Colon and Rectal Cancer, Metastatic (Spreading)

What is metastatic colon and rectal cancer?

Colon or rectal cancer (colorectal cancer) is a growth of abnormal cells in the colon or rectum. The colon and rectum are sections of the large intestine, which is also called the large bowel. Colon or rectal cancer metastasis is the spread of cancer cells from the colon or rectum and nearby lymph nodes to other places in the body. After the cancer spreads, it can form new cancer growths (tumors). These tumors are called metastases.

Cancer cells may spread through the bloodstream or lymph system. Metastatic colon or rectal cancer usually spreads first to the liver or lungs.

How does it occur?

Most colorectal cancers start from a type of polyp called an adenomatous polyp. Polyps are growths of extra tissue on the inside wall of the bowel.

Colorectal cancer is more common in countries where obesity is common, where the diet is high in fat and low in fiber, and where daily exercise is less common. It is not known how this combination of obesity, diet, and lack of exercise combine to increase the risk for colorectal cancer. Colon or rectal cancer usually occurs after age 50, but it can happen at any age.

You may have a greater risk of developing colon cancer if you:

• have had colorectal cancer before
• have adenomatous colorectal polyps or inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease
• have a parent, brother, sister, or child who has had colon cancer or colon polyps
• have had uterine, ovarian, or breast cancer
• eat a high-fat and low-fiber diet
• smoke cigarettes
• are 50 years old or older.

What are the signs and symptoms?

Some possible symptoms of the recurrence or spread of colorectal cancer include:

• abdominal pain
• loss of appetite
• tiredness
• weight loss
• pelvic or rectal pain
• bloody stools
• a change in bowel habits.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. In addition, you will have the following tests:

• blood tests
• bone X-rays (if you have bone pain)
• CT scan of your abdomen and pelvis
• chest X-ray.

Other tests you may have are:

• colonoscopy
• barium X-ray of the lower bowel.

A CT scan uses X-rays in a way that gives more detailed information than plain X-rays, especially about tissues that are not bone.

A colonoscopy is a procedure in which your healthcare provider inserts a slim, flexible tube into the rectum to see the inside of the rectum and all of the colon. Your provider will take a sample, or biopsy, of any abnormal tissue to examine for cancer cells.

A barium X-ray is a procedure in which barium fluid is put into your rectum. X-rays are then taken as the barium moves through the rectum and colon. Your provider will use the X-rays to look for polyps, abnormal shapes, narrowing, or blockage in the colon.

How is it treated?

The treatment depends on where the cancer has spread. Development of more cancer in the colon may require more surgery. Spread to the liver or lungs is usually treated with chemotherapy (anti-cancer drugs). If the cancer has spread to the bone, radiation treatments may lessen pain and prevent further spread. Sometimes surgery or radiation therapy is done to remove cancer that has spread to the liver, or (rarely) to the lungs.

How long will the effects last?

Metastatic colorectal cancer is usually not curable. It can usually be controlled only for a limited time, but sometimes it can be controlled for years, especially if it is just in the liver. Talk to your healthcare provider about the expected course of your disease.

How can I take care of myself?

After you determine with your healthcare provider and family the treatment you prefer at this stage, follow the plan and keep your appointments. If you seek help outside the medical community, keep your provider informed about other drugs or treatments you are using to avoid side effects or interactions with your medical treatment. In addition:

• Get plenty of rest.
• Learn relaxation and meditation techniques to help control fear, anxiety, and stress.
• Eat healthy meals.
• Spend time with people and do activities you like.
• Join a cancer support group.
• Find a counselor to help you deal with difficult issues.

How can help prevent metastatic colon and rectal cancer?

If you are diagnosed with colorectal cancer before it has spread, follow your treatment and follow-up plans carefully. This may help avoid or delay spread of the cancer. See your healthcare provider right away if any signs or symptoms of cancer come back.