctor is checking you regularly but not treating you. It is also called observation or surveillance. Watchful waiting is not a reasonable option when you have symptoms of colorectal cancer.

Who To See

Health professionals who can evaluate your symptoms of colorectal cancer include:

• Family medicine doctors .
• General practitioners .
• Gastroenterologists .
• General surgeons .
• Internists .
• Nurse practitioners .
• Physician assistants .

If your doctor thinks you may have colorectal cancer, he or she may advise you to see a general surgeon or a colon and rectal surgeon . Colorectal cancer is treated by surgeons, medical oncologists , and radiation oncologists .

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

If your doctor thinks you may have colorectal cancer , he or she will ask you questions about your medical history and give you a physical exam. Other tests may include:

• A colonoscopy, a test in which your doctor uses a lighted scope to view the inside of your entire colon. A colonoscopy may be done to look into symptoms such as unexplained bleeding from the rectum, constant diarrhea or constipation, blood in the stool, or pain in the lower abdomen. A colonoscopy is recommended when another screening test shows you may have colorectal cancer. ⁶
• A digital rectal examination , in which your doctor puts a gloved finger into your rectum. This exam is done to look into symptoms such as rectal bleeding or blood in the stool, abdominal or pelvic pain, a change in bowel habits, or urinary problems in men.
• Fecal occult blood test (FOBT), or fecal immunochemical test (FIT), in which your stool is tested with a special solution to see if it contains blood. Or a stool DNA test (sDNA) may be used to check for signs of cancer.
• A sigmoidoscopy, a test in which your doctor uses a lighted scope to view the lower part of your intestine. A sigmoidoscopy may be done to look into symptoms such as unexplained bleeding from the rectum, constant diarrhea or constipation, blood in the stool, or pain in the lower abdomen. Doctors can also remove polyps during this test.
• A barium enema, in which a whitish liquid with barium is inserted through your rectum into your intestine. The barium outlines the inside of the colon so that it can be seen on an X-ray.
• Computed tomographic colonography (CTC), also known as virtual colonoscopy. This test uses X-rays and a computer to make a detailed picture of the colon to help the doctor look for polyps. It may be used as a screening test for people who do not have an increased risk for colon cancer or in people who cannot have a colonoscopy.
• A biopsy , in which a sample of tissue is taken from the inside of your intestine and examined under a microscope. A doctor called a pathologist can look at the tissue sample and see if it contains cancer.
• A complete blood count, which is a blood test. It is used to look into symptoms such as fatigue, weakness, anemia, bruising, or weight loss.

For people who have an increased risk for colorectal cancer, regular colonoscopy is the recommended screening test because it allows your doctor to remove polyps (polypectomy) and take tissue samples at the same time.

When you are diagnosed with colorectal cancer, your doctor may order other tests to determine whether the cancer has spread. These tests include:

• A CT scan to see if the cancer has spread to your liver, lungs, or abdomen.
• A chest X-ray to see if the cancer has spread to your lungs.
• An MRI or PET scan to see if the cancer has spread into your chest or organs in the abdomen or pelvis.
• An ultrasound to find the cause of abdominal pain or increased abdominal girth or to see if the cancer has spread to your liver.
• A blood chemistry panel to see if the cancer has spread to your liver and bones.
• A carcinoembryonic antigen (CEA) blood test to see if the cancer has returned after treatment.

Early Detection

Colorectal cancer is very treatable and can usually be cured when it is caught early. Most people who get colorectal cancer are older than 50 and have no other risk factors besides their age. See the What Increases Your Risk section of this topic for more information.

Research shows that routine screening greatly reduces deaths from colorectal cancer. ⁶ Screening tests look for a certain disease or condition before any symptoms appear. Screening methods include:

• Stool tests, such as the fecal occult blood test (FOBT), the fecal immunochemical test (FIT), and the stool DNA test (sDNA).
• Sigmoidoscopy.
• Colonoscopy.
• Computed tomographic colonography (CTC), also known as virtual colonoscopy.

Talk to your doctor about which test is right for you. People with a higher risk for colorectal cancer, such as African Americans and people with a strong family history of colon cancer, may need to begin routine testing before age 50 and have it more often.

If you have a very strong family history of colon cancer, you may want to talk to your doctor or a genetic counselor about having a blood test to look for changed genes. Genetic testing can tell you whether you carry a changed, or mutated, gene that can cause colon cancer. Having certain genes greatly increases your risk of colon cancer. But most cases of colon cancer are not caused by changed genes.

Which test should I have to screen for colorectal cancer?

Treatment Overview

The first step in treating colorectal cancer is usually an operation to remove the tumor. Sometimes a simple operation can be done during a colonoscopy or sigmoidoscopy to remove small polyps and a small amount of tissue surrounding them. But in most cases a major operation, in which the cancer and part of the colon or rectum around it are removed, is needed. If cancer has spread to another part of your body, such as the liver, you may need more far-reaching surgery.

After the cancer has been examined under a microscope, it will be staged. Staging is a way for your doctor to tell how far, if at all, your cancer has spread. It also helps your doctor decide what your treatment should be.

There are several different types of staging systems, so it's important to ask your doctor to explain carefully what stage your cancer is in and what that means.

In general, the most common staging system describes colorectal cancer this way:

• Stage I: Your cancer has not spread beyond the inside of your colon or rectum.
• Stage II: Your cancer has spread into the muscle layer of your colon or rectum.
• Stage III: Your cancer has spread to one or more lymph nodes in the area.
• Stage IV: Your cancer has spread to other parts of your body, such as the liver, lung, or bones.

Cancers that have not spread beyond the colon or rectum may require only surgery. If the cancer has spread, you may need radiation therapy , chemotherapy , or both.

Initial treatment

You and your doctor will work together to decide what your treatment should be. You will consider your own preferences and your general health, but the stage of your cancer is the most important tool for choosing your treatment.

Surgery is almost always used to remove colorectal cancer . If the cancer is found early, you may need only a simple procedure, called a polypectomy, in which a doctor removes small polyps found in the colon or rectum during a colonoscopy or sigmoidoscopy .

For a larger cancer, more extensive surgery is needed to remove the cancer and part of the colon or rectum around it. This is called a bowel resection. During this operation, your doctor will also remove some of your lymph nodes for testing. The healthy ends of the colon or rectum are then sewn back together.

Sometimes it isn't possible to rejoin the ends, and a colostomy is needed. This creates an opening on the outside of your abdomen where waste can pass through into a colostomy bag. The colostomy may be temporary until your colon heals, or it may be permanent if the entire lower colon or rectum was removed. Very few people who have colorectal cancer need a permanent colostomy.

Radiation therapy, which uses X-rays to destroy cancer cells, is standard treatment for some types of cancer in the rectum. Radiation therapy is often combined with surgery or chemotherapy. Compared to surgery alone, radiation therapy given before surgery for rectal cancer may reduce the risk that the cancer will return and may help you live longer. ⁷

Chemotherapy uses drugs—given either as pills or through a needle—to destroy cancer cells throughout the body. Chemotherapy is used for some stages of colon cancer.

Your doctor may prescribe medicines to control nausea and vomiting caused by chemotherapy. There are also things you can do at home to manage these and other side effects. See the Home Treatment section of this topic for more information.

For more information about specific treatments, see the following topics:

• Colon Cancer – Health Professional Information [NCI PDQ]
• Colon Cancer – Patient Information [NCI PDQ]
• Rectal Cancer – Health Professional Information [NCI PDQ]
• Rectal Cancer – Patient Information [NCI PDQ]

Dealing with your emotions

If you have just been told you have colorectal cancer, you may have many different feelings. Most people feel some denial, anger, and grief. Others have few emotions. There is no normal or right way to react.

There are many things you can do to help with your emotional reaction to colorectal cancer. You may find that talking with family and friends helps. Some people find that spending time alone is what they need.

If your feelings get in the way of your ability to make decisions, it is important to talk with your doctor. Your cancer treatment center may offer psychological services. Your local American Cancer Society chapter can help you find a support group. Talking with other people who have had similar feelings can be very helpful.

Ongoing treatment

After your treatment, you will need regular checkups by a family doctor , general practitioner , medical oncologist , radiation oncologist , or surgeon , depending on your case. During your follow-up visits you may have one or more of these tests:

• Physical exams. How often you have these depends on your general health and the type of colorectal cancer you have. In general, you will see your doctor several times a year for 3 to 5 years and then return to once-a-year checkups.
• Colonoscopy, to inspect the inner surface of your colon and rectum for new problems
• Carcinoembryonic antigen (CEA) and other blood tests, to check the success of your treatment and find out whether the cancer has returned.
• CT scan, PET scan, or MRI, to see if the cancer has spread to other organs

Treatment if the condition gets worse

Colorectal cancer comes back after surgery in about half of people who have surgery to remove the cancer. ⁷ The cancer may be more likely to come back after surgery if it was not discovered in an early stage. Cancer that has spread or comes back is harder to treat. A cure is less likely, but treatment can help you feel better and live longer. For more information, see the topic Colorectal Cancer, Metastatic and Recurrent.

What To Think About

After you have had colorectal cancer, your chances of having it again go up. It's important to continue to see your doctor and be tested regularly to help find any returning cancer or new polyps early.

Clinical trials are designed to find better ways to treat people with cancer and are based on the most current information. Some people who meet the criteria for participation choose to enroll in such clinical trials.

Prevention

Some tests can prevent colorectal cancer . Screening tests look for a certain disease or condition before any symptoms appear. Experts recommend routine colon cancer testing for everyone age 50 and older who has a normal risk for colon cancer. People with a higher risk, such as African Americans and people with a strong family history of colon cancer, should be tested sooner. Talk to your doctor about when you should be tested.

Fewer than half of people who are older than 50 are screened for colorectal cancer. According to the American Cancer Society, if everyone were tested, tens of thousands of lives could be saved each year.

The following guidelines are for people who do not have an increased risk for colorectal cancer.

Colorectal screening guidelines

Test		Frequency
Stool test,* such as the fecal occult blood test (FOBT), the fecal immunochemical test (FIT), or the stool DNA test (sDNA)		Every year* The frequency of the sDNA test has not yet been set.
or
Sigmoidoscopy*		Every 5 years
or
Colonoscopy		Every 10 years
or
Virtual colonoscopy, or computed tomographic colonography		Possibly every 5 years
*One group recommends combining a stool test every 3 years with a sigmoidoscopy every 5 years.

Some people may need to begin routine testing earlier than age 50 and have it done more often. You may need earlier or more frequent testing if you have a higher risk for colon cancer.

Virtual colonoscopy (also called computed tomographic colonography or CT colonography) uses X-rays and a computer to take pictures of the inside of your large intestine. It may be used as a screening test for people who do not have an increased risk for colon cancer or for people who cannot have a colonoscopy.

Which test should I have to screen for colorectal cancer?

Here are other things you can do to help prevent colorectal cancer:

• Watch your weight. In trials, people who were overweight got colorectal cancer more often than those who were not. And people whose extra fat was in the waist area got it more often than people whose extra fat was in the hips or thighs. For more information, see the topic Weight Management.
• Eat well.Eat a variety of healthy foods, especially fruits and vegetables. Eating more vegetables, fruits, legumes, fish, poultry, and whole grains helps prevent cancer. Limit your consumption of animal fat. Talk to your doctor about taking a calcium supplement daily. For more information, see the topic Healthy Eating.
• Limit drinking.People who drink more than 2 alcoholic drinks a day—and especially those who drink more than 3 drinks a day—have a slightly higher risk for colorectal cancer. ⁵
• Get active.Keep up a physically active lifestyle. Being fit also leads to an improved sense of well-being, improved appearance, and increased stamina and strength. For more information, see the topic Fitness.
• Do not smoke. Smokers have a higher rate of cancer than nonsmokers. ² For more information, see the topic Quitting Smoking.

What to think about

If you have a strong family history of colon cancer, you may want to talk to your doctor or a genetic counselor about having a blood test to look for changed genes. Genetic testing can tell you whether you carry a changed, or mutated, gene that can cause colon cancer. Having certain genes greatly increases your risk of colon cancer.

You have a strong family history if each of the following is true:

• You have at least three relatives who have had colon cancer, and at least one of them is a parent, brother, or sister.
• Those relatives are spread over two generations in a row (for example, a parent and a grandparent).
• One of those relatives got cancer before age 50.

Home Treatment

You can do things at home to help manage the side effects of colorectal cancer or its treatment. Be sure to follow your doctor's advice on any drugs you are taking. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms.

• Home treatment for nausea or vomiting includes watching for and treating early signs of dehydration , such as a dry mouth, sticky saliva, having smaller than usual amounts of urine, or having urine that is dark yellow. Your doctor may also prescribe medicines to help control nausea and vomiting. For more information on how to deal with these side effects, see:

  Cancer: Controlling nausea and vomiting from chemotherapy.

• Home treatment for diarrhea includes resting your stomach by not eating for several hours or until you feel better and watching for signs of dehydration. Check with your doctor before using any drugs for your diarrhea.
• Home treatment for constipation includes gentle exercise, drinking plenty of fluids, and eating lots of fruits, vegetables, and foods that contain fiber. Check with your doctor before using a laxative.
• Home treatment for fatigue includes getting extra rest while you are having chemotherapy or radiation therapy. Let your symptoms be your guide. You may be able to stick to your usual routine and just get some extra sleep. Fatigue is often worse at the end of treatment or just after treatment is completed.
• Home treatment for sleep problems includes going to bed at the same time every night, exercising during the day, and avoiding caffeine late in the day.
• Home treatment for pain can range from hot packs or cold packs to relaxation or aromatherapy and can improve your physical and mental well-being. Not all forms of cancer and cancer treatment cause pain. Talk to your doctor before using any home treatment for pain.
• Home treatment for mouth sores can reduce your discomfort:
  • Drink cold liquids, such as water or iced tea, or eat flavored ice treats or frozen juices.
  • Eat foods that are easy to swallow, such as gelatin, ice cream, or custard.
  • Drink from a straw.
  • Rinse your mouth several times a day with a warm saltwater rinse. Mix 1 tsp (5 g) of salt with 8 fl oz (0.2 L) of warm water.

Managing your emotions

Learning that you have colorectal cancer and being treated for it can be very stressful.

You may be able to reduce your stress by talking to others. Consider meeting with a counselor or joining a support group of others who have colorectal cancer. Your doctor may also be able to help you find other sources of support and information. Learning relaxation techniques, such as yoga or visualization exercises, may also help you reduce your stress.

Your feelings about your body may change after treatment. Dealing with your body image may involve talking openly about your worries with your partner and discussing your feelings with a doctor.

Medications

Chemotherapy is the use of drugs to control the cancer's growth or relieve symptoms. Often the drugs are given through a needle in your vein, and your blood vessels carry the drugs through your body. Sometimes the drugs are available as pills you can swallow. Sometimes they are given through a shot, or injection.

Several drugs are used to treat colorectal cancer . There are also several drugs available for treating side effects.

Medication Choices

A combination of drugs often works better than a single drug in treating colorectal cancer. The most commonly used drugs are:

• Fluorouracil (5-FU) combined with leucovorin.
• Fluorouracil (5-FU) combined with leucovorin and oxaliplatin.
• Capecitabine, sometimes combined with irinotecan or oxaliplatin.
• Oxaliplatin, sometimes combined with 5-FU.
• Irinotecan, sometimes combined with 5-FU.

Hair loss, a side effect common with some types of chemotherapy, is usually not a side effect of these drugs.

Treating the side effects

Your doctor may prescribe medicines that can help relieve side effects of chemotherapy. These side effects can include mouth sores, diarrhea, nausea, and vomiting. Your doctor may prescribe medicines to control nausea and vomiting. These drugs may include:

• Serotonin antagonists, such as ondansetron (Zofran), granisetron (Kytril), or dolasetron (Anzemet). These drugs more effectively prevent nausea and vomiting caused by chemotherapy when they are combined with corticosteroids, such as dexamethasone.
• Aprepitant (Emend), which is used in combination with ondansetron and dexamethasone as part of a 3-day program.
• Antiemetics, such as promethazine and prochlorperazine.
• Metoclopramide (Reglan).

There also are things you can do at home to manage side effects. See the Home Treatment section for more information.

What To Think About

Chemotherapy and radiation may be combined to treat some types of colorectal cancer. Radiation or chemotherapy given before or after surgery can destroy microscopic areas of cancer to increase the chances of a cure. In some studies, people who had surgery and then were given the chemotherapy drugs fluorouracil (5-FU) and leucovorin lived longer. ⁸

Clinical trials are designed to find better ways to treat people with cancer and are based on the most current information. Some people who meet the criteria for participation choose to enroll in such clinical trials.

Surgery

Surgery to remove cancer is almost always the main treatment for colorectal cancer . The type of surgery depends on the size and location of your cancer.

Side effects are common after surgery. You may be able to reduce the severity of your side effects at home. For more information, see the Home Treatment section of this topic.

Surgery Choices

• Local excision. When colorectal cancer is discovered in its very early stages, it can be removed during a sigmoidoscopy or colonoscopy . The surgeon cuts out not just the polyp, but also a small amount of tissue around it. The surgeon does not need to cut into the abdomen.
• Bowel resection. This operation involves cutting out the cancer as well as the sections of the colon or rectum that are next to it. Then the two healthy ends of the colon or rectum are sewn back together. The surgery can be done in two ways:
  • Open resection. The surgeon makes a long incision in the abdomen, completes the bowel resection, and closes the incision. Open resection is the best option for cancer of the rectum. ⁹
  • Laparoscopic surgery. Instead of needing a large incision in the abdomen, laparoscopic surgery requires only 3 to 6 small incisions. The surgeon inserts a camera, or laparoscope, and other operating instruments through these incisions to perform the operation. Because the incisions are smaller, there usually is less pain and recovery is faster. In some cases, the surgeon may make 1 or 2 of the incisions a little bigger during surgery in order to complete the procedure, but the opening is still far smaller than in an open resection. Open resection is best for cancer of the rectum, but for other colon cancers, laparoscopic surgery is equally effective. ⁹ But laparoscopic surgery cannot always be done, such as when the cancer has spread to areas outside the colon.

What To Think About

Polypectomy or local excision is used when the cancer has been caught in its early stages. Bowel resection is used when the cancer is larger. Sometimes after this major operation, the two ends of the colon or rectum cannot be sewn back together. When this happens, a colostomy is performed. Most people do not need a colostomy.

For more information, see:

Bowel disease: Caring for your ostomy.

Colorectal cancer comes back after surgery in about half of people who have surgery to remove the cancer. ⁷ The cancer may be more likely to come back after surgery if it was not discovered in an early stage. Even if your doctor thinks that all the cancer has been removed during surgery, radiation therapy or chemotherapy may be recommended to destroy any remaining microscopic areas of cancer.

Clinical trials are designed to find better ways to treat people with cancer and are based on the most current information. Some people who meet the criteria for participation choose to enroll in such clinical trials.

Other Treatment

Radiation therapy uses X-rays to destroy colorectal cancer cells and shrink tumors. It is often used to treat rectal cancer, usually combined with surgery. It is used less often to treat colon cancer. It may also be combined with chemotherapy .

Other Treatment Choices

Radiation may be given:

• Externally, using a machine outside the body that points a beam of radiation at the tumor.
• Internally, by placing tiny radioactive "seeds" next to or into the cancer.

Compared to surgery alone, radiation given before surgery may reduce the risk that rectal cancer will return and may help you live longer. ⁷

What To Think About

Clinical trials are designed to find better ways to treat people with cancer and are based on the most current information. Some people who meet the criteria for participation choose to enroll in such clinical trials.

Other Places To Get Help

Organizations

American College of Gastroenterology
P.O. Box 342260
Bethesda, MD  20827-2260
Phone:	(301) 263-9000
Web Address:	www.acg.gi.org
The American College of Gastroenterology is an organization of digestive disease specialists. The Web site contains information about common gastrointestinal problems.
American Cancer Society (ACS)
Phone:	1-800-ACS-2345 (1-800-227-2345)
TDD:	1-866-228-4327 toll-free
Web Address:	www.cancer.org
The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.
Cancer.Net
Phone:	1-888-651-3036 (571) 483-1300
Fax:	(571) 366-9530
E-mail:	foundation@asco.org
Web Address:	www.cancer.net
Cancer.Net is the information Web site of the American Society of Clinical Oncology (ASCO) for people living with cancer and for those who care for them. ASCO is the world's leading professional organization representing physicians of all oncology subspecialties. Cancer.Net provides current oncologist-approved information on living with cancer.
National Cancer Institute (NCI)
NCI Publications Office
6116 Executive Boulevard
Suite 3036A
Bethesda, MD  20892-8322
Phone:	1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday
TDD:	1-800-332-8615
E-mail:	cancergovstaff@mail.nih.gov
Web Address:	www.cancer.gov (or https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help online)
The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people with cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.

Related Information

• Cancer Pain
• Colon Polyps
• Colonoscopy
• Colorectal Cancer, Metastatic or Recurrent
• Early Disease Detection

References

Citations

1. American Cancer Society (2005). Colorectal Cancer Facts and Figures: Special Edition 2005, pp. 1–20. Available online: http://www.cancer.org/docroot/STT/content/STT_1x_Colorectal_Cancer_Facts_and_Figures_-_Special_Edition_2005.asp.
2. Levin B (2006). Colorectal cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 5. New York: WebMD.
3. Elwing JE, et al. (2006). Type 2 diabetes mellitus: The impact on colorectal adenoma risk in women. American Journal of Gastroenterology, 101(8): 1866–1871.
4. Limburg PJ, et al. (2006). Clinically confirmed type 2 diabetes mellitus and colorectal cancer risk: A population-based, retrospective cohort study. American Journal of Gastroenterology, 101(8): 1872–1879.
5. Cho E, et al. (2004). Alcohol intake and colorectal cancer: A pooled analysis of 8 cohort studies. Annals of Internal Medicine, 140(8): 603–614.
6. Winawer S, et al. (2003). Colorectal cancer screening and surveillance: Clinical guidelines and rationale—Update based on new evidence. Gastroenterology, 124(2): 544–560.
7. Lewis C (2007). Colorectal cancer screening, search date November 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
8. Meyerhardt JA, Mayer RJ (2005). Systemic therapy for colorectal cancer. New England Journal of Medicine, 352(5): 476–486.
9. Guillou PJ, et al. (2005). Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): Multicentre, randomised controlled trial. Lancet, 365(9472): 1718–1726.

Other Works Consulted

• American Cancer Society (2008). Cancer Facts and Figures 2008. Atlanta: American Cancer Society. Available online: http://www.cancer.org/docroot/STT/content/STT_1x_Cancer_Facts_and_Figures_2008.asp.
• Schroy PC (2006). Screening and surveillance guidelines for individuals at increased risk section of Neoplastic diseases of the small and large bowel. In MM Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 890–910. Philadelphia: Saunders Elsevier.

Credits

Author	Bets Davis, MFA
Editor	Maria Essig
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Arvydas D. Vanagunas, MD - Gastroenterology
Last Updated	October 1, 2008