AI Summary Overview
What is Colon Cancer?
Colon cancer is a form of cancer that begins with the mucosa, or the inner membrane of the large intestine (colon). Colon cancer occurs when some benign growths (polyps) located in the inner membrane of the colon undergo genetic changes and become malignant. It usually takes about five to fifteen years for some types of polyps called adenomas to transform into malignancy.
Colon cancer is one of the most dangerous cancers known. A person can get colon cancer due to poor lifestyle habits, such as wrong food habits, physical inactivity, drinking, and smoking. With a highly preventive nature, colon cancer is also considered one of the most preventable cancers.
What are the Types of Colon Cancer?
Different types of colon cancer arise due to the malignancy of the different cells within the intestine. Types of colon cancer include:
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Adenocarcinoma Adenocarcinoma is one of the common forms of colon cancer. The adenocarcinomas derive from the mucous-secreting glands of the colon wall lining. It normally evolves slowly from a harmless polyp called an adenomatous polyp. The two major forms include mucinous adenocarcinoma, which makes lots of mucus, and signet-ring-cell adenocarcinoma, which is highly malignant.
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Carcinoid Tumours (Neuroendocrine Tumours) Carcinoid tumours develop from the hormone-producing cells found in the walls of the intestines. These are typically slow-growing tumours whose symptoms tend to manifest after several years. The colon carcinoids are less common than appendiceal or small intestinal carcinoids, but are still capable of spreading to the liver if left untreated.
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Gastrointestinal Stromal Tumours (GIST) A GIST arises from specific cells in the colon walls, called interstitial cells of Cajal, as opposed to the lining cells. The management of GIST involves the application of molecularly targeted therapy and not the usual chemotherapy.
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Colonic Lymphoma Colonic lymphoma is an uncommon variant of non-Hodgkin's lymphoma that may develop in the colon or spread from the lymph nodes to the colon.
Stages of Colon Cancer
Colon cancer is commonly staged from 0 to IV using the TNM system. The stage describes how deeply the cancer has grown into the colon wall and whether it has spread to nearby lymph nodes or distant organs.
The various stages of colon cancer are described briefly in the table below:
| Stage | Features |
| Stage 0 | Abnormal cells are limited to the innermost lining of the colon and have not invaded deeper tissues. This is also called carcinoma in situ. |
| Stage I | Cancer has grown into deeper layers of the colon wall but has not spread to nearby lymph nodes or distant organs. |
| Stage II | Cancer has grown through the colon wall and may involve nearby tissues or organs, but it has not spread to nearby lymph nodes. |
| Stage III | Cancer has spread to nearby lymph nodes but has not reached distant parts of the body. |
| Stage IV | Cancer has spread to distant organs or tissues, commonly the liver or lungs. This is also called metastatic colon cancer. |
How Common is Colon Cancer in India?
Colon cancer is an important part of the growing colorectal cancer burden in India. Colorectal cancer (CRC) includes cancers that develop in either the colon or the rectum. In 2022, India recorded an estimated 64,863new colorectal cancer cases and 38,367 deaths, making CRC the fourth most common cancer in the country. These figures represent colon and rectal cancers combined.
Over 24.09% of CRC cases occur under the age of 40. Moreover, most of the cases are stages III and IV, which implies that there is no regular screening test being done in India.
Colon cancer is highly underreported in India due to the lack of proper healthcare institutions in rural India, misattribution of symptoms, and the absence of universal screening programmes for colorectal cancers.
What are the Symptoms of Colon Cancer?
Colon cancer may not cause noticeable symptoms in its early stages. When symptoms appear, they often involve changes in bowel habits, bleeding or unexplained changes in general health.
Common early warning signs and advanced stage symptoms of colon cancer are:
| Early Warning Signs | Advanced Stage Symptoms |
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Diseases Similar to Colon Cancer
Colon cancer can resemble other bowel conditions that cause abdominal pain, changes in bowel habits, rectal bleeding or unexplained weight loss. Inflammatory bowel disease (IBD) and diverticulitis can produce overlapping symptoms with colon cancer, but have different causes and treatments.
These three conditions and their distinct features are discussed briefly in the table below:
Colon Cancer Vs. Inflammatory Bowel Disease Vs. Diverticulitis
| Feature | Colon Cancer | Inflammatory Bowel Disease (IBD) | Diverticulitis |
| How It Happens | Abnormal cells in the colon grow uncontrollably and form a malignant tumour. | Persistent inflammation develops in the digestive tract due to conditions such as Crohn's disease or ulcerative colitis. | Small pouches in the colon wall become inflamed or infected. |
| Location | Develops in any part of the colon and may spread to nearby or distant organs. | Crohn's disease can affect different parts of the digestive tract, while ulcerative colitis affects the colon and rectum. | Most commonly affects pouches in the lower part of the colon. |
| Associated Symptoms | Persistent bowel changes, blood in the stool, abdominal discomfort, fatigue and unexplained weight loss may occur. | Diarrhoea, abdominal pain, blood in the stool, fatigue, reduced appetite and weight loss may occur. | Abdominal pain, commonly on the lower left side, may occur with fever, nausea, tenderness, constipation or diarrhoea. |
| Severity | Advanced cancer can cause bowel obstruction or spread to other organs and become life-threatening. | Severe inflammation may cause bleeding, bowel obstruction or other serious complications. | Severe cases may cause abscesses, perforation or other complications requiring hospital treatment. |
| Can It Be Reversed? | Early stage colon cancer may be cured with appropriate treatment, while advanced disease may require long-term management. | IBD cannot usually be cured with medicines, but treatment can control inflammation and maintain remission. | Most uncomplicated cases improve with appropriate treatment, although diverticulitis may recur. |
What Causes Colon Cancer?
Causes and risk factors of colon cancer include:
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Causes
- Dietary Components: The consumption of high quantities of red meats, processed meats (beef, pork, sausage, and ham), and fatty foods increases the chance of developing colon cancer.
- Obesity and Sedentarism: Obesity and lack of physical activity are independent risk factors for colon cancer development, as it may lead to the development of insulin resistance, chronic inflammation, and hormonal imbalance.
- Tobacco Smoking and Chronic Alcohol Consumption: Chronic consumption of both tobacco smoke and alcohol increases the risk of developing colon cancer.
- Inflammatory Bowel Disease (IBD): The presence of chronic ulcerative colitis or Crohn's disease increases the risk of developing colon cancer. Regular colonoscopy in IBD cases is required.
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Risk Factors
- Age: The risk of being affected by colon cancer increases dramatically when someone crosses the age of 50
- Family History of Colon Cancer/Syndrome: If someone has a family history of colon cancer, they are at a higher risk of acquiring the disease.
- Type 2 Diabetes Mellitus: Patients suffering from type 2 diabetes mellitus have high levels of IGF-1, leading to the proliferation of colonic cells.
- Previous Exposure to Radiation to the Abdomen or Pelvis: Exposure of the abdomen/pelvis to radiation as a consequence of the therapy for other cancers leads to the development of secondary colon cancer.
Complications of Colon Cancer
Complications associated with undiagnosed or untreated late-stage colon cancer are:
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Bowel Obstruction: The tumour can partially or totally obstruct the bowel. The result is acute abdominal pain, vomiting, and inability to defecate, which may require urgent surgery.
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Bowel Perforation: Tumour pressure or the tumour itself could perforate the bowel lining. This can lead to an infection called peritonitis.
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Metastatic Spread: Colon cancer can commonly spread to the liver, lungs, and the peritoneal cavity. Nearly half of the patients with advanced colon cancer have metastatic lesions in the liver.
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Severe Anemia: Bleeding slowly from the tumour into the intestine gives rise to anaemia, resulting in chronic fatigue and shortness of breath.
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Colostomy: Surgery may be required to remove some parts of the colon. A colostomy, which involves the creation of an artificial opening in the abdomen to facilitate the evacuation of the bowel contents, will affect body image and quality of life, especially in younger patients.
When Should I See My Healthcare Provider?
Contact a healthcare provider immediately if you experience the following:
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Recurrent rectal bleeding or blood in your feces at any age
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A persistent change in bowel habits over a period of more than four weeks with no identifiable reason
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Weight loss coupled with abdominal discomfort or alteration in the consistency of stools
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Feelings of fatigue and pallor associated with anaemia, particularly above 40 years of age
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The feeling that the bowel motions have not been completely evacuated, especially when it occurs suddenly
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Any first-degree relative who is under 60 years of age with colon cancer or polyps
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Being 45 years old or older, but never having had a colonoscopy done before
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Colitis ulcerativa/Crohn's disease persisting for over eight years
How is Colon Cancer Diagnosed?
Here are the medical tests that doctors often conduct to diagnose colon cancer:
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Colonoscopy: Colonoscopy involves inserting a flexible tube with a camera into the colon through the rectum to visualise the entire colon. It helps observe any tumour or polyp and obtain a biopsy of the detected lesion.
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CT Colonography/Virtual Colonoscopy: It is a non-invasive technique that uses CT images to create a three-dimensional picture of the inside of the colon. The procedure is recommended for patients unable to perform a conventional colonoscopy.
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Faecal Immunochemical Test and Faecal Occult Blood Test: They are non-invasive screening techniques aimed at detecting invisible blood in stool.
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Computed Tomographic Scan of the Chest, Abdomen, and Pelvis: Once colon cancer is diagnosed, a staging CT will be done to determine if there is a metastasis of the disease to other organs.
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Tissue Biopsy and Histopathology Analysis: Histopathology analysis of the tissue sample biopsied through colonoscopy will help confirm the specific type of cancer (such as adenocarcinoma) and its grade of malignancy.
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Molecular and Genetic Testing (MSI, KRAS, BRAF, HER2): Molecular pathology helps determine the patient's suitability for immunotherapy and targeted therapy treatments.
Diagnostic Overview Table
| Test Name | Purpose | What the Doctor Checks |
| Colonoscopy | To examine the inside of the colon and detect abnormalities. | Presence of polyps, tumours, bleeding, inflammation, or other suspicious lesions. Tissue samples can also be collected for biopsy. |
| CT Colonography (Virtual Colonoscopy) | To create detailed images of the colon when a standard colonoscopy is not suitable. | Polyps, masses, narrowing of the colon, or other structural abnormalities. |
| Faecal Immunochemical Test (FIT) and Faecal Occult Blood Test (FOBT) | To screen for hidden blood in the stool. | Microscopic blood that may indicate colon cancer, polyps, or other gastrointestinal conditions. |
| CT Scan of the Chest, Abdomen, and Pelvis | To determine the extent of the disease after diagnosis. | Whether the cancer has spread to nearby tissues, lymph nodes, liver, lungs, or other organs. |
| Tissue Biopsy and Histopathology Analysis | To confirm the diagnosis of colon cancer. | Presence of cancer cells, cancer type (such as adenocarcinoma), and tumour grade. |
| Molecular and Genetic Testing (MSI, KRAS, BRAF, HER2) | To guide treatment planning and assess eligibility for targeted therapies. | Genetic and molecular changes in the tumour that may influence prognosis and treatment response. |
How is Colon Cancer Treated?
Treatment of colon cancer is based on the stage of the cancer, its localisation, genetic factors, and the overall health of the patient. Common treatment methods of colon cancer include:
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Surgery: The primary method of treating localised colon cancer is surgery. The tumour is surgically removed with some normal tissues around it, and the affected lymph nodes.
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Chemotherapy: Chemotherapy can be done after surgery to eliminate microscopic cancer cells (adjuvant chemotherapy).
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Radiation Therapy: Radiation therapy is sometimes used in colon cancer, and is generally applied before the surgery (neoadjuvant chemoradiotherapy) to shrink tumours and reduce the chances of local tumour recurrence.
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Targeted Therapy: These therapies involve the use of drugs that specifically target molecular structures inside tumours. They are particularly useful in stage four colon cancers.
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Immunotherapy: Checkpoint immunotherapy has resulted in significant developments in treating MSI-H colon cancer. Checkpoint inhibitors act by blocking any breaks in the immune system, which enables it to attack the cancer cells.
Common Medicines Used to Treat Colon Cancer
Medicines used for colon cancer depend on the stage of the disease, previous treatment and molecular test results. Treatment may include chemotherapy, targeted therapy or immunotherapy.
Common medicines used for colon cancer treatment are:
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Fluorouracil (5-FU): This chemotherapy medicine is commonly combined with leucovorin and other medicines such as oxaliplatin or irinotecan.
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Capecitabine: This oral chemotherapy medicine is converted to fluorouracil in the body and may be used alone or with oxaliplatin.
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Oxaliplatin: Oxaliplatin is commonly combined with fluorouracil and leucovorin in the FOLFOX regimen or with capecitabine in the CAPOX regimen.
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Irinotecan: This chemotherapy medicine is commonly combined with fluorouracil and leucovorin as the FOLFIRI regimen, particularly for advanced or metastatic colon cancer.
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Bevacizumab: This targeted medicine may be added to chemotherapy for selected patients with advanced or metastatic colon cancer.
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Cetuximab and Panitumumab: These targeted medicines may be used for selected metastatic cancers without certain RAS mutations.
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Encorafenib: This targeted medicine may be combined with cetuximab for metastatic colon cancer with a BRAF V600E mutation.
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Pembrolizumab and Nivolumab: These immunotherapy medicines may be used for selected advanced colon cancers with MSI-high (MSI-H) or mismatch repair-deficient (dMMR) tumours.
Note: The type of medicine used for colon cancer treatment depends on the stage of the malignancy, the tumour genetics, past treatments and the general health of the patient. These drugs should be administered only under the guidance of a qualified oncologist.
Living with Colon Cancer: Daily Challenges and Caregiving
Living with colon cancer can affect bowel habits, energy levels, appetite, work and emotional well-being. Surgery, chemotherapy and other treatments may also cause side effects that require ongoing medical care and support with daily activities.
Some of the challenges and critical caregiving points of colon cancer patients are listed below:
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Challenges
- Changes in Bowel Habits: Diarrhoea, constipation or more frequent bowel movements may affect everyday routines.
- Persistent Fatigue: Cancer and its treatment can cause tiredness that interferes with work, exercise and social activities.
- Eating and Weight Changes: Reduced appetite, nausea or digestive problems may make it difficult to maintain adequate nutrition.
- Adjusting to an Ostomy: Some patients may need a temporary or permanent colostomy or ileostomy and require time to adapt to stoma care.
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Caregiving and Patient Safety
- Daily Support: Caregivers may assist with meals, medicines, transport, appointments and household activities during treatment.
- Stoma Care: Patients with an ostomy may need support with pouch changes, skin care and recognising complications.
- Symptom Monitoring: Persistent vomiting, severe abdominal pain, heavy bleeding or sudden worsening of symptoms should be reported promptly.
- Emotional Support: Family members can provide reassurance and help patients manage anxiety, treatment stress and concerns about cancer recurrence.
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Expenses
- Cancer Treatment: Surgery, chemotherapy, targeted therapy or immunotherapy may contribute substantially to treatment costs.
- Tests and Follow-Ups: Colonoscopies, imaging, blood tests and oncology consultations may create recurring expenses.
- Stoma and Supportive Care: Ostomy supplies, medicines, nutritional support and management of treatment side effects may add to ongoing costs.
- Caregiving and Lost Income: Recovery from surgery or prolonged treatment may require time away from work for both patients and caregivers.
What is the Prognosis for Colon Cancer?
The prognosis of colon cancer mainly depends on the stage of cancer found. For example, in the case of Stage I colon cancer without any surgical procedure, the probability of survival is high. However, for the majority of people in India, colon cancer occurs at stages III and IV when the patient would require much more aggressive therapy with a poorer prognosis.
Total removal is likely to lead to effective treatment at an early stage. Even stage IV colon cancer can be treated with targeted therapies and immunotherapy, extending patients' lives considerably.
How to Prevent Colon Cancer?
Preventive measures for colon cancer include:
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Eating more fiber in the form of whole grains, beans, fruit, and vegetables rather than eating refined carbohydrates
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Eating low quantities of red meat, less than three servings per week, and not eating processed meats such as sausage and ham.
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Maintaining a proper weight because obesity can cause colon cancer
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Scheduling regular exercise for 150 minutes per week. Exercise lowers the risk of developing colon cancer by 25%
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Avoid chronic drinking as it can lead to colon cancer.
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Never smoke because it increases the risk of colon cancer
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Visit your doctor regularly and take colonoscopy tests after reaching the age of 45 years.
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In case of having inflammatory bowel disease, have a colonoscopy every eight years.
Colon Cancer Treatment Cost in India
The treatment cost for colon cancer in India depends on various factors like the stage of disease, type of treatment, hospital, the city and if you need advanced therapies like targeted therapy or immunotherapy. The total cost of the procedure for colon cancer can vary from ₹3 lakh to anywhere above ₹25 lakh.
An overview of colon cancer treatment costs in India is given in the table below:
| Treatment | Average Cost Range (₹) |
| Gastroenterologist consultation | ₹500 - ₹2,500 |
| Colonoscopy | ₹3,000 - ₹10,000 |
| Colonoscopy with biopsy | ₹8,000 - ₹25,000 |
| CT scan | ₹3,000 - ₹10,000 |
| PET-CT scan | ₹18,000 - ₹35,000 |
| Histopathology examination | ₹2,000 - ₹10,000 |
| Colon cancer surgery (colectomy) | ₹2.5 lakh - ₹8 lakh |
| Chemotherapy (per cycle) | ₹12,000 - ₹1 lakh |
| Targeted therapy (per month) | ₹50,000 - ₹2 lakh |
| Immunotherapy (per cycle) | ₹1 lakh - ₹5 lakh |
Note: The above treatment expenses are estimates and may vary depending on the stage of colon cancer, treatment strategy, hospital, city, specialist fees, and patient health. Diagnostic testing, hospitalisation, supportive care, targeted therapy, immunotherapy, and follow-up visits may increase costs.
Does Health Insurance Cover Colon Cancer?
Yes. Colon cancer is covered under standard health insurance plans, cancer insurance plans and critical illness insurance plans in India. It usually covers the cost of in-patient hospitalisation, surgeries, chemotherapies, radiotherapy, day care procedures and even targeted/immunotherapy. If colon cancer is a pre-existing condition, the waiting period can be up to 36 months, depending on the policy.
Critical illness insurance plans usually pay a fixed lump sum when colon cancer is diagnosed for the first time. These plans often have an initial waiting period of up to 90 days and may also require serving a survival period of up to 30 days.
Cancer insurance plans may provide coverage for early stage and major stage of colon cancers, along with features such as a premium waiver or income support. However, the exact coverage, waiting periods and exclusions may vary by policy.
How Much Health Insurance Coverage is Needed for Colon Cancer Treatment?
The treatment cost of colon cancer depends on the stage of cancer, the type of treatment, and the hospital and its location. If the treatment of colon cancer in the earlier stages (stage I – II) is just surgery, the overall cost of treating the disease would be in the range of ₹5 lakh to ₹15 lakh.
Hence, a mediclaim policy with a sum insured amount of ₹10 to 15 lakh is enough to cover uncomplicated surgery and limited adjuvant chemotherapy for colon cancer.
In the case of higher colon cancer stages (III & IV), the treatment may involve surgical intervention and chemotherapy or immunotherapy, which may increase the expenses. Hence, a higher sum insured of ₹15 lakh to ₹25 lakh is recommended.
Frequently Asked Questions (FAQs)
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Q1. What is the difference between colon cancer and rectal cancer?
Ans: Colon cancer begins in the colon, while rectal cancer develops in the rectum, the last part of the large intestine. Together, they are referred to as colorectal cancer. -
Q2. Can colon cancer be cured?
Ans: Yes, colon cancer can be cured only if it is diagnosed on time. Survival rate is high in the early stages. But if diagnosed in later stages, survival rates usually decline. -
Q3. What are the early warning signs of colon cancer?
Ans: Early warning signs of colon cancer include the presence of bleeding while passing stool, prolonged changes in bowel movements, sudden weight loss, and abdominal pain.
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References
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https://www.cancer.gov/about-cancer/treatment/drugs/bevacizumab
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https://www.cancer.gov/about-cancer/treatment/drugs/cetuximab
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https://www.oncarecancer.com/blogs/chemotherapy-cost-in-india/
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https://cancerrounds.com/costs/radiation-therapy/
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https://www.apollohospitals.com/procedures/immunotherapy
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