Colon Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - General Information About Colon Cancer
Cancer of the colon is a highly treatable and often curable disease when localized to the bowel. Surgery is the primary form of treatment and results in cure in approximately 50% of the patients. Recurrence following surgery is a major problem and is often the ultimate cause of death.
Incidence and Mortality
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Note: Estimated new cases and deaths from colon cancer in the United States in 2013:
New cases: 102,480 (colon cancer only).
Deaths: 50,830 (colon and rectal cancers combined).
Gastrointestinal stromal tumors can occur in the colon. (Refer to the PDQ summary on Gastrointestinal Stromal Tumors Treatment for more information.)
Anatomy of the lower gastrointestinal system.
Groups that have a high incidence of colorectal cancer include those with hereditary conditions. Together, these groups account for 10% to 15% of colorectal cancers. These groups include the following:
Hereditary nonpolyposis colon cancer (HNPCC) or Lynch syndrome variants I and II.
A personal history of ulcerative colitis or Crohn colitis.[2,3]
More common conditions with an increased risk include the following:
A personal history of colorectal cancer or adenomas.
First-degree family history of colorectal cancer or adenomas.
A personal history of ovarian, endometrial, or breast cancer.[4,5]
These high-risk groups account for only 23% of all colorectal cancers. Limiting screening or early cancer detection to only these high-risk groups would miss the majority of colorectal cancers. (Refer to the PDQ summaries on Colorectal Cancer Screening and Colorectal Cancer Prevention for more information.)
Because of the frequency of the disease, ability to identify high-risk groups, slow growth of primary lesions, better survival of patients with early-stage lesions, and relative simplicity and accuracy of screening tests, screening for colon cancer should be a part of routine care for all adults aged 50 years and older, especially for those with first-degree relatives with colorectal cancer. (Refer to the PDQ summary on Colorectal Cancer Screening for more information.)
The prognosis of patients with colon cancer is clearly related to the following:
The degree of penetration of the tumor through the bowel wall.
The presence or absence of nodal involvement.
The presence or absence of distant metastases.
These three characteristics form the basis for all staging systems developed for this disease.
Other prognostic factors include the following:
Bowel obstruction and bowel perforation are indicators of poor prognosis.
Elevated pretreatment serum levels of carcinoembryonic antigen (CEA) have a negative prognostic significance.
Many other prognostic markers have been evaluated retrospectively for patients with colon cancer, though most, including allelic loss of chromosome 18q or thymidylate synthase expression, have not been prospectively validated.[9,10,11,12,13,14,15,16,17,18] Microsatellite instability, also associated with HNPCC, has been associated with improved survival independent of tumor stage in a population-based series of 607 patients younger than 50 years with colorectal cancer. Patients with HNPCC reportedly have better prognoses in stage-stratified survival analysis than patients with sporadic colorectal cancer, but the retrospective nature of the studies and possibility of selection factors make this observation difficult to interpret.