Term Paper on "Colorectal Cancers, With Emphasis on the Difficulties"

Term Paper 6 pages (1790 words) Sources: 1+

[EXCERPT] . . . .

colorectal cancers, with emphasis on the difficulties of diagnosis and the wide range of options available for early detection. It considers family history and genetic factors and looks at the pros and cons of the various diagnostic tests available, including a few still in development. It covers ways to detect a genetic predisposition to the disease as well as how such individuals should be followed. Since colorectal cancer often does not give early symptoms, it emphasizes the need for careful monitoring, especially in people particularly susceptible to this disease. It talks about how colorectal cancer is treated once diagnosed.

Colon cancer is the second-highest occurring cancer in the United States, beaten out for first place only by lung cancer. In medical terms, the colon includes the entire large intestine (Columbia Ency, 2004).

Colon cancer can have several contributing causes. Diets too high in fat and not high in fiber sources, such as fruit, vegetables and whole grain, correlates with a higher incidence of colon cancer. However, it is also more common in anyone with a family history of colon cancer, and even a history of cancer in the female reproduction system. Polyps in the colon and a medical history of ulcerative colitis are risk factors.

In addition, several genes have been identified that are risk factors for colon cancers, including mutations on either gene MSH2 or MLH1. This type of cancer is called "hereditary nonpolyposis colorectal Cancer, or HNPCC. Colon cancer occurs most often in people over the age of 50. (Columbia Ency, 2004) for people with HNPCC in their family history, their blood can be tested for the presence of gene mutations. Then they can make alterations to life style and screen carefully for the cancer so that if they do develop it, it will be caught as early as possible (Columbia Ency, 2004).

DIAGNOSIS

Since colon cancer does not always give early warning signs, the medical community has worked to devise ways to diagnose the disease as early as possible. One approach has been for family practitioners to use sigmoidoscopy. However, sigmoidoscopy cannot look at the entire large intestine, and a thorough evaluation requires a colonoscopy, or examination of the entire large intestine. If polyps are found, they then must be removed and checked for the presence of cancer (Nuovo, 2001). Because even early cancer is visible in colonoscopy, the American College of Gastroenterology has changed its recommendations to urge every person to have a colonoscopy every ten years starting at the age of 50 (Editors, 2000).

Colon cancer can produce symptoms, including a change in bowel patterns, or blood in the stool (Columbia Ency, 2004). However, since many things can affect bowel habits, and blood is not always noticeable without lab tests, even these warnings can be overlooked. Recently, researchers have discovered that C-reactive protein, or CRP, found during blood tests, is a risk factor for colon cancer. CRP was previously associated with heart disease (Seppa, 2004). Researchers see a connection between this finding and other findings that anti-inflammatory drugs such an aspirin lowers the risk of colon cancer (Seppa, 2004). In addition, the blood may show carcinoembryonic antigen, or CEA, a substance sometimes present when a person has developed colon cancer.

To actually spot the cancer requires endoscopy of the colon, followed by biopsy of any suspicious areas spotted. So, while colon cancer can be diagnosed early, it can only be done with the use of a fair amount of discomfort to the patient. Early in the cancer's development, the patient may be symptom-free. The doctor will examine the rectum and run a blood test for carcinoembryonic antigen (CEA), a tumor marker produced by colon cancers. These may be followed by an endoscopic examination of the colon with a sigmoidoscope (to examine the rectum and the adjoining sigmoid colon) or colonoscopy (to examine the entire colon). A biopsy of any suspicious tissue is then examined in a laboratory to determine if cancerous changes are present.

If colon cancer is present, the patient must then be examined to see how large the tumor is and whether the cancer has spread to any other parts of the body (Columbia Ency, 2004).

For people without heightened risk for colon cancer, doctors suggest a colonoscopy every 10 years starting at age 50. They feel this approach has several advantages. First, it allows the immediate removal of polyps before they become cancerous (Editors, 2000). Second, a colonoscopy looks at the entire colon, and there has been growing awareness among specialists that cancer can occur high up in the colon (Editors, 2000). They recognize that the procedure is inconvenient and somewhat uncomfortable, and feel they are more likely to get patient compliance when they do not have to undergo the procedure more frequently (Editors, 2000).

Researchers note that colonoscopies are cost-effective. The cost is usually under $750 (Editors, 2000). However, insurance often does not pay for colonoscopies as a screening tool. If the patient cannot afford the cost, the cheaper (but less thorough) use of sigmoidoscopy and checking of stools for blood (FOTB) can be substituted at age 50 (Editors, 2000). In that case, they recommend sigmoidoscopy and stool check every five years.

However, this approach has drawbacks. The bowel is not as completely prepared, meaning that an anomaly could go unobserved. It also tends to be a little more uncomfortable, causing patients to resist the approach (Editors, 2000). Some doctors feel that such tests should be done in ambulatory surgical centers and that evaluations done in the doctor's office may not be as thorough (Editors, 2000).

Patients might prefer that FOTB, perhaps along with blood tests, but the American Cancer Society feels that this approach isn't sensitive enough, and does not endorse it (Editors, 2000). However, it does improve when used on a regular basis -- once every one to two years. The limitations of FOTB alone are so substantial that the American Cancer Society has declined to recommend it as a stand-alone screening procedure (Editors, 2000). However, because the sensitivity of the test improves if it is repeated every 1 to 2 years, the ACG does endorse annual FOBT as a screening procedure. Patients with any kind of positive finding from either sigmoidoscopy or FOBT will then need a full colonoscopy.

Another approach found lacking for early diagnosis is the use of barium enemas, because they do not spot polyps, or adenomas, well. One type of barium enema, called "double contrast," produces better imaging than traditional barium enemas, but should be combined with FOBT. This approach is still not as sensitive as a colonoscopy. If double contrast barium enemas (DCBEs) are used, they should be given every five years (Editors, 2000).

Some research has been done on using CT and MRI's. However, this appraoch is new and unproven, and not yet recommended by the ACG (Editors, 2000). CT's require exposure to radiation, making them less desirable. However, MRI's (magnetic resonance imaging) may eventually produce imaging that some describe as a "virtual colonoscopy (Nuovo, 2001), but this technology is still in the development stage.

Some people are at higher than normal risk. There are two types of hereditary colorectal cancer, and people with that family history have to be checked very carefully and more often. Familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC) have a markedly higher risk of developing colon cancer themselves. The risk is great enough that children of parents with FAP should have a sigmoidscopy every one to two eyars, starting between the ages of 10 and 12. For older patients with a recently diagnosed patient, they must have a full colonoscopy. Another form of genetically-tied colorectal cancer, attenuated adenomatous polyposis coli (APC), which tends to develop later and life, colonoscopy screenings are also called for (Editors, 2000).

The Amsterdam Criteria have been devised to determine other people at high risk for colorectal cancer. Those risk factors include: a person who has 3 relatives with colorectal cancer, two of them first-degree (parents, siblings); the cancer present in two generations; at least one relative who acquired the disease before the age of 50 (Editors, 2000). A modified version of these criteria add the presence of cancer of the ovaries, stomach, small intestine, pancreas, or urinary tract (Editors, 2000). For all these people, the recommendation is that they have a colonoscopy every two years starting at age 20-25, and then every year after age 40 (Editors, 2000). Genetic testing can help identify those most vulnerable to inheriting these types of cancer, but it is not commonly done, and does not predict all cases. In addition, it warns the person of the possibility but cannot tell the patient whether he or she has actually developed cancer or not.

Although having one relative with colon cancer does not put the person in the high risk groups identified by the Amsterdam Criteria, they are still at heightened risk, and doctors recommend a colonoscopy every three to five years after the age of sixty along with screening starting at age… READ MORE

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