Colon carcinoma overview

Last author update: 15 April 2021
Last staff update: 21 April 2021

Copyright: 2002-2023,, Inc.

PubMed Search: "Carcinoma colon"

Raul S. Gonzalez, M.D.
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Cite this page: Gonzalez RS. Colon carcinoma overview. website. Accessed September 21st, 2023.
Definition / general
  • Primary epithelial malignancy arising in the colorectum
Essential features
  • More than 1 million new cases worldwide per year
  • Second or third most common cancer and cause of cancer deaths in men and in women
  • 98% of colonic cancers are adenocarcinomas
  • Most common gastrointestinal tumor in U.S.; less common in Africa, Asia and parts of South America
  • Affects 5% of the U.S. population during their lifetime
  • More common in men than women
  • Most common cause of cancer related death among nonsmokers
  • Peak age 60 - 79 years
    • < 20% of cases occur before age 50
    • Rare before age 40 except in patients with a predisposition syndrome
  • May arise anywhere in the colorectum but sigmoid colon and rectum are most common sites
  • Risk factors: older age, obesity, physical inactivity, alcohol consumption, inflammatory bowel disease, schistosomiasis, family history of colorectal neoplasia
  • Polyposis syndromes: familial adenomatous polyposis and variants (APC gene), Lynch syndrome and variants (MLH1, MSH2, MSH6 and PMS2 genes), juvenile polyposis (SMAD4, PTEN genes), Peutz-Jeghers syndrome (STK11 gene)
  • Dietary risk factors: low vegetable fiber, high refined carbohydrates, increased beef consumption, decreased vitamins A / C / E
    • Low fiber prolongs transit time (toxic oxidative byproducts are in longer contact with colonic mucosa) and alters bacterial flora
    • Beef consumption enhances synthesis of bile acids by liver, which may be converted into carcinogens by bile acids
Clinical features
  • Screening: colonoscopy, guaiac fecal occult blood test
  • Symptoms:
    • Right sided carcinomas cause anemia (due to blood loss) and vague abdominal pain
    • Left sided carcinomas cause change in bowel habits (diarrhea or constipation) and rectal bleeding
    • Some patients may be asymptomatic, and tumors are detected by screening, especially if lesion is early
  • Metastases:
    • 60% of patients have lymph node or distant metastases at diagnosis
    • Most common metastatic sites are regional lymph nodes, liver, peritoneum, lung, ovaries
    • Metastases may simulate primary tumors of affected organs
  • Prognosis:
    • 5 year survival is 40% - 60%
    • Most recurrences are within 2 years
  • Serum CEA: elevated levels associated with various carcinomas or liver disease
    • Useful for monitoring recurrences but not sensitive for early tumors
Radiology description
  • Imaging allows for clinical staging (depth of invasion, possibility of metastasis)
Prognostic factors
  • Poor prognostic factors: high stage, positive margins (particularly radial margin in rectal carcinoma), poor differentiation, signet ring cells, flat or ulcerative gross configuration, tumor budding, tumor perforation, free tumor cells in peritoneal space, lymphovascular invasion, perineurial invasion (Am J Clin Pathol 2003;119:108)
  • Lack of CDX2 expression and reduced claudin 1 expression portend worse survival in stage II tumors (N Engl J Med 2016;374:211, Mod Pathol 2005;18:511)
  • HER2 / neu and VEGF are not important prognostic markers (BMC Cancer 2011;11:277)
  • Resection with endoscopic follow up
  • Local excision (endoscopic mucosal resection) for early rectal carcinoma
  • Surgical excision of isolated distant metastases
  • Radiation therapy or chemotherapy (including neoadjuvant if rectal)
Board review style question #1
What is the most common gastrointestinal malignancy in the U.S.?

  1. Colorectal adenocarcinoma
  2. Esophageal squamous cell carcinoma
  3. Gastric adenocarcinoma
  4. Small bowel adenocarcinoma
Board review style answer #1
A. Colorectal adenocarcinoma

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Reference: Colon carcinoma overview
Board review style question #2
The following syndromes confer an increased risk of colorectal carcinoma. Which syndrome is properly linked to its causative germline mutation?

  1. Familial adenomatous polyposis: MLH1 mutation
  2. Juvenile polyposis: SMAD4 mutation
  3. Lynch syndrome: STK11 mutation
  4. Peutz-Jeghers syndrome: APC mutation
Board review style answer #2
B. Juvenile polyposis: SMAD4 mutation

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Reference: Colon carcinoma overview
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