The human digestive system is consists of the mouth, pharynx (throat), esophagus, stomach, colon, rectum, and anus. The colon and rectum help the body get rid of solid waste (stool). Colorectal cancer means cancer of the colon or rectum. It is an uncontrolled and rapid growth of colon or rectum cells. The cancer cells may spread to other organs (liver, bladder). The cancer cells in the other organ appear similar to the cells that started growing in the colon or rectum.

What are the signs and symptoms?

Colorectal cancer overgrows gradually over the years. These cancers begin as a polyp. If a polyp is removed early, it may prevent the malignancy. Symptoms of colorectal cancer include changes in stool, bleeding in stool, appetite loss (anorexia), or abdominal pain (bellyache).

What are the diagnostic tests for colorectal cancer?

Colonoscopy: The doctor inserts a thin tube having a light on the other end through the anus, into the rectum and colon. If any abnormal mass or polyp is present, the doctor removes a piece of the mass to check for cancer cells.

CT scan: It is a kind of x-ray that takes detailed images of your insides. CT scan is helpful to detect cancer spread.

Ultrasound: The doctor moves a small wand around on the skin. It produces sound waves and picks up the echoes as they bounce off tissues. The echoes are represented as an image on a computer screen. It helps to find cancer and cancer spread.

MRI: It uses radio waves and strong magnets to create detailed images. MRI helps screen the liver, brain, and spinal cord.

Chest x-rays: X-rays help to check cancer spread in the lungs.

PET scan: The doctor puts a small amount of a low-level radioactive substance in the blood, which attaches to the cancer cells. A special camera helps to detect the areas of radioactivity. These scans can help to show the cancer spread.

Biopsy: The doctor removes a small piece of a cancerous mass. The experts check the pieces in the lab for cancer cells. It is an accurate way to know the presence of cancer cells.

Gene and protein tests: The doctor tests cancer cells for proteins (KRAS, BRAF, MMR, and MSI) and genes. Knowing the type of genes or proteins can help the doctor decide the treatments.

How advanced is my cancer?

Staging helps to determine the extent of cancer growth and spread through the layers of the colon wall or rectum wall. It identifies the severity of cancer spread to other organs.

Colorectal cancer has 0,1, 2, 3, or 4 stages. The lower number indicates less spread of cancer. A higher number indicates major cancer spread outside the colon or rectum. Ask your doctor about the cancer stage and what to expect from it.

What are the suitable treatments for me?

Surgery

Surgery helps to cure or control cancer and make symptoms better. It is a standard option to curb colorectal cancer if not spread outside the colon or rectum. For colon cancers, sometimes the doctor creates an opening (colostomy) on the stomach to get rid of stool.

• For early-stage and close to the anus cancers, the doctor removes cancer through the anus, minus cutting through the skin.

• In the case of advanced rectum cancer close to the anus, the doctor may remove cancer to make an opening (colostomy) on the stomach to get rid of body waste (poop).

• If rectal cancer spreads to other organs, the doctor removes the rectum and the affected organs (bladder, prostate, or uterus). You may need a colostomy.

The common side effects of colorectal cancer surgery are frequent pooing, diarrhea (dysentery) or constipation, and feeling bloated.

Radiation

Radiation is high-energy rays. It helps to shrink the tumor and kills cancer cells. There are two ways to treat colorectal cancer with radiation. The first is by focusing the rays at the colon or rectum from a machine outside the body. The second is by putting tiny radioactive pieces or seeds near the affected area using an endoscope.

The common side effects are fatigue (tiredness), skin discoloration, stomachache, and blood in the poop.

Most side effects may get better after radiation ends. Ask your doctor about what to expect.

Chemotherapy

You can administer chemo medicines orally or intravenously. These medicines spread through the body via the blood. The doctor schedules chemotherapy in cycles or rounds. Each cycle is followed by a rest time which helps the body recover from side effects. Most of the time, the doctor recommends two or more chemo medicines. Treatment lasts for a few months. Chemo is beneficial if cancer has spread to other organs.

The common side effects are fatigue (tiredness), appetite loss (anorexia), body pain, and hair loss (alopecia). These side effects go away after chemo treatment ends. If you have side effects, seek help from your doctor.

Targeted therapy

Targeted therapy medicines majorly affect cancer cells more than normal cells. It is beneficial for certain types of colon and rectum cancer. Targeted therapy works when other treatments fail.

The common side effects are high blood pressure, low red blood cell count, heart and liver problems. Seek help from your doctor.

Immunotherapy

It enhances your immune system to attack the cancer cells. Immunotherapy medicines are given into a vein or taken as pills.

The common side effects are fatigue, skin rash, stomachache, problems in the liver, intestines, and thyroid gland.

What are the other treatment options?

The other treatment options may or may not be standard medical treatments. These treatments include vitamin supplements, herbal remedies, and diet. Talk to your doctor about other treatment options.

What to expect after treatment?

You will always be worried about cancer coming back or a recurrence. After treatment ends, visit your doctor ev You may have fear of cancer recurrence. Visit your doctor every three months after the treatment ends. Do not skip follow-up visits. Your doctors will ask you about new symptoms. A physical examination and diagnostic tests may help to check recurrence.

For the first year, the follow-up visits may be every three months. After the first year, follow-up visits might be every six months, and then at once a year after five years.

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