Colon Cancer Symptoms and Stages

Colon cancer is the presence of cancerous tumors in the colon or rectum. Reports from the American Cancer Society suggest rates of colorectal cancer are increasing among younger adults in their 20s, 30s, and 40s. In the U.S., colon cancer is the leading cause of cancer deaths in men below the age of 50 and the second in women under 50, behind breast cancer. But early-onset colon cancers aren't just rising in America. They are a global trend, raising questions about potential causes and lifestyle and environmental factors. In 2021, the U.S. Preventive Services Task Force lowered the recommended age for colorectal cancer screenings to 45.

Full recovery is possible with early detection, and awareness of red flags can empower you to take swift action, no matter how old you are.

Adenocarcinoma is the most common type of colorectal cancer, accounting for more than 90% of colon cancer cases. It is found within the mucus-making cells in the colon's inner lining. Then you have the more rare types of tumors.

• Carcinoid tumors begin in the hormone-producing cells of the intestines.
• Gastrointestinal stromal tumors (GISTs) begin with nerve cells in the digestive tract or involve sarcoma in blood vessels and connective tissue.
• Lymphoma is a cancer of the immune system that usually starts in the lymph nodes but can advance from the colon or rectum.

During stage 0, abnormal cells are found only in the inner lining of the colon, and this is referred to as carcinoma in situ. The abnormal cells may become cancerous and spread. At this stage, an individual typically won't have any symptoms but may experience symptoms similar to those in stages 1 and 2. Stage 0 is usually discovered during routine screenings.

Stage 1 colon cancer moves beyond the inner lining of the colon or rectum to the submucosa or even the muscle layer of the colon wall. This is early-stage cancer and has a high cure rate. During stage 1, individuals may still experience no symptoms, which is why annual colonoscopies are so crucial in folks over 45. But it's also around this stage that you may start to experience belly cramps or pain, excess gas, changes in stool shape or color, rectal bleeding, blood in stool, constipation, or diarrhea.

Monitor your symptoms or changes in bowel patterns, and if they occur for longer than a week or two, make an appointment with your GP.

Stage 2 colon cancer has substages depending on where the cancer has moved to. It may be present at the outermost layer of the colon wall, or it can advance to nearby tissue. Symptoms from Stage 1 may become more pronounced. Bowel movement frequency may increase or decrease, and the normal solutions for constipation or diarrhea may not work. Stool can become narrower than usual, or tar-like in both color and consistency.

The presence of dark blood in stool suggests blood may be coming from higher up the bowel, whereas bright red blood could be due to less concerning hemorrhoids or anal fissures.

Stage 3 colon cancer also has substages depending on the number of lymph nodes the cancer has spread to or whether it has moved to nearby organs. At stage 3, there's still an opportunity for a cure. Symptoms evolve as the disease progresses.

At this stage, they can include unexplained weight loss, loss of appetite, fatigue, weakness, feeling like you can't fully empty your bowels, long-term changes in stool, and vomiting.

Stage 4 is considered late-stage colorectal cancer. At this point, the cancer can spread to other parts of the body, and substages refer to the number of distant organs affected. If colon cancer spreads to the liver, for example, the liver will have colon cancer cells. In addition to symptoms from earlier stages, individuals may present with jaundice, swollen hands and feet, breathing difficulties, chronic headaches, blurry vision, pelvic pain, and anemia. Symptoms at this stage are also related to affected organs.

For example, if cancer spreads to the liver, itchy skin may be an issue, and the abdomen may appear swollen, and if it spreads to the bones, fractures may occur.

If you're getting tired for no apparent reason, or you notice that your clothes are fitting you a little differently without changes to your diet or physical activity, these could be red flags when viewed alongside unusual bowel movements or pain. If stage 4 colon cancer spreads to the lungs, individuals may cough up blood or struggle with a relentless cough. If it spreads to the bones, hypercalcemia can lead to irritability, thirst, and confusion.

It's important not to panic when you first experience symptoms. They can be due to other conditions, or you may have irritable bowel syndrome or inflammatory bowel disease. It's best to consult with your healthcare provider if you have concerns.

During a physical exam, your doctor will feel your abdomen for masses or perform a digital rectal exam with a gloved finger. They will note other irregularities and may recommend blood tests and booking a colonoscopy to view the inside of the colon and rectum. A colonoscopy involves sedating a patient and inserting a tube attached to a camera into the colon from the anus. The procedure takes up to an hour—if the doctor finds polyps, they can remove them via the tube. Tissue samples for biopsies are also collected during colonoscopies.

If close relatives (siblings, parents, or children) or multiple relatives on one side of your family have had cancer, especially when they were younger than 50, you should mention this to your doctor. A family history of bowel cancer could mean doing annual colonoscopies as early as your 30s.

Beyond a family history of colorectal cancer and being over 50 years old, certain risk factors increase the odds that you may develop colon cancer. If you've had colon polyps or bowel diseases in the past, are ethnically African or Ashkenazi Jewish, or have a genetic syndrome like familial adenomatous polyposis, you may need to have regular screenings, and from an earlier age.

Researchers are not entirely sure what has caused the rapid increase in colon cancer among young people. It could be a combination of poor diet, binge drinking, smoking, sedentary lifestyles, medications that alter the gut microbiome, and exposure to toxins such as 'forever chemicals.' More research is needed on the subject.

Treatment differs depending on the type of colon cancer and how far it has spread. During early-stage colon cancer, minimally invasive laparoscopic surgery can remove polyps that a colonoscopy is unable to remove. During later stages, a colectomy can remove cancerous portions of the colon and reconnect healthy parts. If reconnection is impossible, surgery is necessary to provide a means for waste to exit the body into a colostomy bag.

Chemotherapy is often part of pre or post-surgery treatment plans for stage 3 colon cancer. Strong medicines are administered to shrink cancers or kill lingering cancer cells. Sometimes, chemo is used with radiation therapy—instead of medication, energy beams are used to kill cancer cells. At stage 4, immunotherapy helps the immune system find and kill cancer cells. At an advanced stage, the focus may shift to symptom relief and palliative care.

A week or two before surgery, your doctor will give you instructions about what to do on the day of the operation, such as when to stop drinking and eating. They will tell you about the procedure, its risks and benefits, and what you can expect after the surgery. Because of the risk of surgical site infection in colorectal surgeries, you will be given an oral antibiotic preparation and mechanical bowel preparation before surgery to clear the colon of its contents.

After bowel surgery, you may be in the hospital for a few days up to a week. You'll likely need to take nutritional supplement drinks for a few days after surgery to support your recovery, and painkillers will help you keep discomfort at bay. If you've had laparoscopic or keyhole surgery, you'll probably have three small wounds, and open surgery might result in two wounds. A physio will advise you about exercises to prevent clots, and a nurse will give you info about wound care or how to look after a stoma. After you go home, follow-up appointments assess your recovery.

If you experience problems before or after these appointments, contact the surgeon's rooms.

After colorectal surgery, an anastomotic leak can occur where the surgeon reconnected portions of the colon. You might feel abdominal pain, have fever, and other GI symptoms as a result. Seek treatment as soon as possible, as post-operative peritonitis can be life-threatening.

Your bowel might not function properly after surgery, and you'll need to stop eating or drinking and receive nutrition and hydration through a drip temporarily. There could be bleeding, an infection, or clots and swollen legs if you're not moving much. Blood clots can also be life-threatening, so call emergency services if you notice changes in your legs or cough up blood.

With appropriate treatment, folks with early-stage colorectal cancer can go on to live long, full lives, especially if they make healthy lifestyle changes, such as limiting red meat and ultra-processed foods and consuming a balanced diet with whole grains and fresh produce. Make sure you get enough calcium and vitamin D, curb stress as far as possible, maintain a healthy weight, cut out smoking and drinking, and do your annual screenings.

These factors are largely within your control and will help prevent colon cancer recurrence. You might also want to see a qualified mental health professional to discuss the challenges of life after a diagnosis or stoma.