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Getty Images/iStockphoto The cause of colorectal cancer is always that healthy cells change (mutate), degenerate and multiply unchecked.

Colorectal cancer is one of the most common cancers in Germany. It grows slowly, but also often causes no symptoms at first. The first signs of colorectal cancer, what the risk factors are, what treatment looks like and how to prevent it.

A little more than 60.000 people were newly diagnosed with colorectal cancer in Germany in 2018, according to the Robert Koch Institute: just under 34.000 men and more than 26.000 women. Men were 72 years old on average, while women were just under 75 years old . About 24.000 patients have died from colorectal cancer. Five years after being diagnosed with colorectal cancer, around two-thirds of patients were still alive.

Overall, the incidence of colorectal cancer has been decreasing since about 2003. One reason is the introduction of colonoscopy in 2002. If the current trend continues, experts expect a further decline in the incidence of colorectal cancer.

Colorectal cancer is one of the most common cancers in Germany – along with breast, prostate and lung cancer. The tumor usually develops in the large intestine, very rarely in the small intestine.

In medical terms, this is referred to as colorectal carcinoma

Doctors use the term colorectal cancer to refer to cancers of the large intestine (colon carcinoma) and the rectum (rectal carcinoma). Colorectal cancer is therefore also known medically as colorectal carcinoma.

The starting point for colorectal cancer is almost always benign growths of the intestinal mucosa,
the intestinal polyps. In many cases they remain harmless, but not always. The cells of the intestinal mucosa can degenerate and become cancer cells. But it usually takes many years. If doctors remove the polyps during a colonoscopy, the risk is averted.

Colorectal cancer: These are the symptoms

The symptoms of colorectal cancer are not easy to detect. Because it does not grow from one day to the next, but develops slowly over years. Thus, colorectal cancer initially causes no symptoms. Many therefore do not notice the malignant tumor in their intestines at first. And when colorectal cancer signs do appear, they are often very non-specific. That is, they can still occur in many other harmless or benign diseases. This is one of the reasons why many people visit a doctor's office late and doctors detect colorectal cancer late.

Colorectal cancer can cause the following early signs:

– altered bowel movements: constipation or diarrhea, sometimes alternating – frequent urge to defecate, at unusual times of the day, more trips to the toilet – blood in the stool: stool is reddish (fresh blood, then the tumor is located in the region of the rectum), dark or black in color (the blood is older and the cancer is located higher up toward the stomach/duodenum) – stool smells foul or is thin like a pencil – secretion of mucus or blood from the rectum – feeling, Feeling that the bowel does not empty completely, sometimes stool, blood or mucus is discharged unintentionally – Frequent and loud noises in the bowel – It "rumbles" in the intestines – Feeling of fullness, even though the affected person does not eat much – Pain during bowel movement

Symptoms of advanced colorectal cancer

If the tumor is already more advanced, other colorectal cancer symptoms may be added, for example:

– Tiredness, fatigue, exhaustion, pallor due to anemia – Reduced physical performance, declining fitness – Loss of appetite, weight loss – Nausea, vomiting – Slight fever, night sweats , cramps in the abdomen or around the anus – Pain in the pelvis or lumbar spine, which many perceive as back pain because it radiates – hardening in the abdomen, which is even palpable in large tumors , when the colon cancer extremely narrows the intestine – this is a life-threatening condition – doctors must act immediately.

Always see your doctor at the first sign of colorectal cancer. Of course, it is best to regularly attend colorectal cancer screening. This provides rearance that all is well in your bowel.

Colorectal Cancer Month March

The Felix Burda Foundation together with the German Cancer Aid, the Network against Colorectal Cancer e.V. and the LebensBlicke Foundation have been celebrating Colorectal Cancer Awareness Month in March since 2002. Colorectal cancer is the second most common cancer in Germany. But Action Month makes it clear that this cancer can be prevented. Everyone over 50 is entitled to a free bowel check-up. This offer to maintain your own health will be the "deal of a lifetime" this year.

Colorectal cancer is not always behind the symptoms

Colorectal cancer does not always have to be behind your gastrointestinal symptoms. Many other diseases in the gastrointestinal tract can be to blame, which are far less worrying or well treatable.

Some examples:

– intestinal infections – food intolerances (e.g.B. Lactose intolerance, gluten intolerance) syndrome (also cause blood in the stool) , gastric ulcer – inflammatory bowel diseases such as Crohn's disease and ulcerative colitis

Colorectal cancer: Causes and risk factors

The cause of colorectal cancer is always that healthy cells change (mutate), degenerate and multiply unchecked. Colorectal cancer usually starts from the cells of the intestinal mucosa, which initially form benign growths called
Colorectal polyps. In many people they remain harmless throughout their lives. However, they can also become malignant. Evolve to colorectal cancer. This process takes many years. About 90 percent of colorectal cancers develop because intestinal polyps degenerate.

The causes of the cell changes can be very different. Various factors are known to increase the risk of colorectal cancer. Your lifestyle also plays a role.

The most important risk factors for colorectal cancer

AgeThe risk of colorectal cancer and other cancers generally increases with age. Diet with little fiber, a lot of fat and meat (v.a. red meat, cured, smoked sausages) Lack of exercisePeople who do not get enough exercise and spend too much time sitting have been shown to increase their risk of colorectal cancer. Obesityand Obesity (Obesity): The risk of colorectal cancer increases from a body mass index of 25 and higher. Alcohol: If you regularly drink too much, you risk colorectal cancer. Smoking: Tobacco use also increases the risk of malignant tumors in the intestine. ulcerative colitis. Crohn's disease.

Is colorectal cancer hereditary?

In addition to the general risk factors, hereditary predisposition also plays a role in some forms of colorectal cancer. Doctors distinguish:

Familial colorectal cancerSome families have a high incidence of colorectal cancer (25 to 30 percent of cases). There is a hereditary burden, but the responsible genes are still unknown. If a person in the family develops colorectal cancer, the following have a higher risk First-degree relatives have a two- to threefold increased risk, to also fall ill. Second-degree relatives have a lower risk. A specific genetic cause can usually not be determined. Hereditary colorectal cancer (five to eight percent of cases): Some hereditary diseases increase the risk of colon cancer directly.

In most people, doctors do not find a specific cause of colorectal cancer. In any case, there is no "one" trigger, but probably many factors interact in the development of cancer.

In rare cases, however, colorectal cancer is hereditary. Doctors estimate that about five to eight percent of people with colorectal cancer have a hereditary form of the disease. In most cases, they develop the malignant intestinal tumor at a young age. The two most common forms of hereditary colorectal cancer are:

Hereditary non-polyposis colorectal cancer (engl. Hereditary Non-Polyposis Colorectal Cancer = HNPCC, also Lynch syndrome): Children inherit the predisposition for HNPCC from one of their parents. It is thus present from birth. Can lead to colorectal cancer at a young age. The probability of developing the disease in people with HNPCC is 80 percent. Therefore, timely screening is especially important. But the risk of other types of cancer is also increased. A genetic test can detect the gene alterations. Familial Adenomatous Polyposis (FAP)People with FAP develop numerous intestinal polyps at a young age, which are initially benign. But because there are so many polyps, it is almost certain that one of them will develop into colorectal cancer. People with FAP can develop the disease around the age of 20. Around the age of 50. Screening is therefore particularly important in cases of Familial Adenomatous Polyposis. The risk of other types of cancer is also increased.

Colorectal cancer – age is a risk factor

Colorectal cancer and age are also linked. After the age of 50. The risk of colorectal cancer increases from the age of 50, but is rare in people in their 20s and 30s. The reason for this is that as people get older, there are more and more errors in cell division and the body's own repair mechanisms become less effective. Thus, many people with colorectal cancer are already over 75 years old. The situation is different in cases of familial or hereditary colon cancer. In these cases, people often develop a malignant colorectal tumor at a younger age.

Colorectal cancer: What you should know about screening

Colorectal cancer can be prevented in many cases through regular screening. If doctors diagnose intestinal polyps in time and remove them, they cannot develop into colorectal cancer. In addition, the earlier doctors detect a malignant tumor, the better the chances of a cure for colorectal cancer.

Actually, the word "prevention" is not quite correct: it refers to measures you can take to prevent disease, such as not smoking, moderate alcohol consumption or plenty of exercise. More correct is the Term "colorectal cancer screening". It includes all measures to detect a cancer at an early stage. For colorectal cancer, these are colonoscopy or stool testing. Colloquially, however, many people use the terms "screening" and "early detection" interchangeably.

Colorectal cancer screening: from when and how often?

The most important change in advance: since April 2019, the Men already from the age of 50 Colonoscopy for colorectal cancer screening as an alternative to stool testing. The background to this is that the risk of this type of cancer already increases from this age. At Women the age limit of 55 years.

Otherwise, the following recommendations for colorectal cancer screening apply to people between the ages of 50 and 75 years. Colorectal cancer screening is aimed at people who do not yet have any symptoms, feel healthy and are not at increased risk of colorectal cancer.

50 years and older:
Stool test, in which laboratory doctors examine the stool for invisible, hidden blood (occult blood). Doctors recommend this immunological test (iFOBT) once a year between 50 and 54 years of age. It replaced the "old" hemoccult test (Gujak test or gFOBT) in 2017 because it provides much more accurate results and can detect even the slightest traces of blood in stool that are not visible to the naked eye. Public and private insurances cover the costs of the colorectal cancer test. If the findings are conspicuous, a colonoscopy follows. From 50 for men or. 55 years for women: Colonoscopy, in which a specialist (gastroenterologist) examines the colon using a small instrument with a camera – the endoscope. Colonoscopy is not only a method of diagnosis but also a method of treatment. Doctors remove any intestinal polyps directly. Ten years later, insured persons are entitled to a second colonoscopy. The interval is shorter if doctors have discovered polyps during the first colonoscopy. And: If you do not have this examination until you are 65 years old, you are only entitled to a colonoscopy. This applies to both men and women. The statutory and private health insurance companies cover the costs of this colorectal cancer screening.

Those who experience symptoms should always see a doctor promptly, regardless of this colorectal cancer screening. A colonoscopy is possible at any time. The health insurance companies also cover the costs.

Familial and hereditary colorectal cancer – screening starts earlier

At Familial and hereditary colorectal cancer starts colorectal cancer screening much earlier, because those affected can develop the disease at a younger age. The most important measures are:

Familial colorectal cancer: The first colonoscopy should take place ten years before the age at which the family member was diagnosed with colorectal cancer or colon polyps. For example, if one parent has the disease at the age of 50, children should already be examined at the age of 40. Then repeat the examination every ten years.
Hereditary colorectal cancer: For people with HNPCC there are special, very comprehensive preventive measures that can be taken as early as 25 years of age. Begin at the age of 50. They extend not only to the intestine, but also to other organs, because they are also at risk of cancer. Affected people continue screening once a year for the rest of their lives. For people with FAP Start screening even earlier because the risk of colorectal cancer is so high: as early as adolescence, starting at age ten. Here, too, doctors keep an eye on several organs because they can develop cancer. The measures take place once a year, some also in shorter intervals.

Diagnosis: Suspicion of colorectal cancer symptoms? You should have this information ready for the doctor

If you have digestive problems or blood is visible in the stool, always see your family doctor as soon as possible. The diagnosis of colorectal cancer always starts with a discussion with your doctor about your medical history.

The following questions, among others, are of interest to him:

– What exactly are your symptoms?? How long have you had the symptoms. How pronounced are they? – Have you noticed any changes in bowel habits, such as diarrhea, constipation or both in alternation?? – Have you noticed blood in your stool? – If there are known cases of colorectal cancer in your family? – Are there other cancers, such as stomach, ovarian or breast cancer? – Your lifestyle: How do you eat?? How much do you move in everyday life? Exercise regularly? What about your alcohol consumption and smoking habits? – If you have any known diseases, for example irritable bowel syndrome, intestinal infection, food intolerance, hemorrhoids, Crohn's disease or ulcerative colitis?

Your answers will give the doctor a first clue as to what could be the cause of your symptoms. The doctor palpates the abdomen. Detects abnormalities with his hands. Digital rectal examination (DRU): palpation of the rectum with the finger. Doctors can detect changes that may indicate colorectal cancer. Stool testsToday, doctors use the immunological stool test (immunological fecal occult blood test = iFOBT). It has now replaced the "old" hemoccult test. A laboratory evaluates the occult blood test. There are also rapid stool tests for at-home testing, but considered less conclusive. The health insurances do not refund the costs for it therefore. The same applies to the tumor M2-PK stool test, which detects a certain enzyme in the stool. It is typical for colorectal cancer. This test is not yet so well researched, which is why you have to bear the costs yourself (ca. 30 euros). Colonoscopy(colonoscopy): This examination is the most important diagnostic method for colorectal cancer. It is performed by a specialist in gastrointestinal diseases, a specialist in gastroenterology. Through the rectum, he inserts a thin, flexible instrument equipped with a small camera (endoscope). It delivers images from the intestine directly to the monitor of a PC. The doctor can remove polyps during a colonoscopy. Remove tie from suspicious areas (biopsy). This is then examined by a pathologist under the microscope for cancer cells.
SigmoidoscopyThis is a "small" colonoscopy that only examines the last part of the colon. Here, however, malignant intestinal tumors arise particularly often. It only takes a few minutes and is an option if you do not want the normal colonoscopy. It is not routine in the early detection of colorectal cancer. colonoscopy with capsule (capsule colonoscopy)Patients swallow a small capsule that looks like a larger tablet and contains a camera. This "travels" independently through the intestine, taking pictures as it goes along. Until now, health insurance companies have only covered the costs of capsule colonoscopy in exceptional cases. It is better to ask beforehand. If there are any abnormalities, the capsule colonoscopy is followed by a "normal" colonoscopy because no intestinal polyps can be removed or tie extracted. Virtual colonoscopyUsing computed tomography (CT colonography) or magnetic resonance imaging (MRI, MR colonography), radiologists create cross-sectional images of the intestine – in other words, they dissect the organ into "slices". The doctor receives three-dimensional images on his monitor. Virtual colonoscopy is an option when a "normal" colonoscopy is not possible. The reasons can be adhesions or adhesions in the rectum. Statutory health insurers cover the costs only in part or in justified individual cases. Private insurance companies will usually pay for it if you ask. – A Ultrasound of the intestine (rectal ultrasound) shows how far the tumor has grown into the intestine. An abdominal ultrasound can find possible cancer settlements (metastases). – A X-ray examination of the trunk shows whether the colon cancer has already spread to other organs. X-ray of the lungs reveals whether the cancer has spread to the lungs. Blood values: The physician determines the tumor marker called arcinoembryonic antigen (CEA) in the course of a blood test. This blood value is not suitable for early detection, but it can be used to monitor the success of cancer treatment. The method can very accurately distinguish between well-. Differentiate malignant tie. It is not routine in the diagnosis of colorectal cancer – also because it is expensive and not every clinic has such equipment.

If the doctor suspects a familial or hereditary colon cancer, he or she will refer you to a specialized colon cancer center.

Is colon cancer curable?

Whether colorectal cancer is curable depends crucially on the stage at which doctors detect the cancer. In general, the earlier doctors diagnose colorectal cancer, the better it can be treated and the better the prognosis. Even though colorectal cancer progresses very slowly – without treatment it can burrow deep into the intestinal wall and spread to other organs, mostly to the liver. If colorectal cancer has metastasized, it is usually no longer curable, but still treatable. Nevertheless, the chance of survival decreases the further the tumor has spread.

Cancer doctors divide colorectal cancer into different stages, on which the life expectancy also depends. Internationally, two different classifications are in use.

TNM classification:

The letters TNM stand for the following:

T means tumorHow far has the tumor spread?? Known are Tis (carcinoma in situ), T1, T2, T3 and T4 N stands for engl. Node, i.e. lymph nodes: In how many lymph nodes can cancer cells be detected? There are N0 (no lymph nodes affected), N1 (1 to 3 lymph nodes), N2a (4 to 6 lymph nodes) and N2b (more than 7 lymph nodes) M denotes metastasesIf the cancer has metastasized to other organs? The labeling is M0, M1a (only one organ affected – the peritoneum), and M1b (multiple organs affected)

So every letter gets a number behind it. The higher the stage, the more advanced the colorectal cancer and the poorer the chances of survival.

Based on the TNM classification, doctors now assign each colorectal cancer patient a so-called UICC stage. It also depends on these colorectal cancer stages which treatment they select.

Colorectal cancer stage 0 (Tis, N0, M0): Early form of colorectal cancer, small tumor, cancer cells only in the uppermost layer of the intestinal mucosa, no tumor cells in the lymph nodes, no distant metastases in other organs
Colorectal cancer stage 1 (T1 to T2, N0, M0): early colorectal cancer, infestation of the thin tie layer below the intestinal mucosa or the muscle layer underneath it. Lymph nodes free of cancer cells, no distant metastases, good chance of cure after surgery
Colorectal cancer stage 2(T3 to T4, N0, M0): The colorectal cancer has penetrated all layers of the wall, it is either still confined to the intestine or has spread to adjacent tie, no cancer cells in the lymph nodes or distant metastases to other organs. The chances of cure through surgery are good.
Colorectal cancer stage 3(T1 to T4, N1-2, M0): The colorectal cancer has spread to the lymph nodes in the surrounding area. Not all cancer sites can be removed by surgery in most cases. The risk of metastases is increased. Nevertheless, a cure is still possible.
Colorectal cancer stage 4(T1 to T4, N0-2, M1): Doctors can detect metastases in other organs, such as the liver. The cancer is more advanced. In this final stage, colorectal cancer is no longer curable. Life expectancy at this stage: Studies show that after five years, about eight out of 100 patients are still alive. Nevertheless, doctors can improve quality of life and life expectancy thanks to new therapy. Colorectal cancer can be treated well today. Is curable in many cases. Which colorectal cancer therapy doctors choose depends on how far the tumor has already spread. It is important for physicians to know whether metastases have already formed in the lymph nodes or other organs. But even then, a good life is still possible with the right colorectal cancer treatment. Doctors use different cancer treatments against colorectal tumors, often they combine several therapies with each other – depending on the stage.

Colorectal cancer: Treatment best at a certified colorectal cancer center

It is important to find a clinic that specializes in colorectal cancer. Doctors from a wide range of specialties work hand in hand there, and have a great deal of experience with the clinical picture. This is how experienced surgeons have performed many colorectal cancer operations there. Patients have fewer side effects. The results of surgery are also likely to be better.

Colon cancer surgery – the most important therapy

Surgeons try to remove the colorectal cancer as completely as possible during surgery. The goal here is always to cure the cancer. Colorectal cancer surgery is an important treatment option for all stages of the disease.

In the case of early colorectal cancer, surgery is often sufficient as the only treatment option. But even in advanced stages, doctors are often able to stop the further growth of the cancer by surgery. This also prolongs life. It is always important that an experienced surgeon performs the operation. Sometimes doctors shrink the tumor or metastases before surgery by chemotherapy or radiation, sometimes by a combination of both (radiochemotherapy).

Doctors only refrain from surgery if the colorectal cancer is already very advanced and surgery would not bring any prospects of a cure. This is the case, for example, with metastases that cannot be removed.

Metastases, which most frequently form in the liver, can also be operated on in some cases. Liver surgeons are the right people to contact here.

Chemotherapy for colorectal cancer

Chemotherapy consists of drugs (cytostatics) that act throughout the body. They slow down the division and multiplication of cancer cells and destroy them. However, they also attack healthy cells that divide rapidly. These include cells of the skin or mucous membranes. Hair loss is probably the best-known side effect.

Chemo for colorectal cancer is administered by doctors in cycles, i.e. at specific time intervals. In the breaks in between, the body can recover again.

Along with surgery, chemotherapy is one of the most important strategies for treating colorectal cancer. Whether doctors use cell-killing agents depends in turn on the stage and aggressiveness of the colorectal cancer. But also the age, the general state of health, existing concomitant diseases and the personal wishes of the affected person play a role in the decision.

There are different cytostatic drugs for different types of cancer. For colorectal cancer, doctors use the following drugs, for example:

– 5-fluorouracil (5-FU) – capecitabine – oxaliplatin – irinotecan – trifluridine/tipiracil for metastatic colorectal cancer

Targeted drugs for colorectal cancer

Targeted drugs (engl. targeted therapy) are used in advanced colorectal cancer as an adjunct to chemo. The drugs are special proteins (antibodies) that are directed against certain characteristics of cancer cells. The prerequisite for their use is that the tumor cells have the corresponding feature. Examples are:

EGF receptor antibodiesThey target the epidermal growth factor docking sites on tumor cells. epidermal growth factor = EGF). If these receptors are blocked by the drug, the growth factor can no longer dock and tumor growth is slowed down. About eight out of ten patients with advanced colorectal cancer have such EGF receptors. Two agents are approved: Cetuximab and panitumumab. VEGF antibodiesThey ensure that the tumor can no longer form new blood vessels to supply itself with oxygen and nutrients. Such drugs are called angiogenesis inhibitors. Approved active ingredients are bevacizumab, ramucirumab and aflibercept. Tyrosine kinase inhibitors (tyrokinase inhibitors): these drugs enter the cell, block various switch points there (the protein molecules tyrokinases) and thus the growth and development of cells. The active ingredient regorafenib has been approved. The drug is used when other targeted therapies or chemo no longer have sufficient effect in colorectal cancer.

Immunotherapy against colorectal cancer

In the case of colorectal cancer Immunotherapy which doctors are already using for various other types of cancer, such as black skin cancer or lung cancer. Immunotherapy does not attack the cancer cells themselves, but enhances the immune system. This is how it should be able to better defend itself against cancer cells again. So-called check point inhibitors are used. Perhaps they will also be an option for people with colorectal cancer in the future.

All targeted drugs, immunotherapy and chemotherapy have not insignificant side effects. However, these can often be treated well.

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