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Like any cancer diagnosis, colon cancer can be a scary prospect. It’s a tough illness to beat in all but its early stages. It turns out, though, that colon cancer can be caught early and avoided entirely. The reason for this is that it typically takes 10 to 15 years for the earliest manifestations, called polyps, to advance to full-blown tumors. Early screening saves tens of thousands of people from ever having to hear that they’ve been diagnosed with colon cancer.
What is colon cancer?
Colon cancer (Cca) is a cancer of the large intestine, the organ that is responsible for gathering and passing waste products as the last step in the digestive system. Because the colon and rectum are closely joined, colon cancer is often grouped with rectal cancer as colorectal cancer (CRC). Colon cancer and rectal cancer tend to be similar in symptoms and treatment methods.
Colon cancer develops slowly, starting as benign, noncancerous polyps, looking like bumps or swollen blisters on the colon’s inner surface. Colon polyps result from changes to cellular DNA, the molecule that encodes all the “instructions” for making a cell and running its chemical processes. The DNA changes cause colon cells to grow more actively than usual, resulting in small polyp growths. Over time, as polyps grow, the DNA can change even more. Eventually, the cells can grow out of control and turn cancerous. Not all polyps develop into colon cancer, but, when they do, polyps usually take about 10 to 15 years after they first appear to become cancerous. Colorectal cancer screening and early detection can help prevent colon cancer by identifying polyps before they become cancerous.
Around 100,000 Americans are diagnosed with colon cancer each year. Colorectal cancer is the third leading cause of cancer death in the United States, claiming around 50,000 lives each year. However, as the percentage of at-risk Americans being screened for colon cancer increases, the number of annual colon cancer diagnoses in that group has been decreasing (about a 3% decrease per year in people 55 and older). Clearly, screening is hands-down the best treatment for colon cancer.
How is colon cancer diagnosed?
Colon cancer is diagnosed through a colonoscopy, a diagnostic procedure in which a flexible tube with a camera is inserted through the rectum to view the inner lining of the colon. Colon cancer symptoms are the most common trigger for diagnostic colonoscopies, but one in ten colon cancer diagnoses result from routine colonoscopy screening.
A gastroenterologist, or digestive system doctor, performs diagnostic colonoscopies, and pathologists will perform biopsies on the samples taken during a colonoscopy. Once polyps or colon cancer are detected, the treatment plan could involve a gastroenterologist, oncologist (cancer doctor), radiation oncologist, or medical oncologist.
Routine screening is the key to diagnosing colon cancer early enough to increase survival odds. Early screening can detect precancerous polyps or early-stage tumors that can then be removed and treated.
Everyone at risk for colon cancer should be routinely screened. Age is the primary risk factor for colon cancer. Most cases involve patients 50 or older. Other risk factors calling for regular colon cancer screening include inherited conditions such as familial adenomatous polyposis (FAP) or Lynch syndrome, a family history of colon cancer, inflammatory bowel disease (ulcerative colitis or Crohn’s disease), or previous radiation treatment for cancer. Other risk factors include excess weight, sedentary lifestyle, diabetes, smoking, alcohol use, and a low-fiber, red meat diet.
The gold standard for colon cancer screening is a diagnostic colonoscopy performed every ten years. In place of a colonoscopy, a doctor may use other screening tests such as a yearly stool test detecting either blood or cancer DNA in stool samples.
Colon cancer symptoms that trigger a diagnostic colonoscopy are rectal bleeding, blood in the stool, fatigue, a change in bowel habits, and abdominal pain.
Identifying a tumor through colonoscopy and verifying it as cancer through biopsy is sufficient for a colon cancer diagnosis. A CT scan with contrast dye of the abdomen, chest, and pelvis will help determine the stage of the cancer as well as provide a comprehensive picture to guide surgery.
A key part of diagnosis is determining the stage of the cancer. Colon cancer stages represent how far the cancer has grown and determine the most appropriate treatment. Here are the stages:
- Stage 0—Colon cancer has just started growing and has not penetrated the inner layer of the colon.
- Stage I—Colon cancer has grown into inner layers of the colon and has not spread to any nearby lymph nodes.
- Stage II—colon cancer has grown into the outer layers of the colon or beyond but has not spread to lymph nodes or other parts of the body.
- Stage III—Colon cancer has spread out of the colon to nearby lymph nodes.
- Stage IV—Metastatic colon cancer has spread to other parts of the body.
Colon cancer treatment options
Colon cancer treatment will depend on the cancer’s stage. Surgery, chemotherapy, targeted therapy, immunotherapy, and radiation are the standard treatments.
Surgery
Surgical removal of the tumor is the only treatment necessary for early-stage (stage 0 or stage I) colon cancer. Later stages will involve surgery and a few months of chemotherapy, called adjuvant chemotherapy, to guarantee any remaining cancer is killed. When colon cancer spreads to other parts of the body (stage IV colon cancer), surgery is rarely possible.
Depending on the cancer’s stage, a surgeon might perform:
- Polypectomy If precancerous polyps are detected during a diagnostic colonoscopy, they are removed with surgical tools inserted into the colonoscope.
- Local excision An early-stage tumor can also be removed during a colonoscopy.
- Colectomy The tumor and a part or all of the colon is removed either in open surgery or using a laparoscope. In laparoscopic surgery, a small, flexible tube with a camera is inserted through the abdominal wall into the colon. The surgeon performs the surgery using a video monitor and tools inserted through other incisions. The surgeon will also remove at least 12 lymph nodes around the tumor site. The surgeon will then rejoin the remaining colon segments.
- Colostomy if after a colectomy the two colon segments cannot be rejoined, the surgeon will perform a temporary colostomy. The surgeon cuts an opening in the abdomen, called a stoma, and connects the colon to that opening. Waste products will pass through that opening into an attached bag.
Radiation treatment
Radiation therapy kills cancer cells by exposing tissues to high-energy X-rays, gamma rays, or charged particles. Though it is a standard rectal cancer treatment, radiation therapy is rarely used for colon cancer. For colon cancer, radiation may be used to shrink a tumor before surgery or to kill any remaining cancer cells following surgery.
Medications
Surgery for stage II or stage III colon cancer is followed by a chemotherapy regimen. Called adjuvant therapy, chemotherapy is intended to eliminate any cancer remaining after surgery. For metastatic (stage IV) cancer, cancer drugs are usually the first-line therapy.
Enormous advances have been made in the medical management of late-stage colon cancer, substantially increasing the survival rate. Medical oncologists may use a combination of chemotherapy, targeted therapy, and immunotherapy medications.
Colon cancer medications
Colon cancer medications are used as a follow-up therapy to surgery. However, for early-stage colon cancer, surgery alone is enough to cure cancer, but the doctor may offer drug therapy as an additional option. For later-stage cancers, medications are often the only treatment that can help.
Chemotherapy
Doctors follow established regimens for drug therapy depending on the stage of the cancer. For colon cancer, the most common drug therapy following colon surgery is a combination of oxaliplatin, a platinum-based drug, with fluorouracil and leucovorin, a therapy known as FOLFOX. Oxaliplatin interferes with the ability of cancer cells to grow, fluorouracil kills cancer cells by blocking their ability to make copies of their DNA, and leucovorin is a substance similar to folate (vitamin B9) that amplifies the effects of fluorouracil.
Other first-line therapies for colon cancer include irinotecan, fluorouracil, and leucovorin (FOLFIRI) or oxaliplatin with capecitabine (CAPOX). Irinotecan is an alkaloid that causes cancer cell DNA to break down, both killing the cell and preventing its growth. Capecitabine is a drug that the body converts into fluorouracil.
Targeted therapy
Targeted therapy drugs attach to proteins on the outside of cancer cells and prevent them from growing. Braftovi (encorafenib) blocks the growth of colon cancer cells that have a particular mutation, called the BRAF mutation. Stivarga (regorafenib) “turns off” proteins, called tyrosine kinases, that signal tumor cells to grow.
Monoclonal antibodies
Monoclonal antibodies are a type of targeted therapy that uses synthetic antibodies similar to those produced naturally by the body. Avastin (bevacizumab) and Cyramza (ramucirumab) are used to block a protein called VEGF that tumors need to grow new blood vessels to the tumor. Without new blood vessels, the cancer cells die from lack of oxygen. Erbitux (cetuximab) and Vectibix (panitumumab) attach to and shut down a protein, called EGFR, which activates the growth of cancer cells.
Examples of first-line drug therapies for late-stage colon cancer are a combination of Avastin (bevacizumab) with two chemotherapy drugs, oxaliplatin and capecitabine, a therapy known as BCapOx, or a combination ofAvastin and FOLFOX. After an initial course of drugs, maintenance therapy commonly consists of Avastin and capecitabine.
Immunotherapy
For later-stage, inoperable colon cancer, patients may be given drugs that ramp up the immune system’s attacks on the tumors, including Keytruda (pembrolizumab), Libtayo (cemiplimab-rwlc), and Opdivo (nivolumab). These drugs are synthetic antibodies that attach to the “off” switch, called a checkpoint, on immune system cells. With the “off” switch blocked, immune cells go into overdrive attacking cancer cells.
What is the best medication for colon cancer?
The types of colon cancer medications used are determined by the cancer stage, response to treatment, and tolerance of side effects. Physicians follow well-researched regimens, so there is no “best” medication for colon cancer, just the most appropriate combination of drugs for the medical situation.
| Best medications for colon cancer | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Eloxatin (oxaliplatin) | Platinum-based alkylating agent | Intravenous (IV) infusion | Dose depends on body surface area | Fatigue, anemia, diarrhea |
| Fluorouracil | Antimetabolite | Intravenous (IV) infusion | Dose depends on body surface area | Diarrhea, nausea, mouth sores |
| Leucovorin | Folic acid analog | Intravenous (IV) infusion | Dose depends on body surface area | Nausea, diarrhea, swelling of the mouth and lips |
| Camptosar (irinotecan) | Alkaloid, topoisomerase I inhibitor | Intravenous (IV) infusion | Dose depends on regimen and body surface area | Hair loss, nausea, vomiting |
| Xeloda (capecitabine) | Antimetabolite | Oral | Dose depends on body surface area; taken twice daily with water 30 minutes after a meal | Nausea, vomiting, fatigue |
| Lonsurf (trifluridine and tipiracil) | Antimetabolite, pyrimidine analog | Oral | Dose depends on body surface area; taken twice daily on days 1 through 5 and days 8 through12 of a 28-day cycle | Fever, nausea, diarrhea |
| Avastin (bevacizumab) | Monoclonal antibody, antiangiogenic agent | Intravenous (IV) infusion | Dose depends on body surface area | Headache, joint pain, high blood pressure |
| Erbitux (cetuximab) | Monoclonal antibody | Intravenous (IV) infusion | Dose depends on body surface area; infusions are given weekly | Rash, headache, diarrhea |
| Stivarga (regorafenib) | Kinase inhibitor | Oral | Four 40 mg tablets daily for the first 21 days of a 28-day cycle | Fatigue, decrease in appetite, hand-and-foot syndrome |
| Keytruda (pembrolizumab) | Monoclonal antibody | Intravenous (IV) infusion | 200 mg every three weeks or 400 mg every six weeks | Fatigue, joint pain, decrease in appetite |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of colon cancer medication?
Side effects of colon cancer medications will vary depending on the medication, the dose, and the patient’s other medical conditions. This is not a complete list. Consult with a healthcare professional if you have any concerns or questions about possible side effects and drug interactions.
Colon cancer therapies often decrease the number of white blood cells, or important immune system cells, produced in the bone marrow. As a result, infections are a common side effect of chemotherapy and could be serious enough to require hospitalization. These drugs also compromise the ability of bone marrow to produce red blood cells and platelets, the cells responsible for blood clotting. Anemia and bleeding problems are a common problem when taking chemotherapy drugs.
Depending on the drug, common side effects of chemotherapy drugs include hair loss, mouth sores, fatigue, peripheral nerve pain, diarrhea, abdominal pain, headache, cough, and flu-like symptoms.
Targeted therapy drugs cause several different side effects depending on the drug, but the most common are nausea, fatigue, tiredness, diarrhea, abdominal pain, and loss of appetite. The most serious side effect of monoclonal antibodies is a potentially life-threatening reaction to the infusion.
From one-third to almost half of patients on checkpoint inhibitors can experience gastrointestinal problems such as diarrhea, ulcers, and inflammation of the colon (colitis). These problems can emerge several months after the drug has been given. Other side effects include liver damage (hepatitis), kidney problems, hormone problems, muscle pain, joint pain, and rash. Kidney failure, type I diabetes, and severe and potentially life-threatening allergic reactions are a few of the most severe side effects of immunotherapy.
What is the best home remedy for colon cancer?
There are no effective home remedies for colon cancer. On the other hand, self-care is vital in minimizing the effects of surgery and chemotherapy.
Follow the discharge instructions
After surgery or radiation treatment, you will be given a detailed set of discharge instructions as well as medications to control pain or other complications. Follow these instructions to the letter. Refrain from any activities the healthcare provider has told you to avoid, such as driving or going back to work.
Keep surgical wounds clean
Wash and cover any surgical incisions daily. Check for swelling, redness, or any drainage around the wound. If you have a stoma, diligent care is often needed to prevent infection. Follow all instructions for stoma care given by the hospital.
Keep all follow-up appointments
Monitoring by a healthcare provider is a critical part of treating colon cancer. It is especially important for patients who have surgery only with no adjuvant chemotherapy. This is to monitor and ensure the cancer doesn’t re-appear.
Eat a nutritious diet
Loss of appetite, nausea, diarrhea, and weight loss are common effects of both surgery and colon cancer drug therapies. Eat small nutritious meals spaced evenly throughout the day. Bland foods are best.
Drink fluids
Diarrhea commonly results from both radiation and colon cancer drug therapies, so drink small amounts of fluids throughout the day.
Replace electrolytes
Electrolytes are quickly lost due to vomiting or diarrhea, so include electrolyte-rich foods such as broth or electrolyte drinks.
Practice safe hygiene
Colon cancer drugs leave patients vulnerable to infections. Now is the time to be careful about hygiene. Wash your hands regularly, take a couple of short showers each day, and avoid people sick with infections.
Frequently asked questions about colon cancer
How treatable is colon cancer?
Colon cancer is not only treatable, it is completely curable if caught early enough. Regular screening and early detection are crucial for catching colon cancer before it becomes life-threatening.
How long do you live after being diagnosed with colon cancer?
If colon cancer is caught early enough at a precancerous stage, it’s possible to live the rest of your life without colon cancer. Screening and early detection are vital. If colon cancer is caught at later stages, the five-year survival rate can be as low as 14% for metastasized colon cancer and as high as 90% for localized (stage I or II) colon cancer.
How can I treat colon cancer at home?
Colon cancer cannot be treated at home. Surgery, medications, or both are often required to rid the body of the cancer.
Is colon cancer usually fatal?
Colon cancer, if detected early enough, is not only survivable, it’s curable. The longer it goes on before being detected, however, the more likely it is to be fatal. Discuss with your doctor risk factors associated with colon cancer and the most appropriate early screening for your medical situation.
Is Stage 4 colon cancer curable?
Tremendous advances have been made in recent years. Stage IV colon cancer can be treated with innovative therapies such as targeted therapy and immunotherapy. Even with those advances, however, the five-year survival rate for stage IV colon cancer is 14%.
Does chemo for colon cancer make you sick?
Common side effects of chemotherapy include hair loss, mouth sores, abdominal pain, diarrhea, fatigue, nerve pain, headache, and flu-like symptoms. Chemotherapy drugs also reduce the ability of bone marrow to make red blood cells, white blood cells, and platelets, the blood cells responsible for clotting. As a result, infections, anemia, and bleeding may be experienced while taking these drugs.
What are the long term side effects of oxaliplatin?
Oxaliplatin can be poisonous to the body’s nerves, especially over long periods of time. It can cause nerve pain, numbness, and tingling that can sometimes last for months after the drug has been discontinued.
What foods help fight colon cancer?
The best diet for preventing colon cancer is one high in fiber and low in red meats. Vegetables, fruits, whole grains, and fish are in. Pork, beef, burgers, and bacon are out.
What herbal medicine is good for colon cancer?
Research on dietary supplements, herbal remedies, and Asian herbal medicines has been inconclusive. Some research suggests that a few Asian herbal medicines may improve mortality rates in colon cancer patients treated with chemotherapy. However, herbal remedies are not usually manufactured to specific standards nor are they industry regulated. The possible benefits from specific herbal remedies may vary depending on the manufacturer or practitioner.
Can colon cancer be cured without surgery?
Surgery is the first-line treatment for colon cancer that has not spread to other parts of the body. For metastasized, or stage IV, colon cancer, surgery is rarely possible. The first-line treatment for late-stage colon cancer will often be drug therapy involving targeted therapy combined with chemotherapy.