Colon Cancer: A Leading Cause of Cancer Deaths

Categories: Cancer

Colon cancer is one of the leading cause of cancer deaths in the United States. There are many risk factors associated with this disease. Some can be controlled, others cannot. It’s important to maintain a healthy life style and be proactive. There are preventative measures that can be taken. Visual and stool- based tests can distinguish diseased tissue from normal tissue. The diseased tissue is staged using a staging system. There are three different systems that can be used when staging colon cancer.

Once cancer is confirmed and staged, physicians create a treatment plan. Every individuals’ cancer is unique. There is not going to be one answer. Every patient’s treatment will be unique to their diagnosis. There are many treatment options for colon cancer including chemotherapy, radiation therapy, and surgery. There is no one size fits all therapy.

Sharon Osbourne, an English television host and the wife of heavy-metal singer-song writer Ozzy Osbourne was diagnosed with colon cancer in July of 2002, after a routine exam.

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She was an overall healthy person with no family history of colon cancer. Sharon admits she never thought this would happen, and she believed she was invincible. Many people carry the same mind set but in reality colon cancer is the second leading cause of death from cancer when men and women are combined. It is the third leading cause when men and women are considered separately. Men are slightly more at risk when compared to women. The risk of developing colon cancer increases with age, with more than 90% of cases occurring in people older than fifty years of age.

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(Washington, & Leaver, 2016) Individuals of African American decent are at the highest risk for developing and dying of colon cancer in the United States. It is unclear as to why they are at a greater risk. Some believe it is due to a lack of access to healthcare. The diagnosis comes at a more advanced stage leading to a worse prognosis than if detected in the earlier stages. “One in every three people who develop colorectal cancer have other family members who have had it” (American Cancer Society, 2018). However, there are more individuals without a family history diagnosed than individuals with a family history, Sharon included.

Many inherited syndromes such as Familial Adenomatous Polyposis (FAP), Hereditary Non- Polyposis Colorectal Syndrome (HNPCC), Peutz- Jeghers Syndrome and others increase the risk of developing cancer. FAP is a disease in which a person develops hundreds of adenomatous polyps in their colon and rectum. A person with this disorder will develop cancer if complete removal of the colon and rectum is not done. HNPCC or Lynch syndrome, develops in three or more family members, two of which are first degree relatives, involving two generations with one member diagnosed before age 50 (Washington, & Leaver, 2016). While there are many factors that cannot be controlled there are just as many lifestyles choices that can be. Alcohol consumption, smoking, and obesity along with diets high in red meat and low in fiber contribute to increased risk. Diets high in fiber like vegetables and fruits act as an inhibitor therefore carcinogens spend less time in the colon. It’s important to make healthy lifestyle choices by dieting and exercising. Individuals should listen to their body and watch for signs and symptoms of cancer.

Signs and symptoms of colon cancer may not be evident right away. With any cancer, one of the most common symptoms a patient experiences leading them to seek medical attention is weight loss. Change in bowel habits such as diarrhea and constipation that lasts more than a few days is indictive of a medical concern. Patients should report any rectal bleeding or blood in their stools to their doctor. Sharon did not experience any symptoms but looking back she admits to being fatigued but contributed it to her busy life as Ozzy’s manager.

Screening tests have led to the drop-in colon cancer death rates. Screening is the process of looking for cancer or pre-cancer in people who have no symptoms of disease (American Cancer Society, 2018). Polyps are slow growing and with detection screening, doctors can find and remove them before they become cancerous. Screening tests are divided into two groups: stool- based tests and visual exams. Stool-based tests evaluate the stool for signs of cancer. Fecal tests include fecal immunochemical test (FIT), Guaic- based fecal occult blood test (gFOBT), and stool DNA test. Although these tests are less invasive than visual exams they need to be done more often. Visual exams look at the structure of the colon and rectum for any abnormal areas. This is done either with a scope (a tube-like instrument with a light and tiny video camera on the end) inserted in the rectum, or with special imaging exams (American Cancer Society, 2018). A colonoscopy is an example of a visual exam in which the doctor looks at the entire colon and rectum through a colonoscope. A colonoscope, is a small flexible tube with a light and small video camera on the end (American Cancer Society, 2018). If any areas of concern are found during the exam the doctor can biopsy or remove any suspicious areas, such as polyps. This is how Sharon’s cancer was diagnosed.

Sharon credits Ozzy with the early detection of her cancer. In an interview Sharon talked of how Ozzy is very health conscious and stays on top of his yearly check-ups. Ozzy urged Sharon to get checked as it had been three years since she had seen a doctor. “He kept on and on about it. If he hadn’t of hounded me, I wouldn’t have gone. I just wouldn’t have.” Sharon said during the interview (Becker, 2016). The American Cancer Society (ACS) has guidelines for screening and detecting colon cancer. The ACS recommends that either a stool-based or visual exam be done starting at the age of 45 and continue every ten years until the age of 75. Individuals with a personal history or strong family history of colon cancer, inflammatory bowel disease, or a hereditary syndrome should begin screening before the age of 45. Upon detection of colon cancer, a complete workup is done. The workup includes a physical exam, medical imaging exams like CT, MRI, and PET scans evaluating the extent of the disease. Labs are drawn, and a chest x-ray is also taken. Chest x-rays are used for evaluation of metastasis to the lung as this is the second most common site of metastasis after the liver. Colonoscopies are not only used for diagnosis, they are used as a guide when obtaining a biopsy for staging.

Biopsies during a colonoscopy assess the size and location of the lesion. There are three different types of staging systems used- the Dukes’, modified Astler- Coller (MAC), and TNM. The Dukes’ is a post-operative staging system that classifies the tumor according to the level of invasion into the bowel wall and the lymph nodes negative or those that test positive. A letter from A-C is assigned. If the tumor has not penetrated the bowel call its assigned the letter A. B will be assigned to a lesion that has penetrated the bowel wall but tests negative for node involvement. If there is nodal involvement the letter C is assigned. The MAC is also a post-operative staging system that is based on the Dukes’ system. This system is more specific regarding the level of penetration through the bowel wall and node status, including categories for surrounding organs and structures. TNM is the most commonly used system evaluating the number of positive nodes and depth of invasion through the bowel wall. It can be used before or after surgery. Nodal involvement and depth of invasion determines the type of treatment a patient will receive. During Sharon’s colonoscopy suspicious areas of her large bowel were identified, biopsied, and then sent for testing. She later received a phone call on July 1st confirming her worst fear, she had cancer.

July 3rd, a few days after her diagnosis, she underwent surgery to remove a foot of disease found in her colon. At this time, they biopsied surrounding lymph nodes. The results later came back positive, indicating the cancer had spread beyond the bowel wall. She started chemotherapy on July 29th to treat and kill the remaining cancer cells. In an interview with Blabbermouth (2002) Sharon stated, “My chemo almost killed me.” Sharon suffered from dehydration, a drop in red counts, and seizures while undergoing chemotherapy. She was rushed to the hospital and treated for dehydration, where they worked ten days to get her red count up. She also talks of the less serious side effects she encountered. Her sense of smell and taste was distorted, and she experienced hair loss. Individuals that undergo chemotherapy can also experience loss of appetite, mouth sores, weight loss, nausea and vomiting, diarrhea, and are at an increased risk for infection. Sharon was not treated with radiation therapy, but this is another treatment option.

Radiation is sometimes used before or after surgery. Radiation treatments help to shrink the tumor before surgery or it can be used to radiate the tumor bed, lymph nodes, or areas of metastasis after surgery. There are two types of treatment: endocavitary radiation therapy and external- beam radiation therapy (EBRT). Endocavitary is a sphincter- preserving procedure. For this treatment, a small balloon- like device is placed into the rectum to deliver high- intensity radiation. This type of treatment is used for small rectal cancers, avoiding major surgery and a colostomy (American Cancer Society, 2018). EBRT is accomplished with a three or four-field set up. Traditionally, a three-field technique in which the patient is positioned prone is used, this allows for homogenous dose to the tumor bed sparing the small bowel (Washington, & Leaver, 2016). A four-field set up with posterior and anterior beams and two lateral beams can be used when there is risk of involvement of the vagina or prostate.

Before a patient begins treatment, they must go through a simulation process to aid the doctor in planning. The CT simulator software allows physicians to digitize in different colors the target volume and critical healthy structures, such as the bladder, rectum, and lymph nodes on each CT slice (Washington, & Leaver, 2016). Patients are placed prone on a belly board, just as they would be positioned for treatment. They are given oral contrast before the scan or contrast is introduced into the rectum via a tube at the time of scanning. Contrast is used to distinguish between the small and large bowel. The scan is taken, from there the doctor determines the isocenter of the tumor. The isocenter coordinates are then programmed into the moveable lasers in the scanner room, and the patient is marked accordingly with tattoos (Washington, & Leaver, 2016). These tattoos will be used to line the patient up for radiation treatments. The radiation dose delivered during treatment will be in fractions of ___cGy a day for ____ days. The total dose delivered to the large volume including regional nodes is 4500cGy, with a coned down volume of the tumor bed receiving 5000cGy to 5500cGy in 6 to 6.5 weeks (Washington, & Leaver, 2016). Just as for chemotherapy there are side effects with radiation. Possible side effects include skin irritation, nausea, incontinence, fatigue, and impotence when the prostate and vagina are involved.

Individuals should maintain a healthy lifestyle and follow the guidelines put out by the American Cancer Society on when to begin screening for colon cancer. The prognosis for this disease is favorable when caught early. Sharon was fortunate to have a colonoscopy when she did. She had no intentions on being screened but her husband pushed for it. If someone you know should be screened but hasn’t, encourage them to be tested. Since being diagnosed and treated for colon cancer, Sharon has established her own program. “The Sharon Osbourne Colon Cancer Program works to improve the lives of patients and their loved ones by providing at-home help, childcare, transportation, access to support groups and patient care services offered within Cedars- Sinai Medical Center” (Cedars-Sinai, 2018). Sharon was open about her cancer journey and the struggles she encountered. She continues to be open in hopes that she can educate the public on colon cancer and preventative exams.

References

  1. American Cancer Society. (2018, February 21). What is colorectal cancer? Retrieved from https://www.cancer.org/cancer/colon-rectal-cancer/about/what-is-colorectal-cancer.html
  2. Becker, N. (2016, January 22). Kicking colon cancer’s butt: Sharon Osbourne – Kiel colon cancer. Retrieved from https://kielcoloncancer.org/kicking-cancers-butt-first-lady-heavy-metal-sharon-osbourne/
  3. Blabbermouth. (2002, September 29). Sharon Osbourne on cancer battle: ‘Life goes on’. Retrieved from http://www.blabbermouth.net/news/sharon-osbourne-on-cancer-battle-life-goes-on/
  4. Cedars-Sinai. (2018). Colon cancer Program. Retrieved from https://www.cedars-sinai.org/programs/cancer/we-treat/colorectal/services/colon-cancer.html
  5. Washington, C. M., & Leaver, D. (2016). Principles and practice of radiation therapy (4th ed.). Elsevier.

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Colon Cancer: A Leading Cause of Cancer Deaths. (2021, Aug 06). Retrieved from https://studymoose.com/colon-cancer-a-leading-cause-of-cancer-deaths-essay

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