Colon cancer
- davorkust
- Apr 7
- 4 min read
Introduction and frequency
The large intestine is the last in a series of organs of the digestive system, whose main purpose is to process the food we eat. It is divided into the colon and rectum (the final part of the large intestine that continues to the anus), which is also important from an oncological point of view, given that there are certain differences in the treatment of the colon and rectum. According to data from the Croatian Cancer Registry, in 2017, colorectal cancer (CRC) was in 3rd place in the frequency of malignant tumors in men with 16%, and in 2nd place in women with 14%. When both sexes are taken together, CRC is the most common malignant tumor in Croatia. Men, on average, develop the disease at a slightly earlier age than women. In developed countries, the overall risk of developing this disease during life is about 4-5%, and the risk increases with age.
Risk factors
Risk factors for CRC include a positive family history (CRC in the family), a positive personal history (CRC, ovarian cancer, or the presence of high-risk polyps in the colon earlier in life), hereditary syndromes (familial adenomatous polyposis (FAP), Lynch syndrome), inflammatory bowel diseases (ulcerative colitis or Crohn's disease), obesity, smoking, excessive alcohol consumption, and older age. You can read more about risk factors for developing cancer in a separate article .
Signs and symptoms
Symptoms of CRC are generally nonspecific. The most common symptoms include a change in bowel habits, blood in the stool, diarrhea or constipation, narrower stool diameter, bloating, weight loss, and vomiting. Constipation is more commonly associated with tumors on the left side, and bleeding with tumors on the right side of the body.
Making a diagnosis
The basis is a detailed examination of the patient and taking a thorough medical history. A digital rectal examination analyzes the rectum with a finger for possible formations or other unusual findings in that part of the intestine. A fecal occult blood test examines the stool under a microscope to detect possible traces of blood invisible to the human eye. Colonoscopy is a basic examination, it involves inserting a long, thin, flexible tube through the rectum (Figure 1). The colonoscope has a camera at the tip, so the doctor can analyze the entire colon, and if he encounters a suspicious formation, he can take a sample for later analysis (biopsy) in the same procedure. The analysis is performed by a pathologist under a microscope, and this is a necessary method for making a definitive diagnosis. CEA and sometimes CA19-9 are used as tumor markers . Other tests can be performed if necessary. After making a diagnosis, a CT scan of the chest, abdomen, and pelvis should definitely be performed (in the case of rectal cancer, MRI is performed instead of CT scan of the pelvis) to assess the extent of the disease. You can read more about cancer diagnostics in a separate article .
Since 2008 , the National Colon Cancer Early Detection Program has been launched in Croatia, whereby people aged 50 to 74 are referred to a fecal occult blood test every two years, in order to detect CRC at the earliest possible stage. Patients with a positive result are further referred for a colonoscopy.
Figure 1. Colonoscopy. The doctor inserts a flexible scope (colonoscope) into the colon and uses a camera at the tip to view the inner lining of the colon to look for any cancerous growths. During the procedure, a sample of tumor tissue (biopsy) may be taken to confirm the diagnosis of malignancy.
Treatment
The treatment of CRC depends on the stage of the disease . Earlier stages are successfully treated surgically , and depending on the postoperative findings, some patients may need additional chemotherapy after surgery. In patients with rectal cancer, if chemotherapy is required after surgery, it should be combined with radiotherapy . In metastatic disease, when the disease has spread beyond the intestine, surgical treatment of the intestinal tumor is usually not used (unless there is a blockage in the passage of stool), but systemic treatment is used. The most common combination of chemotherapy and targeted therapy is used, but the choice of a specific protocol depends mostly on the general condition of the patient. It should be emphasized that in most patients with metastatic CRC, we cannot expect a cure, but the goal is to prolong survival while preserving (or improving) the quality of life. During treatment, regular control with imaging tests is necessary to assess the effect of therapy.
Some of the protocols and drugs most commonly used in treatment are: FOLFIRI (irinotecan + 5-fluorouracil), FOLFOX (oxaliplatin + 5-fluorouracil), CAPEOX (oxaliplatin + capecitabine), trifluridine + tipiracil, regorafenib, bevacizumab and aflibercept (vascular endothelial growth factor inhibitors), cetuximab and panitumumab (epidermal growth factor receptor inhibitors), but some can also be used according to the doctor's instructions others. Immunotherapy can also be used in a certain part of the patient.
Treatment at onkologija.net : We treat our patients according to American and Western European guidelines, and we provide genetic testing for personalized targeted therapy. Contact us for more details.
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