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gross

Colorectal cancer (CRC)

Common, often silent, and usually preventable

Colorectal Cancer (or CRC for short) is a malignant disease of the large bowel or the rectum. The vast majority of these cancers (more than 90 percent, called adenocarcinomas) arise from the glands in the lining of the bowel.

CRC is one of the most prevalent cancer types worldwide, with over one million cases occurring every year. According to the World Cancer Report, the incidence of colorectal cancer ranks 4th in men (after lung, prostate, stomach) and 3rd in women (after breast and cervix).

More than 9 out of 10 people diagnosed with colorectal cancer are older than 50. About fifty percent of CRC patients will have died from their disease five years after diagnosis, but the chances of healing are directly dependent on the stage of the cancer at the time of diagnosis – the earlier it is found and treated, the better.

Cause of CRC

Most CRCs develop from polyps in the bowel. These polyps are common and usually benign, and they do not cause any problems. After many years, large polyps can change and develop into cancer. The more polyps a person has in his or her large bowel, the higher their risk of CRC.

There is some evidence that a so-called 'healthy life-style' may reduce the risk of CRC as well as the risk of other cancers and cardiovascular disease: Maintaining a healthy body weight, regular exercise, low or no alcohol consumption. This is probably because a sedentary life-style and obesity increase the risk of polyps in the large bowel and thus the risk of CRC.

Although it had been previously assumed that eating a lot of high-fiber foods - like vegetables, whole grains and nuts - would reduce the CRC risk, no scientific evidence of this has been found.

CRC: Prevention

One important preventative measure for CRC is checking for polyps and removing them if necessary. It is recommended that everyone should have an investigation of the large bowel (colonoscopy) at an age of around fifty or in the presence of certain risk factors for colorectal cancer even earlier. Colonoscopy - inserting a tube with a camera into the bowel from behind - allows a direct view of the bowel lining, and polyps can be removed immediately in the same session.

CRC: Symptoms

Most colorectal cancers do not cause any symptoms in the early stages , so they can grow 'silently' for years while the patient feels perfectly healthy. When clinical symptoms occur, the tumor is often in an advanced stage. This is why early detection through colonoscopy is so important.

Any symptoms or CRC may just as well be caused by a different condition, so there is no specific sign of this disease.

Some patients notice changes in their pattern of bowel movement (unexplained diarrhea or constipation), sometimes patients have pain, and if the cancer is situated near the anus there may be red blood when moving the bowels. If an undetected tumor causes chronic bleeding, this may over time lead to anemia with pallor and fatigue. Unexplained weight loss is another sign that a cancer may be present, but this is by no means exclusive to CRC.

CRC: Treatment

The most important treatment for CRC is removal of the cancer via surgery. Depending on the stage in which the cancer is detected, it may be enough to remove the cancer itself with a safety margin, but often part of the large bowel must be removed. If the cancer is near the anus, the patient will have to have an artificial orifice (stoma) with a bag for collecting the stools, at least temporarily.

Chemotherapy (anti-cancer drugs) alone or in combination with radiation therapy can be used either before an operation to shrink the tumor, or after an operation to reduce the risk for local recurrence and to eliminate any possible small undetected metastases, in case the tumor has already spread. If definite metastases are present, chemotherapy is the mainstay used to prolong the patient's life even if it is no longer possible to achieve a cure.

New drug for CRC under investigation

Bayer HealthCare has conducted an international clinical trial with a new drug in CRC patients with metastases whose tumor had progressed after treatment with standard therapies. The results are positive. We are planning the approval for the first half of 2012.

Advice for patients
Every body reacts differently to medicines. Therefore it is impossible to tell which medicine works best for you. Please consult your physician.