Intestinal polyps and cancer

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Overview

Colorectal (bowel) cancer is one of the more common forms of cancer in many countries, including Germany. The name "colorectal cancer" is used to describe bowel cancer that starts in the colon (the large intestine) or the rectum. Cancer of the small intestine is very rare.

Colorectal cancer almost always develops from growths called colorectal polyps that form in the lining of the colon. But by no means do all polyps become cancerous – and if a polyp does become cancerous, it takes many years. One way to prevent colorectal cancer is to have a colonoscopy, which also allows doctors to remove polyps.

Having colorectal cancer can be a life-changing experience. What happens after the diagnosis has been made will depend on various factors, including the stage of the cancer. In early-stage colorectal cancer, the tumor just needs to be surgically removed. In advanced stages, additional treatments may be considered, such as chemotherapy or radiation therapy.

In Germany, high-quality medical care is available for people who have cancer. There are also a number of sources of support, for instance to help cope with the disease emotionally and make it easier to go back to work.

Symptoms

Colorectal cancer often doesn't cause any symptoms at first, so it may remain unnoticed for a while. Sometimes it leads to abdominal pain or a change in bowel movements. By this we mean that the frequency of bowel movements or the usual time of day when you go to the toilet may change, or you might start having constipation or diarrhea. Black or very dark stool may be caused by traces of blood and could also be a sign of colorectal cancer. When colorectal cancer has reached a more advanced stage it can also cause weight loss, nausea and loss of appetite.


But it's important to keep in mind that these symptoms could have any number of other causes. Most of the time there is no serious underlying condition or the symptoms are signs of another, non-cancerous health problem, such as enlarged hemorrhoids or inflammatory bowel disease.

Rectal bleeding. This can be a sign of colon polyps or cancer or other conditions, such as hemorrhoids or minor tears of the anus.

Change in stool color. Blood can show up as red streaks in your stool or make stool appear black. ...

Change in bowel habits. ...

Pain. ...

Iron deficiency anemia.

Causes

Colorectal cancer arises when cells in the mucous lining of the intestine change (mutate) and then multiply out of control. This growth pushes the cells into surrounding tissue. There are a number of possible causes of these kinds of changes, including pollution or radiation. But they often simply occur by chance. The body’s immune system can normally deal with these malignant cells, but not always. As we grow older, mistakes in cell division increase while the body’s ability to repair these problems decreases. This is why most types of cancer are more common in older people.


In most people who have colorectal cancer, no clear cause can be found. About 5 out of 100 people with colorectal cancer have a genetic form: either familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC, or Lynch syndrome). These two types are more likely to start at a younger age.

Age. ...

Having inflammatory intestinal conditions, such as ulcerative colitis or Crohn's disease of the colon. ...

Family history. ...

Smoking and excess alcohol use. ...

Obesity, lack of exercise and fat intake. ...

Race.

Risk factors

There are factors that can slightly increase the risk of developing colorectal cancer. For instance, people who have chronic inflammatory bowel conditions such as Crohn's disease and ulcerative colitis are at greater risk of getting colorectal cancer. Having parents or siblings who developed colorectal cancer doubles the risks listed in the following table. Other factors like diet, diabetes or being overweight have less of an influence.

Older age. ...

African-American race. ...

A personal history of colorectal cancer or polyps. ...

Inflammatory intestinal conditions. ...

Inherited syndromes that increase colon cancer risk. ...

Family history of colon cancer. ...

Low-fiber, high-fat diet. ...

A sedentary lifestyle.

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Complications

Colorectal cancer develops gradually over a period of many years. Non-cancerous (benign) growths in the mucous lining are the first stage. These growths aren't yet considered to be dangerous. The medical term for them is polyps or adenomas. Some of them look like small wart-like mounds, while others look somewhat like small mushrooms with stems. Colorectal polyps become increasingly common with age. About one third of all adults over the age of 55 have at least one colorectal polyp.


The great majority of these polyps stay small and don't pose any threat. But some continue growing for several years, and some turn malignant (cancerous).


If a polyp turns malignant, there's a risk that the cancerous cells will grow deeper into the wall of the colon. If the tumor continues to grow, it could spread to other organs, such as the liver. When cancer cells spread like this it's called “metastasis.” There are a number of different factors that will influence how the cancer develops over time. If a smaller, localized, early-stage tumor can be removed, the prognosis (outlook) is good: Most people then recover fully after surgery. If the cancer is more advanced, the chances of complete recovery drop. And if metastatic tumors are discovered, full recovery can usually no longer be expected. In that case, the aim of treatment is to slow down tumor growth and help maintain a good quality of life for as long as possible.


It usually takes about five years to know if the cancer is completely gone. The chances of the cancer coming back depend on various factors, including its stage at the time it was treated.

Rectal bleeding. This can be a sign of colon polyps or cancer or other conditions, such as hemorrhoids or minor tears of the anus.

Change in stool color. Blood can show up as red streaks in your stool or make stool appear black. ...

Change in bowel habits. ...

Pain. ...

Iron deficiency anemia.


Prevention

You can greatly reduce your risk of colon polyps and colorectal cancer by having regular screenings. Certain lifestyle changes also can help:


Adopt healthy habits. Include plenty of fruits, vegetables and whole grains in your diet and reduce your fat intake. Limit alcohol consumption and quit all tobacco use. Stay physically active and maintain a healthy body weight.

Talk to your doctor about calcium and vitamin D. Studies have shown that increasing your consumption of calcium may help prevent recurrence of colon adenomas. But it isn't clear whether calcium has any protective benefits against colon cancer. Other studies have shown that vitamin D may have a protective effect against colorectal cancer.

Consider your options if you're at high risk. If you have a family history of colon polyps, consider having genetic counseling. If you've been diagnosed with a hereditary disorder that causes colon polyps, you'll need regular colonoscopies starting in young adulthood.