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Colorectal cancer
From Wikipedia, the free encyclopedia
Colorectal cancer |
Classification and external resources |

Diagram of the lower gastrointestinal tract |
ICD-10 | C18-C20/C21 |
ICD-9 | 153.0-154.1 |
ICD-O: | M8140/3 (95% of cases) |
OMIM | 114500 |
DiseasesDB | 2975 |
MedlinePlus | 000262 |
eMedicine | med/413 med/1994ped/3037 |
Colorectal cancer, commonly known as bowel cancer, is a cancer from uncontrolled cell growth in the colon or rectum (parts of the large intestine), or in the appendix. Symptoms typically include rectal bleeding and anemia which are sometimes associated with weight loss and changes in bowel habits. Most colorectal cancer occurs due to lifestyle and increasing age with only a minority of cases associated with underlying genetic disorders. It typically starts in the lining of the bowel and if left untreated, can grow into the muscle layers underneath, and then through the bowel wall. Screening is effective at decreasing the chance of dying from colorectal cancer and is recommended starting at the age of 50 and continuing until a person is 75 years old. Localized bowel cancer is usually diagnosed through sigmoidoscopy or colonoscopy. Cancers that are confined within the wall of the colon are often curable with surgery while cancer that has spread widely around the body is usually not curable and management then focuses on extending the person's life via chemotherapy and improving quality of life. Colorectal cancer is the fourth most commonly diagnosed cancer in the world, but it is more common in developed countries.[1] Around 60% of cases were diagnosed in the developed world.[1] It is estimated that worldwide, in 2008, 1.23 million new cases of colorectal cancer were clinically diagnosed, and that it killed 608,000 people.[1] Contents  [hide]  * 1 Signs and symptoms * 2 Cause * 2.1 Inflammatory bowel disease * 2.2 Genetics * 3 Pathogenesis * 4 Diagnosis * 4.1 Pathology * 5 Prevention * 5.1 Lifestyle * 5.2 Medication * 5.3 Screening * 6 Management * 6.1 Surgery * 6.2 Chemotherapy * 6.3 Radiation * 6.4 Palliative care * 7 Prognosis * 7.1 Follow-up * 8 Epidemiology * 9 Society and culture * 9.1 Notable cases * 10 Research * 11 References * 12 External links | -------------------------------------------------

[edit]Signs and symptoms
The symptoms and signs of colorectal cancer depend on the location of tumor in the bowel, and whether it has spread elsewhere in the body (metastasis). The classic warning signs include: worsening constipation, blood in the stool, weight loss, fever, loss of appetite, and nausea or vomiting in someone over 50 years old.[2] While rectal bleeding or anemia are high-risk features in those over the age of 50,[3] other commonly described symptoms including weight loss and change in bowel habit are typically only concerning if associated with bleeding.[3][4] -------------------------------------------------

Greater than 75-95% of colon cancer occurs in people with little or no genetic risk.[5][6] While some risk factors such as older age and male gender cannot be changed many can.[6] A high fat,alcohol or red meat intake are risk factors for colorectal cancer as is obesity, smoking and a lack of physical exercise.[5] The risk for alcohol appears to increase at greater than one drink per day.[7] [edit]Inflammatory bowel disease

People with inflammatory bowel disease (ulcerative colitis and Crohn's disease) are at increased risk of colon cancer.[8] The risk is greater the longer a person has had the disease,[9] and the worse the severity of inflammation.[10] In these high risk groups both prevention with aspirin and regular colonoscopies are recommended.[9] People with inflammatory bowel disease account for less than 2% of colon cancer cases yearly.[10] In those with Crohn's disease 2% get colorectal cancer after 10 years, 8% after 20 years, and 18% after 30 years.[10] In those with ulcerative colitis approximately 20% develop tumors within the first 10 years.[10] [edit]Genetics

Those with a family history in two or more first degree relatives have a two to threefold greater risk of disease and this group accounts for about 20% of all cases.[6] A number of genetic syndromes are also associated with higher rates of colorectal cancer. The most common of these is hereditary nonpolyposis colorectal cancer (HNPCC or Lynch syndrome) which is present in about 3% of people with colorectal cancer.[6] Other syndromes that are strongly associated include: Gardner syndrome,[11] and familial adenomatous polyposis (FAP) in which cancer nearly always occurs and is the cause of 1% of cases.[12] -------------------------------------------------

Colorectal cancer is a disease originating from the epithelial cells lining the colon or rectum of the gastrointestinal tract, most frequently as a result of mutations in the Wnt signaling pathway that artificially increase signaling activity. The mutations can be inherited or are acquired, and must probably occur in the intestinal crypt stem cell.[13][14] The most commonly mutated gene in all colorectal cancer is the APC gene, which produces the APC protein. The APC protein is a "brake" on the accumulation of β-catenin protein; without APC, β-catenin accumulates to high levels and translocates (moves) into the nucleus, binds to DNA, and activates the transcription of genes that are normally important for stem cell renewal and differentiation but when inappropriately expressed at high levels can cause cancer. While APC is mutated in most colon cancers, some cancers have increased β-catenin because of mutations in β-catenin (CTNNB1) that block its degradation, or they have mutation(s) in other genes with function analogous to APC such as AXIN1, AXIN2, TCF7L2, or NKD1.[15] Beyond the defects in the Wnt-APC-beta-catenin signaling pathway, other mutations must occur for the cell to become cancerous. The p53 protein, produced by t...

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