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Constipation, diarrhea, and abdominal pain can all be symptoms of colorectal cancer.???

But they can also be signs of other conditions, including Crohn¡¯s disease, irritable bowel syndrome and even a stomach virus.??

So, how do you know when it¡¯s time to see a doctor???

¡°Any time symptoms persist for longer than two weeks, they are cause for concern,¡± says gastroenterologist ¡°That¡¯s particularly true if they¡¯re accompanied by abdominal pain, bloody stools or unintentional weight loss.¡±??

Here¡¯s how six of our patients knew they had colorectal cancer, in their own words.??

Blood in the stool or toilet bowl??

¡°I experienced bloody stools, bowel changes, and abdominal pains for months,¡± admits Anatole Karpovs, M.D., a pediatrician from Lake Charles, Louisiana, who was diagnosed in 2013. ¡°But as a 37-year-old doctor with a busy practice and a hectic family life, I didn¡¯t have time to be sick. So, I explained away my symptoms or minimized them. It was only later, when they became persistent enough that I couldn¡¯t ignore them, that I finally sought treatment.¡±?

Robert Harris was 76 when he was diagnosed with colorectal cancer in early 2019. ?¡°I started having dark stools and a little pain in my lower abdomen, so I called my family doctor,¡± explains the retired army veteran and project manager in the oil and gas industry. ¡°She thought it might be my appendix, since the pain was on my right side, so she brought me in for a check-up. But then she did a digital exam and said there was blood in my stool.¡±?

Diarrhea??

Courtney Nash, who was 35 when she was diagnosed, had been dealing with chronic diarrhea, frequent stomach aches and other digestive issues for more than 20 years due to ulcerative colitis.???

¡°But after the birth of my second daughter in 2011, my symptoms increased dramatically,¡± says Courtney, a sugar cane farmer from Harlingen, Texas. ¡°I started dropping weight, losing my hair and even passing blood occasionally.¡±???

Constipation or problems having a bowel movement??

¡°I started having problems going to the bathroom in the fall of 2015,¡± recalls John Kennedy, a then 48-year-old factory worker from Indiana. ¡°The constipation went on for two or three weeks, so I did the home remedy thing. I figured I¡¯d eat some greasy foods, and things would just slide right on through. But one day, I literally doubled over with stomach pain so bad that I had to leave work and go to an urgent care clinic.¡±??

¡°I¡¯ve always been easily constipated,¡± notes Abigail Pardo, who had recently graduated from high school when she was diagnosed with colorectal cancer in 2013. ¡°So, it didn¡¯t seem that strange to me. But a few months later, I started feeling really out of breath after even the slightest activity, and whenever I lifted something heavy, I¡¯d throw up right afterward. My family told me I looked really pale. Finally, I went to a doctor.¡±??

Unexplained and unexpected weight loss??

¡°Most people get a bit heavier over the holidays,¡± says Kenneth Rolston, M.D., a retired MD Anderson infectious diseases specialist who was 66 when he was diagnosed. ¡°But I¡¯d been losing weight steadily for about four months by early 2017. And I was not trying to. I was also experiencing fatigue.¡±??

Kenneth finally made an appointment after his wife looked across the dinner table at him one night and said, ¡°You are literally melting away before my eyes. What¡¯s it going to take to get you to go to the doctor?¡±???

Don¡¯t wait to call your doctor if you see any of these symptoms??

Colorectal cancer symptoms such as diarrhea, constipation, bloating and fatigue are common and non-specific enough that they could be caused by any number of conditions.

But if you experience one or more of the following ¡°alarm symptoms,¡± consider it a red flag and contact your doctor immediately.???

• Rectal bleeding??
• Stools that are black and either loose and sticky or tarry???
• Unusually severe fatigue (impedes your ability to perform daily activities)??
• Low blood count??
• Unintentional weight loss??
• Iron-deficiency anemia??

¡°Things like diarrhea and constipation are so general that they could be due to almost anything,¡± notes Richards. ¡°None of them necessarily mean that you have colorectal cancer. But if a symptom is persistent, rather than a one-time issue, it should at least warrant a conversation with your doctor.¡±??

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The sigmoid colon is the part of the large intestine (colon) closest to the rectum. It absorbs water from stool and pushes the stool to the rectum and anus until it¡¯s ready to be expelled when you use the bathroom.

Colorectal cancer is an umbrella term for colon cancer and rectal cancer. Studies have shown that colorectal cancer is more common in the sigmoid colon, which is on the left side, along with the descending colon and rectum. The rectum is also considered the left side even though it¡¯s not part of the colon.

Gastrointestinal medical oncologist , estimates that about 70% of colorectal cancers are diagnosed on the left side.

¡°It¡¯s unclear why colon cancer starts in a particular location, although some explanations exist,¡± says Raghav. ¡°However, left-side colon cancers are more common than right-side colon cancers.¡±

The colon starts at the cecum, which is on the right side. It goes up to the ascending colon, across the body to the transverse colon and down to the descending colon and sigmoid colon, which are on the left side.

We spoke with Raghav to learn more about the differences between left-side and right-side colon cancer. Here¡¯s what he shared.

It¡¯s common for left-side tumors to cause symptoms.

It's common for people with left-side colorectal cancer to have changes in their bowel habits or blood in their stool. People with right-side tumors often show fewer symptoms.

Left-side tumors and right-side tumors have different genetic characteristics.

Tumors that develop on the left side of the colon have more mutations of tumor-suppressing genes, like APC and TP53. These genes help prevent tumors from growing. Mutations in these genes make you more likely to develop certain cancers, including colon cancer.??

Tumors that develop on the right side of the colon are more likely in people who have hereditary cancer syndromes. These include high microsatellite instability (MSI-high) ¨C also referred to as DNA mismatch repair deficiency (dMMR) ¨C and Lynch syndrome.

Left-side tumors are easier to detect during a colonoscopy.

During a colonoscopy, your doctor examines the walls and lining of your colon, including the sigmoid colon, by inserting a flexible scope into your rectum and around your large intestine. Doctors examine the left side first since it¡¯s closer to where the scope is inserted. Colorectal cancer usually starts as a polyp in the colon or rectum.

Left-side tumors often present as polypoid lesions, which protrude into the lumen of the gastrointestinal tract and are easier to see. Colonoscopies are good at detecting these polyps, which is why getting this routine screening is so important.

Many polyps on the right side of the colon are sessile serrated adenomas. These are flat and harder to detect during a colonoscopy. Because of this, right-side colon cancers are often diagnosed at advanced stages and may be harder to treat.

Colonoscopy prep is important because your colon will need to be completely clean of any stool, so your doctor can easily see both the left and right side of your colon.

The side on which cancer develops helps determine your treatment.

Overall, left-side tumors have a better prognosis than right-side tumors. This is because colon cancer on the left side responds better to chemotherapy and targeted therapies, like anti-EGFR and HER2 drugs.

Right-side tumors tend to have more genetic mutations, which are often associated with more aggressive cancers. Right-side tumors are also harder to detect, so they¡¯re often diagnosed when the disease is more advanced. Recently, immunotherapy has been effective in treating these cancers because the body can recognize the abnormal cells and attack them. Immunotherapy has helped improve the prognosis for patients with stage IV right-side colon cancer.

Your doctor and care team will work together to develop the best treatment plan for you.?

Knowledge of left-side and right-side colon cancer leads to treatment advances.

We¡¯ve been treating colorectal cancer for a long time. But only in the last four or five years have we really started to understand the differences between colon cancer that develops on the left side versus the right side. Before then, it wasn¡¯t as commonly acknowledged.

Over the years, we have learned that colon cancer can¡¯t be viewed as one disease. We¡¯re now looking at it as a complex disease with many subtypes and trying to develop targeted and personalized therapies that can be used depending on the specific type people have. Slowly and steadily, we are moving the bar for personalized therapy in colorectal cancer. And I think the location of the cancer ¨C left side versus right side, including the sigmoid colon ¨C is a part of that.?

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Anal cancer and colorectal cancer both develop in the lower gastrointestinal tract, but these types of cancer differ in many ways.??

We spoke with gastrointestinal radiation oncologist , to learn more about the differences between anal cancer and colorectal cancer.

What parts of the lower digestive system do anal cancer and colorectal cancer affect??

Anal cancer affects the anal canal and anus.

Colorectal cancer affects the large intestine, including the cecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum.

What are the risk factors for anal cancer and colorectal cancer?

The most common cause of anal cancer is the human papillomavirus (HPV), particularly types 16 and 18, which cause 90% of anal cancers and precancers.

Other less common risk factors for anal cancer include:

• HIV infection
• smoking
• a weakened immune system caused by medicines taken for organ transplants, autoimmune diseases or other conditions

You¡¯re at greater risk for colorectal cancer if you have:

• history of precancerous polyps
• genetic syndromes, such as familial adenomatous polyposis or Lynch syndrome
• inflammatory bowel diseases, such as Crohn¡¯s or ulcerative colitis

Other risk factors for colorectal cancer include:

• a diet high in processed meats and low in fruits and vegetables
• lack of physical activity
• being overweight

What are the symptoms of anal cancer and colorectal cancer?

There are some overlapping symptoms. Anal cancer and colorectal cancer can both cause:

• weakness or fatigue
• unexplained weight loss
• belly or pelvic pain
• changes in bowel habits, such as:
  • anal or rectal bleeding
  • constipation
  • diarrhea
  • urgent bowel movements
  • difficulty controlling bowel movements

Symptoms specific to anal cancer include:

• itching or pain around the anus
• lumps in or around the anus
• pain in the anus when passing bowel movements

Symptoms specific to colorectal cancer include:

• abdominal pain
• bloating
• a feeling that the bowels don¡¯t empty completely

Anal cancer and colorectal cancer often have symptoms that can be mistaken for other conditions. For example, anal cancer is often misdiagnosed as hemorrhoids. This is why regular cancer screenings are so important. Be sure to get a colonoscopy or seek a second opinion if your symptoms don¡¯t resolve in a few weeks.

How are anal cancer and colorectal cancer diagnosed?

Anal cancer and colorectal cancer can be diagnosed at regular screening colonoscopy exams, even before a patient develops symptoms.

If you develop symptoms in between screening colonoscopies, a diagnostic colonoscopy can be performed to look inside the anal canal, rectum and colon to check for cancer. A biopsy can be performed to determine whether or not cancer is present.

How are anal cancer and colorectal cancer treated?

The most common type of cancer cell causing anal cancer is squamous cell carcinoma. It responds well to and is most commonly treated with radiation therapy and chemotherapy delivered together. We can sometimes use a procedure called a local excision to remove very small and early-stage anal cancers that have not metastasized to the lymph nodes and do not invade the sphincter. This represents a minority of anal cancer cases.

Treatment options for colorectal cancer differ depending on the location of the cancer. Tumors in the colon can be treated with surgery alone, or chemotherapy may be given before or after surgery, depending on the size of the tumor and whether or not the cancer has spread to lymph nodes.

Tumors in the rectum have a higher chance of coming back after surgery, so rectal cancer is often treated with chemotherapy and/or radiation therapy before surgery. Patients with rectal cancer have several treatment options, depending on the location of the tumor in the rectum, its size and whether the cancer has spread to lymph nodes. These treatment options are:?

• chemotherapy followed by surgery and no radiation if the tumor shrinks enough after chemotherapy
• chemotherapy followed by radiation and no surgery if there is no cancer left after chemotherapy and radiation
• chemotherapy, radiation and surgery if there is a high risk of recurrence

Getting the right diagnosis is the best way to ensure you get the correct treatment. And with early detection, both anal cancer and colorectal cancer can be successfully treated.

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Most people diagnosed with colon cancer won¡¯t mention pain as one of their symptoms. But when they do, how do they describe it? What does the pain caused by colon cancer actually feel like? And, does it tend to occur only in certain locations?

We went to gastrointestinal medical oncologist , for insight. Here¡¯s what he shared.?

What does colon cancer pain feel like?

Most patients who come to our clinic with pain as a symptom describe it as an intermittent crampy feeling in their abdomen.?

But it¡¯s important to note that many of our patients say that they don¡¯t have any pain at all. Instead, they might report an odd sensation of fullness in their abdomen or notice some blood in their stool.

How common is pain as a sign of colon cancer?

Not very. I¡¯d say only about 15% of our patients mention pain as one of their colon cancer symptoms.

Does colon cancer pain always occur in a particular spot??

No. But patients with more advanced colon cancer that has spread to the liver sometimes notice a sense of fullness or bloating in the upper right side of their abdomen.

And, depending on where a tumor is located, it can also cause an obstruction, or a blockage in the colon, which can cause severe pain. Those typically occur on the lower left side of the abdomen.??

But again, a lot of our colon cancer patients don¡¯t report pain as a symptom. They just see a little blood on the toilet paper and get referred for a colonoscopy.??

To be clear here, are we talking about actual pain?or just significant discomfort?

One person¡¯s painful is another person¡¯s uncomfortable. So, there¡¯s a wide spectrum. And it¡¯s very subjective.

Primary tumors located in the colon ¡ª and even those that have spread to other organs ¡ª can cause real pain. And patients who have a full-blown obstruction can be in a lot of pain. But those who don¡¯t might just experience some mild discomfort or even an occasional crampy feeling.

What other conditions do patients tend to confuse with colon cancer pain??

• constipation
• hemorrhoids?
• gas?
• spicy foods
• irritable bowel syndrome (IBS)?

If you¡¯re experiencing abdominal pain or discomfort for more than a couple of weeks, talk to your doctor and make a plan. Try traditional interventions first to address the most common complaints and see if that resolves them. If not and your symptoms persist, please follow up.

What¡¯s the one thing you want people to know about pain as a symptom of colon cancer?

Colon cancer is not just a diagnosis of the elderly anymore. More and more young people are being diagnosed with colon cancer ¡ª even in their late 30s and early 40s. They¡¯re also presenting with more advanced cases of disease. That¡¯s why the recommended age for people¡¯s first colon cancer screening with a colonoscopy was recently lowered from age 50 to 45.

That¡¯s also why it¡¯s so important to be aware of your body. If something doesn¡¯t feel right, see your doctor.

Don¡¯t chalk up your symptoms to something like hemorrhoids or constipation, especially if you¡¯ve also noticed a change in your bowel habits, such as:

• more frequent bowel movements
• feeling like you¡¯re not emptying your bowels completely
  
• your stool shape or consistency has changed and/or
• rectal bleeding

Even a new, vague sense of discomfort is not unreasonable to investigate since a growing number of people are getting diagnosed with colon cancer at a younger age. So, listen to your body and take your symptoms seriously.

or by calling 1-877-632-6789.

Anal cancer?can be hard to talk about. And, even when it is talked about, anal cancer is often mistaken for ¡ª or lumped together with?¡ª?colorectal cancer, instead of being recognized as the distinct type of cancer that it is.

But talking about anal cancer is important, both for educational purposes and to allow those affected by the disease to feel less alone?¡ª especially with rates of HPV-related anal cancer climbing. The topic may be a bit uncomfortable, but it isn¡¯t without hope. Most early-stage anal cancers can be cured with chemoradiation alone.?

Here are some common anal cancer questions I hear.?

What is anal cancer, and how does it differ from colorectal cancer?

Anal cancer is a completely different disease with a different biology. It¡¯s also treated differently.?

Colorectal cancers tend to be adenocarcinomas, which arise from the glands in the gastrointestinal tract. Anal cancers, on the other hand, tend to be squamous cell carcinomas, which develop on the surfaces lining the body.??

Anal cancer is also primarily caused by HPV infection; colorectal cancer is not.??

The two cancers are also treated differently. The standard treatment for anal cancer is chemoradiation alone if the cancer hasn¡¯t spread. But colorectal cancer may be treated with some?combination of chemotherapy, radiation and surgery, depending on its location.?

Who is most at risk for developing anal cancer??

In the United States, women are twice as likely as men to develop anal cancer. People who are immunocompromised ¡ª whether it¡¯s due to cancer treatment, diseases like HIV, immunosuppressive drugs for autoimmune diseases or a prior organ transplant ¡ª are also at higher risk.?

Still, it¡¯s important to note that anal cancer is not very common. Only about 9,000 people are diagnosed with it a year in the United States.?

Can anal cancer be prevented???

The majority of anal cancer cases are?caused by exposure to the human papillomavirus (HPV). HPV is the most common sexually transmitted disease.??A lot of people never even realize they¡¯ve been exposed to HPV, because the body usually clears it naturally. Only a very small fraction will develop HPV-related cancers like anal cancer.?

That¡¯s why we highly recommend getting vaccinated against HPV, ideally at around age 11 or 12, or before the onset of sexual activity. That¡¯s when you¡¯ll derive the most benefit from it as a cancer-preventing vaccine. As early as age 9 is reasonable, though, and everyone up to age 26 should get the HPV vaccine. If you¡¯re age 27-45 and have been sexually active, there may still be some benefit to getting the HPV vaccine. Talk to your doctor to see if it¡¯s right for you.?

The vaccine has proven to be safe and effective at preventing infection from the nine known strains of HPV that are linked to cancer and genital warts. In addition to preventing most anal cancers, the vaccine also prevents most cervical, penile, vaginal and vulvar cancers, plus HPV-related throat cancers.??

How is anal cancer typically diagnosed? Are anal cancer symptoms ever mistaken for other things?

Anal cancer is often detected initially after patients experience certain symptoms, such as:?

• pain during a bowel movement
• a little bleeding during or after a bowel movement?
• a change in bowel habits?

That¡¯s normally when people consult their doctors: when their symptoms persist, increase or get worse.

Can hemorrhoids cause anal cancer???

No. Sometimes, people have what they think is a hemorrhoid that won¡¯t go away, and it turns out to be anal cancer. But hemorrhoids and anal cancer are two separate things. And neither one causes the other.?

Is bowel leakage ever a sign of anal cancer????

No. Not usually. But anal bleeding and discharge can be.??

What does anal cancer look like? Is it ever a lump you can see?

Occasionally, someone will be able to feel a lump or a mass through the skin. But anal cancer is not typically visible from outside the body. It tends to form internally, so the more common ways to see it usually are through an endoscope or on a scan.

How fast does anal cancer grow???

Anal cancer is a fairly slow-growing disease. It probably takes several years to develop.?

What can patients expect during their first appointment for anal cancer?

At MD Anderson, you¡¯ll meet with a team of specialists, including a medical oncologist, a radiation oncologist, and a surgical oncologist. All of them will specialize in treating anal cancer.??

You¡¯ll go over your medical history. At some point, you¡¯ll likely have a proctoscopy, a type of internal examination conducted with a scope. It¡¯s similar to a colonoscopy but doesn¡¯t require anesthesia or the same type of preparation. It can usually be performed in a doctor¡¯s office.???

You¡¯ll also have some imaging studies done to fully assess the extent of the cancer, and blood tests to help determine the most appropriate chemotherapy dosages.

What treatments are available for anal cancer??

Most patients with anal cancer that hasn¡¯t spread can be cured with chemoradiation alone. That¡¯s when chemotherapy is given in tandem with radiation therapy to make the radiation more effective.???

If the cancer comes back, we¡¯ll do surgery. We do everything we can to prevent that, though, because it often requires a permanent ostomy. We¡¯ll use immunotherapy and other systemic therapies if other organs are involved.??

One thing we do differently here at MD Anderson involves the selection of chemotherapy agents and their dosages. We may dose patients differently than your local doctor normally would. What that means is that if you come to MD Anderson, your likelihood of survival will be about the same, but your treatment can be much less toxic. And that means you¡¯ll likely have fewer side effects and a better quality of life.

Can anal cancer be cured????

We cure over 80% of our patients with?stage I or stage II anal cancer, and about 60% of our patients with stage III anal cancer.

Stage IV anal cancer usually cannot be cured, but it can be treated.?

What lifestyle changes can anal cancer patients expect after treatment?

Patients typically experience side effects for up to six months after treatment ends. But it takes some patients up to a year before they start feeling more like their old selves.?

Tender, sensitive skin is one of the most common short-term side effects of radiation therapy. For that, we normally recommend moisturizing creams and topical ointments.?

Long-term side effects may include differences in sexual, bowel or bladder function. We educate patients about how to manage those.

What are the latest research advances for anal cancer?

We¡¯ve developed an in-house circulating DNA blood test to detect the presence of HPV and identify patients at high risk for recurrence.??

We¡¯re also developing an immunotherapy clinical trial for these patients, which would be the first in the world to use circulating HPV-positive tumor DNA as a prerequisite for study entry.

What advice would you give to newly diagnosed anal cancer patients?

Where you go first for anal cancer treatment matters. You want to make sure you¡¯re going someplace with a lot of experience in treating anal cancer.?

MD Anderson is one of the leading institutions in the United States for treating patients with anal cancer. Our focus is not only on curing the cancer but on personalizing the treatment so it¡¯s less toxic than the standard therapy you might otherwise get from your local oncologist.??

We want our patients¡¯ quality of life to remain as high and functional as possible, even after treatment. So, we go out of our way to create treatment plans that will cause fewer long-term disruptions to patients and their families.

or call 1-877-632-6789.