Colorectal Cancer

Colorectal [koh-luh-REK-tl] cancer is cancer that originates in the colon or rectum. Cancer is the overgrowth of cells that can clump together and form a mass, otherwise known as a tumor. In colon cancer, these malignant [ma-LIG-nant] cancer cells form tumors in the lining of the colon. The colon, also called the large intestine, is a five-foot-long section of the digestive tract. The colon extracts salt and water from undigested food and pushes it along to the rectum.

Colorectal cancer is common in both men and women after the age of 50, but is rare in children. There are several different types of colon and rectal cancer, depending on the location and type of tumor. Most colorectal cancers (about 95 percent) are adenocarcinomas [ad-n-oh-kahr-suh-noh-muhs], which start in the mucous membranes that lubricate the colon and rectum.

Colorectal cancer often has few symptoms until it reaches the advanced stages. Some possible symptoms include the following:

• Diarrhea or constipation
• A feeling that the bowel is still full even after passing stools (pooping)
• Blood in the stool
• Narrow stools
• Frequent gas or cramps
• Weight loss
• Fatigue
• Nausea or vomiting

If your child experiences any of the above symptoms, you should take them to see their doctor, who may recommend testing. While colorectal cancer is the third most common type of cancer among men and women, it is extremely rare among children. Your doctor may also recommend additional testing if colorectal cancer runs in your family and your child has inherited risk factors.

Colorectal cancer is one of the few cancers has few inherited or genetic risk factors. There are, however, some lifestyle factors that can influence whether your child is at greater risk for colorectal cancer, including the following.

• Diet. Foods high in fat but low in fiber can lead to increased risk of colon cancer, especially eating broiled, grilled, and fried meats often.
• Colorectal polyps. If your child previously had these benign [bih-NINE] growths or they are common in your family, your child may be at higher risk for colon cancer.
• Ulcerative colitis [UHL-suh-rey-tiv kuh-ALHY-tis] and Crohn’s disease. These diseases and other chronic conditions of the digestive system can lead to increased risk of colorectal cancer.
• Race. There is an increased risk for colon cancer in African Americans and people of Eastern European Jewish ancestry, but scientists do not know why.

Several tests can be done to determine if your child has colorectal cancer. They might include any combination of the following:

• Digital rectal exam. For this test, your child’s doctor gently places their gloved finger in your child’s rectum to feel for abnormalities.
• Colonoscopy [COL-uhn-AHS-kuh-PEE]. A long, flexible tube with a camera on it is inserted through your child’s rectum and guided into their colon. The camera sends pictures of the inside of your child’s colon to a computer screen.
• Fecal [FEE-kuh l] occult blood test. This test shows whether there is hidden blood in your child’s stool (poop), which can be a sign of colorectal cancer.
• Blood tests. These tests can help your child’s doctor determine the best treatment for your child and might show how likely the cancer is to recur (come back after treatment).
• Barium enema [BAIR-ee-uh m-EN-uh-muh] or x-rays of the intestine. A mixture of barium and water flows into your child’s rectum and colon through a tube. The barium coats your child’s colon and makes it easier to take x-ray pictures.
• Biopsy. In this test, a small piece of tissue is removed from your child’s colon for examination under a microscope.

The diagnosis of colorectal cancer also includes determining which stage of cancer your child has. A stage is defined as not only how far the cancer has spread, but to what parts of the body. The stages of colorectal cancer are generally defined here, but there are sub-stages and specifics that you should discuss with your child’s doctor.

Stage 0: This is the earliest stage of cancer where the cells have not grown beyond the inner layer of the intestine.

Stage 1: This stage describes growth into the wall of the intestine but has not spread to any lymph [LIMF] nodes or other areas.

Stage 2: The outermost layers of the colon are affected by cancer at this stage, but other organs and lymph nodes are not.

Stage 3: Tumors have penetrated through the layers of the colon but not reached other organs. Some surrounding lymph nodes are usually affected at this stage.

Stage 4: Tumors have penetrated the colon and cancerous cells have spread to other organs of the body, with or without affecting lymph nodes. The most common organs to be affected at this point are the liver and the lungs. This stage is often referred to as metastasized [muh-TAS-tuh-sahyzd] cancer.

Treatment for colorectal cancer is usually given by a pediatric specialist who is part of a treatment team. Often that team includes not only your child’s doctor but a gastroenterologist [GAH-strow-EHN-troh-AHL-ih-JIST], an oncologist [on-CALL-oh-jist], a colorectal [koh-luh-REK-tl] surgeon, and a radiation or medical oncologist [on-CALL-oh-jist]. They may recommend some or all of the following treatments for your child’s colon or rectal cancer:

• Surgery. Early detection makes this one of the most effective ways to treat colorectal cancer.
• Medication. This includes not only chemotherapy [KEE-moh-THER-uh-PEE] but also targeted drug therapies and immunotherapy [ih-MYOO-noh-THER-uh-PEE].
• Radiation. Depending on the stage of your child’s cancer, this may be recommended along with other treatment methods.

The treatment method recommended for your child’s colon cancer will depend on the stage of cancer, whether the colon is blocked or partially blocked, and your child’s general health. In some cases, a colostomy [kuh-LOS-tuh-mee] will be performed as part of your child’s surgery. In a colostomy, an opening is created in your child’s belly and the end of their colon is brought through the opening. The part of the colon that comes out of your child’s body is called a stoma [STOH-muh]. Your child will wear a bag over their stoma to collect stool (poop). This may be temporary or permanent, depending on the type of surgery your child needs.

Additional alternative cancer treatments focus on pain management and improving quality of life, but should only be done under the supervision of your child’s treatment team to avoid complications.

Because colorectal cancer has several kinds of risk factors, it can be prevented in part by addressing those lifestyle factors that are within your control. Many cancers share the same kinds of risk factors. Here are two to focus on to prevent colorectal cancer and some other types of cancer:

• Exercise. A healthy lifestyle that includes daily exercise can lower general cancer risk.
• Eat a healthy diet. A diet low in fat and high in fiber can reduce your child’s risk of colorectal cancer.

Pediatric cancers are not as strongly influenced by lifestyle factors as adult cancers are. Pediatric cancers are often not preventable.

Colorectal [koh-luh-REK-tl] cancer is one of the most common types of cancer to affect both men and women, but is rarely found in children. It involves cancer of the colon and rectum and can be associated with lifestyle risk factors like diets high in fat, inherited risk factors, and lack of exercise.