Colon and Rectal Cancers
The colon and rectum are parts of the body’s digestive system.
The digestive system removes and processes nutrients (vitamins,
minerals, carbohydrates, fats, proteins, and water) from foods
and helps pass waste material out of the body.
The digestive system is made up of the esophagus, stomach, and
the small and large intestines. The first 6 feet of the large intestine
are called the large bowel or colon. The last six inches are the
rectum and the anal canal. The anal canal ends at the anus (the
opening of the large intestine to the outside of the body).
Colon cancer is cancer that forms in the tissues of the colon
(the longest part of the large intestine). Most colon cancers are
adenocarcinomas (cancers that begin in cells that make and release
mucus and other fluids). Rectal Cancer is a disease in which malignant
(cancer) cells form in the tissues of the rectum.
Most of these cancers evolve from benign growths called adenomatous
polyps. Most tumors of the intestine do not produce symptoms
during the early stages. As they develop and become more
advanced certain symptoms may develop. Blood may appear in
the stool either as visible to the naked eye or as microscopic
or "occult" usually picked up by a laboratory test. When
tumors grow large enough they can partially block the lower intestine
causing a change in the caliber of the stools. They may also
cause a rectal fullness not relieved with a bowel movement.
It is estimated that 4,590 people in New Jersey are diagnosed
each year with colorectal cancers, and that 1,580 die annual of
the disease. Ninety percent of colorectal cancers occur in
people over age 50. The risk for colon cancer appears to
be far higher in industrialized nations than less developed countries. People
who have a first-degree relative (sibling or parent) who developed
colorectal cancer before age 50 have a significantly higher life-time
risk (about 25 percent) than people who do not have a family history
or did not develop colorectal cancer until after age 60.
Screening tests for colon cancer are extremely important for detecting
the premalignant form of cancer, i.e. polyps as well as early stages
of colon cancers which may be removed completely for cure.
The Digital Rectal Exam is used to detect tumors in the lower
portion of the rectum as well as the prostate.
Fecal occult testing - blood in bowel movements is not always
visible to the naked eye. There are tests using color changes
to detect if occult blood is present. Other more advanced
methods to visualize the colon include Sigmoidoscopy, Colonoscopy
or Double Contrast Barium Enema.
A sigmoidoscope is a flexible tube containing a camera and a light
at the end. It can only view the rectum and the lower left
portion of the colon while a colonoscopy allows for visualization
of the entire colon and in some cased the very terminal portion
of the small intestine. A barium enema is a radiologic procedure
that is strictly diagnostic for assessing the colon and rectum
for polyps or tumors.
Screening should start at age 50 in those who have no symptoms
and no family history of colon cancer. An annual digital
rectal exam and fecal occult blood test should start at this age
along with a screening sigmoidoscopy or colonoscopy.
To learn more, visit http://www.cancer.gov/cancertopics/types/colon-and-rectal.
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Anal Abcess
This condition is defined as any collection of pus in the perianal
or rectal area. The cause is typically from a blockage
of one of the anal glands that are part of the normal anal anatomy. They
may also be caused by an infected anal fissure, sexually transmitted
infections or inflammatory bowel disease such as Crohn's disease. Most
abscesses occur in an area that is accessible for drainage. However,
they may be found higher in the rectum from a source in the pelvis. The
abscess often appears as a swollen, red, tender lump at the edge
of the anus or in the surrounding perianal region. There
may be discharge of pus from the rectum. The patient may
have an associated fever. The typical complaint is a deep,
dull ache often feeling like increasing pressure in the rectum.
A rectal exam will usually suffice to make the diagnosis of an
anorectal abscess. Sometimes a proctosigmoidoscopy may be
performed to visualize the mucosal lining of the rectum.
The most definitive treatment involves an incision and drainage
of the purulent fluid from the abscess cavity. This can often
be performed in an outpatient setting under a local anesthetic. If
the cavity is noted to be very deep and not within easy reach from
the peri anal area, surgeryin an operative room setting may be
indicated.
Warmer, sitz baths may assist in increasing the drainage from
the abscess and assist with pain relief.
The outcome is good following surgery although one out of three
patients undergoing an incision and drainage may develop a fistula
tract to the drainage site.
Call your doctor if you should develop fever, chills or other
symptoms following treatment of an anorectal abscess.
To learn more, visit http://www2.niddk.nih.gov/AboutNIDDK.
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Anal Fissure
An anal fissure is a small tear in the skin of the anal canal,
which often causes pain and bleeding. A fissure is most often
caused by a hard bowel movement but can also occur after diarrhea
and inflammation of the anorectal area.
Fissures can heal without specific treatment and may improve with
the use of stool softners, fiber supplements and warm water baths
or sitz baths. The longer a fissure is present the less likely
it is to heal without treatment. Associated sphincter muscle spasm
or tightness makes healing less likely.
Specific treatment of anal fissures may include the use of topical
medicated creams, dilute nitroglycerin ointment, injection of Botox
or surgery.
Surgery may consist of a small operation to remove the fissure
and divide a small portion of the anal sphincter to reduce spasm
and promote healing. Cutting this muscle rarely interferes with
bowel control and can usually be performed in the office.
Complete healing after treatment usually occurs in a few weeks
although the pain often disappears in a few days.
Anal fissures do not lead to colon cancer but symptoms of pain
and bleeding need to be carefully evaluated since serious conditions
other than fissure can cause similar symptoms.
Anal fissures do not lead to colon cancer but symptoms of pain
and bleeding need to be carefully evaluated since serious conditions
other than fissure can cause similar symptoms.
To learn more, visit http://www2.niddk.nih.gov/AboutNIDDK.
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Anal Fistula
An anal fistula is a passage that develops between the anus and
the skin. Most fistulas are the result of an abscess or infection
that spreads to the skin. Fistulas are typical of Crohn’s
disease.
To learn more, visit http://www2.niddk.nih.gov/AboutNIDDK.
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Anal or Rectal Bleeding
There are many causes of anal or rectal bleeding some of which
are quite serious. Causes of rectal bleeding
include hemorrhoids, anal fissure, colitis, or proctitis, colon
and rectal cancer or polyps, diverticulosis, abnormal blood vessels,
infections and other disorders of the intestinal tract.
In all cases of bleeding, medical attention should be sought and
the patient should be examined.
Investigation of bleeding may include a visual examination with
a proctosocope, flexible sigmoidoscope or colonoscopy. Other
tests may include a Barium Enema, Upper Endoscopy, Angiogram or
Cat Scan.
As there are many causes of rectal bleeding there are many ways
ot treat it. Most importantly all cases of rectal bleeding
should be evaluated by a physician. It is wrong to assume
that bleeding is benign and will go away. Many patients with
colorectal cancer or precancerous polyps have delayed treatment
by assuming that their bleeding was caused by hemorrhoids.
To learn more, visit http://www2.niddk.nih.gov/AboutNIDDK.
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Chron’s Disease
Crohn’s disease is an ongoing disorder that causes inflammation
of the digestive tract, also referred to as the gastrointestinal
(GI) tract. Crohn’s disease can affect any area of the GI
tract, from the mouth to the anus, but it most commonly affects
the lower part of the small intestine, called the ileum. The swelling
extends deep into the lining of the affected organ. The swelling
can cause pain and can make the intestines empty frequently, resulting
in diarrhea.
Crohn’s disease is an inflammatory bowel disease, the general
name for diseases that cause swelling in the intestines. Because
the symptoms of Crohn’s disease are similar to other intestinal
disorders, such as irritable bowel syndrome and ulcerative colitis,
it can be difficult to diagnose. Ulcerative colitis causes inflammation
and ulcers in the top layer of the lining of the large intestine.
In Crohn’s disease, all layers of the intestine may be involved,
and normal healthy bowel can be found between sections of diseased
bowel.
Crohn’s disease affects men and women equally and seems
to run in some families. About 20 percent of people with Crohn’s
disease have a blood relative with some form of inflammatory bowel
disease, most often a brother or sister and sometimes a parent
or child. Crohn’s disease can occur in people of all age
groups, but it is more often diagnosed in people between the ages
of 20 and 30. People of Jewish heritage have an increased risk
of developing Crohn’s disease, and African Americans are
at decreased risk for developing Crohn’s disease.
Crohn’s disease may also be called ileitis or enteritis.
To learn more, visit http://digestive.niddk.nih.gov/ddiseases/pubs/crohns.
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Colitis
Ulcerative colitis is a disease that causes inflammation and sores,
called ulcers, in the lining of the rectum and colon. Ulcers
form where inflammation has killed the cells that usually line
the colon, then bleed and produce pus. Inflammation in the colon
also causes the colon to empty frequently, causing diarrhea.
When the inflammation occurs in the rectum and lower part of the
colon it is called ulcerative proctitis. If the entire colon is
affected it is called pancolitis. If only the left side of the
colon is affected it is called limited or distal colitis.
Ulcerative colitis is an inflammatory bowel disease (IBD), the
general name for diseases that cause inflammation in the small
intestine and colon. It can be difficult to diagnose because its
symptoms are similar to other intestinal disorders and to another
type of IBD called Crohn’s disease. Crohn’s disease
differs because it causes inflammation deeper within the intestinal
wall and can occur in other parts of the digestive system including
the small intestine, mouth, esophagus, and stomach.
Ulcerative colitis can occur in people of any age, but it usually
starts between the ages of 15 and 30, and less frequently between
50 and 70 years of age. It affects men and women equally and appears
to run in families, with reports of up to 20 percent of people
with ulcerative colitis having a family member or relative with
ulcerative colitis or Crohn’s disease. A higher incidence
of ulcerative colitis is seen in Whites and people of Jewish descent.
To learn more, visit http://digestive.niddk.nih.gov/ddiseases/pubs/colitis.
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Diverticulosis
Diverticulosis of the colon is a common condition affecting approximately
50 percent of Americans by age 60. Very few people with diverticulosis
have any symptoms and few will ever require surgery.
Diverticula are out-pouching of the colon wall and occur most
commonly in the sigmoid or left side of the colon. Diverticulitis
is the inflammation, perforation or surrounding infection of the
diverticulum.
Symptoms of diverticulitis include abdominal pair or cramping,
a change in bowel habits, and occasionally fever. Diverticulosis
can also cause severe rectal bleeding in a small percentage of
patients.
How is diverticulosis treated? Mild symptoms of diverticulosis
are usually treated by diet and occasionally medications. Increased
fiber in the diet is usually recommended to help reduce pressure
in the colon. Diverticulitis can be mild or complicated and usually
requires antibiotics and may require hospitalization. Surgery to
remove the area of diverticulitis may be necessary to treat recurrent
or severe attacks of diverticulitis that do not respond to medication.
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Fecal Incontinence
Fecal incontinence is the inability to control your bowels. When
you feel the urge to have a bowel movement, you may not be able
to hold it until you get to a toilet. Or stool may leak from
the rectum unexpectedly, sometimes while passing gas.
More than 5.5 million Americans have fecal incontinence. It affects
people of all ages—children and adults. Fecal incontinence
is more common in women and older adults, but it is not a normal
part of aging.
To learn more, visit http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence.
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Hemorrhoids
Hemorrhoids are enlarged veins of the anus and rectum. There are
two types of hemorrhoids based on their location: internal hemorrhoids
and external hemorrhoids. Internal hemorrhoids occur in the anus
and rectum. Painless bleeding and protrusion are the most common
symptoms. External hemorrhoids develop outside the anus where
they are noticeable and are covered with sensitive skin. Blood
clots can form within external hemorrhoids causing pain, swelling
and bleeding if they rupture.
Hemorrhoidal veins are present in everyone, but symptomatic hemorrhoids
may be caused by various factors including pregnancy, chronic constipation,
diarrhea, straining during bowel movements, overuse of laxatives
or enemas, heredity, aging, or spending a long time on the toilet.
Common hemorrhoidal symptoms include bleeding, itching, protrusion,
pain and sensitive lumps, these symptoms can be treated in various
ways. Minor symptoms may respond well to conservative dietary changes
and topical treatments.
Symptoms caused by internal hemorrhoids can often be relieved
by quick , effective and relatively painless office procedures
such as rubber band ligation, injection or infra-red photocoagulation.
Surgery to remove hemorrhoids (hemorrhoidectomy) is often not
necessary in many patients, but can be the best method of treatment
for permanent removal of symptomatic internal and external hemorrhoids.
Hemorrhoidectomy is most often performed under a local anesthetic,
as an outpatient without the need for hospitalization.
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Polyps
A colon polyp is a growth on the surface of the colon, also called
the large intestine. Sometimes, a person can have more than one
colon polyp. Colon polyps can be raised or flat. The large intestine
is the long, hollow tube at the end of your digestive tract.
The large intestine absorbs water from stool and changes it from
a liquid to a solid. Stool is the waste that passes through the
rectum and anus as a bowel movement.
Some colon polyps are benign, which means they are not cancer.
But some types of polyps may already be cancer or can become cancer.
Flat polyps can be smaller and harder to see and are more likely
to be cancer than raised polyps. Polyps can usually be removed
during colonoscopy—the test used to check for colon polyps.
To learn more, visit http://digestive.niddk.nih.gov/ddiseases/pubs/colonpolyps_ez.
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Rectum Prolapse (Rectocele)
A rectocele occurs when the end of the large intestine (rectum)
pushes against and moves the back wall of the vagina. An enterocele
(small bowel prolapse) occurs when the small bowel presses against
and moves the upper wall of the vagina. Rectoceles and enteroceles
develop if the lower pelvic muscles become damaged by labor,
childbirth, or a previous pelvic surgery or when the muscles
are weakened by aging.
Surgical repair of rectoceles and enteroceles is used to manage
symptoms such as movement of the intestine that pushes against
the wall of the vagina, low back pain, and painful intercourse.
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