10. Colorectal cancer

In this series featuring information for patients and professionals taken from SIGN’s evidence-based guidelines, we reproduce the ‘information for discussion with patients and carers’ section from SIGN guideline number 67, on management of colorectal cancer.

Colorectal cancer

Information for discussion with patients and carers

The following sample information sheet can be used in discussion with patients to highlight issues of particular importance. It is intended as a guide only and should not be used to plan treatment or to replace the important consultations that should be held between patient and clinicians.

Notes for discussion with patients and carers

What is colorectal cancer?

The colon and rectum are parts of the body’s digestive system, which remove nutrients from food and store waste until it passes out of the body. Together, the colon and rectum form a long, muscular tube called the large intestine (also called the large bowel). The colon is the first six feet of the large intestine, and the rectum is the last eight to ten inches.

Cancer that begins in the colon is called colon cancer, and cancer that begins in the rectum is called rectal cancer. Cancers affecting either of these organs may also be called colorectal cancer.

Who is at risk of colorectal cancer?

The exact causes of colorectal cancer are not known. Studies show that the following risk factors increase a person’s chances of developing colorectal cancer:

  • Age: Colorectal cancer is more likely to occur as people get older. This disease is more common in people over the age of 50. However, colorectal cancer can occur at younger ages, even, in rare cases, in the teens.
  • Lifestyle factors: Colorectal cancer seems to be associated with low levels of physical activity, excess weight, and low intake of vegetables. There is accumulating evidence that long term smoking increases risk.
  • Polyps: Polyps are benign growths on the inner wall of the colon and rectum. They are fairly common in people over age 50. Some types of polyps increase a person’s risk of developing colorectal cancer.
  • A rare, inherited condition called familial polyposis causes hundreds of polyps to form in the colon and rectum. Unless this condition is treated, familial polyposis is almost certain to lead to colorectal cancer.
  • Personal medical history: Research shows that women with a history of cancer of the ovary, uterus, or breast have a somewhat increased chance of developing colorectal cancer. Also, a person who has already had colorectal cancer may develop this disease a second time.
  • Family medical history: First degree relatives (parents, siblings, children) of a person who has had colorectal cancer are somewhat more likely to develop this type of cancer themselves, especially if the relative had the cancer at a young age. If many family members have had colorectal cancer, the chances increase even more.
  • Ulcerative colitis: Ulcerative colitis is a condition in which the lining of the colon becomes inflamed. Having this condition increases a person’s chances of developing colorectal cancer.

Recognising symptoms

Common signs and symptoms of colorectal cancer include:

  • a change in bowel habits
  • diarrhoea, constipation, or feeling that the bowel does not empty completely
  • blood (either bright red or very dark) in the stool
  • stools that are narrower than usual
  • general abdominal discomfort (frequent gas pains, bloating, fullness, and/or cramps)
  • weight loss with no known reason
  • constant tiredness
  • vomiting.

These symptoms may be caused by colorectal cancer or by other conditions. It is important to check with a doctor.

Diagnosing colorectal cancer

To help find the cause of symptoms, the doctor evaluates a person’s medical history. The doctor also performs a physical examination and may order one or more diagnostic tests:

  • X-rays of the large intestine can reveal polyps or other changes
  • a sigmoidoscopy lets the doctor see inside the rectum and the lower colon and remove polyps or other abnormal tissue for examination under a microscope
  • a colonoscopy lets the doctor see inside the rectum and the entire colon and remove polyps or other abnormal tissue for examination under a microscope
  • a biopsy is the removal of a tissue sample for examination under a microscope by a pathologist to make a diagnosis

Treatment for colorectal cancer

Treatment depends mainly on the size, location, and extent of the tumour, and on the patient’s general health. Patients are often treated by a team of specialists, which may include a gastroenterologist, surgeon, medical oncologist, and radiation oncologist. Several different types of treatment are used to treat colorectal cancer. Sometimes different treatments are combined.

  • Surgery to remove the tumour is the most common treatment for colorectal cancer. Generally, the surgeon removes the tumour along with part of the healthy colon or rectum and nearby lymph nodes. In most cases, the doctor is able to reconnect the healthy portions of the colon or rectum. When the surgeon cannot reconnect the healthy portions, a temporary or permanent colostomy is necessary. Colostomy, a surgical opening (stoma) through the wall of the abdomen into the colon, provides a new path for waste material to leave the body. After a colostomy, the patient wears a special bag to collect body waste. Some patients need a temporary colostomy to allow the lower colon or rectum to heal after surgery. About 15 percent of colorectal cancer patients require a permanent colostomy.
  • Chemotherapy is the use of anticancer drugs to kill cancer cells. Chemotherapy may be given to destroy any cancerous cells that may remain in the body after surgery, to control tumour growth, or to relieve symptoms of the disease. Chemotherapy is a systemic therapy, meaning that the drugs enter the bloodstream and travel through the body. Most anti-cancer drugs are given by injection directly into a vein (IV) or by means of a catheter, a thin tube that is placed into a large vein and remains there as long as it is needed. Some anticancer drugs are given in the form of a pill.
  • Radiation therapy, also called radiotherapy, involves the use of high energy X-rays to kill cancer cells. Radiation therapy is a local therapy, meaning that it affects the cancer cells only in the treated area. Most often it is used in patients whose cancer is in the rectum. Doctors may use radiation therapy before surgery (to shrink a tumour so that it is easier to remove) or after surgery (to destroy any cancer cells that remain in the treated area). Radiation therapy is also used to relieve symptoms. The radiation may come from a machine (external radiation) or from an implant (a small container of radioactive material) placed directly into or near the tumour (internal radiation). Some patients have both kinds of radiation therapy.

The importance of follow up care

Follow up care after treatment for colorectal cancer is important. Regular check-ups ensure that changes in health are noticed. If the cancer returns or a new cancer develops, it can be treated as soon as possible. Check-ups may include a physical exam, a blood test, a colonoscopy, chest X-rays, and laboratory tests. Between scheduled check-ups, a person who has had colorectal cancer should report any health problems to the doctor as soon as they appear.

Sources of further information for patients and carers

Beating Bowel Cancer
39 Crown Road, St Margaret’s, Twickenham, Middlesex TW1 3EJ; tel: 020 8892 5256; website: www.bowelcancer.org
Charity set up by TV presenter Lynne Faulds Wood to raise funds and increase awareness of bowel cancer.
British Colostomy Association
15 Station Road, Reading, Berkshire RG1 1LG; tel: 0118 939 1537; helpline: 0800 328 4257; website: www.bcass.org.uk
The British Colostomy Association is the national registered charity which represents the interests of people with a colostomy and which provides support, reassurance and practical information to anyone who has had, or is about to have, a colostomy.
CancerBACUP
3 Bath Place, Rivington Street, London EC2A 3JR; tel: 0808 800 1234 (freephone) or 020 7739 2280; website: www.cancerbacup.org.uk CancerBACUP offers a free cancer information service staffed by qualified and experienced cancer nurses. There are a growing number of CancerBACUP local centres in hospitals up and down the country, also staffed by specialist cancer nurses.
Cancer Research UK
PO Box 123, Lincoln’s Inn Fields, London WC2A 3PX; tel: 020 7242 0200; website: www.cancerresearchuk.org
Cancer Research UK is a new charity which was formed in 2002 as a result of the merger between The Cancer Research Campaign and Imperial Cancer Research Fund. Cancer Research UK is the largest volunteer-funded cancer research organisation in the world.
Colon Cancer Concern
9 Rickett Street, London SW6 1RU; tel: 020 7381 9711; infoline: 08708 50 50 50; website: www.coloncancer.org.uk
The Ileostomy and Internal Pouch Support Group
Peverill House, 1-5 Mill Road, Ballyclare, Co. Antrim BT39 9DR. Freephone: 0800 018 4724; website: www.the-ia.org.uk
Macmillan Cancer Relief
89 Albert Embankment, London SE1 7UQ. Freephone: 0808 808 2020; website: www.macmillan.org.uk
Macmillan Cancer Relief is a UK charity supporting people with cancer and their families with specialist information, treatment and care.
Marie Curie Cancer Care
89 Albert Embankment, London SE1 7TP. Tel: 020 7599 7777; website: www.mariecurie.org.uk
Marie Curie Cancer Care is dedicated to the cure of people affected by cancer and the enhancement of their quality of life through its caring services, research and education.
Sources of further information for health professionals
CancerIndex
Website: www.cancerindex.org
This non-profit guide contains over 100 pages and more than 4000 links to cancer related information.
Adapted from: SIGN 67. Management of Colorectal Cancer – A national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network, March 2003.

Reproduced with permission from SIGN 67. Management of colorectal cancer – A national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network, February 2003. The full guideline can be downloaded from the SIGN website: www.sign.ac.uk

Guidelines in Practice, June 2003, Volume 6(6)
© 2003 MGP Ltd
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