Colon Cancer Questions & Answers

Updated: Mar 11, 2020
  • Author: Tomislav Dragovich, MD, PhD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Questions & Answers

Overview

What is colon cancer?

What is the role of surgery in the treatment of colon cancer?

What are the signs and symptoms of colon cancer?

Which physical findings suggest colon cancer?

Which lab studies are used to detect colon cancer?

Which imaging studies are helpful in the staging of colon cancer?

Which procedures may be warranted in the evaluation of suspected colon cancer?

What are the surgical options to treat colon cancer?

What are the nonsurgical therapeutic options for colon cancer?

What are the regimens used for systemic chemotherapy in the treatment of colon cancer?

What are the regimens used for adjuvant (postoperative) chemotherapy in the treatment of colon cancer?

Which biologic agents are used in the treatment of colon cancer?

What is the efficacy of screening in the prevention of colorectal cancer?

How are research advances in colorectal cancer used to improve treatment outcomes?

What is the pathophysiology of colon cancer?

What is the role of the APC gene (adenomatous polyposis gene) in the pathophysiology of colon cancer?

What is the role of abnormal DNA methylation in the pathophysiology of colon cancer?

What is the role of genetics in colon carcinogenesis?

What is the role of deficient DNA mismatch repair in the pathophysiology of colon cancer?

What causes colon cancer?

What is the greatest factor in the etiology of colon cancer?

What is the risk for developing colon cancer in patients with hereditary nonpolyposis colon cancer syndrome (HNPCC, Lynch syndrome)?

What percentage of colon cancer is due to a hereditary nonpolyposis colon cancer syndrome (HNPCC, Lynch syndrome) etiology?

What is the role of diet in the etiology of colon cancer?

Which factors are associated with a lower risk for colon cancer?

What is the role of obesity and lifestyle in the etiology of colon cancer?

What is the association between body mass index (BMI) and the risk of colon cancer?

What is the role of the WNT signaling pathway in the etiology of colon cancer?

What is the role of inflammatory bowel diseases in the etiology of colon cancer?

What is the role of antibiotics in the etiology of colon cancer?

What is the trend in the incidence and mortality of colon cancer in the US?

What is the estimate of new colon cancer cases in 2020 in the US?

What is the effect of colonoscopy on colon cancer mortality?

What is the global incidence of colon cancer?

How do the mortality rates for colon cancer vary geographically?

What is the incidence of colon cancer in Europe?

What is the racial predilections for colon cancer?

How does the incidence of colon cancer vary by sex?

How does the incidence of colon cancer vary by age?

What is the 5-year survival rate for colorectal cancer in the US?

What are independent predictors of worse outcome in patients with colorectal liver metastases?

What are predictors of survival in colon cancer?

What are predictors of clinical outcome in colon cancer?

What is the race-related disparities in the prognosis of colon cancer?

How does body mass index (BMI) affect the prognosis of colon cancer?

How does cadherin-associated protein ? 1 (CTNNB1 or ?-catenin) affect the survival of patients with colon cancer?

How does aspirin affect the prognosis of colon cancer?

How do mental health conditions affect the prognosis of colon cancer?

How does smoking affect the prognosis of colon cancer?

Presentation

What are the signs and symptoms of colon cancer?

Which physical findings are characteristic of colon cancer?

DDX

Which conditions should be included in the differential diagnoses of colon cancer?

What are the differential diagnoses for Colon Cancer?

Workup

What is the role of screening in the diagnosis of colon cancer?

What are the American College of Gastroenterology screening guidelines for colon cancer?

When is hereditary nonpolyposis colon cancer syndrome (HNPCC, Lynch syndrome) testing indicated in the evaluation of colon cancer?

Which tests are performed following tissue diagnosis confirmation of colon cancer?

What drives further workup following a colon cancer diagnosis?

Which lab studies are performed in the workup of colon cancer?

How is a serum carcinoembryonic antigen (CEA) level used in the workup of colon cancer?

What are the roles of CT scanning and MRI in the workup of colon cancer?

What is the role of positron emission tomography (PET) scanning in the workup of colon cancer?

What is the goal of colorectal cancer screening?

What is the joint guideline for colon cancer screening from the American Cancer Society, US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology?

What are the screening options for colon cancer?

Which colon cancer screening tests detect adenomatous polyps and malignancy?

Which tests primarily detect colon cancer?

What is the benefit of flexible sigmoidoscopy compared to stool-based tests in the screening for colon cancer?

How are FIT kits used to screen for colon cancer?

Why is colonoscopy colon cancer screening contraindicated in patients on clopidogrel therapy?

How is Cologuard used to screen for colon cancer?

How is Epi proColon used to screen for colon cancer?

What are high-risk factors that indicate screening for colon cancer at an earlier age?

How are patients with hereditary familial syndromes screened for colon cancer?

What are the benefits of an earlier screening age for colon cancer?

How can screening for colon cancer be increased in ethnically diverse populations?

How is capsule colonoscopy used to screen for colon cancer?

What are the American College of Gastroenterology (ACG) guidelines for colorectal cancer screening?

What are alternative cancer detection tests recommended in the American College of Gastroenterology (ACG) guidelines?

What are the screening considerations for patients with one first-degree relative diagnosed with colorectal cancer or advanced adenoma?

What is the recommended scheduling of follow-up screening for colon cancer based on colonoscopy findings?

What are the American Society for Clinical Pathology, the College of American Pathologists (CAP), the Association for Molecular Pathology, and the American Society of Clinical Oncology (ASCO) evidence-based guidelines on colorectal cancer molecular test..

What is the TNM staging of colon cancer?

How is colon cancer staged?

What are the prognostic factors associated with staging of colon cancer?

Which features are associated with worse prognosis of colon cancer?

Which molecular prognostic factors are not yet incorporated into standard clinical practice for colon cancer?

What is the significance of KRAS mutations in colon cancer?

What is the significance of deficient mismatch repair (dMMR) in colon cancer?

What is the 5-year relapse-free survival rate for T3 or T4 colorectal cancer?

How does the prognosis of colon cancer vary by stage?

What are the revisions of the TN categorization for colon cancer?

What are the histologic subtype and metastatic patterns for colon cancer?

Treatment

What is the role of surgery in the treatment of colon cancer?

What is included in the treatment of colon cancer?

What is the standard management of metastatic colorectal cancer?

What are the indications for surgery to treat colon cancer?

What surgery is indicated for lesions in the cecum and right colon?

What surgery is indicated for lesions in the proximal or middle transverse colon?

What surgery is indicated for lesions in the splenic flexure and left colon?

What surgery is indicated for sigmoid colon lesions?

What are the indications for total abdominal colectomy with ileorectal anastomosis for the treatment of colon cancer?

What is the role of laparoscopic surgery in the treatment of colon cancer?

What is the standard management for metastatic colorectal cancer?

How is asymptomatic, surgically incurable colorectal cancer managed?

What is the role of surgery in the treatment of liver metastases in colon cancer?

What is the role of hepatic arterial infusion (HAI) in the treatment of colon cancer?

What is the role of colonic stents in the treatment of colon cancer?

What is the role of cryotherapy in the treatment of colon cancer?

How is radiofrequency ablation (RFA) used to treat colon cancer?

What is the role of cetuximab in the treatment of colon cancer?

What is the role of adjuvant therapy in the treatment of colon cancer?

How is adjuvant therapy used to treat colon cancer in elderly patients?

What is the role of fluorouracil in the treatment of colon cancer?

What is the role of capecitabine (Xeloda) in the treatment of colon cancer?

What is the optimal duration of adjuvant therapy for colon cancer?

How is risk status used to determine the duration of adjuvant therapy for colon cancer?

What is the role of adjuvant chemotherapy for stage II colon cancer?

What is the efficacy of adjuvant chemotherapy for stage II colon cancer?

What is the efficacy of combination regimens in the treatment of metastatic colon cancer?

How is fluorouracil used to treat patients with metastatic colon cancer?

What has impeded the development of evidence-based treatment guidelines for colon cancer in elderly patients?

What is the role of tipiracil/trifluridine (Lonsurf) in the treatment of colon cancer?

Which biologic agents are used to treat colon cancer?

What is the role of bevacizumab in the treatment of colon cancer?

What is the efficacy of bevacizumab in the treatment of colon cancer?

What is Mvasi (bevacizumab-awwb) and how is it used to treat colon cancer?

What are the efficacy of cetuximab in the treatment of colon cancer?

What is the role of panitumumab in the treatment of colon cancer?

How is panitumumab used in the treatment of wild-type RAS (both KRAS and NRAS) metastatic colorectal cancer?

What is the role of ramucirumab in the treatment of colon cancer?

What is the role of nivolumab in the treatment of colon cancer?

What is the role of pembrolizumab in the treatment of colon cancer?

What is the role of regorafenib in the treatment of colon cancer?

What is the role of ziv-aflibercept in the treatment of colon cancer?

What is the role of larotrectinib in the treatment of colon cancer?

What is the role of immunotherapy in the treatment of colon cancer?

How is HER2-positive colon cancer treated?

What is the role of radiation therapy in the treatment of colon cancer?

What new and selective ways of administering radiation therapy to treat colon cancer are being investigated?

How does the addition of radioembolization with yttrium-90 affect the outcomes for patients with colon cancer?

What is the role of dietary fiber in the development of colon cancer?

When should a surgical consultation be obtained for patients with colon cancer?

When is a gastroenterology (GI) consultation needed in the treatment of colon cancer?

What is included in the long-term monitoring of patients with colon cancer?

What are the guidelines for the follow-up care of survivors of stages II and III colorectal cancer?

What are the strategies for colorectal cancer prevention?

What lifestyle factors contribute to the prevention of colon cancer?

How does diet and physical activity affect the risk for recurrence of colon cancer?

How is calcium and vitamin D supplementation used to prevent colon cancer?

What is the role of medications in the prevention of colon cancer?

How is celecoxib (Celebrex) used to prevent colon cancer?

How is aspirin used to prevent colon cancer?

How is a combination of sulindac and dimethylformamine (DMFO) used to prevent colon cancer?

Guidelines

Which organization have issued guidelines for colon cancer?

How do the screening guidelines for colon cancer differ from one another?

What are the guidelines for the screening of colon cancer in asymptomatic men and women?

Which patient groups should undergo screening for colon cancer at an earlier age?

Which colon cancer screening tests detect adenomatous polyps and cancer?

Which colon cancer screening tests primarily detect colon cancer?

What are the 2018 revised ACS colorectal cancer screening guidelines?

What are the USPSTF guidelines for colon cancer screening?

What stool-based screening tests and intervals are used to detect colon cancer?

What are the direct visualization screening tests for colon cancer?

What are the American College of Physicians guidelines for colon cancer screening?

What are the recommendations for interval screening with fecal testing or flexible sigmoidoscopy?

What are the American College of Gastroenterology (ACG) guidelines for colorectal cancer screening?

What are alternative colon cancer detection tests recommended in the American College of Gastroenterology (ACG) guidelines?

What are the American College of Gastroenterology (ACG) guidelines for patients with first-degree relative diagnosed with colon cancer?

What are the National Comprehensive Cancer Network (NCCN) guidelines for colon cancer screening?

What are the NCCN guidelines for colon cancer screening in patients at increased risk?

What are the NCCN guidelines for evaluation for high-risk syndromes of colon cancer?

Which organizations have published guidelines for hereditary nonpolyposis colorectal cancer (HNPCC) screening?

What are the American Gastroenterological Association guidelines for Lynch syndrome screening?

What are the European Society for Medical Oncology (ESMO) guidelines for familial risk-colorectal cancer?

What are the Bethesda guidelines for Lynch syndrome and microsatellite instability in colon cancer?

What are the US Multi-Society Task Force on Colorectal Cancer guidelines for postpolypectomy surveillance?

What are the BSG/ACPGBI/PHE guidelines on postpolypectomy surveillance?

What are the European Society of Medical Oncology guidelines for colon cancer surveillance of classic familial adenomatous polyposis (FAP)?

What are the European Society of Medical Oncology guidelines for colon cancer surveillance of attenuated familial adenomatous polyposis (FAP)?

What are the American Society of Colon and Rectal Surgeons guidelines for colon cancer surveillance in patients with familial adenomatous polyposis (FAP)?

What are the NCCN-recommended adjuvant therapy regimens for colon cancer?

What are the American Society of Clinical Oncology (ASCO) recommendations for adjuvant chemotherapy in the treatment of colon cancer?

Which organizations have issued guidelines on follow-up care for survivors of stage II and stage III colorectal cancer?

What are the US Multi-Society Task Force on Colorectal Cancer guidelines for colonoscopy after colorectal cancer resection?

What is the American Society for Clinical Pathology (ASCP), the College of American Pathologists (CAP), the Association for Molecular Pathology (AMP), and the American Society of Clinical Oncology (ASCO) guidelines for gene mutation testing in colon can..

What are the European Society of Medical Oncology (ESMO) treatment guidelines for patients with metastatic colorectal carcinoma (mCRC)?

What are the NCCN guidelines on targeted therapy to treat colon cancer?

What are the American Society of Colon and Rectal Surgeons surgical guidelines for colon cancer?

What are the NCCN guidelines for use of laparoscopic-assisted colectomy in the treatment of colon cancer?

What are the NCCN recommendations for lymphadenectomy in the treatment of colon cancer?

Medications

What are the most commonly used chemotherapy regimens for colon cancer?

What are the indications for use of pembrolizumab to treat colon cancer?

Which medications in the drug class PD-1/PD-L1 Inhibitors are used in the treatment of Colon Cancer?

Which medications in the drug class Antineoplastics, VEGF Inhibitor are used in the treatment of Colon Cancer?

Which medications in the drug class Antineoplastics, Tyrosine Kinase Inhibitors are used in the treatment of Colon Cancer?

Which medications in the drug class Antineoplastic Agent, Monoclonal Antibody are used in the treatment of Colon Cancer?

Which medications in the drug class Antineoplastic Agent, Alkylating Agent are used in the treatment of Colon Cancer?

Which medications in the drug class Antineoplastic Agent, Miscellaneous are used in the treatment of Colon Cancer?

Which medications in the drug class Antidote, Folic Acid Antagonist are used in the treatment of Colon Cancer?

Which medications in the drug class Antineoplastic Agent, Antimetabolite (pyrimidine analog) are used in the treatment of Colon Cancer?

Which medications in the drug class Antineoplastics, Other are used in the treatment of Colon Cancer?