Colorectal cancer: Get informed

A good understanding of the diagnosis and treatment options in colorectal cancer will help you make better decisions that are fully informed by the underlying issues, and help everyone involved deal with the situation.

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Colorectal cancer

It can be difficult to explain all the feelings that arise when the news of a cancer diagnosis arrives. It is easy to feel overwhelmed by the information, which takes time to understand, and the many questions inevitably raised. Facing up to all this at an emotional time means that patient and family alike need to work hard on understanding what might happen, so as to make the right decisions for everyone involved.

The job of the intestine is to absorb nutrients from the diet. It is a hollow tube whose length varies, but it's usually about 7 metres (21 feet) long. The first part, known as the small intestine, is composed of the duodenum, jejenum, and ileum, which run into the large intestine, or colon. The intestinal contents then in turn pass through the caecum (to which the appendix is attached), the ascending colon, transverse colon, descending colon, sigmoid colon and rectum, before ending at the anus. 

In western countries, cancer of the colon or rectum is the third commonest cause of cancer death, after breast cancer (in women) and lung cancer (in men). The disease represents about 12% of all cancers,  with around 43,000 new cases (in both sexes) discovered each year in the UK. Sadly, colorectal cancer  also caused 16,187 deaths in 2012.
The majority of colorectal cancers start with a small growth called a polyp. These are usually benign, but sometimes the cells within them start to proliferate and transform into a cancer. Polyps may be described by their appearance, being pedunculated (attached to the wall of the intestine by a stalk), or sessile (no stalk).
 

Three types of polyp

- Hyperplastic polyps are characterised by rapid proliferation of the mucosa, 
- Hamartomatous polyps (also known as juvenile or Peutz-Jeghers polyps) 
- Adenomatous polyps
 
Only adenomatous polyps may lead to cancer, and only a small proportion of these actually do so. A polyp's size is a good predictor of whether it will develop into an invasive cancer. The risks are as follows: 
 
- Minimal (less than 2%) if the polyp is smaller than 1.5cm
- Intermediate (2-10%): diameter between 1.5 and 2.5 cm 
- Significant (10%): greater than 2.5 cm. 
 
There are so many factors to take into account. Knowing about the disease, and how it may develop, the various treatments, and all the family and work issues that may ensue in daily life, are all important elements in dealing with cancer. Openly discussing it all will help to get you through. You can speak to others on the Colorectal Forum.

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