Topic Overview
Is this topic for you?
This topic is about
metastatic and recurrent colorectal cancer. If you want to learn more about early-stage
colorectal cancer, see the topic
Colorectal Cancer.
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 polyps. Over time, some polyps can turn into cancer. This cancer is also
called colon cancer or rectal cancer, depending on where the cancer is.
Metastatic cancer is cancer that
has spread to other parts of the body. When colon or rectal cancer spreads, it
most often spreads to the liver. Sometimes it spreads to the lungs, bones, or other organs in the body.
Colon and rectal cancers
often return months or years after treatment. This is called recurrent cancer.
If the original cancer was removed before it was able to spread, the chances
that it will return are lower.
What causes metastatic or recurrent colorectal cancer?
The exact cause is not known, but the cancer is more likely to spread or come back if it is in a later, more advanced stage when it is first
discovered.
Sometimes cancer cells are too small to be found by tests. These cells may continue to grow and show up later as metastatic cancer, even years after being treated.
What are the symptoms?
Some people do not have any
symptoms. When they do occur, the most common symptoms are:
- Belly pain, especially gas pains, cramps, or
a feeling of fullness.
- Blood in your stool or very dark stools.
- A change in your bowel habits, such as more frequent stools,
thinner stools, or a feeling that your bowels are not emptying completely.
- Loss of appetite.
- Losing weight without trying.
- Constant tiredness (fatigue).
If your cancer has spread, you may have other symptoms,
depending on where the cancer is. If it has spread to:
- The lymph nodes of
your belly, it may cause bloating, a swollen belly, loss of appetite, or a
feeling of fullness.
- The liver, it may
cause pain on the upper right side of your belly, bloating, loss of appetite,
or a feeling of fullness.
- The lungs, it
may cause you to cough, spit up blood, or have a hard time breathing.
- The bones, it may cause bone pain,
especially in your back, hips, and pelvis.
- The brain, it may cause problems with memory, concentration, balance, or
movement.
How is metastatic or recurrent colorectal cancer diagnosed?
Colon or rectal cancer that has spread or returned is
diagnosed using a physical exam and several tests, including blood tests, chest
X-rays,
bone scans,
ultrasounds, and
CT,
PET, or
MRI scans.
The diagnosis is usually
confirmed with a
biopsy. During this test, your doctor will 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.
If you have been
treated for colon or rectal cancer in the past, it's important to have regular
checkups to find any new cancer as soon as possible.
How is it treated?
Colon and rectal cancers that
have spread or returned may be cured in some cases. Treatment may include
surgery, radiation, chemotherapy, and targeted therapy. When the cancer cannot be cured,
treatment can help you feel better and live longer.
Learning that you have cancer that has spread or come back can be very hard. Some people find that it helps to talk about their feelings with
their family and friends. You may also want to talk with your doctor or with other people who have had
this kind of cancer. Your local American Cancer Society chapter can help you find a support group.
Frequently Asked Questions
Learning about metastatic and recurrent colorectal cancer: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
End-of-life issues: | |
Cause
The exact cause of
colorectal cancer is not known. Most cases begin as
small growths, or
polyps, inside the intestine.
If
colorectal cancer is not detected and removed, it invades and destroys nearby
tissues and may spread to other parts of the body. Even after treatment that seems successful, colorectal cancer may spread or come back.
Sometimes cancer cells are too small to be found by tests. These cells may continue to grow and show up later as metastatic cancer, even years after being treated.
Symptoms
Some people who have
metastatic or recurrent colorectal cancer do not have
any symptoms for some time. When symptoms do appear, the most common ones are:
- A change in bowel habits, such as narrow stools
or frequent diarrhea or constipation.
- Blood in the stool, or stools
that look like black tar.
- Loss of appetite.
- Pain in the
belly.
- Unexplained weight loss.
- Constant
tiredness (fatigue).
If your cancer has spread, you may have other symptoms,
depending on where the cancer is. If it has spread to:
- The lymph nodes of your
abdomen, it may cause bloating, a swollen belly, loss of appetite, or a feeling
of fullness.
- The liver, it may cause pain on
the upper right side of your abdomen, bloating, loss of appetite, or a feeling
of fullness.
- The lungs, it may cause
coughing, spitting up blood, or a hard time breathing.
- The bones, it may cause bone pain, especially in the back,
hips, and pelvis.
- The brain, it may cause
problems with memory, concentration, balance, or movement.
What Happens
Cancer is the growth of abnormal cells in
the body. These extra cells grow together and form masses, lumps, or tumors. In
colorectal cancer, these growths usually start as
harmless (benign) polyps in the
large intestine (colon or rectum).
Colon polyps are common and most do not cause
problems. But if polyps are not detected and removed, some of them can turn
into cancer.
If the cancer is allowed to continue growing, it
eventually will invade and destroy nearby tissues and then spread farther.
- Colon cancer often spreads first to nearby lymph nodes. From there it may spread
to other parts of the body, usually to the liver. It may also spread to the
lungs, bones, or other organs in the body.
- Rectal cancer may spread directly to the lungs, bypassing the liver.
Metastatic or recurrent colorectal cancer occurs when cancer cells travel, through
either the bloodstream or the
lymph system, to other parts of the body and continue
to grow in their new location. Recurrent colorectal cancer occurs when the
cancer begins to grow again months or years after treatment.
How
colorectal cancer will affect your life span depends on the
stage of your cancer. A cancer's stage depends on how
far it has spread.
The 5-year survival rate for people who have colorectal cancer that has
spread to nearby organs or lymph nodes is 69%.1 This means that an average of 69 out of 100 people are still alive 5 years or longer
after their cancer was discovered. For people who have colorectal cancer that has spread farther away to other parts of their bodies, the rate is 12%.1 This means that an average of 12 out of 100 people are still alive 5 years or longer after their cancer was discovered.
These numbers are taken from reports that were done at least 5 years ago, before newer treatments were available. So the actual chances of your survival are likely to be higher than these numbers.
What Increases Your Risk
Even after treatment that seems successful, colorectal cancer may come back (recur). But this depends on the stage of the cancer before treatment.
Your risk for recurrent or metastatic cancer depends on how aggressive your cancer is and how well treatments work.
When To Call a Doctor
Some people who have
metastatic or recurrent colorectal cancer do not have
any symptoms for some time. Colorectal cancer may be discovered before symptoms appear, either on X-rays or other lab tests.
You may be seeing a doctor
regularly to check for symptoms, but symptoms might start between visits. Be
aware of what is normal for you, and tell your doctor about any changes right
away. Be sure to let your doctor know if you feel even very small
changes.
What symptoms you may have will depend on which part of
your body is affected by the cancer. Call your doctor if you have any of these
symptoms:
- A change in bowel habits, such as bleeding from
your rectum, bright red or dark blood in your stools, frequent diarrhea,
constipation, a feeling that your bowel is not emptying completely, or stools
that are narrow (may be no wider than a pencil)
- Pain in your
belly
- Bloating or loss of appetite
- Unexplained weight
loss
- Constant
tiredness (fatigue)
- Cough
- Difficulty
breathing or shortness of breath
- Bone pain
Watchful Waiting
Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition without giving
treatment to cure your cancer. Watchful waiting may be an option if treatment
may cause more harm than good and cannot cure your cancer. Remember,
though, that watchful waiting does not mean your doctor won't treat your
symptoms, such as pain.
Who To See
If you have been treated for colorectal cancer,
doctors who can evaluate any new symptoms include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Tests to help your doctor see if
colorectal cancer has
spread or come back include:
- An
abdominal ultrasound to find the cause of pain or
swelling in your abdomen.
- A
colonoscopy to see if cancer has returned to your
intestine.
- Blood tests to find out if cancer has returned (CEA) or to find the cause of symptoms such as
weakness, fatigue, fever, bruising, or weight loss (complete blood count).
- A
chest X-ray to find the cause of symptoms such as
persistent coughing, coughing up blood, chest pain, or difficult
breathing.
- A
computed tomography (CT) scan,
magnetic resonance imaging (MRI), or
positron emission tomography (PET) scan to see if colorectal cancer has spread into
the chest or organs in the abdomen or pelvis.
- A brain CT scan or
MRI to look into symptoms such as confusion, paralysis, numbness, vision
problems, vertigo, or headaches.
- A biopsy, such as a
liver biopsy or a
lung biopsy, to find out where the cancer cells have
spread.
- A
bone scan to find out whether cancer cells have spread
to the bones.
What to think about
Colorectal cancer often comes
back, even after treatment that seemed successful. If you had colorectal cancer in the
past, pay close attention to your body and see your doctor regularly. Tell your
doctor about any changes, such as decreased appetite, bloating, or an increase
in the size of your belly.
Your cancer may return even if you do
everything you can to prevent it. If this happens, focus on what you and your
doctor can do to treat your symptoms to help you feel better and live
longer.
Treatment Overview
Your treatment for
metastatic or recurrent colorectal cancer will depend
on specific information about the cancer, your preferences, and your
health.
Some cases of metastatic or recurrent colorectal cancer
can still be cured. When it cannot be cured, treatment can help you feel better
and live longer.
Your treatment may include:
- Surgery. If your cancer
has come back in your intestine, surgery may be used to remove it. If it has
spread to other parts of the body, it can sometimes be treated surgically.
Cancer that has spread to the liver is sometimes successfully removed with
surgery. For more information, see the Surgery section of this
topic.
- Chemotherapy. These medicines kill cancer cells that have spread to other parts of your body. They also can relieve pain caused by the cancer. For more information, see the
Medications section of this topic.
- Radiation therapy. X-rays can be used to shrink colorectal tumors that may be
causing blockages. They can also reduce bleeding or pain. For more information,
see the Other Treatment section of this topic.
- Targeted therapy. This treatment uses medicines called monoclonal antibodies to treat colorectal cancer. It is often given along with chemotherapy. For more information,
see the Other Treatment section of this topic.
- Clinical trials. These are studies of new or different ways
to treat cancer.
Pain control
Pain is one of the main concerns of people who have cancer. But cancer pain can almost always be controlled. There are several ways to 
control your pain, such as using strong medicines like opiates. Or you can have treatments that shrink tumors and block nerve pain.
Palliative care
As your cancer gets worse, you may
want to think about
palliative care. Palliative care is a kind of care for
people who have serious illnesses. It
is different than care to cure your illness, called curative treatment.
Palliative care focuses on improving your quality of life—not just in your
body but also in your mind and spirit.
Palliative care may help you manage symptoms
or side effects from treatment. It could also help you cope with your feelings
about living with a long-term or terminal illness, make future plans around your medical
care, or help your family better understand your illness and how to support
you.
If you are interested in palliative care, talk to your
doctor. He or she may be able to manage your care or refer you to a doctor who
specializes in this type of care.
For more information, see the
topic
Palliative Care.
End-of-life issues
There may come a time when treatments to cure your cancer are no longer working. Or you may decide that you want to spend the time you have left in other ways and only have medical care that keeps you comfortable. If so, talk to your doctor about hospice care.
Hospice care is palliative care for people who are at the end of life, with about 6 months or less to live. Hospice caregivers are concerned with
enhancing the quality of your remaining life by keeping you as alert and
comfortable as possible in a familiar environment with family and friends.
Hospice programs offer services in your own home or in a hospice center,
nursing home, or hospital.
You may wish to discuss health care
and other legal issues that arise near the end of life with your family and
your doctor. You may find it helpful and comforting to state your health care
choices in writing (with an advance directive or living will) while you are
still able to make and communicate these decisions. Think about your treatment
options and which kind of treatment will be best for you. You may wish to
choose a health care agent in case you become unable to speak for
yourself.
Learning all you can about end-of-life
issues may help you feel better. For more information, see one of the following
topics:
Prevention
There is no sure way to prevent
colorectal cancer from returning or showing up in
other parts of your body. After you have had it, your risk of having it again
increases. When it comes back, it is called
metastatic or recurrent colorectal cancer. It often
comes back after surgery, especially if it was not discovered when it was in an
early stage.2
But there are lifestyle changes that can help you after treatment. Research shows that these things may help:3
Initial treatment for colorectal
cancer is followed by regular doctor visits and screening to help catch the
cancer if it returns.
The frequency of your follow-up visits and how often you have more tests will depend on your general health and the type of colorectal cancer you had. As part of your follow-up visits, you may
have:
Home Treatment
Home treatment may be all that is needed
to help manage the side effects that often accompany
metastatic or recurrent colon cancer or its treatment.
Healthy habits such as eating a balanced diet and getting enough sleep and
exercise may help control your symptoms. Be sure to follow any instructions
your doctor has given you.
- 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 also may prescribe
medicines to control nausea and vomiting. For more
information on how to deal with these side effects, see:
- Home treatment for pain can range from
cold packs and over-the-counter medicines to massage and meditation. For more
information, see the topic
Cancer Pain.
- 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 medicines for your diarrhea.
- Home treatment for constipation includes getting 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.
- 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 keep
your usual routine and just get some extra sleep. Fatigue is often worse at the
end of treatment or just after treatment is over. If you find you have trouble
sleeping, some
tips to relieve sleep problems may be helpful.
Managing stress
Learning that you have colorectal cancer and being treated for it can be
very stressful. There are steps you can take to reduce your stress. You may want to talk with family or friends. Some people find that spending time alone is what they need.
If your emotions interfere with your ability to
make decisions, it is important to talk to your doctor about them. Your cancer
treatment center may offer counseling services, support groups, and classes
such as yoga.
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.
Contact your local chapter of the American Cancer Society
to find a support group. Talking with other people who have had similar
experiences can be very helpful.
Having cancer can change your life in many ways. For help with managing these changes, see the topic Getting Support When You Have Cancer.
Medications
Chemotherapy is the use of medicines to stop
cancer's growth or relieve symptoms. Sometimes chemotherapy may be used to shrink tumors in the liver so they can be removed with surgery.
The medicines may be given through a needle
in your vein, as pills you can swallow, or as a shot (injection). For colorectal cancer that has spread to
the liver, researchers are studying ways to deliver chemotherapy directly to the liver.
Several medicines are used to
treat
metastatic or recurrent colorectal cancer. Other medicines are
also available to treat side effects, such as nausea.
Medicine Choices
The most commonly used medicines for the treatment of
colorectal cancer are:
Cancer medicines are often used in combination. For example,
a treatment called FOLFOX4 uses oxaliplatin, leucovorin, and fluorouracil,
while the treatment called FOLFIRI uses folic acid, fluorouracil, and
irinotecan. There are several of these specific combinations.
Cetuximab (Erbitux) and panitumumab (Vectibix) may be
used for colorectal cancer that has spread and has not improved during or
after treatment with other drugs. These kinds of medicines, called
monoclonal antibodies, may not work for some people.
So before you have this treatment, your tumor tissue will be checked for
certain gene changes (mutations).
Your doctor may prescribe
medicines to control nausea and vomiting. These medicines
include:
- Aprepitant (Emend), which is used in
combination with other medicines to prevent nausea and vomiting.
- Metoclopramide (Reglan).
- Phenothiazines, such as promethazine and
prochlorperazine.
- Serotonin antagonists, such as ondansetron (Zofran),
granisetron (Kytril), or dolasetron (Anzemet). These medicines prevent nausea
and vomiting caused by chemotherapy more effectively when they are combined
with corticosteroids, such as dexamethasone.
Clinical trials that test new drugs are ongoing. Talk
with your doctor about participating in a clinical trial.
Surgery
Surgery to remove cancer may be used to treat
metastatic or recurrent colorectal cancer. The type of
surgery chosen depends upon the
stage of the cancer. Surgery may be used to remove cancer that is in the colon or rectum. Or surgery may be done to remove cancer that has spread to other organs in the body.
Surgery Choices
Surgical options include:
- Bowel resection. This operation
involves cutting into the abdomen to reach the area of the colon or rectum that
is affected by the cancer. The surgeon cuts out the cancer as well as the parts
of the colon or rectum that are next to it. Then the two healthy ends of the
colon or rectum are sewn back together.
- Liver resection. In this operation the surgeon cuts
out cancer that has spread to the liver and also cuts out parts of the liver that are
next to the cancer. Up to half of your liver can be removed as long as the rest
is healthy. If the cancer in your liver is too large to remove with surgery, you may be given chemotherapy to shrink the tumor. If the tumor becomes small enough, it can be removed with surgery.
- Lung, adrenal, or ovarian resection, depending on where the cancer has spread and whether you are a good candidate for this surgery.
If cancer that has returned to your intestine is large,
more of your colon or rectum may have to be removed. The ends of your colon or
rectum are rejoined during surgery. If they can't be rejoined, you may need a
colostomy. Most people do not need a permanent
colostomy.
When cancer has spread to other parts of the body, the
kind of surgery you will need depends on where the cancer is and how big the
tumor is. Sometimes surgery is used not to cure your cancer but to make your
life more comfortable. For example, the surgeon may create a colostomy to give you relief from symptoms caused by a tumor blocking your colon.
Other Treatment
Radiation treatment
Radiation therapy uses X-rays to destroy
colorectal cancer cells. It is often combined with
surgery or chemotherapy. Radiation therapy may also be used to reduce the
cancer's size when it is blocking the colon or rectum or to relieve pain from
cancer that has spread to other organs.
Radiation treatments are
not likely to cure
metastatic or recurrent colorectal cancer. But they
may ease pain and discomfort, slow the spread of the disease, and help you live
longer.
Treatment for cancer that has spread to the liver
Sometimes colorectal cancer that has spread to the liver can be removed
by surgery. But usually other treatments are needed, such as:
- Radiofrequency ablation. A small wire that emits radio waves is inserted into the
tumor. The radio waves destroy the cancer that has spread to the liver without harming healthy
tissue.
- Cryosurgery. This may be done in
surgery for cancer that has spread to the liver. Liquid nitrogen
is used to freeze and destroy cancer cells.
- Embolization. Tumor embolization shrinks a cancer that has spread to the liver by
cutting off its blood supply.
- Interstitial radiation therapy. In
this type of internal radiation therapy, radioactive material sealed in
needles, wires, seeds, or catheters is placed directly into the tumor or body
tissue.
- Intra-arterial hepatic chemotherapy. The surgeon implants a small pump in the belly that
delivers chemotherapy right into the tumor. The pump can be left in place as
long as needed.
Complementary therapies
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
Mind-body treatments like those mentioned above may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment. But they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.
Clinical trials
Clinical trials are
studies designed to find better ways to treat people and are based on the most
up-to-date information. There are a number of clinical trials involving the
treatment for metastatic or advanced colorectal cancer. If you match the
guidelines, you may be able to enroll in one. If you are interested, ask your
doctor whether there are trials in which you can participate. The National
Cancer Institute or your local chapter of the American Cancer Society can also
help you find clinical trials.
Other Places To Get Help
Organizations
| American Cancer Society (ACS) |
| Phone: | 1-800-ACS-2345 (1-800-227-2345) |
| 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 number have information about services and activities
in local areas and can provide referrals to local ACS divisions. |
|
| American College of
Gastroenterology |
| 6400 Goldsboro Road |
| Suite 200 |
| Bethesda, MD 20817 |
| Phone: | (301) 263-9000 |
| Web Address: | http://patients.gi.org |
| |
The American College of Gastroenterology is an organization of digestive disease specialists. The website contains information about common gastrointestinal problems. |
|
| American Society of Colon and Rectal
Surgeons |
| 85 West Algonquin Road |
| Suite 550 |
| Arlington Heights, IL 60005 |
| Phone: | (847) 290-9184 |
| Fax: | (847) 290-9203 |
| Email: | ascrs@fascrs.org |
| Web Address: | www.fascrs.org |
| |
The American Society of Colon and Rectal Surgeons is the leading
professional society representing more than 1,000 board-certified colon and
rectal surgeons and other surgeons dedicated to treating people with diseases
and disorders affecting the colon, rectum, and anus. |
|
| Cancer.Net |
| Phone: | 1-888-651-3038
(571) 483-1780 |
| Fax: | (571) 366-9537 |
| Email: | contactus@cancer.net |
| Web Address: | www.cancer.net |
| |
Cancer.Net is the information website 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) |
| 6116 Executive Boulevard |
| Suite 300 |
| Bethesda, MD 20892-8322 |
| Phone: | 1-800-4-CANCER (1-800-422-6237) |
| Web Address: | www.cancer.gov (or
https://livehelp.cancer.gov/app/chat/chat_launch 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 who have 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. |
|
| National Institutes of Health: Health
Information |
| 9000 Rockville Pike |
| Bethesda, MD 20892 |
| Phone: | (301) 496-4000 |
| TDD: | (301) 402-9612 |
| Email: | NIHinfo@od.nih.gov |
| Web Address: | http://health.nih.gov |
| |
The U.S. National Institutes of Health (NIH) conducts
and supports medical research to improve people's health and save lives. NIH
provides access to health and wellness information, free newsletters, current
research, health databases, fact sheets, and many other resources. |
|
References
Citations
- American Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012.
- Lewis C (2007). Colorectal cancer screening, search
date November 2006. Online version of BMJ Clinical Evidence:
http://www.clinicalevidence.com.
- National Comprehensive Cancer Network (2012). Colon cancer. NCCN Clinical Practice Guidelines in Oncology, version 3. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.
Other Works Consulted
- Eng C (2011). Colorectal cancer. In EG Nabel, ed., ACP Medicine, section 12, chap. 5. Hamilton, ON: BC Decker.
- Libutti SK, et al. (2011). Cancer of the rectum. In VT DeVita Jr. et al., eds., DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 9th ed., pp. 1127-1141. Philadephia: Lippincott Williams and Wilkins.
- National Cancer Institute (2011). Colon Cancer PDQ: Treatment—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/colon/Patient.
- National Cancer Institute (2011). Rectal Cancer PDQ: Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/rectal/HealthProfessional/allpages.
- National Cancer Institute (2012). Rectal Cancer Treatment (PDQ)—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/rectal/Patient.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | Kenneth Bark, MD - Surgery, Colon and Rectal |
|---|
| Last Revised | September 5, 2012 |
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