Introduction: Cancers of the colon and rectum, often collectively referred to as colorectal cancer, are life-threatening tumors that

develop in the large intestine. More than 80% of colorectal tumors develop from adenomatous polyps. These gland-like growths develop on the mucous membrane that lines the large intestine. They are usually either: Tubular polyps, which protrude mushroom-like Villous adenomas, which are flat and spreading and are more apt to become malignant (cancerous)

Polyps are very common, and most of them are benign. Their numbers increase with age. Polyps are found in about 25% of people by age 50, and 50% of people by age 75. Fewer than 1% of polyps under 1 centimeter (slightly less than half an inch) become cancerous. About 10% of larger polyps become cancerous within 10 years, and about 25% of these larger polyps become cancerous after 20 years.

NATURE OF THE DISEASE: Colorectal cancer is a disease in which normal cells in the lining of the colon or rectum begin to change, start to grow uncontrollably, and no longer die. These changes usually take years to develop; however, in some cases of hereditary disease, changes can occur within months to years. Both genetic and environmental factors can cause the changes. Initially, the cell growth appears as a benign (noncancerous) polyp that can, over time, become a cancerous tumor. If not treated or removed, a polyp can become a potentially life-threatening cancer. Recognizing and removing precancerous polyps before they become cancer can prevent colorectal cancer.

PHYSIOLOGY OF THE ORGAN: The Gastrointestinal Tract Digestion takes place in the gastrointestinal (GI) tract, essentially a long tube that extends from the mouth to the anus. It is a complex organ system that first carries food from the mouth down the esophagus to the stomach. Food then travels through the small and large intestines before being excreted through the rectum and out the anus. The esophagus, stomach, and large and small intestine -- aided by the liver, gallbladder, and pancreas -convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

Esophagus The esophagus is a narrow muscular tube, about 9 1/2 inches long, that begins below the tongue and ends at the stomach.

Stomach

The stomach is a portion of the digestive system responsible for breaking down food. The lower esophageal sphincter at the top of the stomach regulates food passing from the esophagus into the stomach, and prevents the contents of the stomach from reentering the esophagus. The pyloric sphincter at the bottom of the stomach governs the passage of food out of the stomach into the small intestine. Small intestine

The small intestine is the portion of the digestive system most responsible for absorption of nutrients from food into the bloodstream. The pyloric sphincter governs the passage of partly digested food from the stomach into the duodenum. This short first portion of the small intestine is followed by the jejunum and the ileum. The ileocecal valve of the ileum passes digested material into the large intestine.

Large intestine

The large intestine is the portion of the digestive system most responsible for absorption of water from the indigestible residue of food. The ileocecal valve of the ileum (small intestine) passes material into the large intestine at the cecum. Material passes through the ascending, transverse, descending and sigmoid portions of the colon, and finally into the rectum. From the rectum, the waste is expelled from the body. Rectum and Anus. Feces are stored in the descending and sigmoid colon until they are passed through the rectum and anus. The rectum extends through the pelvis from the end of the sigmoid colon to the anus.

PATHOPHYSIOLOGY OF THE DISEASE: Cancer of the colon and rectum is predominantly (95%) adenocarcinoma (ie, arising from the epithelial lining of the intestine). It may start as a benign polyp but may become malignant, invade and destroy normal tissues, and extend into surrounding structures. Cancer cells may break away from the primary tumor and spread to other parts of the body (most often to the liver).

Most Common Site: Rectosigmoid area (70%)