Colon Cancer

Furthermore, most polyps are non-cancerous, however, some types of polyps such as adenomas have the potential to become cancerous over time. It usually takes about 10 years for cancer to form in a colon polyp. Therefore, doctors recommend regular screening tests to look for polyps in the colon.

In addition to the above, Colon cancer is a serious global health concern and is one of the most common types of cancer worldwide. Therefore, understanding the basics of colon cancer, including its development and symptoms, is the first step towards early detection of this disease.

1. Please note, colon and rectum are the parts of your large intestine. Further, most of the large intestine is made up of the colon.
   
   
2. Colorectal cancer is also known as colon cancer or rectal cancer. Both of them are often grouped together as colorectal cancer, because they have many features in common.

What causes Colon cancer?

Medical researchers are not entirely sure about the exact causes of colon cancers, but it is understood that the colon cancer occurs when cells in the colon develop changes in their DNA. Further, these changes in DNA instruct the cells to grow and multiply uncontrollably. This causes too many cells. As a result, uncontrolled growth of cells may lead to the formation of a tumor that can spread to other parts of your body.

Furthermore, as the exact reasons for the DNA changes are often unknown, however, there are several factors such as lifestyle, environment and certain health conditions (including inherited conditions) may increase yours chances of developing colon cancer. 

Who is more likely to develop Colon cancer?

Factors that may increase the risk of colon cancer are as following:

• Personal history of colorectal cancer or polyps: If you have had colon cancer or colon polyps in the past, your risk of developing colon cancer again is higher.
  
  
• Family history of colon cancer or polyps: Having a blood relative especially (parent, sibling and child), who has had colon cancer or polyps increases your risk. Further, the risk is even higher if more than one family member is affected or if a relative was diagnosed with colon cancer before age 45.

• Inherited syndromes: Certain inherited syndromes such as Familial adenomatous polyposis (FAP) and Lynch syndrome may increase your risk of developing colon cancer.
  
  In other words, colon cancer may occur if you inherit a gene that causes cancer.
   
• Radiation therapy for cancer: Previous radiation therapy focused at your abdomen or pelvic area for the treatment of other cancers can also increase the risk of colon cancer.
    
• Inflammatory bowel diseases (IBD): IBD is the common name used to describe two chronic diseases of the intestines, Crohn’s disease and Ulcerative colitis, that cause pain, swelling and inflammation of the intestines.
  
  
  • Crohn’s disease can affect any part of the gastrointestinal tract from the mouth to the anus.
    
  • Ulcerative colitis can affect any part of the large intestine.
    
    Furthermore, inflammatory bowel diseases (IBD) may increase the risk of colon cancer.
    
    
• Older age: Colon cancer can happen at any age. But, the risk increases as you get older. Further, most diagnoses of colon cancer occurring after the age of 50.
  
  
• Black race: Black individuals in the United States have a higher risk of developing colon cancer compared to other races.
  
  
• Diet (Low in fiber and high in fat): A diet low in fiber and high in fat and calories may be linked to an increased risk of colon cancer. Furthermore, high consumption of red meats such as beef, pork and lamb and processed meats (hot dogs and sausage) has also been linked with higher risk of colon cancer. Moreover, a diet low in fruits and vegetables may also play a role.  
  
  In addition to the above, some studies have found an increased risk of colon cancer in people who eat a lot of red meat and processed meat.
  
  
• Obesity (overweight): Being overweight or obese increases the risk of colon cancer. Moreover, obesity also increases the risk of dying from colon cancer. Please note, the link between obesity and colon cancer may be stronger in men.
   
• Lack of regular physical activity: People who are not physically active are more likely to develop colon cancer. Please note, any kind of physical activity may reduce your risk of developing colon cancer.
   
• Smoking cigarettes. : Long-term tobacco smoking is a known risk factor for developing colon cancer.
  
  
• Drinking alcohol: Heavy consumption of alcohol may increase the risk of colon cancer. Even light alcohol intake has some risk of developing cancer.
  
  
• Type 2 diabetes: People with diabetes or insulin resistance have an increased risk of developing colon cancer.
  
  
• Low vitamin D levels: Some studies suggests that, having low levels of vitamin D in your blood may lead to colon cancer.  

Please note that, having one or more of above mentioned risk factors does not mean that you will develop colon cancer. However, being aware of risk factors and making lifestyle changes where possible can help reduce your risk of colon cancer. Furthermore, regular check-up, especially if you are over 45 or with increased risk factors may help in early detection of colon cancer.

What are the symptoms of colon cancer?

In the early stages, you may not experience any symptoms at all. However, when symptoms do occur, they can vary depending on the size and location of the cancer in the large intestine (colon). It is important to remember that some symptoms of colon cancer are similar to symptoms of other less serious health issues.

Here are some of the common symptoms of colon cancer in detail:

• Changes in bowel habits: This is one of the most common symptoms and can include more frequent diarrhea or constipation. Furthermore, you may also experience changes in the consistency of your stool, such as it becoming looser or harder than usual. These changes may continue for more than a few days.
  
  
  • Diarrhea: Experiencing more frequent loose watery stools that last for more than a few days.
     
  • Constipation: Having difficulty passing stools, passing them less frequently than usual, or having hard stools for an extended period.
    
    
  • Alternating diarrhea and constipation: You may also experience both diarrhea and constipation without an obvious reason.
     
• Blood in the stool or Rectal bleeding: The presence of blood in your stool is a warning sign and must be checked by the doctor. Further, the blood may look bright red or very dark.
  
  
  • Bright Red Blood: You may notice blood on the toilet paper after wiping or see it mixed in with your stool.
    
    
  • Dark Stool: This could indicate bleeding higher up in the colon, as the blood has been digested, giving your stool a dark appearance.  
    
    Further, it is important to remember that blood in your poop does not mean you have colon cancer. Other things such as hemorrhoids, anal tears or eating beets may change the appearance of your poop. But it is always better to check with your healthcare provider if you notice blood in or on your stool.
    
    
• Pain in the abdominal (Belly area): Talk to your doctor if you have pain in the belly area that doesn’t go away, because, frequent abdominal pain can be a sign of colon cancer. This can include:
  
  
  • Cramps: Painful muscle contractions in the belly area.
    
    
  • Gas: Feeling bloated or having excessive gas.
    
    
  • Pain: A general ache or sharp pain in the abdomen that does not go away. The pain may be frequent or come and go.
    
    
• Feeling that the bowel does not empty completely: You may experience a continues feeling that your bowel does not empty completely during a bowel movement. Therefore, you might still feel the urge to go again.  
  
  In other words, feeling like you need to poo again, even if you have just been to the toilet.
  
  
• Weakness or Tiredness (Fatigue): Feeling unusually tired or weak even after getting enough rest can be an indicator of colon cancer. Further, this fatigue is often unexplained and endless.
  
  
• Unexplained weight loss: You may lose a noticeable amount of weight without making any changes to your diet or exercise habits, can be a sign of colon cancer.
  
  
• Narrow or Stringy stools: You may notice that your stool is narrower, stringy or thinner than usual, which can be described as pencil-thin stools. This may happen, if a tumor is obstructing the passage of your stool.

• Other less common symptoms: Less common symptoms are as following:
  
  
  • Frequent gas pains, bloating, fullness or cramps: Feeling uncomfortably full or discomfort in the belly such as gas, cramps or pain.
    
    
  • Anemia: Anemia can be an early sign of colon cancer. It may happen when the tumor in your colon starts to bleed. This can lead to reduced levels of red blood cells (RBCs) in your body. As a result, you may feel the symptoms such as tiredness, weakness, dizziness, short of breath and have headaches.
    
    Please note, RBCs are needed to deliver oxygen and nutrients to the tissues throughout your body.
    
    
  • Lump in your tummy: You may have a noticeable lump in your tummy (abdomen area). Further, if the lump does not go away or affects how you sleep or eat, contact your doctor immediately.
    
    
  • Nausea and Vomiting: Talk to your doctor, if you have been vomiting for no known reason or if you vomit a lot in 24 hours.
    
    
  • Poor Appetite: A decrease in your desire to eat.

It is important to note that, the absence of symptoms does not mean you are free of colon cancer, especially in the early stages. Therefore, regular screening is so important. Furthermore, if you notice any of these symptoms, make an appointment with your doctor immediately. Early detection and diagnosis are key to successful treatment of colon cancer .

Stages of colon cancer

The colon cancer is divided into five stages, which shows how far the cancer has spread in your body. This process is called staging. The staging help doctors to understand how serious the cancer is and how best to treat it.

Furthermore, the five stages of colon cancer are stage 0, stage I, stage II, stage III, or stage IV. Each stage shows how far the cancer has spread. A higher number, such as stage IV, means more advanced cancer.

Details of the stages of colon cancer are as following:

• Stage 0 (Carcinoma in Situ): This is the earliest stage, where abnormal cells are found only in the innermost layer of the colon, called the “mucosa”. These abnormal cells may become cancerous but have not yet spread to nearby tissue. Therefore, stage 0 is also known as Carcinoma in situ meaning “in its original place”.
  
  
• Stage I: In stage I, colon cancer has grown beyond the mucosa and has spread to the submucosa (the layer directly beneath the mucosa) or to the muscle layer of the colon wall. However, the cancer has not spread to the nearest lymph nodes. The cancers is still contained within the colon.
   
• Stage II: In this stage, the cancer has grown even deeper into the wall of your colon. However, like stage I and stage II, the cancer has not spread to the nearby lymph nodes.
  
  Further, stage II is divided into three types:
  
  
  • Stage IIA: The cancer has spread through most of your colon wall but has not grown into the outer layer of colon wall.
     
  • Stage IIB: The cancer has spread to the outer layer of your colon wall, but has not spread to any other organs or lymph nodes.
     
  • Stage IIC: The cancer has spread through outer layer of colon wall and into nearby organs. However, the cancer has not spread to lymph nodes or distant organs.
    
    
• Stage III: In this stage, the cancer has grown beyond the wall of your colon (intestine) and reached one or more nearby lymph nodes.
  
  Further, stage III is also divided into three types:
   
  • Stage IIIA: The colon cancer has spread through the innermost layer (mucosa) to the layer next to mucosa known as submucosa. Moreover, the cancer has also spread to one to four nearby lymph nodes.
    
    
  • Stage IIIB: In stage IIIB:
    
    
    • The cancer has spread through the muscle layer of the colon wall to the outermost layer (serosa) or the cancer has spread through the outermost layer of colon to the visceral peritoneum (tissue that wraps around the organs in the abdomen). Moreover, cancer has also spread to one to three nearby lymph nodes, is a stage IIIB colon cancer.
      
      Or
      
      
    • The colon cancer has grown to the muscle layer or to the outermost layer of the colon wall. Moreover, the cancer has also spread to four to six nearby lymph nodes, is a stage IIIB colon cancer.
      
      Or
      
      
    • The cancer has spread through the innermost layer (mucosa) of the colon wall to the submucosa (the layer directly beneath the mucosa). Moreover, the cancer has spread to seven or more nearby lymph nodes, is a stage IIIB colon cancer.
      
      
  • Stage IIIC: In stage IIIC:
    
    
    • The cancer has grown through the serosa (outermost layer) of the colon wall to the visceral peritoneum (tissue that wraps around the organs in the abdomen). Further, the cancer has spread to four to six nearby lymph nodes, is a stage IIIC colon cancer.
      
      Or
      
      
    • The cancer has spread through the muscle layer of the colon wall to the outermost layer (serosa) or the cancer has spread through the serosa to the visceral peritoneum. Further, the cancer has spread to seven or more nearby lymph nodes, is a stage IIIC colon cancer.
      
      Or
      
      
    • The cancer has spread through the outermost layer of the colon wall to nearby organs. Further, the cancer that has spread into a nearby organ and one or more lymph nodes, is a stage IIIC colon cancer.
      
      
• Stage IV: This is the most advanced stage of colon cancer, also known as metastatic colon cancer. It means the cancer has spread from the colon to other parts of your body such as liver, lungs or ovaries. Please note, lungs and liver are very common sites to develop metastasis from colon cancer.
  
  Further, stage IV is divided into three categories:
  
  
  • Stage IVA: In this stage, the cancer has spread to one organ or area that is not near the colon, such as the liver, lung, ovary or a distant lymph node.
    
    
  • Stage IVB: In this stage, the cancer has spread to more than one distant organ or area of your body.
    
    
  • Stage IVC: In this stage, the cancer has spread to the peritoneum (tissue that wraps around the organs in the abdomen). Moreover, the cancer may have spread to other organs of your body such as liver, lungs, ovary and brain.  

It is important to understand that, chances of survival are generally higher in earlier stages of colon cancer. Therefore, early diagnosis is crucial for successful treatment.

Tests for Colon Cancer Screening and Diagnosis

Since colon cancer may not cause symptoms during early stage, therefore, it is important to have regular screening tests to find out if you have colon cancer. Furthermore, if cancer is present, screening tests help to find it early, before you feel any sings or symptoms. It is important to understand that, when cancer is found early, it may be easier to treat.

Types of Colon Cancer screening tests are as following:

1. Visual exams:

• Colonoscopy: This is the most common screening test for colon cancer. In this test, a long flexible tube with a camera (colonoscope) is inserted through your anus and up into your colon (large intestine). This allows the doctor to view the entire lining of your colon and detect any abnormal growths like polyps. Further, polyps may be removed during a colonoscopy.
  
  Please note, before colonoscopy, your colon must be clear of stool so that your doctor has good visibility. Therefore, preparations for this test may include a liquid diet, an enema and laxatives medicines.
  
  
• Flexible Sigmoidoscopy: This test also is similar to a colonoscopy but uses a shorter scope (sigmoidoscope) to examine only the rectum and the lower part of the colon.
  
  Please note, before sigmoidoscope, your colon must be clear of stool so that your doctor has good visibility.
  
• Virtual Colonoscopy (CT Colonography): This test is also called Computerized Tomography (CT) colonography. It uses x-ray to take highly detailed 3D images of your entire colon to look for polyps and cancer. However, if polyps are found in your colon, a traditional colonoscopy is needed for removal.
  
  Please note, due to the use of x-ray, this test is not recommended if you are pregnant or if you have any implanted medical devices such as a pacemaker. Therefore, it is important to discuss with your doctor about your pregnancy or implanted medical devices before Virtual Colonoscopy.

2. Stool tests to look for Blood in your stool:

• Fecal Occult Blood Test (FOBT): This test checks for any presence of blood in your stool that is not visible to the naked eye. Further, in this test, chemical reaction is used to detect the presence of hidden blood in stool samples collected over a few days. Blood in your stool may be a sign of polyps, cancer, or other conditions.
  
  
• Fecal Immunochemical Test (FIT): This test uses antibodies to specifically detect human blood in the stool and is considered more accurate than FOBT test due to its higher accuracy.
   
• Stool DNA Test: This more advanced test analyzes your stool samples for the presence of abnormal DNA that may be shed by colon cancer cells or large polyps, and it also checks for hidden blood.

Doctors are trying to better understand which people are at high risk of getting colon cancer. Moreover, they also ask about the things you do and the things around you to see if you may cause cancer. This information helps doctors to recommend who should be screened for cancer, what type of screening tests should be used, and how often the tests should be done.

In addition to the above, if your screening test shows abnormalities, your doctor may recommend additional tests known as diagnostic tests. Diagnostic tests help doctors to decide if cancer is present, its stage and the best possible treatment.

Types of Colon Cancer diagnostic tests are as following:

1. Physical Exam:

A physical exam will be performed by your doctor, which may include feeling your abdomen area to check for any unusual lumps or enlarged organs. Moreover, a digital rectal exam (DRE) may also be conducted, where the doctor inserts a lubricated gloved finger into lower part of your rectum to feel for any abnormal areas or lumps.  

2. Blood Tests:

Blood tests are not used to diagnose colon cancer directly. However, blood tests may provide important information about your overall health and may indicate colon cancer. Common blood tests may include:  

• Complete Blood Count (CBC): This test measures different types of cells in your blood such as red blood cells, hemoglobin and white blood cells. Moreover, CBC test can reveal if you have anemia, which may be caused due to long-term bleeding from a colon tumor.
  
  
• Liver Enzyme Tests (LFTs): Liver Enzyme Tests also known as Liver Function Tests use a sample of your blood to measure several enzymes, proteins and other substances made by your liver. This test can help to show how well your liver is functioning and may indicate if the cancer has spread to the liver.
  
  The Liver Function Tests measure the levels of below mentioned enzymes and proteins in your blood:
  
  
  • ALT (Alanine Transaminase)
  • AST (Aspartate Transaminase)
  • ALP (Alkaline Phosphatase)
  • GGT (Gamma-Glutamyl Transpeptidase)
  • PT (Prothrombin Time)
  • Bilirubin
  • Albumin
  • Total Protein
    
    
• Carcinoembryonic antigen assay (CEA): Carcinoembryonic antigen (CEA) is a protein sometimes produced by cancer cells and can be found in the blood. However, CEA levels in blood of an individual may be normal with cancer or higher due to other reasons. Therefore, CEA test does not necessarily tell you whether you have cancer.
  
  In-addition to the above, doctors do not use this test for initial diagnosis of cancer. But this test may show important information, if you already know that you have cancer or previously diagnosed with cancer. Moreover, your doctor may also use a CEA test to monitor the effectiveness of the treatment and detecting if the cancer comes back.

3. Imaging Tests:

If colon cancer is diagnosed, imaging tests are often used by doctors to analyze the size of the tumor and whether it has spread to other parts of the body. Common imaging tests may include:  

• Computed Tomography (CT) Scan: This uses X-rays to create detailed images of the inside of your body. Further, CT scans may help doctors to find out if the cancer has spread to lymph nodes, liver, lungs or other organs.
  
  
• Magnetic Resonance Imaging (MRI) Scan: MRI uses strong magnetic fields and radio waves to create detailed images of organs and soft tissues inside your body. Further, MRI can be used to examine abnormal areas in the liver, brain and spinal cord. For rectal cancer, an endorectal MRI can provide detailed information about how far the tumor has grown through the rectal wall.
   
• Ultrasound: An abdominal ultrasound can look for tumors in the liver and other abdominal organs but is not effective for imaging the colon or rectum. However, an Endorectal Ultrasound may be used to see how far a rectal cancer has grown into the rectal wall.
   
• Positron Emission Tomography (PET) Scan: A PET scan uses a radioactive drug called tracer to look for organs with increased metabolic activity, which can indicate the presence of cancer cells. Furthermore, PET scan can be helpful in analyzing if the cancer has spread to other parts of the body.
   
• Chest X-ray: This may be done to check if cancer has spread to the lungs.

4. Biopsy:

A biopsy is a crucial step in diagnosing colon cancer. If a suspected colon tumor is found during the screening tests such as “colonoscopy” or “sigmoidoscopy”, a biopsy is usually performed. This involves removing a small tissue sample with a special instrument from your colon. Further, the tissue sample is then sent to a pathologist who examines it under a microscope to check if cancer cells are present.

Moreover, biopsy can also identify the type and grade of the cancer, which indicates how quickly the cancer cells are growing.

5. Molecular Tests and MSI/MMR Testing:

After a biopsy confirms colon cancer, following additional tests may be performed on the tissue sample.

• Molecular tests: This test can look for specific gene mutations or protein changes in the cancer cells that can help predict how the cancer might respond to certain treatments such as targeted therapy.
  
  
• Microsatellite instability (MSI) and Mismatch repair (MMR) testing: These tests are also important, particularly for identifying cancers that may be associated with Lynch syndrome (a hereditary cancer syndrome) and to decide if immunotherapy may be a treatment option.  

Please note that, the results from above mentioned diagnostic tests are carefully reviewed by your doctor. Moreover, the information gathered from these diagnostic tests are important to find out the stage of the colon cancer, which is a key factor in deciding the most effective treatment plan.

Colon Cancer Treatment

Treatment for colon cancer depends on several factors such as the stage and location of the cancer, your overall health and your preferences. A team of doctors, including gastroenterologists, oncologists and surgeons will work together to develop the most effective treatment plan for you.

Furthermore, the main types of treatment used for colon cancer are surgery, chemotherapy, radiation therapy, targeted therapy and immunotherapy. Sometimes, a combination of these treatments may be used.  

Different treatment options for colon cancer are as following:

1. Surgery: Surgery is the first and most crucial treatment for colon cancer. The goal of surgery is to completely remove the tumor and affected tissues. Further, the surgery will depend upon the stage and location of the colon cancer.  

• Early-stage colon cancer: For very early-stage cancers, minimally invasive techniques are used by the doctors such as:
  
  
  • Polypectomy: If the cancer is found within a polyp (a small growth in the colon lining), it can often be removed during a colonoscopy using tiny tools or a wire loop inserted through the colonoscope. This method of treatment is typically used for Stage 0 and sometimes early Stage I cancers. However, regular follow-up colonoscopies are usually recommended by the doctors.
    
    
  • Local Excision: For slightly larger, early-stage cancers that cannot be removed with a simple polypectomy, a Local Excision may be performed by your doctor. This involves removing the cancerous tissue without making a large incision in the abdomen. Instead, your doctor may put a tube with a cutting tool through your rectum into the colon to cut out the cancer.
    
    
  • Endoscopic Mucosal Resection (EMR) or Endoscopic Submucosal Dissection (ESD): This advanced endoscopic technique is used during a colonoscopy to remove larger polyps and some surrounding tissues of colon lining. This method allows doctors to perform precise removal of polyps and can sometimes avoid the need for major surgery.
    

• More Advanced Colon Cancer: When the cancer has grown larger or spread deeper into the colon wall, your doctor may recommend:
  
  
  • Partial Colectomy: If the cancer is larger, your surgeon will do a partial colectomy, which involves removing the part of your colon containing the cancer along with a small amount of surrounding healthy tissue. Further, they will reconnect back the remaining healthy colon parts.
    
    In-addition to the above, this procedure can often be done using minimally invasive techniques like laparoscopic or robotic surgery, which involve smaller incisions, less pain and faster recovery.
    
    
  • Surgical resection with Colostomy: In some situations, it may not be possible to immediately reconnect the healthy parts of the colon or rectum after colectomy. In these cases, the surgeon may create an opening on the surface of the abdomen called a stoma and the end of the colon is brought through this opening for poop to pass through. Further, a collection bag is then attached to the stoma to collect poop.
    
    Please note, a colostomy can be a temporary measure to allow the colon or rectum to heal or it may be permanent if a large portion of the colon has been removed.
    
    
• Advanced or Metastatic Colon Cancer: When colon cancer has spread to other parts of the body, surgery may still play a role:
  
  
  • Metastectomy: If the cancer has spread to a limited number of sites, such as the liver, lungs or ovaries, surgery to remove these tumors (metastectomy) may be an option in carefully selected patients.
    
    
  • Peritoneal Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC):
    For cases where colon cancer has spread into the lining of the abdominal cavity (peritoneum), a procedure called Peritoneal Cytoreductive Surgery may be performed by your surgeon to remove all visible tumors from the lining of the abdomen.
    
    In some cases, this surgery is followed by Hyperthermic Intraperitoneal Chemotherapy (HIPEC) where heated chemotherapy drugs are circulated within the abdominal cavity to kill any remaining cancer cells.
    
    
  • Radiofrequency Ablation and Cryosurgery: These techniques use heat (radiofrequency ablation) or freezing (cryosurgery) to destroy cancer cells when traditional surgery is not an option.  

2. Chemotherapy: In chemotherapy (also called chemo), strong medicines are used to kill cancer cells or stop them from growing and multiplying. It can be given in different ways:  

• Neoadjuvant Chemotherapy: This chemotherapy is given before surgery to shrink a large tumor, making it easier and safer for surgeons to remove.
   
• Adjuvant Chemotherapy: This chemotherapy is given after surgery to kill any remaining cancer cells that may not be visible and to reduce the risk of the cancer returning. It is often recommended for patients with Stage II or Stage III colon cancer, particularly if cancer cells have been found in the lymph nodes.
   
• Chemotherapy for Advanced or Metastatic Cancer: For colon cancer that can not be removed with surgery or that has spread to other parts of the body (Stage IV), chemotherapy is often the main treatment. It can help to slow the growth of the cancer, relieve symptoms, and improve quality of life. Further, combinations of different chemotherapy drugs are often recommended by the doctors.
   
• Regional Chemotherapy: When colon cancer has spread to the liver, chemotherapy can be delivered directly to the liver through a procedure called chemoembolization or hepatic arterial infusion (HAI).
  
  In this procedure, the anticancer medicines are placed directly into the main artery that supplies blood to the liver. This allows a higher concentration of the anticancer medicine to reach the cancer cells in the liver. Only a small amount of the medicine reaches other parts of the body. 

Please note that, the way the chemotherapy is given depends on the type and stage of the colon cancer.

3. Radiation Therapy: Radiation therapy uses high-energy X-rays or protons to kill cancer cells or prevent them from growing. It can be used in different situations as following:

• Neoadjuvant Radiation Therapy: Radiation may be used before surgery to shrink a large tumor and making it easier to remove.
  
  
• Adjuvant Radiation Therapy: Radiation may be given after surgery to kill any remaining cancer cells in the area where the tumor was removed.
   
• Palliative Radiation Therapy: Radiation can be used to relieve symptoms caused by colon cancer, such as pain or bleeding. Furthermore, it can help to shrink tumors that are pressing the nerves or other organs.
   
• Stereotactic Body Radiation Therapy (SBRT): To treat tumors in a specific areas of the body, this type of external radiation therapy can deliver high doses of radiation to the targeted area in the body such as liver, spine or lung. The radiation beams are carefully targeted to focus on abnormal growth of cells which are called tumors, anywhere in the body.

Please note that, radiation therapy can be delivered externally using a machine outside the body or internally using radioactive materials placed directly into or near the cancer.  

4. Targeted Therapy (attacking specific cancer cell features): Targeted therapy medicines work by attacking specific chemicals, genes, proteins and tissues that are important for the growth and survival of colon cancer cells. Targeted therapy can cause cancer cells to die or prevent them from growing and spreading. Furthermore, this therapy is usually combined with chemotherapy for advanced colon cancer.

Moreover, your doctor may suggest biomarker testing on the tumor tissues to know if the cancer is responding to specific targeted therapy medicine.

Targeted therapies used to treat colon cancer include:

• Angiogenesis Inhibitors: These medicines work by blocking the growth of new blood vessels that tumors need to grow and spread.
  
  
• EGFR Inhibitors: These medicines target the Epidermal Growth Factor Receptor (EGFR), a protein found on some cancer cells that helps them to grow. Further, these medicines are typically used in patients whose tumors do not have mutations in the KRAS or NRAS genes.
  
  
• BRAF Inhibitors: Encorafenib is a BRAF inhibitor used in combination with cetuximab for patients with metastatic colorectal cancer that has a specific mutation in the BRAF gene called V600E.
  
  
• KRAS Inhibitors: Adagrasib and sotorasib are targeted therapies for patients with metastatic colorectal cancer that has a specific mutation in the KRAS gene called G12C.
  
  
• HER2 Inhibitors: The combination of tucatinib and trastuzumab is approved for advanced colorectal cancer that has an excess amount of the HER2 protein.
  
  
• Fruquintinib: This is another targeted therapy used in some cases of advanced colorectal cancer.
  

5. Immunotherapy: Immunotherapy is a treatment with medicine that helps your immune system to recognize and attack cancer cells. Please note, one reason cancer cells can keep growing and spreading is that they can hide from your immune system. Therefore, immunotherapy helps the immune system to find and kill the cancer cells.

Furthermore, immunotherapy medicines block certain proteins on your immune cells that normally keep them from attacking other cells in the body. As a result, the immune system is better able to recognize and kill cancer cells. Moreover, your doctor may also suggest biomarker testing to help predict your response to certain immunotherapy medicines.

If you are getting immunotherapy, your doctor will monitor your treatment closely.

6. Palliative Care: Palliative care is a specialized medical care that is focused on providing relief from the pain and other symptoms of serious illnesses like cancer, at any stage of the disease. The goal is to improve the quality of life for both the patient and their family.

Furthermore, palliative care is an extra layer of support during cancer treatment. When palliative care is used with all other treatments, people with cancer may feel better and live longer.

Please remember, it is important to discuss all your treatment options with your healthcare team and doctor.

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