Colorectal cancer

Location and appearance of two example colorectal tumors
Longitudinally opened freshly resected colon segment showing a cancer and four polyps. Plus a schematic diagram indicating a likely field defect (a region of tissue that precedes and predisposes to the development of cancer) in this colon segment. The diagram indicates sub-clones and sub-sub-clones that were precursors to the tumors.
Colon cancer with extensive metastases to the liver
Relative incidence of various histopathological types of colorectal cancer. The vast majority of colorectal cancers are adenocarcinomas.
Micrograph of colorectal adenocarcinoma, showing "dirty necrosis".
A diagram of a local resection of early stage colon cancer
A diagram of local surgery for rectal cancer
Colon and rectum cancer deaths per million persons in 2012

Development of cancer from the colon or rectum (parts of the large intestine).

- Colorectal cancer
Location and appearance of two example colorectal tumors

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Endoscopic image of a colon affected by ulcerative colitis. The internal surface of the colon is blotchy and broken in places. Mild-moderate disease.

Ulcerative colitis

Long-term condition that results in inflammation and ulcers of the colon and rectum.

Long-term condition that results in inflammation and ulcers of the colon and rectum.

Endoscopic image of a colon affected by ulcerative colitis. The internal surface of the colon is blotchy and broken in places. Mild-moderate disease.
Classification of colitis, often used in defining the extent of involvement of ulcerative colitis, with proctitis (blue), proctosigmoiditis (yellow), left sided colitis (orange) and pancolitis (red). All classes extend distally to the end of the rectum.
Gross pathology of normal colon (left) and severe ulcerative colitis (right), forming pseudopolyps (smaller than the cobblestoning typically seen in Crohn's disease), over a continuous area (rather than skip lesions of Crohn's disease), and with a relatively gradual transition from normal colon (while Crohn's is typically more abrupt).
Aphthous ulcers involving the tongue, lips, palate, and pharynx.
Pyoderma gangrenosum with large ulcerations affecting the back.
Endoscopic image of ulcerative colitis affecting the left side of the colon. The image shows confluent superficial ulceration and loss of mucosal architecture. Crohn's disease may be similar in appearance, a fact that can make diagnosing UC a challenge.
H&E stain of a colonic biopsy showing a crypt abscess, a classic finding in ulcerative colitis
Colonic pseudopolyps of a person with intractable UC, colectomy specimen
Biopsy sample (H&E stain) that demonstrates marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and architectural distortion of the crypts.

Complications may include abnormal dilation of the colon (megacolon), inflammation of the eye, joints, or liver, and colon cancer.

The three most common sites of intestinal involvement in Crohn's disease (left) compared to the areas affected by colitis ulcerosa (right).

Crohn's disease

Type of inflammatory bowel disease that may affect any segment of the gastrointestinal tract.

Type of inflammatory bowel disease that may affect any segment of the gastrointestinal tract.

The three most common sites of intestinal involvement in Crohn's disease (left) compared to the areas affected by colitis ulcerosa (right).
An aphthous ulcer on the mucous membrane of the mouth in Crohn's disease.
A single lesion of erythema nodosum
Endoscopic image of colon cancer identified in the sigmoid colon on screening colonoscopy for Crohn's disease
NOD2 protein model with schematic diagram. Two N-terminal CARD domains (red) connected via helical linker (blue) with central NBD domain (green). At C-terminus LRR domain (cyan) is located. Additionally, some mutations which are associated with certain disease patterns in Crohn's disease are marked in red wire representation.
Distribution of gastrointestinal Crohn's disease.
Endoscopic image of Crohn's colitis showing deep ulceration
CT scan showing Crohn's disease in the fundus of the stomach
Endoscopic biopsy showing granulomatous inflammation of the colon in a case of Crohn's disease.
Section of colectomy showing transmural inflammation
Resected ileum from a person with Crohn's disease

Bowel obstruction may occur as a complication of chronic inflammation, and those with the disease are at greater risk of colon cancer and small bowel cancer.

Colonoscopy being performed

Colonoscopy

Endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus.

Endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus.

Colonoscopy being performed
A container of PEG (polyethylene glycol or macrogol) with electrolyte used to clean out the intestines before certain bowel exam procedures such as a colonoscopy.
Schematic overview of colonoscopy procedure
Polyp is identified.
A sterile solution is injected under the polyp to lift it away from deeper tissues.
A portion of the polyp is now removed.
The polyp is fully removed.

It can provide a visual diagnosis (e.g., ulceration, polyps) and grants the opportunity for biopsy or removal of suspected colorectal cancer lesions.

A coronal CT scan showing a malignant mesothelioma
Legend: → tumor ←, ✱ central pleural effusion, 1 & 3 lungs, 2 spine, 4 ribs, 5 aorta, 6 spleen, 7 & 8 kidneys, 9 liver

Cancer

Group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body.

Group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body.

A coronal CT scan showing a malignant mesothelioma
Legend: → tumor ←, ✱ central pleural effusion, 1 & 3 lungs, 2 spine, 4 ribs, 5 aorta, 6 spleen, 7 & 8 kidneys, 9 liver
Symptoms of cancer metastasis depend on the location of the tumor.
The GHS Hazard pictogram for carcinogenic substances
Share of cancer deaths attributed to tobacco in 2016.
The incidence of lung cancer is highly correlated with smoking.
Cancers are caused by a series of mutations. Each mutation alters the behavior of the cell somewhat.
The central role of DNA damage and epigenetic defects in DNA repair genes in carcinogenesis
Chest X-ray showing lung cancer in the left lung
Three measures of global cancer mortality from 1990 to 2017
Engraving with two views of a Dutch woman who had a tumor removed from her neck in 1689
University of Florida Cancer Hospital
CancerTreeMammal
An invasive ductal carcinoma of the breast (pale area at the center) surrounded by spikes of whitish scar tissue and yellow fatty tissue
An invasive colorectal carcinoma (top center) in a colectomy specimen
A squamous-cell carcinoma (the whitish tumor) near the bronchi in a lung specimen
A large invasive ductal carcinoma in a mastectomy specimen

Early detection through screening is useful for cervical and colorectal cancer.

Micrograph showing tumor-infiltrating lymphocytes (in a colorectal cancer), a finding associated with MSI-H tumours, as may be seen in Lynch syndrome. H&E stain.

Hereditary nonpolyposis colorectal cancer

Micrograph showing tumor-infiltrating lymphocytes (in a colorectal cancer), a finding associated with MSI-H tumours, as may be seen in Lynch syndrome. H&E stain.
HNPCC is inherited in an autosomal dominant fashion.

Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome is an autosomal dominant genetic condition that is associated with a high risk of colon cancer as well as other cancers including endometrial cancer (second most common), ovary, stomach, small intestine, hepatobiliary tract, upper urinary tract, brain, and skin.

Constipation in a young child seen on X-ray. Circles represent areas of fecal matter (stool is white surrounded by black bowel gas).

Constipation

Bowel dysfunction that makes bowel movements infrequent or hard to pass.

Bowel dysfunction that makes bowel movements infrequent or hard to pass.

Constipation in a young child seen on X-ray. Circles represent areas of fecal matter (stool is white surrounded by black bowel gas).
Bristol stool chart
Significant constipation in the plain X-ray of an 8-year-old
19th century satirical cartoon of a monkey rejecting an old style clyster for a new design, filled with marshmallow and opium

Underlying associated diseases include hypothyroidism, diabetes, Parkinson's disease, celiac disease, non-celiac gluten sensitivity, colon cancer, diverticulitis, and inflammatory bowel disease.

Thinly sliced raw beef is red.

Red meat

Commonly red when raw and a dark color after it is cooked, in contrast to white meat, which is pale in color before and after cooking.

Commonly red when raw and a dark color after it is cooked, in contrast to white meat, which is pale in color before and after cooking.

Thinly sliced raw beef is red.
Roast beef is a darker color after being cooked.
Cooked duck with potatoes, showing the red color of the meat
Meat with a dark exterior, common in high temperature cooking

Overall, diets high in red and processed meats are associated with an increased risk of diabetes, cardiovascular disease, cancer (particularly colorectal cancer), and all-cause mortality.

Micrograph showing inflammation of the large bowel in a case of inflammatory bowel disease. Colonic biopsy. H&E stain.

Inflammatory bowel disease

Group of inflammatory conditions of the colon and small intestine, Crohn's disease and ulcerative colitis being the principal types.

Group of inflammatory conditions of the colon and small intestine, Crohn's disease and ulcerative colitis being the principal types.

Micrograph showing inflammation of the large bowel in a case of inflammatory bowel disease. Colonic biopsy. H&E stain.
Associated loci pane. Pink genes are in IBD associated loci, blue are not.

Many studies identified that microRNAs dysregulation involved in IBD and to promote colorectal cancer.

Endoscopic image of sigmoid colon of patient with familial adenomatous polyposis

Familial adenomatous polyposis

Autosomal dominant inherited condition in which numerous adenomatous polyps form mainly in the epithelium of the large intestine.

Autosomal dominant inherited condition in which numerous adenomatous polyps form mainly in the epithelium of the large intestine.

Endoscopic image of sigmoid colon of patient with familial adenomatous polyposis
CHRPE - Congenital hypertrophy of the retinal pigment epithelium
Micrograph of a tubular adenoma, the colorectal cancer precursor most commonly associated with FAP
Colectomy specimen showing numerous polyps throughout the large bowel

While these polyps start out benign, malignant transformation into colon cancer occurs when they are left untreated.

Scheme of digestive tract, with rectum marked

Rectum

Final straight portion of the large intestine in humans and some other mammals, and the gut in others.

Final straight portion of the large intestine in humans and some other mammals, and the gut in others.

Scheme of digestive tract, with rectum marked
The inside of a normal human rectum in a 70-year-old, seen during colonoscopy
Retroflexed view of the human rectum seen at colonoscopy showing anal verge
A digital rectal exam is conducted to investigate or diagnose conditions including of the prostate.
Arteries of the pelvis
Blood vessels of the rectum and anus
Cross-section microscopic shot of the rectal wall
Dog rectum cross-section (40×)
Microscopic cross-section of the rectum of a dog (400×), showing a high concentration of goblet cells in amongst the column-shaped lining. Goblet cells can be seen as the circular cells with a clear inner material (cytoplasm).

Rectal cancer, a subgroup of colorectal cancer specific to the rectum.