institute for cancer research

What is Colorectal Cancer?

Colorectal cancer is a disease in which normal cells in the colon or rectum stop functioning properly and begin to grow uncontrollably. If not treated or removed, these cancerous cells will eventually form a growth or tumor, which can interfere with proper functioning of the colon or rectum and spread to cause cancer in other parts of the body.

The colon and rectum are segments of the large intestine, and they play an important role in the body's ability to digest food and pass waste. The colon makes up the first 6 feet of the large intestine and the rectum is the last 8 to 10 inches ending near the anus.

The colon has four sections. The ascending colon is the part that goes up from a pouch called the cecum on the right side of the abdomen. The transverse colon crosses the top of the abdomen. Then the descending colon takes food down the left side. Finally, the sigmoid colon at the bottom takes food a few more inches downward to the rectum.

Colorectal cancer can begin in either the colon or the rectum. Cancer that begins in the colon is often referred to as colon cancer and cancer that begins in the rectum may be called rectal cancer.

Most colorectal cancers begin in polyps, non-cancerous growths that may occur on the inner wall of the colon and rectum as people get older. Since certain types of polyps may eventually turn cancerous, one way to prevent colorectal cancer is to detect and remove polyps before they become cancerous.

Most colon and rectal cancers form cancerous tumors called adenocarcinomas, cancers of the cells that line the inside tissue of the colon and rectum. Tumors called carcinoid tumors, gastrointestinal stromal tumors and lymphomas can also begin in the colon or rectum.

As we well know, there are many kinds of cancer; unfortunately they all come about because of the out-of-control growth of abnormal cells.

Cancer of the Colon and Rectum is the third most common cancer in adults and accounts for 10% of all cancer deaths. It is also referred to as colorectal cancer or carcinoma and usually grows in the lining of the large intestine. Other types of cancer that can grow in the large intestine include lymphomas, melanomas or sarcomas.

In most cases, colon cancer has no symptoms, therefore, it is very often diagnosed and treated in the advanced stages when the success rate is reduced. Hidden blood in the stool is mostly the first, and often times the only warning sign. In a high percentage polyps precede the development of colon cancer.

Incidence
Colorectal cancer generally occurs in 1 out of every 20 individuals at some point in their lifetimes. Approximately 150,000 new cases are diagnosed each year in this country. This is about 15% of the total number of new cancer diagnoses. Colorectal cancer causes about 56,000 deaths a year in the United States, although this number appears to have been declining over the past two decades.

When colorectal cancer is detected early, survival rates are much higher. For example, 92% of patients who receive early treatment are still alive after 5 years. When adjacent organs or lymph nodes are affected, 64% of people survive 5 years. If the cancer is carried to distant organs, the rate drops to only 7%.

Since these statistics are based on patients who were treated 5 years ago, patients currently undergoing treatment may show higher survival rates due to more effective detection and treatment methods.

Most professionals believe that colorectal cancer develops gradually over a period of years. Cells change from a precancerous state to a cancerous state during this time. Thus it is essential that patients undergo screening for early detection of precancerous conditions.

The American Cancer Society estimates that about 106,370 new cases of colon cancer (50,400 men and 55,970 women) and 40,570 new cases of rectal cancer (23,220 men and 17,350 women) will be diagnosed in 2004.

Colorectal cancer is expected to cause about 56,730 deaths (28,320 men and 28,410 women) during 2004.

Screening tests can prevent colorectal cancer

There are ways to prevent colorectal cancer — screening tests are the most effective. Most cases of the disease begin as non-cancerous polyps — grape-like growths on the lining of the colon and rectum. These polyps can become cancerous.

Removing these polyps can prevent colorectal cancer from ever developing. Approximately 90 percent of colorectal cancers and deaths are thought to be preventable.

Because there are often no symptons related to polyps, it is important to be routinely screened.

... or detect it in its earliest, most curable stages

Colorectal cancer screening tests save lives even when they detect polyps that have become cancerous by catching colorectal cancer in its earliest, most curable stages. When discovered early, the disease can be cured in most cases.

Along with regular colorectal cancer screenings, regular exercise and maintaining a healthy weight can reduce your risk of being diagnosed with colorectal cancer. While recent research has presented conflicting evidence about fruits and vegetables and the prevention of colorectal cancer, a diet rich in fruits and vegetables provides overall health benefits and can help prevent other cancers. On-going research will help answer questions about the extent to which dietary changes can protect against colorectal cancer.

The risk of developing colorectal cancer increases with age. Starting at age 50, men and women who are at average risk for the disease should get screened. Men and women who have a higher risk of colorectal cancer may need to be tested earlier and should talk to their health care professional about when.

Some people are at a higher risk for developing colorectal cancer and may need to be tested earlier. Because of disproportionate screening, minorities, particularly African-Americans and Hispanics, are more likely to be diagnosed with colorectal cancer in advanced stages. As a result, death rates are higher for these populations than they are for white Americans.

All men and women should talk with their health care professional about colorectal cancer and colorectal cancer screening tests. It is also very important to know your family medical history, because colorectal cancer can be hereditary.

• Personal or family history of colorectal cancer, colorectal polyps or inflammatory disease, like ulcerative colitis


• Diet low in vegetables, fruits and fiber


• Diet high in fat and saturated fat


• Diet high in red meat and/or processed meat


• Diet high in sugar and/or alcohol


• Over the age of 50


• Live in an economically developed, industrialized, urban environment


• Above average height and/or weight


• Physically inactive


• Smoke

• Eat more vegetables, fruits, legumes, and whole grains


• Eat less fat and saturated fat


• Stay active and maintain healthy weight


• Drink alcohol in moderation, if at all


• Don’t use any form of tobacco


• Have regular exams by a physician


• Be alert of symptoms
  • Prolonged diarrhea
  
  
  • Blood in stool
  
  
  • Stools smaller in width than usual
  
  
  • General abdominal discomfort
  
  
  • Frequent gas pains
  
  
  • Feeling as if bowel does not empty completely
  
  
  • Abnormal fatigue

Healthy Cells vs. Cancer Cells

Healthy cells are like a cat. They need structure to determine the size of bones and shape of the body, tail and whiskers. The DNA in genes and chromosomes determine this. They need energy to play and prowl and sustain life. This is derived from chemicals in food. Cats need a system to deliver chemicals (food nutrients like amino acids, carbohydrates, fats, vitamins and minerals) to all parts of their body. These are the blood vessels. Growth factors take a kitten into a lazy old cat, all the while helping it to function normally.

The body and its cells are mostly made up of protein. The building blocks of proteins are substances called amino acids that in the form of enzymes and hormones literally control every chemical reaction within the cells. When these are modified, different messages are sent to a complex control system that can alter their function. There are twenty different kinds of amino acids that are essential to life. Twelve of these can be synthesized within the body however; eight must be supplied by the daily diet

 

Overview

Information about the prevention of cancer and the science of screening appropriate individuals at high-risk of developing cancer is gaining interest. Physicians and individuals alike recognize that the best "treatment" of cancer is preventing its occurrence in the first place or detecting it early when it may be most treatable.

Colorectal cancer is the second leading cause of cancer death in the United States. The disease strikes both men and women, with 130,000 cases diagnosed each year. Approximately 56,000 people die from colorectal cancer each year.

The chance of an individual developing cancer depends on both genetic and non-genetic factors. A genetic factor is an inherited, unchangeable trait, while a non-genetic factor is a variable in a person’s environment, which can often be changed. Non-genetic factors may include diet, exercise, or exposure to other substances present in our surroundings. These non-genetic factors are often referred to as environmental factors. Some non-genetic factors play a role in facilitating the process of healthy cells turning cancerous (i.e. the correlation between smoking and lung cancer) while other cancers have no known environmental correlation but are known to have a genetic predisposition. A genetic predisposition means that a person may be at higher risk for a certain cancer if a family member has that type of cancer.

Heredity or Genetic Factors

People with a personal or family history of adenomatous polyps or familial adenomatous polyposis (FAP) are at an increased risk for developing colorectal cancer. Adenomatous polyps are non-cancerous tumors that grow in the colon or rectum and become cancerous, ultimately developing into colorectal cancer. Familial adenomatous polyposis (FAP) is a genetic disease that causes hundreds of adenomatous polyps to form in the colon or rectum. FAP most often affects adolescents and young adults, many of whom develop colorectal cancer at an early age.

Hereditary nonpolyposis colorectal cancer (HNPCC) is a genetic syndrome caused by mutation in one of several genes. HNPCC accounts for about 3-5% of all colorectal cancer. With HNPCC, people develop a single colorectal cancer rather than an unusual number of polyps, as in FAP. Individuals with the HNPCC gene mutations have an 80% lifetime risk of developing colorectal cancer.

Individuals with a family history of colorectal cancer or colorectal adenomas (polyps) also have an increased risk of developing colorectal cancer, as do those with a personal history of either of these conditions. In addition, people suffering from inflammatory bowel disease have a greater chance of developing colorectal cancer. Research indicates that the presence of a gene called the pituitary tumor transforming gene (PTTG) may help to identify colon polyps most at risk for becoming cancerous.

Environmental or Non-Genetic Factors

About 75% of all new cases of colorectal cancer occur in people who have no known risk factors other than age. Research indicates that the risk for colorectal cancer increase substantially after age 50.

Diet: Some, but not all, research indicates that a high-fat diet, as well as a diet low in fiber and folic acid, may play a role in the development of colorectal cancer. Three recently published clinical studies, however, have failed to produce evidence to support the theory that a diet low in fiber leads to colorectal cancer. There is considerable evidence, however, that a high intake of red meat increases the risk of colorectal cancer.

In a study involving 76,402 women, researchers at the Harvard School of Public Health in Boston found that a “western” diet increases the risk of colon cancer, compared to a “prudent” diet. A “western” diet was defined as including higher levels of red and processed meats, sweets and desserts, French fries, and refined grains while the “prudent” diet consisted of higher intakes of fruits, vegetables, legumes, fish, poultry and whole grains. After the data was adjusted for additional risk factors (which can skew statistical results), the researchers reported that women on a Western diet were 46% more likely to develop colon cancer than women who ate a prudent diet. Obesity also appears to influence the development of polyps and their progression to malignancy. The reason for the relationship between obesity and colon cancer remains unknown; however, some researchers have theorized that elevated insulin may be a factor.

Smoking: The use of alcohol and tobacco in combination has been linked to the risk of developing colorectal cancer. A recent study by the American Cancer Society (ACS) indicates that long-term smoking may significantly increase the risk of colorectal cancer. The ACS researchers examined 14 years of data (1982-1996) collected from the Cancer Prevention Study II (CPS II). They evaluated the smoking patterns of 312,332 men and 469,019 women as reported by these participants when they entered the study in 1982. The researchers found that colorectal cancer death rates were highest among current smokers, intermediate among former smokers and lowest among never smokers. The risk of dying from colorectal cancer was higher among those who smoked for 20 or more years.

The duration and amount of smoking was a significant factor, as the data showed that the risk of colorectal cancer increased with the number of cigarettes smoked daily and the number of years of smoking. A younger age at initiation also increased the risk. On the other hand, the colorectal cancer risk decreased with each year after quitting smoking. The data also showed that cigar and pipe smokers had an increased risk of colorectal cancer as well.

Since the data showed that the risk of dying from colorectal cancer increased with the duration and amount of smoking, the researchers concluded that there might be a causal relationship between smoking and colorectal cancer. If this causal relationship does indeed exist, then approximately 12% of colorectal cancer deaths in the U.S. in 1997 were attributable to smoking.

Prevention

Cancer is largely a preventable illness. Two-thirds of cancer deaths in the U.S. can be linked to tobacco use, poor diet, obesity, and lack of exercise. All of these factors can be modified. Nevertheless, an awareness of the opportunity to prevent cancer through changes in lifestyle is still under-appreciated.

Because colorectal cancer is a highly curable disease when detected early, the best form of prevention is screening and early detection. When an adenomatous polyp, which is a precursor lesion, develops, it takes 10 to 15 years to transform into cancer; therefore, people with an increased risk for developing colorectal cancer may want to undergo screening at a younger age and continue with screening frequently in an attempt to prevent this development. Several screening programs may be used to detect early stage colorectal cancer and polyps. These polyps can then be removed, thereby preventing the development of colorectal cancer.

Diet: Diet is a fertile area for immediate individual and societal intervention to decrease the risk of developing certain cancers. Numerous studies have provided a wealth of often-contradictory information about the detrimental and protective factors of different foods.

There is convincing evidence that excess body fat substantially increases the risk for many types of cancer. While much of the cancer-related nutrition information cautions against a high-fat diet, the real culprit may be an excess of calories. Studies indicate that there is little, if any, relationship between body fat and fat composition of the diet. These studies show that excessive caloric intake from both fats and carbohydrates lead to the same result of excess body fat. The ideal way to avoid excess body fat is to limit caloric intake and/or balance caloric intake with ample exercise.

It is still important, however, to limit fat intake, as evidence still supports a relationship between cancer and polyunsaturated, saturated and animal fats. Specifically, studies show that high consumption of red meat and dairy products can increase the risk of certain cancers. One strategy for positive dietary change is to replace red meat with chicken, fish, nuts and legumes.

High fruit and vegetable consumption has been associated with a reduced risk for developing at least 10 different cancers. Some researchers believe that this may be a result of potentially protective factors such as carotenoids, folic acid, vitamin C, flavonoids, phytoestrogens and isothiocyanates, often referred to as antioxidants.

For many years, researchers speculated that the low incidence of colorectal cancer in parts of Africa could be linked to a high-fiber diet; however, several studies have failed to support this theory. In 1999, three pivotal clinical studies evaluating the effects of a high-fiber diet on colorectal cancer failed to establish a correlation between high fiber consumption and reduction in the incidence of colorectal cancer. In two of these studies, researchers directly compared 2 groups of individuals with either high or low fiber consumption and found an equal number of polyps in each group. There are many reasons to eat a diet high in fiber, particularly to help reduce the risk for coronary artery disease; however, such a diet does not appear to help prevent the development of colorectal polyps or cancer.

There is strong evidence that moderate to high alcohol consumption also increases the risk of certain cancers. One reason for this relationship may be that alcohol interferes with the availability of folic acid. Alcohol in combination with tobacco creates an even greater risk.

Exercise: Higher levels of physical activity may reduce the incidence of some cancers. According to researchers at Harvard, if the entire population increased their level of physical activity by 30 minutes of brisk walking per day (or the equivalent energy expenditure in other activities), we would observe a 15% reduction in the incidence of colon cancer.

A group of Swiss researchers compared the physical activity levels of 223 individuals with colorectal cancer and 491 individuals without colorectal cancer. The results indicated an increased that individuals with a sedentary lifestyle have an increased risk of developing colorectal cancer. This association was present regardless of age, gender, weight or alcohol intake. Although there is no sure way to prevent any cancer from developing, these researchers concluded that increasing one’s level of physical activity may help to prevent one-fifth to one-third of all colorectal cancer cases.

Celecoxib: Research has indicated that a non-steroidal, anti-inflammatory drug called Celecoxib may reduce the number of polyps that develop in patients with FAP, thus significantly reducing their risk for developing colorectal cancer. The FDA has approved this drug to be used for treatment of individuals with FAP. Clinical studies will be ongoing to determine if other high-risk individuals can benefit from Celecoxib.

Statins: A large study presented at the 2004 meeting of the American Society of Clinical Oncology showed that the use of statins (cholesterol-lowering drugs) for 5 years or more is associated with a 46% reduction in the risk of colorectal cancer. This rate was adjusted for other known risk factors such as age, physical activity, and diet.

Screening and Early Diagnosis

For many types of cancer, progress in the areas of cancer screening and treatment has offered promise for earlier detection and higher cure rates. The term screening refers to the regular use of certain examinations or tests in persons who do not have any symptoms of a cancer but are at high risk for that cancer. When individuals are at high risk for a type of cancer, this means that they have certain characteristics or exposures, called risk factors that make them more likely to develop that type of cancer than those who do not have these risk factors. The risk factors are different for different types of cancer. An awareness of these risk factors is important because 1) some risk factors can be changed (such as smoking or dietary intake), thus decreasing the risk for developing the associated cancer; and 2) persons who are at high risk for developing a cancer can often undergo regular screening measures that are recommended for that cancer type. Researchers continue to study which characteristics or exposures are associated with an increased risk for various cancers, allowing for the use of more effective prevention, early detection, and treatment strategies.

Screening is crucial for the prevention and early treatment of colorectal cancer. It is currently recommended that all patients over age 50 be screened regularly for colorectal cancer. Additionally, people with a personal or family history of adenomatous polyps, FAP, HNPCC, or colorectal cancer may begin screening much earlier.

Several screening strategies are currently available. These include the fecal occult blood test (FOBT), flexible sigmoidoscopy, colonoscopy and double contrast barium enema. It is currently recommended that patients begin receiving an annual fecal occult blood test (FOBT) at age 50 and a flexible sigmoidoscopy every 5 years after age 50. It is also recommended that a colonoscopy be performed every 10 years, and if the FOBT is positive or if adenomas are found during the sigmoidoscopy. Some physicians also recommend that a double-contrast barium enema be performed every 5 to 10 years after age 50, however, current research indicates that the colonoscopy may be a more effective screening procedure. Individuals interested in colorectal cancer screening should discuss the options with their physician in order to determine the most appropriate procedure.

Fecal Occult-Blood Test (FOBT): The fecal occult-blood test checks for hidden blood in the stool. Recently, results from an 18-year study indicated that annual or biannual FOBT could significantly reduce the incidence of colorectal cancer. This test indicates the presence of bleeding polyps and thereby indicates a need for further screening. This follow-up screening allows for both the identification and removal of polyps, which results in a reduced incidence of colorectal cancer.

Flexible sigmoidoscopy: During this procedure, a physician uses a lighted tube to look inside the rectum and the lower part of the colon (sigmoid colon) for polyps or areas suspicious for cancer. The physician may perform a biopsy in order to collect samples of suspicious tissues or cells for closer examination. This is an outpatient procedure that does not require sedative anesthesia or pain medication. There are no or few complications associated with this procedure.

Colonoscopy: During this procedure, a longer flexible tube that is attached to a camera is inserted through the rectum, allowing physicians to examine the internal lining of the colon for polyps or other abnormalities. The physician may perform a biopsy in order to collect samples of suspicious tissues or cells for closer examination. This is a more difficult procedure than sigmoidoscopy requiring anesthesia or heavy sedation. Significant complications occur 1% of patients or less.

Double-contrast barium enema: A chalky substance called barium is inserted through the rectum and into the colon and rectum. The patient then undergoes x-rays of the colon and rectum so that the physician can evaluate the area for polyps or other abnormalities. The barium helps open the colon so that the x-rays are more detailed and clear.

While these screening strategies help to monitor for the development of adenomatous polyps and colorectal cancer, other tests exist which may allow physicians to identify patients who are at risk for the development or recurrence of colorectal cancer.

Carcinoembryonic antigen (CEA): The CEA test is designed to identify cancer cells in the patient’s blood by recognizing a specific protein that is found on the surface of these cells, called the CEA. The CEA test is not currently utilized for screening purposes because it is a non-specific test, which means that the presence of CEA could be an indicator of any of a number of conditions. The presence of CEA in the blood appears to be a useful indicator to identify patients at high risk for recurrence after standard treatment for colorectal cancer.

Predictive genetic testing: A predictive medicine test for hereditary colorectal cancer is now available. This test detects disease-causing mutations in two genes, MLH1 and MSH2, which are responsible for the majority of hereditary non-polyposis colorectal cancer (HNPCC). This test may allow patients who are identified to be at a high risk for HNPCC to have earlier and more frequent exams and to have pre-cancerous polyps removed. Individuals interested in genetic testing should consult with their physicians about the risks and benefits of this procedure.

Research is ongoing to develop and refine the optimal screening programs for individuals at risk of developing colorectal cancer.

Strategies to Improve Screening and Early Detection of Colon Cancer

The potential for earlier detection and higher cure rates increases with the advent of more refined screening techniques. In an effort to provide more screening options and perhaps more effective prevention strategies, researchers continue to explore new techniques for the screening and early detection of cancer.

Several new strategies for the screening of colorectal cancer have recently emerged. Despite progress in this area, it is still important that individuals continue to utilize the standard screening procedures in an effort to maintain health and detect colorectal cancer early when it is most treatable. However, these new procedures hold promise for earlier and more reliable detection of colorectal cancer and some individuals may be interested in participating in clinical trials that will help to determine the effectiveness of these new techniques.

DNA stool test: This new screening procedure involves looking for abnormal DNA in stool samples. Changes in DNA occur as tumors develop in the colon. The tumors shed cells into the intestine, which makes it possible to detect the abnormal DNA cells in stool samples. This simple, non-invasive screening procedure has proven effective in clinical studies. Research is ongoing to determine the feasibility of using this as a standard screening procedure.

Virtual colonoscopy: In virtual colonoscopy, spiral CT scanners scan the entire colon to produce a 3-D image. The procedure allows for the complete visualization of the colon more quickly and less invasively than with conventional colonoscopy. While this is a promising new technique, more research will be needed to refine the procedure before it becomes a standard screening procedure for colorectal cancer. This procedure may evolve as technology continues to improve.

The above-mentioned techniques are new areas of exploration in the screening and early detection of colorectal cancer. Clinical trials are being utilized to determine the efficacy of these procedures. While the results look promising and the implications could be exciting, these procedures are not yet the standard. It is imperative that individuals continue to utilize the existing methods of screening for colorectal cancer in order to ensure early detection.

The colon and rectum are parts of the body's digestive system and together form a long, muscular tube called the large intestine. The colon is the first 6 feet of the large intestine and the rectum is the last 8-10 inches. Treatment approaches differ between cancers of the colon or rectum and are, therefore, discussed separately. A separate section has been created for Rectal Cancer.

Adenocarcinoma refers to cancer that begins in the cells that line the colon or large intestine and accounts for over 90%-95% of cancers originating in the colon. Other cancers, including carcinoid and leiomyosarcoma, also originate in the colon, but are not referred to as colon cancer. This treatment overview deals only with adenocarcinoma of the colon, which will be referred to as colon cancer.

The treatment of colon cancer typically consists of surgery and/or chemotherapy and may involve several physicians, including a gastroenterologist, a surgeon, a medical oncologist and other specialists. Care must be carefully coordinated between the various treating physicians involved in management of the cancer.

Colon cancer begins in cells that line the colon. As the cells increase in number, they spread circumferentially around the colon like a "napkin ring." If not detected early, the cancer may invade adjacent organs and spread through the lymph and blood systems throughout the body to the liver, lungs and other organs. In order to understand the best treatment options available for treatment of colon cancer, it is important to first determine where the cancer has spread in the body.

Staging

Determining the stage of the cancer or the extent of the spread requires a number of tests and is ultimately confirmed by surgical removal of the cancer and exploration of the abdominal cavity. The following tests may be used to look for cancer in the chest, abdomen and pelvis.

Computerized Tomography (CT) Scan: A CT scan is a technique for imaging body tissues and organs, during which X-ray transmissions are converted to detailed images, using a computer to synthesize X-ray data. A CT scan is conducted with a large machine positioned outside the body that can rotate to capture detailed images of the organs and tissues inside the body. This method is more sensitive and precise than the chest x-ray.

Magnetic Resonance Imaging (MRI): MRI uses a magnetic field rather than X-rays, and can often distinguish more accurately between healthy and diseased tissue. MRI gives better pictures of tumors located near bone than CT, does not use radiation as CT does, and provides pictures from various angles that enable doctors to construct a three-dimensional image of the tumor.

Colonoscopy: Because 3-5% of patients with a colon cancer can already have an additional cancer in their colon, colonoscopy is routinely recommended to identify whether a second cancer is present in the colon prior to surgery. During a colonoscopy, a long flexible tube that is attached to a camera is inserted through the rectum, allowing physicians to examine the internal lining of the colon for polyps or other abnormalities. The physician may perform a biopsy in order to collect samples of suspicious tissues or cells for closer examination.

Doppler Ultrasound: Doppler ultrasound is a technique that can be used to measure blood flow in the artery to the liver (hepatic artery) and total liver flow in patients with colon cancer. This measurement is helpful because abnormalities occurring in hepatic artery blood flow can be used to detect early cancer metastasis to the liver. While this procedure is typically used to identify patients who need additional adjuvant treatment, one clinical study showed that it could more accurately predict outcomes following surgery than does the stage of cancer as determined by standard tests. Thus, Doppler ultrasound may actually predict those patients at a higher risk of a relapse in the liver.

Surgery

Upon completion of the clinical "staging evaluation", surgery is performed to remove the cancer along with part of the normal adjacent colon (hemi-colectomy) and determine the level of spread within the colon and abdomen. Surgery is performed through an abdominal incision and more recently through a laparoscope. Laparoscopic hemi-colectomy may be associated with faster healing than traditional surgery and is currently being evaluated in clinical trials.

Following surgical removal of colon cancer and examination of removed tissue under a microscope, a final "pathologic" stage will be given. This may be a letter or a number, as several different staging systems are used to describe colon cancer. All new treatment information concerning colon cancer is categorized and discussed by the stage. In order to learn more about the most recent information available concerning the treatment of colon cancer, click on the appropriate stage.

Stage I or A-B1: Cancer is confined to the lining of the colon.

Stage II or B2-3: Cancer may penetrate the wall of the colon into the abdominal cavity or other adjacent organs but does not invade any local lymph nodes.

Stage III or C1-3: Cancer invades one or more of the local lymph nodes but has not spread to other distant organs.

Stage IV or D: Cancer has spread to distant locations in the body, which may include the liver, lungs, bones or other sites.

Recurrent/Relapsed: Colon cancer has progressed or returned (recurred/relapsed) following initial treatment.

Obesity May Increase Colorectal Cancer Risk

Recently, the journal Cancer Causes and Control published the results of a study that found that women with a higher body mass index value (BMI) have an increased risk of developing colorectal cancer.

Colorectal cancer is the second leading cause of cancer related deaths in the United States. Colorectal cancer is a malignancy that involves both the large intestines (colon) and a distal portion of the colon known as the rectum. There are many risk factors associated with colorectal cancer, some which are unalterable such as older age, male sex, inflammatory bowel disease, certain hereditary conditions, and a family history of colorectal cancer or adenomatous polyps. However, only 25% of all colorectal cancers occur in people with known predisposing factors for the disease. Other risk factors that have been associated with colorectal cancer include smoking, diets high in red meat, as well as diets high in fat and low in fiber. Evidence relating the risk of obesity to colorectal cancer in women has been uncertain; however, recent studies indicate that the presumed association of obesity with colorectal cancer may be modified depending on the women’s hormonal status.

Body mass index is the common medical standard for measuring a person’s body fat and is determined based on height and weight. Frequently, BMI is used to evaluate a person for obesity or for their risk of developing other diseases. A normal BMI is considered to be a score in the range of 18.5-24.9; individuals considered overweight have a BMI score in the range of 25-29.9; and obesity is determined if the BMI score is 30 or greater.

This recent trial involved women who were premenopausal or who were postmenopausal but were receiving hormone replacement therapy. The goal of the study was to evaluate women with relatively high hormone levels and determine the role of BMI in the risk of developing colorectal cancer. Baseline BMI was determined for 37,671 otherwise healthy women, ages 45 years or older, who were followed for 8 years. During the 8 years, 202 women developed colorectal cancer. Risk analysis found that the greatest risk was associated with women who had a BMI score greater than 27 when compared to women with a BMI score of <23. Further analysis found that women with higher BMI scores remained at the highest risk of colorectal cancer despite their use of hormone therapy or not.

Researchers concluded that women with higher BMI scores had an elevated risk of colorectal cancer that was not altered by their hormonal status. Patients are encouraged to speak to their physician regarding their individual risk factors and what they can do to decrease their risk of colorectal cancer.

INTEGRATIVE THERAPY

THE SCIENTIFICALLY FORMULATED AMINO ACID THERAPY

(Keep in mind, CAAT is much more than just a “diet”; it is an amino acid, carbohydrate, & glucose REDUCTION protocol which strategically uses the chemical reactions of amino acids, foods, and nutritional supplements to impair the development of cancer cells, thus starving them to death.) Clinical trials have already been done with humans using amino acid depravation formulas, and with much success. (Journal American Medical Association. 1967; 200:211)

CAAT is a course of therapy to control a patient’s amino acid intake. This is achieved by taking certain foods out of a persons’ daily food plan for a short time and by replacing them with a scientifically supported formula of amino acids. It is also important to emphasize that the food plan that accompanies the amino acid formula needs to be followed so not to offset any of the benefits we are creating by depriving the cancer cells the nutrients they need to grow. Also, it is important to realize that the patient does not need to abandon their conventional cancer treatment, (surgery, chemotherapy, radiation, hormone treatments) nor is it recommended that they do so unless it has already failed them. CAAT works synergistically with chemotherapy and/or radiation to enhance their benefits (see study by Dr. Marco Rabinowitz of the National Cancer Institute). His report on amino acid deprivation, such as with Controlled Amino Acid Therapy (CAAT), proven to inhibit phosphofructokinase which shuts down the energy supply to cancer cells, simultaneously enhancing the benefits of chemotherapy while lessening their toxic side effects. CAAT has also proven to work successfully alone.

Phase 1: CAAT Formulation

The most important component of CAAT is the scientifically formulated amino acids. Based on the specific formula for each cancer, it consists of separate amino acids, citric acid, and small amounts of sodium benzoate. Each formula replaces most of the regular daily proteins found in meats, dairy, fish, beans and nuts, which cancer cells can derive their energy from. The CAAT formula taken two times per day will nourish the healthy cells while causing the cancer cells to starve to death. Of course each individual has specific needs concerning their diet, and this is explained in the second phase of the protocol as well as with a specialist at the Institute when beginning the CAAT therapy.

Phase 2: Daily Food Intake

DISCLAIMER: The following food program SHOULD NOT be consumed without the amino acid formula and without consent from your doctor and our Institute.

Breakfast:
*1/2 Grapefruit or 1-orange or 6-ounces of fresh orange juice.
Whey Enhanced Protein (Vanilla Flavor – Vitamin Shoppe Brand) approximately
10 – 12 grams of protein – read label carefully, based on 150 lb. person ].
A serving of Grits (Butter, cinnamon and other spices are okay).
1 cup of green or black tea (Fructose is sweetener of choice).
* Do Not have ½ grapefruit if taking Chemotherapy

Explanation: ½ Grapefruit or 1 orange or 6 ounces of fresh orange juice are rich in the natural nutrients called Limonene and Citric Acid. Limonene helps shut down the Ras cancer gene which is over active in 90 percent of all cancers. Citric Acid helps shut down glycolosis which in turn helps starve cancer cells to death.

Whey Enhanced Protein (Vanilla Flavor – Vitamin Shoppe Brand) Phosphorus is a nutrient that cancer cells must utilize in order to grow and reproduce. This brand of whey protein is very low in phosphorous and contains no additional vitamins, so when using approximately 10 – 12 grams of protein per 150 lb. person, it helps to protect normal cells, maintain a normal appetite, and also helps to fight edema. (Edema is the swelling or water build up in the legs or other sites in the body)
Whey protein is included in the daily menu of all advanced or metastatic cancer patients. When treating cancers that are stable or have regressed in size, patients then have the option of including other protein foods at their breakfast meals such as cottage cheese, yogurt, or soy foods. Eggs are allowed in the diets of patients with lymphoma and brain cancers.

Grits or Cream of Wheat or 1 slice of white toast or ½ plain bagel or ½ English muffin (Butter is okay)
Grits or white rice is the preferred carbohydrate food at each meal. The other choices are options once the patient’s cancer is stable or reduced in size. Unrefined carbohydrates are included in the CAAT menu instead of whole grains to deprive cancer cells of a certain B-complex vitamin called Pyridoxine (Vitamin B-6). Cancer cells require this vitamin to manufacture certain amino acids that we keep away from through CAAT’s amino acid reduction formula and diet.
Grits is the preferred carbohydrate food at all meals instead of rice, corn, or pasta because it helps deplete Tryptophan in the body, which is essential for the growth and spreading of cancer cells.

1 cup of green or black tea, using fructose as the sweetener of choice. These teas are rich sources of several compounds that help shut down glycolosis and cut off the energy supply to cancer cells. Also, green or regular tea helps to prevent certain hormones and tumor growth factors from stimulating cancer cells to grow and metastasize to other parts of the body. Brassica teas can also be taken because they contain sulphorane, a nutrient that inhibits cancer growth, and also shuts down the cancer genes.
* Why we use fructose as the sweetener of choice will be explained in detail at the end of this phase of the CAAT protocol.

Lunch:

Amino acid formula (4 level plastic scoops) mixed with any of the following: Water & Fructose; Sugar free Kool-Aid; Diet ginger ale; Fresh lemonade & Fructose; Chicken or Beef broth; V8 juice.
Generous amounts of One cooked vegetable or a combination of the following: asparagus, broccoli, cabbage, brussell sprouts, spinach, squash, string beans.
One serving (1/2 cup)of fresh fruit. Choice of: pear, orange, blueberries, raspberries, strawberries.
1 serving (moderate) of grits or corn or rice or pasta (Add tomato sauce or butter)
1 tablespoon of coconut oil
8 to 10 black or green olives
2 tablespoons of vinegar (minimum of 5% acidity) add to vegetables or food
1 cup of green or black tea (Fructose as desired)

Explanation:

This Amino Acid Reduction Formula (4 level plastic scoops may vary) combined with the special diet, allows the CAAT Protocol to reduce certain amino acids in the daily diet of the cancer patient, and is designed to replace most of the animal protein in the diet. Cancer cells require the amino acids glycine, serine, glutamic acid, and aspartic acid to synthesize DNA, build new blood vessels or duplicate its entire contents of proteins. Also, cancer cells require these and certain other amino acids in order to synthesize other proteins that act as growth promoting hormones or tumor growth factors. CAAT impairs the synthesis of a protein called elastin, which is absolutely essential to the manufacture of new blood vessels. The Amino Acid Reduction Formula, diet, certain phytochemicals and herbs work efficaciously to attack cancer cells at each and every biological front.

The generous amounts of one cooked vegetable or a combination of such helps keep normal cells healthy. They are low in carbohydrates and proteins, and high in phytochemicals, compounds which help fight cancer. Patients are allowed to eat these vegetables and salads whenever desired.

The 8 to 10 olives are rich in squalene and oleic acid, nutrients that have been reported to inhibit certain cancer growth factors. The calories in olives also help control body weight and increases ketones in the blood. Ketones help fight cancer by impairing glycolosis – a process in which cancer cells depend almost exclusively upon for their daily supply of energy. Vinegar (and fructose) are two natural products that increase the production of both ACETIC ACID and CITRIC ACID in the body.

Acetic acid and citric acid also help fight cancer by shutting down the process of glycolosis.
Normal cells derive most of their daily energy supply from acetic acid and citric acid, where as cancer cells derive most of their daily energy from glycolosis.

Dinner:

Amino acid formula (4 plastic level scoops) mixed with any of the following: Water & fructose; Sugar free Kool–Ade; Diet Ginger Ale; Fresh lemonade & Fructose; Chicken or Beef broth; V8 Juice.
Generous amounts of One cooked vegetable or a combination of the following: asparagus, broccoli, cabbage, brussel sprouts, spinach, squash, string beans.
One serving (1/2 cup) of stewed plums with fresh cream & fructose; use 4-ounces of orange juice if plums are not in season.
Avacado salad with lettuce, tomatoes, celery, onions, with lemon juice and coconut oil or olive oil.
2 tablespoons of vinegar (minimum of 5% acidity) add to vegetables or food.
1 serving of grits or corn or pasta or rice (Add garlic and butter or tomato sauce)
1 cup of green or black tea (Fructose as desired)

Mid Evening Snack: Ketogenic Cocktail – 2 ounces of fresh cream, ½ ounce each of both coconut & olive oil, 1 tablespoon of Fructose.
Sugar free Jell-O with whipped cream & Fructose or 1 plum or 4 ounces of orange juice.

Explanation: The sugar free jell-o helps to appease the appetite. Plums contain quinlic acid, which is converted into benzoic acid in the body and which in turn helps to deplete the availability of the amino acid Glycine (Glycine is essential to the synthesis of DNA for cancer cells) and the proteins that cancer cells require to build new blood vessels and their tumor growth factors. If underweight take two ounces of light cream and one ounce of olive oil/coconut oil as needed to maintain weight.

Optional Meal:

3 to 4 ounces of Veal, Fish of choice, Beef, Chicken breast, and 1-slice of white bread.

Consume this meal with a minimum of 3 hours before or after taking the amino acids.

Explanation: If the patient is 10 or more pounds underweight or if their albumin levels are below normal is when the optional meal is allowed. This meal should be eaten a minimum of 3 hours before or after taking the amino acids. CAAT provides sufficient protein to maintain the health of normal cells and adequate amounts of calories to maintain desired body weight. Any proteins taken in excess of amounts recommended in the diet will counter act the benefits of the CAAT protocol.

Special Diets: A special diet will be created for any cancer patient whose ability to consume food and liquids has placed them in a critical situation. When a patient is using a feeding apparatus, or they have become too weak or lethargic to eat and drink the daily minimum amount for survival, we will break up the total breakfast, lunch, and dinner over a period of every 2 hours during the entire day until the patient is capable of returning to a daily diet as outlined above.

Carbohydrate and glucose reduction in this diet: CAAT’S dietary menu provides approximately 20 percent of its calories in the form of carbohydrates. Calories need not be a focal point or counted daily. It is recommended that all patients combat their cancers by keeping their body weight at normal or slightly below normal levels. A patient’s desired body weight is regulated by their rate of metabolism, which in turn is regulated by their blood levels of thyroxine, cortisone, insulin, and the amounts of fats and oils in the diet. Studies with human cancer patients and laboratory animals show that reducing the calories of carbohydrates (glucose) in their daily diet by only 10 percent reduced the size of cancerous tumors. When carbohydrate (glucose) calories were reduced 40 percent, the cancers disappeared. It is recommended that those patients who are obese gradually and systematically lose their excess weight to increase the efficiency of the CAAT protocol. Those patients who are underweight shoudn’t gain weight unless they are more than 10 pounds below normal levels. When a patient is underweight due to anorexia or cachexia, such illnesses must be addressed before the CAAT protocol can begin.

Why we use Fructose and Vinegar to treat cancer:

Nobel Prize winner Dr. Otto Warburg discovered more than 50 years ago that all cancer cells produce inordinate amount of lactic acid but he couldn’t explain why.

In 2001 our Institute published the first study to show that cancer cells produce excess amounts of lactic acid because they could not access the oxygen in compartments in the cells called the mitochondria. This provided evidence that cancer cells depend almost exclusively upon glycolosis or the metabolism of glucose as their major source of energy.

Dr. Spitz and Dr. Lee with other cancer researchers published studies showing that when cancer cells are deprived glucose, their energy supply is cut off which causes these cancer cells to commit suicide.

Therefore shutting down glycolosis would be one means of destroying cancer cells because energy can only be derived from glucose through the metabolic process called glycolosis.

Recently our Cancer Institute discovered that both acetic acid and citric acid could inhibit the activity of a key enzyme in glycolosis called phosphofructokinase, which in turn shuts down the process of glycolosis. Our cancer Institute is the first to introduce both fructose and vinegar as treatments for cancer because they either contain or produce acetic acid.

In conclusion, fructose and vinegar are added as supplements to the CAAT protocol because of their acetic acid properties that help shut down glycolosis, shutting off cancer cells energy supply and causing them to die off.

Phase 3: Nutritional Supplements

Nutritional supplements are based on each unique situation. For example, slow-growing cancers produce low levels of toxic free radicals. Tumor cells that grow aggressively produce large amounts of toxic free radicals. The patient will be instructed whether or not to take anti-oxidants (in a nutritional supplement), and at what dosage, according to the levels of toxic free radicals produced in the cancerous cells.

An example of how nutritional supplements can help manipulate cancer cells involves vitamin B-6 (pyroxidine) There are four amino acids essential to the synthesis of DNA. However, those amino acids cannot be synthesized without a certain enzyme, which includes vitamin B-6 among other components. Any supplement containing vitamin B-6 SHOULD NOT be taken during the first 2 months of the CAAT protocol.

The patient will be instructed as to which nutritional supplements or phytochemicals should be purchased and at what dosage strength. Keep in mind that each supplement only complements the CAAT protocol. However, when they are combined they augment the therapeutic benefits of the aminoacid, carbohydrate, and glucose reduction diet.

Parsley: Contains ingredients that can help shut down certain enzymes called Epithelial Growth Factors, which stimulate the growth and spread of cancer. ( CAAT’S amino acid reduction diet works in the same manner )

Vitamin D: Helps activate in many kinds of cancers enzymes called Phosphotases, which literally shut down the activities of other enzymes called Kinases, which are essential to the growth and reproduction of cancer cells.

Green Tea Extract: Phytochemicals in tea help shut down glycolosis (cancer cell’s main supplier of energy) and thereby help to starve cancer cells to death. These effects help complement the effects of CAAT’S carbohydrate reduction.

Anti-Oxidants: The controversy as to whether or not to treat cancer with anti-oxidants is slowly resolving with the current understanding of how they affect the activity of genes and enzymes in cancer cells. The prevailing data shows that the benefits or lack of benefits depend upon the oxidative state the cancer cells are in. Anti-oxidants taken when the cells are in a very high oxidative state may prevent cancer cells from entering apoptosis ( apoptosis is when a cancer cell commits suicide) When oxidative stress in cancer cells is only slightly above normal, anti-oxidants are then expected to stop their growth and reproduction.

Blood Chemistry: Blood tests are usually taken every 6 to 8 weeks, depending upon the results of each test. Not only is it important to monitor the tumor markers but equally important to keep abreast of the overall health of normal tissues and organs. For example, it is important to learn of the health of the kidneys and liver, whether the body is producing sufficient red and white blood cells, etc. Low albumin levels most often indicate insufficient intake of proteins in the diet and this problem would have to be addressed. CAAT is designed to attack cancer but keep the normal cells and tissues functioning harmoniously.

Whey Protein: This protein food is recommended at the breakfast meal to help meet the daily needs of amino acids for the normal cells of the body, and to help keep albumin levels normal and to help prevent edema. We recommend Whey protein purchased from the Vitamin Shoppe because it is the only brand that we have seen with no phosphorous or additional vitamins added to it.

Grits: Grits are also recommended at the breakfast meal in place of whole grains because it is low in vitamin B-6. Cancer cells require B-6 to manufacture the amino acid Glycine, which is required for DNA synthesis. Grits, instead of whole grains, therefore helps prevent cancer cells from manufacturing DNA and building new blood vessels.

Calcium D-Glucurate: This phytochemical helps the body to retain a compound called Glucuronic acid. This is necessary to eliminate both estrogen and testosterone from the body. This is why Calcium D-Glucurate is added to the regiments of patients with breast & prostate cancers. Calcium D-Glucurate is not to be confused with calcium carbonate, which is nothing more than a calcium supplement.

D-Limonene: This phytochemical found mostly in citrus fruits blocks the process called Isoprenylation, which is necessary for tumor growth factors such as the RAS gene, Epithelial Growth factor, Tyrosine Kinase, and Insulin-Like-Growth-factor, to send their signals into the nucleus of a cancer cell and directs them to grow and divide into more cancer cells.

Tocotrienols: This member of the Vitamin E family also helps shut down Isoprenylation and assists D-Limonene in blocking the actions of the various tumor growth factors. More specifically, tocotrienols shut down an enzyme called HMG-2, which is essential to the synthesis of the building blocks that form the Isoprenylation process.

Niacin: This B-Complex vitamin works with D-limonene and the Tocotrienols to shut down the process of Isoprenylation, which as mentioned above prevents the cancer promoting RAS genes from sending signals into the nucleus of the cell. Niacin also helps deplete thee amino acid Glycine, which cancer cells need to synthesize DNA. And by reducing cholesterole in the body, Niacin helps lower the production of estrogen and testosterone.

Choline: This B-complex vitamin is included in our supplement list to help the liver metabolize Niacin and other compounds and to help fight fatigue that accompanies most forms of cancer.

Selenium: Numerous studies show that this mineral can interfere with the activity of certain genes that promote the growth of cancer and to induce cancer cells to commit suicide (apoptosis)

Perilla Oil: This oil is rich in Alpha Linolenic Acid which can inhibit the growth of cancer cells in several ways. One way is to inhibit the synthesis in the body of a tumor growth promotin hormone called Prostaglandin-2, also, Alpha Linolenic Acid inhibits the actions of certain genes that promote the growth of cancer cells. Linolenic acid is not to be confused with linoleic acid, which is a bad fat that stimulates the growth of cancer cells. This bad fat, linoleic acid, is found in all vegetable oils and nuts (With the exception of coconut oil). Olive oil has the least amount of this bad fat.

Super Miraforte: This herb impairs the synthesis of estrogen from testosterone in the body and is included in the regiments of women with breast cancer.
Licorice Root Extract & Pantothenic Acid: This herb and vitamin are added to the regiment when it is desirable to produce steroid like actions in the body. Also used to help patient’s gain weight and to inhibit the growth of lymphomas and leukemia’s.

Resveratrol: This phytochemical blocks the actions of a number of a number of cancer promoting genes thereby causing cancer cells to enter into apoptosis (cell death) and is included in the treatment of all cancers.

Indole-3 Carbinol & D.I.M.: These two phytochemicals block the actions of both estrogen and testosterone and are included in the regiments of both breast and prostate gland cancer.

Melatonin: Numerous studies show that this hormone blocks the synthesis of the cancer promoting chemicals in the body called Leukotrienes, and is included in the treatment of all cancers.

Artho Pro System: This combination of herbs and phytochemicals inhibits the synthesis of the cancer promoting hormone called Prostaglandin-2 and the Leukotriens and replaces the drug celebrex when liver problems are present. The Prostaglandin hormone is over active in most cancers and stimulates cancer growth. The body manufactures the Prostaglandin hormone from the bad fat, Linoleic acid, mentioned above.

Licorice Root Extract & Pantothenic Acid: This HERB and VITAMIN are added to the regiment when it is desirable to produce steroid like actions in the body. Used also to help patients gain weight and ti inhibit the growth of Lymphomas and Leukemias.

CAAT is designed to attack cancer, while keeping normal cells and tissues functioning harmoniously.

* When considering any type of complementary cancer treatment or alternative cancer treatment, always consult with your physician first, as possible interactions could reduce your regimen’s efficacy.

If this information has generated any questions you would like answered.