What Are Colon Cancer Symptoms?

Getting a Handle on Colon Cancer Symptoms

Colon cancer symptoms aren't always obvious, but you can learn what these symptoms look and
feel like. Understanding colon cancer symptoms is important, because you can use this
knowledge to work with your doctor to find out the cause and take care of your long-term health.

What is the Colon?

In order to understand what colon cancer symptoms might feel like, it helps to learn a bit about
the colon. The colon is an important part of the digestive system, and as such, it has a major role
in helping the body absorb nutrients, minerals, and water. The colon also helps rid the body of
waste in the form of stool. The colon makes up the majority of the large intestine, approximately
six feet in length. The last six inches or so of the large intestine are the rectum and the anal canal.

What are the Symptoms of Colon Cancer?

Colon cancer can have many symptoms. However, in the early stages, people with colon cancer
often have no symptoms at all. This is why regular screening beginning at 50 is an important
investment in your healthy future.
Colon cancer symptoms come in two general varieties:
1. Local
2. Systemic
Local Colon Cancer Symptoms

Local colon cancer symptoms affect your bathroom habits and the colon itself. Some of the more
common local symptoms of colon cancer include:

Changes in your bowel habits, such as bowel movements that are either more
or less frequent than normal

Constipation (difficulty having a bowel movement or straining to have a

bowel movement)

Diarrhea (loose or watery stools)

Intermittent (alternating) constipation and diarrhea

Bright red or dark red blood in your stools or black, dark colored, "tarry"
stools

Stools that are thinner than normal ("pencil stools") or feeling as if you
cannot empty your bowels completely

Abdominal (midsection) discomfort, bloating, frequent gas pains, or cramps

If you experience any of these for two or more weeks, call your doctor right away to discuss your
concerns and arrange for tests to get to the bottom of your symptoms.

Systemic Colon Cancer Symptoms

Systemic colon cancer symptoms are those that affect your whole body, such as weight loss, and
include:

Unintentional weight loss (losing weight when not dieting or trying to lose weight)

Loss of appetite

Unexplained fatigue (extreme tiredness)

Nausea or vomiting

Anemia (low red blood cell count)

Jaundice (yellow color to the skin and whites of the eyes)

If you experience any of these for any length of time, even a few days, call your doctor right
away to discuss your concerns and arrange for tests to get to the bottom of your symptoms.
What Should I Do if I Have Colon Cancer Symptoms?

Call your doctor so he or she can set up an appointment to see you. During the appointment your
doctor will take a medical history, collect blood samples for testing, and schedule you for followup tests, if needed.
Many people are afraid of colon cancer screening. They worry that it will hurt and that it is
embarrassing. Your doctor and nurse have performed hundreds, and in some cases even
thousands, of these procedures. There is nothing to be embarrassed about and remember: Even
your doctor and nurse undergo these same tests to take care of their own health.
Preparing for Colon Cancer Tests

If you are worried about preparing for your colon cancer tests, ask your doctor about how best to
get ready for any procedures. There are different medications for clearing your colon of stool to
ensure a good screening. There is no reason to suffer in silence!

Diagnosis of Colon Cancer and How Not to Dread Colon Cancer Screening provide detailed
information on screening procedures, plus tips on how to make preparing for these tests easier.

Bowel Movement Changes Can Be a Symptom of Colon

Cancer
Bowel movement changes typically aren't something you'd discuss at the dinner table, but you
should be aware of why this is an important topic. Changes in how often you are going to the
bathroom, and whether or not you experience constipation or diarrhea regularly, are important
clues to what's going on inside your digestive tract.

What "changes in bowel movements" means can vary from person to person. For example, if it is
normal for a person to have three bowel movements per day, and he or she is having only one per
day, or one every other day, this may signal constipation. On the other hand, another person's
typical bowel pattern may be to have a bowel movement every other day. In this case, having one
bowel movement per day may be unusually frequent, and it may signal a change in typical bowel
habits.
As such, it's a good idea to know what's normal for you. You certainly don't need to keep a
detailed record of your bathroom habits, but if you notice a change from what is typical for you,
pay attention. If the changes only last a short time, or you know the reason for the change (say,
you've been sick or you ate something that doesn't agree with you), you don't need to worry.
On the other hand, if you experience changes in bowel habits that last for more than a few weeks,
or if you struggle with chronic constipation, chronic diarrhea, or intermittent constipation or
diarrhea, you should make an appointment to see your doctor sooner, rather than later.
Changes in bowel habits can have many causes ranging from the not-so-serious to the very
serious. You don't want to ignore these changes. If they signal something serious, such as colon
cancer or inflammatory bowel disease, the sooner you get a diagnosis the better. With colon
cancer, for example, if it is diagnosed in the earliest stages, survival rates are well over 90%. If
the cancer is more advanced, and has spread beyond the colon, survival rates drop dramatically.
If you notice changes in your bowel habits, waiting to find out why is not a good idea. You may
be scared about the possibility of having colon cancer, but finding out now is the best way to take
care of yourself and get the medical care you need. In the overwhelming majority of cases, you
will find out that you do not have colon cancer and that something far less serious is causing
your symptoms.

A screening exam, such as a colonoscopy or flexible sigmoidoscopy, may be scheduled to help

your doctor diagnose you and make recommendations for treatment.

What Is Constipation?
Constipation is a decrease in the frequency of bowel movements or difficulty in the formation or
passing of stool, the body's solid waste.
What feels like constipation to one person may be normal for another.
The colon (large intestine) controls the formation and passage of stool from the body. The colon
absorbs water out of the solid waste and moves the waste to the rectum and anus. Anything that
changes the colon's ability to regulate the amount of water in stool or that affects the muscles and
nerves of the colon that are responsible for moving waste toward the rectum and anus can lead to
constipation.

Common Causes of Constipation

The three most common underlying causes of constipation are:

Too much water is absorbed from the waste as it passes through the colon, resulting in
hard, dry stools.

There are changes in the colon's ability to coordinate the muscle contractions needed to
pass the stool to the rectum and anus, causing stool to become "stuck."

The colon is blocked by something, such as a tumor.

There are a variety of reasons why one of these three things can occur and lead to constipation.
Common causes of occasional, "garden-variety" constipation that many people experience from
time to time, include:

Not eating enough dietary fiber

Not drinking enough water and other liquids

Lack of exercise

Ignoring the urge to defecate until a more convenient time

Stopping a laxative after using one frequently

Using certain medications, particularly some chemotherapy drugs and those used for pain
(opiates), nausea and depression

Constipation As a Symptom of Cancer

When stool enters the colon, it is a thick liquid that can flow around partial blockages or through
narrow areas. As it progresses through the colon and more water is removed, it becomes thicker.
This inhibits its ability to get around blockages and narrow areas. A tumor in the middle to lower
portions of the colon, or in the rectum, can make it difficult for stool to pass by, leading to
constipation.
If you suffer from chronic or intermittent constipation, the sooner you get a diagnosis the better.
With colon cancer, for example, if it is diagnosed in the earliest stages, survival rates are well
over 90%. If the cancer is more advanced, and has spread beyond the colon, survival rates drop
dramatically.
If you notice changes in your bowel habits, talk to your doctor. In many cases, you will find out
that you do not have colon cancer and that something less serious is causing your constipation.
But it is better to err on the side of caution and get it checked out.

Finding the Cause of Your Symptoms

A screening exam, such as a colonoscopy or flexible sigmoidoscopy, may be scheduled to help
your doctor find the cause of your symptoms. If you are nervous about getting screened, you can
educate yourself so you know what to expect and don't have to dread your screening test.
See Your Doctor If...

Three or more days have passed since your last bowel movement; two days if you have
used a laxative

You see blood in or on your stool

You have persistent cramps or severe abdominal or rectal pain

You are vomiting in association with severe constipation

You are frequently or regularly constipated

What is a Colonoscopy?
Colonoscopy Examinations are an Important Part of Your Health Care

Among the many tests used to screen for colon cancer is the colonoscopy.

What is a Colonoscopy?

A colonoscopy is a test that doctors use to look for and remove adenomas and polyps, growths in
the colon that if left untreated, may turn into colon cancer. This test is also used to screen for
colon cancer itself.
How Do You Prepare for a Colonoscopy?

To prepare for this test, your doctor or nurse will give you instructions for the day or two before.
This will involve taking laxatives or other medications and possibly a special diet. This clears the
stool out of your colon so your doctor can see everything clearly during the test.
How Not to Dread Colon Cancer Screening provides detailed information on how to get ready
for this test, along with tips for making this preparation easier.
What Happens During the Test?

During a colonoscopy, your doctor inserts a long, thin tube into your rectum and the full length
of your colon. A colonoscopy is similar to a sigmoidoscopy, but it uses a longer instrument and
lets your doctor see your whole colon. This is the advantage of a colonoscopy over a
sigmoidoscopyno part of your colon is left unexplored. Air or water will be put into your
colon, as well, to allow for a better view.
Will I Be Sedated?

Your doctor will sedate you, or knock you out, during the procedure. This means you wont feel
a thing and you wont remember the procedure, either. This makes this test much easier than
most people imagine.
What Happens Next?

If your doctor finds any suspicious growths, he or she will remove them at that time. This colon
tissue sample will be sent to a lab to check for cancer.
What are the Possible Complications of Colonoscopy?

A possible complication of this test is puncture of the colon, but thankfully, this is rare. If you
have concerns about serious complications, such as a colon puncture, talk to your doctor.
You may have some gas pains or cramps after the test until the air leaves your colon. But most
people find the test itself to be easy, because they dont remember it!
You may see blood in your stool for a day or two after the test, but this is usually not serious. If
in doubt, call your doctor.

What is a Colon Biopsy?

A colon biopsy is an exam that tests tissue samples from your colon. The doctor is looking for
abnormal tissues, such as cancerous or pre-cancerous cells. Keep in mind - just because your
doctor ordered a biopsy does not mean you have cancer.
Why Biopsies are Ordered

Your doctor found an irregularity in one of your colon cancer screening exams. The only way to
definitively tell if the abnormality is cancerous is by extracting tissue and taking a look at it
under a microscope. If abnormalities were found during a sigmoidoscopy or a colonoscopy, the
doctor can extract tissues during that same test. If irregularities (tumors, masses, blood in stool)
were found during another screening test (double contrast barium enema or fecal occult blood
tests), you will be scheduled for a colonoscopy.
CT-Guided Versus Colonoscopy

There are different approaches to the biopsy procedure, which are dependent on where the
irregular tissues were found. The most common way to obtain a biopsy of the colon is through a
colonoscopy. However, if your doctor found abnormalities on your computed tomography (CT)
scan that were not isolated in the colon, he or she may order a CT-guided biopsy.
A CT-guided biopsy, also called a needle or CT-guided needle biopsy, is completed in the CT
room at the hospital or clinic. This type of biopsy is most frequently ordered when masses are
found outside of the colon, including those in the lungs, liver or pelvis. The doctor uses the CT
scanner to pinpoint the abnormal area, inserts a needle into the mass in question, and extracts
tiny tissue samples. You can go back to work the same day, wont need sedation, and the entire
process takes about one hour.
If the irregular tissues are confined to your colon, your doctor will order a colonoscopy to take
the biopsy. The colonoscopy uses a lighted probe, called a colonoscope, to visualize the interior
of your colon. This flexible probe allows the passage of specialized instruments that can retrieve
(clip) a sample of tissue from your colon for the biopsy.

Preparing for Your Colon Biopsy

The colonoscopy preparation requires a complete bowel preparation prior to the procedure. Your
doctor may order a combination of liquid laxatives, suppositories, or an enema to cleanse the
inside of your colon. This cleansing procedure makes the lining of your colon visible by flushing
out fecal matter and fluids in the large intestine. Talk to your doctor if you are diabetic or take
prescription medications, especially blood thinners, as your doctor may have special orders for
you prior to the exam.

Potential Complications and Risks

Like any medical procedure, a colon biopsy is not devoid of risks. However, the sooner you learn
if you have colon cancer, the sooner you can begin treatment. Your doctor will discuss the risks
versus the benefits with you before the procedure. Be sure to ask questions if the procedure
details are not clear. The potential risks of a colon biopsy include:

Bleeding

Infection

Bowel perforation

Hospitalization

Postpolypectomy syndrome

Failed colonoscopy

Complications from weaning off of blood thinners prior to exam

Complications from anesthesia

If you have a complex medical history or are elderly, your risk factors may increase. Discuss any
prescription or over-the-counter medications with your doctor prior to the procedure. A nurse or
staff member from the hospital or clinic may call you to review instructions prior to your
procedure.

What Will Happen? Will it Hurt?

In all likelihood, you will be sedated for the colonoscopy and biopsy; therefore, you shouldn't
feel a thing. Following the procedure, you will be taken to a recovery area, where the staff will
monitor you until you are awake and alert. Due to the sedation, you will not be allowed to drive
yourself home, even if you feel up to it. Your judgment is considered officially impaired for 24
hours following sedation (dont sign any legal documents, either). Air was inserted into your
colon during the procedure, which may cause some cramping and passing gas.
Do not hesitate to contact your doctor if you develop a fever, shaking, chills, abdominal pain,
dizziness or notice blood in your stools following the biopsy.

Waiting for Results

Immediately following your biopsy, the tissue sample is shipped off to the pathologist. A
pathologist is a special M.D. (medical doctor) who examines tissues and blood under a
microscope. The pathologist will need time to examine your tissue sample thoroughly, and then
he or she will construct a pathology report. The report describes if the tissues obtained were
normal or cancerous, and will help your doctor decide the staging and grade of your cancer.
Preferably before the procedure (as you may not remember afterwards), ask your doctor when
you can expect results. He or she will be able to give you a ballpark figure and encourage you to
make a follow-up appointment.

Getting Your Results

Once your doctor receives your biopsy result from the pathologist, he or she will call you. If you
do not already have an appointment to discuss these results, one will be scheduled for you at this
time. The doctor will want to discuss your results in person - not over the phone or by email.
Although the wait may produce some severe anxiety, it is better to sit down and talk with your
doctor about results face-to-face.

What the Pathology Report Says

Your doctor has the medical background and training to explain your pathology report to you.
The pathologists report will include:

Where the lesion(s) were located - anatomically in the colon

Histology - type of cells found, such as normal (benign) or malignant (cancerous). If

malignant, the report will display the cancer type (adenocarcinoma is the prevalent colon
cancer type).

Grade - This is what the doctor uses to stage your cancer. The grade explains how
mutated the tissues are (are they somewhat similar to regular colon tissue, not identifiable
at all, or some grade in between).

Invasion - If your tissue was taken during surgery for colon cancer, the surgeon will
send the extracted piece of bowel to the pathologist, who will then determine how far the
cancer spread into healthy tissues.

Do not hesitate to ask your doctor and nurses questions at any point along the way. The medical
professionals are there to assist you.

Diagnosis of Colon Cancer

Do you have blood in your stool? Check. Fullness, bloating, and excess gas? Check, check,
check. You could potentially have every symptom indicative of colon cancer -- but that doesn't
mean you have colon cancer. Making the leap from symptoms or a family history to a diagnosis

requires tests to verify the presence of cancerous cells, followed by more tests to identify if the
cancer is localized in the colon or if it has spread (metastasized) to other areas in your body.
A diagnosis of colon cancer may come as a complete surprise following a routine screening
exam, such as a colonoscopy, without the presence of any symptoms.

What to Expect at Your Initial Visit

Following a positive screening exam or the presence of concerning symptoms, your doctor will
schedule a diagnostic workup for colon cancer. He or she will obtain a thorough medical history
and examination that may include a digital rectal exam. This simple, painless test allows the
doctor to check your rectum for any growths or masses. The doctor may also collect a stool
sample for a fecal occult blood or immunochemical test, which identify trace amounts of blood
in the stool. Your doctor may order further testing, such as:

Blood tests, including a complete blood count, clotting times (especially if you take blood
thinners) and an electrolyte panel, help your doctor form a picture of your general health.
If you have a history of cancer, the doctor may also order a carcinoembryonic antigen
(CEA) test, which can help identify if tumors have returned.

Diagnostic imaging tests use different forms of x-rays to see your colon and surrounding
tissues. These tests are usually painless and can include x-rays, computed tomography
(CT) scans, magnetic resonance imaging (MRI), or rectal ultrasounds. The doctor may
order a contrast agent, such as barium, to be given orally, rectally or in an intravenous
line before the picture is taken. Contrast agents make your colon more visible -- like
turning on the lights when you enter a dark room.

Colonoscopy and sigmoidoscopy are procedures that use a small, lighted probe with a
camera, inserted through your rectum, to see inside your colon and rectum. If the doctor
finds polyps or unhealthy tissues in your colon, he or she can take a biopsy during the
procedure.

A biopsy refers to any time the doctor takes a tiny sample of tissue from your body. Colon
biopsies can be completed during colonoscopies, sigmoidoscopies or during a CT scanguided needle biopsy. A pathologist, or a special doctor who can differentiate between
cancerous and non-cancerous cells, carefully examines the tissue samples. Biopsy results
can take from 72 hours up to a week for processing. Ask your doctor when to expect
results.

It's Colon Cancer, Now What?

You will be asked to come back to the doctor's office to discuss your test results and diagnosis.
Consider bringing a family member or trusted friend to this visit -- he or she can provide support
and another set of ears.

Once a diagnosis of colon cancer is made, the next step involves finding out if the cancer has
spread (metastasized) to other parts of your body. This process, also known as staging the cancer,
will require a few more tests before you can move forward to treating the cancer. The most
common sites for colon cancer metastasis include the lungs, liver and the peritoneum, or the
abdominal lining. Your doctor may order a:

Chest x-ray to make sure your lungs are clear and free of metastasis

Abdominal ultrasound to see if the cancer has spread to sites in your abdomen, such as
the liver, stomach or peritoneum

Positron emission tomography (PET) scan to take a look for cancerous growths within
your entire body

Colon Cancer Staging Tools

There are two ways to stage the spread and severity of cancer: clinical and pathological staging.
Clinical staging is the process by which your doctor compares the test results with your physical
presentation. Pathologic staging, which is more accurate, uses three systems to represent the
extent of disease progression. These systems include:

American Joint Committee on Cancer Staging System (TNM)

Astler-Coller

Dukes

Out of the three, the TNM system is the most widely used system for staging colon cancers. The
three letters are used to stage the size of the tumor (T), spread to lymph nodes (N), and the extent
of metastasis (M). Each letter is followed by a descriptor, usually a number, which will describe
the severity of your colon cancer. Lower numbers, such as a 0, are desirable in staging as they
signify that the cancer is small and localized (in situ).
Another term you will come across is called grading the tumor. When the pathologist identifies
cancerous cells, he or she can also determine how mutated those cells appear, or how abnormal
the cancerous tissue appears compared to regular tissue. Similar to staging, cancers with a lower
grade (a more normal appearance) are usually found early and are easier to treat, whereas very
mutated or high-grade cancers have a higher probability of spreading quickly.

Treatment Plan
Your doctor will work with you to form a treatment plan for the colon cancer, which may include
surgery, chemotherapy, radiation or a combination of treatments. Your plan will be tailored for
your specific needs, but is largely based on the grade and stage of the cancer and your overall
physical health.

Home Testing for Colon Cancer

As recent as a decade ago, testing your bowel movements for DNA was a futuristic concept.
Science has made leaps and bounds towards making simple screening exams available, such as
the fecal DNA test, for colon cancer testing in the comfort of your home. As of summer 2014 the
DNA stool test was approved by the United States Food and Drug Administration and made
available to the general public, furthering the accessibility and options for colorectal cancer
screening tests.
Before you get too excited about this news I must clarify one major point: A colonoscopy
remains the only definitive test used to check for colon cancer, and is also the gold standard in
testing. I'm no scientist, but I'm fairly sure we will never get to do those at home.

FOBT
Stool testing for colon cancer is not a new concept. People have been testing stool for occult
blood for many years. The medical name is called guaiac, but you might know it as the fecal
occult blood test, or FOBT for short. It's a simple, cheap, and quick screen that tests for
microscopic blood in your stool. The presence of blood in the stool -- even in trace amounts -could signify a polyp or the presence of a tumor.
Although it is a very good screening tool, the FOBT has several drawbacks. You cannot eat
anything that might mimic blood in the stool for a few days prior to the exam. Foods to avoid
include:

Red meat (beef, venison, wild game, lamb)

Raw broccoli

Radishes (to include horseradish) and turnips

Cantaloupe

Likewise, if you are prone to nose bleeds, you may accidentally swallow some of your own
blood, which may result in a false positive test. You must also avoid taking any over-the-counter
medications or supplements without first talking to your doctor. Ibuprofen, aspirin and even
vitamin C supplements can alter your test results.
FIT

Once medical science recognized the limitations of the guaiac stool test, a new test was
developed called the fecal immunochemical test, which is also known as FIT. This test also
checks for trace amounts of blood in the stool, but it can more accurately detect human blood,

and not just the steak you had last night for dinner. There are no dietary or pharmaceutical
restrictions prior to collecting samples for a FIT test.
DNA

There are a few major differences between fecal occult blood tests and stool DNA tests. Unlike
the FOBT or FIT, stool DNA testing does not check for blood, but rather DNA markers
indicative of a cancerous growth in the colon. While there are many different manufacturers of
stool guaiac and immunochemical tests, there is only one brand of stool DNA test currently and
that is Cologuard, made by Exact Sciences. There are test result variances as well; stool DNA
testing has less false positive results that stool blood testing. The final difference is in cost -- the
stool DNA test costs about 25 times more than a simple guaiac. However, Cologuard contains
both a stool DNA and FIT test in each kit -- so you get both types of stool test with one kit.

Stool Testing Frequency

Despite the release of the DNA stool test, the U.S. Preventive Services Task Force encourages
Americans to adhere to the standards released that encourage FOBT or FIT annually for people
over 50 years and for anyone with a strong history (personal or familial) of colorectal cancers.
However, the Centers for Medicare and Medicaid Services have proposed coverage of the stool
DNA test with a proposed frequency of every three years for people who meet testing criteria.
Obtaining the Test

Despite the fact that you can collect the stool samples and complete these tests from home, you
still need to visit your doctor and obtain a prescription for stool testing. Typically your doctor
provides you with the materials to complete FOBT or FIT, and you mail the results to the
laboratory once the specimens are collected. The DNA stool test is similarly completed, except
that the kit is mailed to your home.
Follow Up for Positive Results

In most cases, a positive FOBT, FIT or DNA test is cause for further colorectal cancer screening
and typically will lead to a colonoscopy. Think of the stool tests as entry-level screening tools -they cannot definitively prove if you do or do not have colon cancer. Your doctor will review
your results with you and provide further recommendations for your care.
False positives can and do occur with any of the three stool tests. Try not to panic if your stool
test is positive -- suggesting you have either blood or cancerous DNA in your stool -- and follow
up with your doctor.

What Are Current Colon Cancer Screening Guidelines?

Question: What Are Current Colon Cancer Screening Guidelines?
The guidelines for colon cancer screening are vitally important for preventing deaths. Yet only 1
out of 5 (just 20% of) doctors follow current colon cancer screening guidelines for their patients.
Educate yourself on which guidelines apply to you.
Answer:
Colon cancer screening guidelines differ, depending on an individual's risk for developing the
disease. The American Cancer Society recommends the following:
First, consider your personal risk for colon cancer. Are you at average or high risk? How do you
know?
You are at average risk if all of the following are true for you:

You have no family history of the disease.

You have no personal history of colon polyps or adenomas or colon cancer.

You have no personal history of inflammatory bowel disease, such as ulcerative colitis or
Crohn's disease.

There are no genetic conditions in your family that are linked to a higher colon cancer
risk, such as hereditary nonpolyposis colorectal cancer (Lynch syndrome), familial
adenomatous polyposis, juvenile polyposis or Peutz-Jeghers syndrome.

If you do not fall into any of the above categories, colon cancer screening should begin at age 50
for men and women. Acceptable strategies for screening for precancerous polyps and colon
cancer include:

Flexible sigmoidoscopy* every five years (sigmoidoscopy examines the lower part of the
colon)

Colonoscopy every 10 years (colonoscopy is the most complete test and examines the
entire length of the colon)

Double-contrast barium enema* once every five year

CT colonoscopy (virtual colonoscopy)* once every five years

*If any of the marked tests are abnormal (shows a polyp or other growth) a full colonoscopy
should be performed.
The above tests are preferred over the ones below, which can only detect colon cancer, not
precancerous polyps:

Fecal occult blood test (FOBT) or fecal immunochemical test every year

Stool DNA test; recommended frequency varies, ask your doctor how often you may
need this test

Colon Cancer Screening Guidelines for People at Higher Colon Cancer Risk
If you are at above average risk for colon cancer, you likely need to begin colon cancer screening
earlier than age 50. You also may need to be screened more often than someone at average risk.
You have a higher-than-average risk for colon cancer if any of the following are true:

You have a family history of colon cancer, particularly in a first-degree relative (parents,
siblings, children), and especially if that relative was under age 50 at the time of
diagnosis.

You have a personal history of colon polyps or adenomas or colon cancer.

You have a personal history of inflammatory bowel disease, such as ulcerative colitis or
Crohn's disease.

There are genetic conditions in your family that are linked to a higher colon cancer risk,
such as hereditary nonpolyposis colorectal cancer (Lynch syndrome), familial
adenomatous polyposis (FAP), juvenile polyposis (JP) and Peutz-Jeghers syndrome
(PJS).

If any of these describe you, your first step is to talk with your doctor to determine which colon
cancer screening schedule is best for you.
In addition to this, you should familiarize yourself with the detailed colon cancer screening
recommendations for people at increased or high risk from the American Cancer Society. Keep
in mind that the guidelines change as technology changes. Most gastroenterologists feel that a
regular colonoscopy is still the best test for preventing colon cancer.

How Reliable are DNA Stool Tests?

Question: How Reliable are DNA Stool Tests?

I've heard that there is a test that can tell you if you have colon cancer without any tubes,
needles, or embarrassing doctors visits. Is this true? If so, how accurate are the tests?
Answer:
There are DNA stool tests that can detect the presence of colon cancer using only your fullyformed bowel movement, but the accuracy of these tests still isn't perfect, they're not yet
approved by the FDA, and they're not in routine clinical use. Unlike other stool sampling tests,
such as the fecal occult blood test, this test requires a complete stool sample. A collection tray is
provided with the kit, and you do not have to touch or manipulate your stool at all. You simply
return the collected sample to your doctor for processing, or ship it directly to the lab.
Your results are either positive or negative, with a positive meaning that there is the presence of
DNA suggesting cancer in your colon, and a negative meaning no cancerous DNA was found.
But the tests are not yet 100 percent accurate, which means that there is a chance for falsepositive and false-negative results.
Despite these new, noninvasive tests, the golden standard for colon cancer diagnosis remains the
endoscopic colonoscopy. This test, although invasive (a tube with a camera on the end is inserted
through the anus to visually inspect the colon, while the patient is sedated), can find cancerous
and precancerous growths in your large intestine. And though like any test it's not 100 percent
accurate, it's the most sensitive test for colon cancer to date. So far, stool DNA tests are most
likely to only detect cancer once it has formed not when it is still in the precancerous stage. If
your colonoscopy is positive for growths that can soon become cancerous, your doctor can
remove them before they get the chance to mutate, but in some cases, the DNA stool test might
not even pick up their presence.

How Do The Tests Work?

Every living organism has a regeneration process that allows it to grow or maintain life. Snakes
shed skins, trees get new leaves, and certain cells in your body, such as your skin cells, are
constantly regenerated. Your colon sheds dead tissues along with food waste in each bowel
movement, which is the main reason that, even if you do not eat or drink anything, you will
continue to make and pass stool.
The innermost lining of your large intestine is routinely shed. As cells die, they are dispersed
throughout your bowel movements and replaced by healthy, new cells. DNA stool tests can
identify these shed cells as colon tissue versus food particles; the cells are then chemically
altered to see if they contain certain genes identifiable with the types of colon cancer.

Sensitivity Versus Specificity

If you've followed studies on DNA stool testing, you may have seen the key words "sensitivity"
and "specificity" mentioned. Sensitivity correlates to the test's ability to pick up the microscopic
traces of shed DNA in the stool. These tests, which have been evolving for the last decade,
originally couldn't reliably identify colon cancer cells in the stool samples and had a very low

sensitivity rate. But more recent studies, like one published in Clinical Gastroenterology and
Hepatology in 2007, showed a sensitivity of 52 percent and a specificity of 94 percent.
Specificity relates to the likelihood that a person without colon cancer will have negative test
results.
A study published in the New England Journal of Medicine that compared the fecal occult blood
test, a test used to check for trace amounts of blood in the stool, showed that the DNA stool test
was superior in colon cancer sensitivity. In this study, 51.6 percent of cancers were identified
with DNA in the stool, whereas only 12.9 percent were identified with fecal occult blood testing.
The pros of DNA stool testing for colon cancer are pretty obvious:

The test is non-invasive, so there's no pain or downtime: it's as simple as sending off a
complete stool sample and waiting for the results.

The sensitivity of these tests is improving dramatically, and more colon cancer cases are
being caught by having yet another diagnostic tool available for people who cannot or
will not have a routine colonoscopy.

You can request (and pay for) the test on your own you are not dependent upon the
rules and screening guidelines set forth for more invasive tests, such as the colonoscopy.

The cons of this test are counterpoint to the stated benefits:

Although the test is simple and painless, studies show that a colonoscopy is twice as
likely to find cancer in your colon as the DNA stool test.

If you have a positive result, you will still need a colonoscopy to confirm, and possibly
remove and biopsy smaller growths.

The tests are still fairly expensive, costing hundreds of dollars per sample.

It is not covered by Medicare or most private insurances.

The test does not identify pre-cancerous growths that are typically removed during
colonoscopy.

If you are still interested in having this test, talk to your doctor. He or she can further discuss the
benefits and drawbacks of this test and help you select a screening method suitable to your health
and needs, as well as one that can diagnose colon cancer in its earliest, and most treatable, stages.

How Not to Dread a Colonoscopy

Youre sitting in the pastel-walled examination room and your doctor just told you he wants to
schedule a colonoscopy. What? Will it hurt? The technical explanations and pre-procedural
instructions were probably lost as you entertained an internal dialogue of questions.
Before you toss your prep instructions in the trash and avoid making that appointment, know
this: Almost 60 percent of colon-cancer related deaths might have been avoided with early
screening.

Do I Have To?
Look at the people around you - if they are over 50 years old, one of them has already had a
colonoscopy. Subjective symptoms, such as chronic diarrhea, or observable problems, like
bloody bowel movements, do not provide a definitive diagnosis. Your doctor has ordered a
colonoscopy as a routine screening exam or a diagnostic tool.
Routine screening colonoscopies find problems before they start. The doctor can find and
possibly remove polyps or abnormal tissues before they have the chance to become cancerous,
which can take up to 10 years.
Diagnostic colonoscopies are performed when there are symptoms, positive test results, or a
strong familial history of colon cancer. Colonoscopies are not without risk; if your doctor
prescribed this test, it was not ordered arbitrarily.

Preparation
The preparation for a colonoscopy cleans out your colon. Your bowels must be squeaky clean to
help the doctor see the lining clearly. Stay close to a bathroom; you will probably be in there
quite a bit. As uncomfortable as the constant toilet trips may be, follow the preparation orders to
the letter. If your bowels are not cleaned out, there is a chance you will have to repeat the
procedure.
The doctor may order laxatives, enemas, and a clear liquid diet to induce bowel movements and
clean out the colon. You may have frequent, watery stools. If you are placed on a clear liquid
diet, do not eat or drink anything with red or purple food coloring, such as purple sports drinks or
gelatin, as they can stain the colon.
If you want to breeze through the dreaded colonscopy prep, ask your doctor these questions
before you begin:

Can you prepare a couple days in advance or does the laxative solution need to be taken
on the night before the procedure?

Can the solution be refrigerated?

Is it okay to add flavoring, such as commercial drink powders or sports drinks, to

improve the taste?

You may be instructed not to eat or drink four to six hours prior. This helps prevent vomiting,
and possibly choking, while you are sedated for the procedure.

What to Expect on Test Day

Arrange for someone to drive you home from the procedure and leave your jewelry and
expensive items at home. Bring your wallet; you will need at least one form of identification to
check in at the facility.
You will be asked to remove your clothing and change into a hospital gown, but you may get to
keep your socks on, so be sure they don't have holes. Your nurse will obtain a written consent for
the procedure; this is a good opportunity to ask any remaining questions or concerns, such as
when to expect test results.
The procedural room may contain a couple television-like monitors, emergency equipment, and
other assorted medical devices. The nurse will connect a blood pressure cuff on your arm, a
probe on your finger, and electrodes on your chest. This allows the nurse to monitor your wellbeing during the exam.
An intravenous catheter, inserted into your arm or hand, will pinch a bit at first but is necessary
for the medications to help keep you relaxed during the procedure. Try taking deep breaths while
the catheter is being put in to relieve discomfort. Feel free to tell the nurse where your best veins
are if you know -- that may help decrease the number of pokes you experience.
A flexible probe will be gently inserted into your rectum. You may feel pressure or an urge to
bear down, which should pass shortly.
The procedure will take approximately 15 to 20 minutes, while the doctor advances the scope
through the entire colon looking for unhealthy tissues.

Recovery
You may spend an hour or two in a recovery area while the sedative wears off. It is okay if you
feel groggy; this feeling should pass shortly. Your nurse will continue to monitor you closely
until you are safe to go home with a responsible adult.
Following the procedure, you may pass more gas than usual; this is a normal effect, as air was
introduced into your colon during the procedure. You may also notice some bright red blood in
your stool, which may be normal if the doctor took a tissue sample or removed polyps.

Its Over What Now?

Whatever your test results bring, your doctor will have a plan for you. Whether it involves a
referral to a specialist, or a clean bill of health and a promise of no more colonoscopies for five
to 10 years, you made it through this exam. Take a walk, a deep, cleansing breath, or vent to
loved ones. You made it through the dreaded colonoscopy; you can make it through your next
challenge as well.

Are Chronic Stomach Pains a Sign of Colon Cancer?

Chronic pain of any kind -- or pain that lasts longer than three months -- can be an indication that
something in your body is not working quite right. One person may suffer chronic pain in his or
her lower back, perhaps from a herniated disc, but another person may have long term pain in his
or her belly caused by endometriosis.
The term stomach pain is a poor catchall phrase, but it has been around forever. You have many
different organs in your abdomen, and there is no way to be sure that your stomach is the culprit
of any abdominal pains, although it often gets labeled that way. Regardless of the cause, any type
of chronic pain needs to be investigated by your doctor, but it doesn't always signify a lifethreatening illness.
Although most "stomach pains" are caused by a problem within your gastrointestinal system,
abdominal pain can also arise from your genitourinary (kidneys, bladder) or reproductive organs,
or even from a problem with your blood supply or muscles in that area. Chronic "stomach pains"
can be a sign of late colon cancer, but it is not all that common. Actually, the majority of people
deny any symptoms prior to getting diagnosed with colorectal cancer.

Talking to Your Doctor

Hopefully you've arranged an appointment to discuss this pain with your doctor. If the pains
haven't abated in three months there is a very good chance they will not go away without medical
intervention. When you go to see the doctor, he or she will ask many questions about your
stomach pain. Although the amount of questions may seem ridiculous, your doctor has very good
reason for the inquisition.
Be prepared to answer questions about the description of your pain -- is it sharp and stabbing,
burning, or a general achy cramp? Also be ready to discuss the frequency that you hurt, how long
it hurts for, and if there is anything that helps relieve the pain (passing stool, vomiting, urination)
or makes the pain worse (standing, walking, passing stool). Your doctor is gathering this detailed
history because sometimes the type, duration, location or intensity of the pain lets he or she know
if this needs to be investigated further now or if you can take a wait-and-watch approach.

During the Exam

During the physical -- or hands on -- portion of your exam the doctor is looking to complete the
picture you provided with your pain and medical history. He or she will be looking at your
abdomen to see if there are any unusual findings that support your complaints of pain including:

Bloating

Rigidity

Too loud or absent bowel sounds

Tenderness or pain with pressure

Any unusual masses or lumps

Your doctor may also ask many questions that seem completely unrelated to "stomach pain"
including questions about diet, weight loss and your menses (for women). Likewise, it is
important to bring an up to date medication list to your appointment. Make sure to include any
over the counter or herbal supplements you might be taking as well. Sometimes, the chronic pain
can be caused by nothing more than a medication interaction that can be quickly remedied but
changing your prescriptions or stopping an over the counter supplement.

What Could Be Causing It?

There are literally dozens of reasons people suffer chronic abdominal pain. Some of the
most common causes include:

Cirrhosis

Gallstones

Crohn's disease or Ulcerative Colitis

Diverticulitis

Endometriosis

Irritable Bowel Syndrome

Ulcers

Pelvic Inflammatory Disease

Pancreatitis

Your doctor may choose to encourage further testing, such as blood labs, x-rays, or even
computed tomography (CT) scans to find the cause of your pain. The majority of these tests are
very straightforward, painless, and carry very little risk.

Treatment
Since the etiology of abdominal pain is so diverse, the treatment of your pain is dependent upon
the cause. Ulcerative colitis is treated far differently than endometriosis, for example. It should
be noted that sometimes, in very rare cases, your doctor will not be able to target a cause of the
pain.

Advice About Bright Red Blood in Stool

Blood is supposed to stay in your body. Seeing blood in your bowel movement is very
frightening. It is also an indication that something is not working right. But it is not always a
herald of colon cancer.
Rectal bleeding has many causes, but only one of them is colon cancer. The best action you can
take now, to advocate for yourself, is to pay attention to this symptom and be prepared to discuss
it with your doctor. Ask yourself these questions:

Was the blood in the stool, toilet bowl or on the toilet paper?

Was the blood bright red or dark red?

Approximately how much blood did you see? (Keep in mind, a drop of blood in a toilet
bowl will turn all of the water red.)

Did you have to strain to pass the bowel movement?

How frequently do you have bowel movements?

Do you have other symptoms?

When was your last colon screening exam or colonoscopy?

Do you have a history of polyps or a family history of polyps?

What Causes the Bleeding?

Many things can cause blood in the stool, ranging from abrasive toilet paper to a large, bleeding
polyp. Like the lining of your mouth or nose, the lining of the colon is very vascular and has a

healthy blood supply. A smear of blood on the toilet paper may be nothing to worry about, but
dont take a chance. Talk to your doctor. He or she will help you discover the cause.
Hemorrhoids are a common, mostly benign problem. They are the No. 1 cause of bright red
blood smears on the toilet paper. You may or may not feel any associated discomfort with a
hemorrhoid. Pregnancy and straining on the toilet are two common causes of these swollen blood
vessels, which are easily treatable and may even resolve on their own.
Inflammatory processes in the colon, such as irritable bowel disease (IBD), irritable bowel
syndrome (IBS), Crohns disease, ulcerative colitis or diverticular disease, can cause bright red
or dark red blood in the stools.
Colon polyps can and do bleed at times, especially following a colonoscopy or biopsy. Most
polyps are benign growths that do not stimulate any symptoms (hence the importance of routine
colon screening). However, sometimes the larger ones can bleed, which may require a
colonoscopy for investigation and removal of the polyp. Untreated polyps can lead to colon
cancer.
Constipation and straining to pass a large bowel movement can lead to smears of bright red
blood on the toilet paper. Not drinking enough water, low-fiber diets and a lack of exercise can
lead to constipation. Let your doctor know if you are straining to pass bowel movements. This
straining can lead to tiny, uncomfortable tears in your anal tissues, called fissures. Anal
intercourse can also cause these tiny fissures and rectal bleeding.
Untreated bowel infections, such as Escherichia coli (E. coli), can cause bloody diarrhea and
abdominal discomfort. E. coli can stem from eating undercooked meats or unpasteurized juice or
dairy products. The infection requires antibiotic therapy.
Colon cancer can cause blood in the stool. Caught early, most cancers of the colon do not
generate any symptoms. This is why fecal testing is suggested yearly, to catch cancer very early.
If a tumor is bleeding to the point where you see the blood in your stool, the cancer may be at an
advanced stage. If the visible blood in your stool is from colon cancer, it is most likely from the
left side of the colon (descending colon, sigmoid colon or rectum). Any blood from the right
colon will merge with the stool and is probably undetectable to the human eye.

During Your Doctors Visit

Your doctor will complete a physical exam to look for any overt causes of the rectal bleeding
(hemorrhoids, anal abrasion) and obtain a medical history. He or she may order tests to further
investigate the cause, even if it is obvious. The doctor might order a:

Complete blood count: Determines how much blood you may have lost.

Clotting time: If you take anticoagulants (blood thinners), the doctor may want to check
if your blood is too thin (runny)

Fecal occult blood test (FOBT) or fecal immunochemical test (FIT): Checks for the
presence of blood in the stool.

Colonoscopy: Uses a scope to take a look inside the colon. This test allows the doctor to
see, and possibly remove, bleeding polyps from the lining of the colon.

Sigmoidoscopy Similar to a colonoscopy, but allows the doctor to see only the final
portion of the colon, including the sigmoid colon and the rectum.

X-rays: Films of the lower intestinal tract may show any large deformities of the colon.

Following the test(s), your doctor will discuss the findings with you, potentially order further
testing if abnormalities are found or develop a treatment plan, as needed.

When to Call the Doctor Now

If the bleeding does not stop, you notice large amounts of blood or have foul-smelling stools
with a coffee-grain appearance, you need to seek treatment right away. Your doctor will have to
find and stop the cause of the bleeding.

How is Chemotherapy Used to Treat Colon Cancer?

Chemotherapy can be an effective way to manage colon cancer, either alone or used together
with other forms of treatment, such as surgery and radiation therapy.

What is Chemotherapy?
The term chemotherapy covers a lot of different medications that are used to treat cancer. Some
of these medications are given intravenously (into a vein), in an outpatient setting. Other forms
of chemotherapy are taken orally, as a pill. A few types of chemotherapy may require that you
are admitted to the hospital for a day or two to receive them, but this is less common.

How Does Chemotherapy Work?

Many chemotherapy medications target fast-growing cells. Cancer cells typically grow more
rapidly than other body cells. This means chemotherapy will affect cancer cells more than most
other cells in the body. Unfortunately, some of our normal healthy cells do grow and divide

rapidly as well, and these are affected by chemotherapy, too. This includes hair and skin cells,
immune system cells, and cells in the mouth, throat, and digestive tract.

How is Chemotherapy Given?

Typically, chemotherapy is given in cycles. For example, you might take chemotherapy once a
week for eight weeks. You might take chemotherapy once a month for nine months. Or you
might take chemotherapy every day for one full week, followed by three weeks off, with this
pattern repeating for several months. The schedule will depend on your cancer and the type of
chemotherapy.
Chemotherapy is given as an infusion, meaning into your vein or intravenously (IV). Some forms
of chemotherapy are taken as pills. How your receive your chemotherapy will depend on the type
of medications your doctors feel is best for treating your cancer.

What are the Side Effects of Chemotherapy?

Chemotherapy affects hair, skin, immune system, mouth, throat, and digestive tract cells the
most, so common side effects include hair loss, mouth sores, nausea, diarrhea, and low immune
cell (blood) counts. If you talk to someone who went through chemotherapy 15 or even 10 years
ago, you may hear about these side effects and other "horrors" of cancer treatment.
Fortunately, there are many more medications today to manage chemotherapy side effects than in
years past. You shouldnt assume that because someone you know had a difficult experience with
cancer treatment that you will, too. So many medical advances have been made in recent years
that other than hair loss, many cancer patients experience few major side effects.

How Do I Manage Chemotherapy Side Effects?

The two most important things you can do to manage side effects of chemotherapy are to:
1. Take all of your medications as prescribed, because its easier to prevent side effects than
to treat them once they occur.
2. Keep the lines of communication open with your medical team. What works to manage
side effects for one person may not work for you. Talk to your doctor or nurse about
options to help you get through treatment with minimum side effects.
Dont accept that feeling badly is a natural part of chemotherapy. Many side effects can be
eliminated or at least minimized enough to allow you to continue the activities that matter most
to you.

Do I Need to Follow a Special Diet During Chemotherapy?

You can ask your doctor, nurse, or dietitian about special diet guidelines for during
chemotherapy, but some general diet guidelines include:

Avoid raw or undercooked meat and eggs, deli meats, and food served from bulk
containers if your blood counts are low.

Always use safe food handling practices in your home.

Always thoroughly wash or peel raw fruit and vegetables if you blood counts are low.

Drink plenty of water, about 8 cups per day, in order to help your kidneys process the
chemotherapy medications.

Avoid acidic food, such as citrus fruit and juice, if your mouth or throat is sore.

Avoid dry and crunchy food such as crackers, dry cereal, or dry toast if your mouth is
sore.

Avoid alcohol unless your medical team says it is OK to drink.

Avoid over-the-counter medications, dietary supplements, herbs, vitamins, or minerals

unless your doctor, nurse, or dietitian has given you the OK to use them.

Inherited Causes of Colon Cancer

Polyps typically begin growing in the colon when a person is between the ages of 40 and 60
years. Some polyps grow very slowly and can take as many as 10 years to turn cancerous. Some
inherited genetic conditions -- hereditary non-polyposis colon cancer (HNPCC [also known as
Lynch syndrome]) , Peutz-Jeghers syndrome , and familial adenomatous polyposis (FAP) -cause polyps to begin growing much earlier in life (sometimes as early as the teen years) and
markedly increase the risk of colon cancer. People with a family history of these conditions need
intensive colonoscopic screening (colonoscopies done on a regular basis) and surgical
consultation.

Polyps
Colon Polyps
A colon polyp is a growth that occurs on the wall of the large intestine, or colon. A polyp that is
flat in shape is called sessile, and one that has a long stalk is called pedunculated. Polyps are
common in people over the age of 40 and often grow slowly. Polyps can develop into colon
cancers, which is why they are typically removed during a colonoscopy.

Symptoms of Colon Polyps

In most cases, polyps do not cause any symptoms. Because they typically don't cause symptoms,
polyps can go undetected until they are found during a colonoscopy or other test on the colon.
When polyps do cause symptoms, they can include:

Blood in the stool (black or red).

Bleeding from the rectum.

Constipation or diarrhea that doesn't go away.

Those at Risk for Colon Polyps

Certain people are more at risk for developing polyps in their colon than others, because of age
or family history. Some of these risk factors include:

Age over 50 years.

A family history or personal history of polyps.

A family history of colon cancer.

A personal history of cancer in the uterus or the ovaries.

Other risk factors for colon polyps are due to lifestyle, and include:

A high-fat diet.

A history of cigarette smoking.

A history of drinking alcohol

A sedentary lifestyle.

Obesity.

There is no one specific way to prevent developing colon polyps, but living a healthier lifestyle
by eating properly, exercising, and not smoking or drinking may help. Calcium, folic acid
supplements, and a daily low dose of aspirin may also protect against the development of polyps.
Some rare genetic conditions can cause polyps to grow in younger people, even teenagers.
People who have these disorders, hereditary non-polyposis colon cancer (HNPCC [also known
as Lynch syndrome]), Peutz-Jeghers syndrome, and familial adenomatous polyposis (FAP), are at
increased risk of developing colon cancer.

Types Of Polyps
There are four main types of colon polyps: adenomatous (tubular adenoma), hyperplastic,
inflammatory, and villous adenoma (tubulovillous adenoma).
Adenomatous or Tubular Adenoma. This type of polyp has a risk of turning cancerous, and is the
most common. When this type of polyp is found, it will be tested for cancer. Anyone who has
these polyps will need periodic screening to check for any more polyps and to have them
removed.
Hyperplastic. These polyps are common, small, and are at a low risk of turning cancerous. Any
hyperplastic polyps found in the colon would be removed and tested to ensure they are not
cancerous.
Villous Adenoma or Tubulovillous Adenoma. This type of polyp carries a high risk of turning
cancerous. They are commonly sessile, which makes them more difficult to remove.
Inflammatory Polyps. Inflammatory polyps most often occur in people who have inflammatory
bowel disease (IBD). These types of polyps are also known as pseudopolyps because they are
different from the other three forms, and do not turn cancerous. They occur as a result of the
chronic inflammation that takes place in the colon of people with Crohn's disease and ulcerative
colitis.

How Polyps Cause Colon Cancer

A polyp is a precancerous growth, which means that if it is left in place in the colon, it may turn
cancerous. If it is removed, such as during a colonoscopy, it does not have the opportunity to turn
cancerous. After a polyp is removed, it will be tested for cancer by a pathologist. Sessile polyps
are more likely to turn cancerous than pedunculated polyps.

Colon Cancer Screening

People older than 50 should get screened for colon cancer -- except for patients in certain risk
groups who need screening earlier and more frequently. Those who are at high risk for colon
cancer because of a personal or family history of cancer are at higher risk and should be tested
more frequently and at a younger age than those that don't have any risk factors. People who
have inflammatory bowel disease (IBD), and especially those who have had ulcerative colitis for
10 years or more, are also at a higher risk for colon cancer.
Some tests that might be used to look for polyps include:

Colonoscopy

Sigmoidoscopy

Virtual Colonoscopy

Polyps might be detected through the above tests, but can only be removed during a
sigmoidoscopy or a colonoscopy.
If you are concerned about your risk of colon cancer, speak to your doctor about when and how
often you should be screened.

Chemotherapy Side Effects

What are common chemotherapy side effects? These medications work by interfering with cell
division. Cancer cells are continuously dividing and are therefore most susceptible to these
medications, but some normal cells that divide frequently (such as those lining the stomach and
mouth, hair follicles, and bone marrow) are also affected.
Everyone experiences chemotherapy differently depending on the medications used and other
factors, such as age, sex, and general health. You may have several of the symptoms below, or
you may not experience any symptoms at all.
Be sure to let your cancer team know about any symptoms you are experiencing during
chemotherapy, so they can work with you to make the journey as comfortable as possible.
Management of side effects has come a long way over the last few decades, and many of these
can be controlled with medications and other therapies.

Bone Marrow Suppression

Red blood cells, white blood cells and platelets are continuously produced in the bone marrow
and often affected by chemotherapy. Your oncologist will monitor these cells with blood counts
during your therapy.

Coping With Anemia (Low Red Blood Cell Count)

Coping With Neutropenia (Low White Blood Cell Count)

Coping With Thrombocytopenia (Low Platelet Count)

Digestive Symptoms
Nausea is one of the most dreaded side effects of chemotherapy, but ways of managing this
symptom have come a long way in recent years. Your doctor may prescribe anti-nausea
medications at the time of your treatment in an effort to prevent nausea from occuring altogether.
Diarrhea can be a dangerous symptom, often prompting a change in the dose of chemotherapy or
discontinuing treatment. Dehydration is also a concern if diarrhea is present. Loss of appetite
may occur as a side effect of chemo, but may also be due to the cancer itself.

Hair Loss
Hair loss is usually more of a nuisance than a symptom, but it can be distressing nonetheless.
According to research, hair loss is one the most feared side effects of chemotherapy. Some
medications are more likely to cause hair loss than others, and hair loss can range from a little
thinning to total baldness. It helps to be aware (and frequently comes as a surprise) that all hair
can be affected, and it is not uncommon to lose eyebrow hair, facial hair, and even pubic hair.
Hair loss usually begins a week or so after the start of chemotherapy and begins to grow back 6
to 8 weeks after completing therapy. Talking about options such as wigs and other head
coverings before you lose your hair can ease some of the anxiety at this time

More About Chemotherapy Induced Hair Loss

Fatigue
Of all the chemotherapy side effects, fatigue is one of the most distressing. Unlike ordinary
tiredness, chemotherapy-related fatigue is frequently described as tiredness that does not resolve
with rest, whole body tiredness or a feeling in which even the most mundane activities require
effort. Fatigue may begin shortly into treatment and can persist for up to a year, and maybe more,
following completion. The first step toward coping with cancer-related fatigue is to understand
that it is normal and common.

What is Cancer Fatigue?

Tips for Coping With Fatigue During Chemotherapy

Oral Symptoms
Both mouth sores and taste changes can make eating difficult for some people. Mouth sores often
develop a week or so after beginning chemotherapy and resolve soon after treatment is finished.

Coping With Mouth Sores

Coping With Taste Changes

Peripheral Neuropathy
Some medications can cause symptoms of numbness, tingling, or burning in the hands and feet.
With lung cancer, this is most commonly seen with Platinol (cisplatin), Navelbine (vinorelbine),
Taxotere (docetaxel) , and Taxol (paclitaxel). These symptoms may occur early on in treatment
and go away, or they may occur weeks to months after treatment, and in some cases may be
permanent. Clinical trials are in progress to find ways of preventing peripheral neuropathy
related to chemotherapy.

Coping with Chemotherapy-Induced Peripheral Neuropathy

Final Thoughts
Chemotherapy, as well as other treatments for cancer, are physically and emotionally draining.
Yet it's also an opportunity to see the glass as half full rather than half empty. During my own
chemotherapy treatments I chose a different friend to accompany me to each of my "visits." I
cherish those times to spend several hours wtih each of these friends without the distraction of
kids and... well... life. Managing the side effects can also be an opportunity to not only accept a
new normal, but to strive for an awesome new normal. I chose to add in therapies such as
acupuncture, meditation, and qigong to help me cope, as well as reaching out to friends that "get
it" but I hadn't spent much time with. Everyone is different. What can help you not only cope
with these symptoms, but thrive during treatment?

Alternative Treatments That May Help With Cancer Symptoms - An Integrative

Approach

How to Keep a Positive Attitude During Cancer Treatment

Long Term Side Effects of Chemotherapy for Cancer

The long term side effects of chemotherapy arent usually your first concern when you find out
chemotherapy is recommended for your cancer. And thats how it should be. In most cases, the
benefits of treatment far outweigh any possible complications down the line. But with improved
survival from many types of cancers, it's important to understand the long term side effects of
chemotherapy that may occur months or years after treatment is completed.
Before addressing possible long term side effects, keep in mind that everyone is different. Some
people may have several of these side effects, while many will have none. Side effects also vary
considerably depending on the particular chemotherapy medications that are used.

Cardiac Concerns
Chemotherapy can cause cardiac effects early in treatment, but in some cases the effects may not
show up until much later. One notable example is heart damage following treatment with the
medication Adriamycin (doxorubicin) . With this drug, a possible long term side effect is
weakening of the heart muscle, resulting in a decreased ability to pump blood through the body (
heart failure ). Symptoms may include increasing shortness of breath, fatigue, and swelling of the
feet and ankles. If you have been treated with Adriamycin, your doctor may recommend a
MUGA scan to monitor how your heart is pumping.
Other cancer treatments, such as radiation therapy to the chest area, may cause damage to the
heart muscle as well.

Heart Problems with Doxorubicin

What Is the MUGA Scan?

Left Breast Radiation May Damage Coronary Arteries

Fatigue
During chemotherapy, most people deal with fatigue -- yet a third of people continue to
experience fatigue for months to years after chemotherapy is completed. It is important to share
this symptom with your doctor, because many causes of fatigue are reversible.

How Is Cancer Fatigue Different from Being Tired?

Coping with Cancer Fatigue

Chemobrain
"Chemobrain" -- a constellation of symptoms that includes problems with memory and
concentration -- has only recently been recognized as a long-term side effect of chemotherapy.
Chemobrain symptoms can be very frustrating, but an awareness of things you can do to cope
with the symptoms can be very helpful. In most cases, chemobrain symptoms improve over time.

Details on Chemobrain

Infertility
Primarily a concern for younger people with cancer, loss of fertility after chemotherapy can be
heartbreaking. Infertility following treatment varies with the dose and type of chemotherapy
medications used, and doesnt affect everyone. If you believe you may want to have children
after treatment (for both men and women), talk to your physician about the options available to
you before you start treatment.

Chemotherapy Drugs Known to Cause Infertility

Infertility After Treatment

Peripheral Neuropathy
Peripheral neuropathy, experienced most often as a sensation of numbness and burning in your
feet and hands, along with constipation, is another long-term side effect of chemotherapy. This
side effect occurs more commonly in people with a history of diabetes, alcoholism, or
malnutrition.
Some drugs that can cause this side effect in up to a third of people include Taxotere (docetaxel)
and Taxol (paclitaxel). Other medications, such as Platinol (cisplatin), Oncovin (vincristine), and
Novelbine (vinorelbine), can also result in peripheral neuropathy.

Coping With Neuropathy from Chemotherapy

Hearing Loss
One of the most common long-term side effects of Platinol (cisplatin) , a medication used for
many cancers including lung cancer, is hearing loss. Other medications may also cause hearing
loss and tinnitus (ringing in the ears).

Ototoxicity Damage to Hearing Caused by Medications

Skeletal Effects
Osteoporosis (thinning of the bones) is the most common late effect of chemotherapy. Most
chemotherapy drugs cause bone loss to accelerate, and changes in diet that accompany cancer
and its treatment can amplify the problem. The greatest concern over the long run is fractures
that can result from this bone loss.
Chemotherapy has also been associated with osteomalacia, bone loss related to a deficiency of
vitamin D.

What You Need to Know About Osteoporosis

Respiratory Effects
Chemotherapy can cause scarring of the lung (pulmonary fibrosis) and decreased lung capacity
in some people. This may be more pronounced when chemotherapy is combined with radiation
therapy to the chest area.

Liver Effects
Many chemotherapy medications can cause toxic damage to the liver (hepatotoxicity).
Thankfully, the liver has a remarkable potential to regenerate most of the time, as long as other
damaging effects (such as excess alcohol intake) are avoided.

Kidney and Bladder Effects

Certain chemotherapy medications, such as cisplatin, can cause damage to the kidneys and
bladder. This can result in a decreased ability of your kidneys to filter your blood. Damage to the
bladder can also occur and may be temporary or permanent. Symptoms of bladder irritation may
include pain or urgency with urination, or blood in your urine.

Effect on the Eyes

Steroids are often given along with chemotherapy or for symptoms and side effects related to
cancer. This can hasten the development of cataracts in some people.

Secondary Cancer

Due to the mechanism by which chemotherapy medications work, they can cause DNA damage
in normal cells, which may result in secondary cancers down the line. Some chemotherapy
medications are more likely to cause this damage, with a category called alkylating agents being
most likely (an example of these is Cytoxan (cyclophosphamide) ).
Medications used to treat lung cancer that may cause a secondary cancer (though less likely)
include Vepesid (etoposide) and Platinol (cisplatin.

What Can You Do to Lower Your Risk?

Until we know more about long-term survivorship issues following chemotherapy for adults,
there are a few things you can do:

Ask your oncologist about any late effects that you may expect from the particular
chemotherapy drugs you were given. Are there any screening tests (for example, tests for
heart problems, hearing loss, or osteoporosis) that she would recommend?

Keep a record of your chemotherapy regimen with you in case you see a physician who is
unfamiliar with your medical history.

If you smoke, quit.

Make regular appointments with your dentist and eye doctor.

Engage in regular physical activity.

Limit your intake of alcohol.

Let your doctor know if you experience any new symptoms or worsening of current
symptoms you have.

For childhood cancer survivors, survivorship issues have been addressed in an excellent
review:

Long Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young
Adult Cancers