What You Should Know About Cecum Cancer

Signs and Symptoms, Diagnosis, and Treatment

Stomach pains
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The signs and symptoms of cecum cancer are sometimes elusive. The cecum demarcates the beginning of your large intestine. This pouch-like section of intestine connects a portion of the small intestine, called the ileum, to the ascending colon. This region of the colon can be more difficult to examine, but is important, in that some studies have found that up to 20 percent of colorectal cancers occur in the cecum (in some studies it is much less common).

What are the signs and symptoms of cecum cancer, how is it diagnosed, and how is it treated?

Anatomy of the Colon and Cecum

In order to understand where the cecum falls in the abdomen, and hence, symptoms you might expect, it's helpful to review the anatomy of the colon.

Your colon is divided into four main parts:

  • Cecum and ascending colon: The cecum and ascending colon are often referred to your "right" colon." The cecum joins the small intestine near the region of the appendix, in your right lower abdomen, and the ascending colon runs up along the right side of your abdomen to the transverse colon.
  • Transverse colon: This portion of your colon runs horizontally across your upper abdomen from the right to the left.
  • Descending colon: The descending colon runs down the left side of your abdomen, from the upper to lower part.
  • Sigmoid colon: The sigmoid colon connects the descending colon to the rectum and anus.

    The location of the cecum can make it more difficult to find cancer than in other regions of the colon.

    Function of the Cecum

    The cecum, being the beginning of the colon where water is absorbed from stool, contains stool which is liquidy and not fully formed. The function of your cecum is to absorb the remaining nutrients from your bowels, and begin the reabsorption of water which results in the waste you see when you defecate (poop).

    Anatomically, the cecum sits in the right lower area of your abdomen, where your appendix is positioned. Just like you can live without an appendix, which is attached to the cecum, it's possible to live without a cecum.

    Symptoms of Cancer of the Cecum

    The symptoms of cecum cancer can be nonspecific and are often different than what you would think of with colon cancer symptoms. The most common symptoms of colorectal cancer overall include a feeling of fullness or pressure in the rectum, rectal bleeding, and a frequent urge to defecate. Chances are you will not experience these telltale symptoms with cecum cancer. Inflammation in the cecum, unlike the rectum or sigmoid colon, will not make you feel the urge to defecate or cause bowel habit irregularities (although it is sometimes associated with diarrhea) because the stool passing through the cecum is slushy and can easily bypass masses in this part of the intestine.

    Unfortunately, the majority of cecum cancer symptoms are late, meaning the disease is already very advanced by the time you feel these symptoms. Potential symptoms may include:

    • Anemia, and symptoms that go along with anemia such as fatigue, shortness of breath, weakness, and a rapid heart rate. Bleeding from this area of the colon is often microscopic, and not recognized until a doctor finds that you have iron deficiency anemia on a complete blood count (CBC). 
    • Dark, tarry stools (melena): When bleeding occurs in the cecum and ascending colon, it usually causes black stools that can appear tar-like, rather than the bright red blood seen with bleeding lower in the digestive tract. 
    • Gas and bloating:  Gas and bloating may occur, but are nonspecific, and often first attributed to another cause.
    • Abdominal pain: Like gas and bloating, abdominal pain is nonspecific and can have many possible causes. When pain is present, it may be noted in the region known for pain with appendicitis, McBurney's point. This point can be located by drawing a line from your right hip bone to your belly button and locating the midpoint. That said, abdominal pain may be diffuse, and often does not say much about the location of the underlying problem.
    • Nausea and vomiting: Large tumors in the right side of your colon may cause food to "back up" through the small intestine and stomach, causing vomiting. Vomiting is often "bilious" appearing, or yellow in color.
    • Weight loss: Unintentional weight loss is often seen with advanced tumors, and should always be investigated. Unintentional weight loss is defined as the loss of 5 percent of body weight or more over a 6 to 12 month period. This would be equivalent to a 150-pound person losing 7.5 pounds without trying.

    Other Causes of Cecum Cancer Symptoms (Differential Diagnosis)

    The presence of the symptoms noted above does not mean you have cecum cancer, and there are several different conditions which can appear similar. Some of these include:

    • Cecal volvulus: An uncommon condition, a cecal volvulus occurs when your cecum and ascending colon twist, and cause an obstruction which blocks the passage of stool through your bowels. This torsion can lead to abdominal pain, swelling, cramps, nausea, and vomiting. It may be caused by pregnancy, severe fits of coughing or abdominal adhesions—scar tissue in the abdomen often caused by previous surgery—and most frequently affects people between the ages of 30 and 60.
    • Inflammatory bowel disease (IBS): IBS, including disorders such as Crohn's disease and ulcerative colitis, can cause abdominal pain, abdominal swelling, and irregular bowel movements among other symptoms. Not only can IBS mimic the symptoms of inflammatory bowel disease, but IBS is a risk factor for the development of colon cancer.
    • Acute appendicitis: The symptoms of appendicitis mirror those of cecum cancer, including abdominal pain which is worst in the right lower abdomen, nausea, and vomiting. In addition, having cancer in the cecum can lead to inflammation of the appendix. In some ways, this isn't all bad, and may result in a diagnosis of cecum cancer earlier than it would otherwise be made.

    Diagnosis

    colonoscopy is the best test for visually detecting a cancer of the cecum. In a colonoscopy, a doctor advances a colonoscope through your entire colon, up to the cecum, looking for polyps or suspicious growths which could be cancerous. If polyps are detected, they can be removed. Since most colon cancers begin as precancerous polyps, a colonoscopy cannot only detect cancer, but, via removal of these polyps, may prevent the development of colon cancer.

    During a colonoscopy, however, roughly 10 percent of the time the colonoscope cannot be introduced all the way to the cecum, and therefore misses this region. This may occur due to adhesions, or other problems which make the colon torturous or difficult to navigate. Barium enemas may be done, but also lack some accuracy. When this is the case, a virtual colonoscopy may be able to detect a cancer of the cecum when other tests fail.

    Other tests, such as a CT of your abdomen, may also be done to explore the area of your cecum, and to look for evidence of any spread of the cancer.

    Unfortunately, the test sometimes used to screen for colon cancer, flexible sigmoidoscopy, only evaluates the left side of the colon and would miss cancers of the cecum and right colon.

    Treatment

    If the cancer is too large to be removed in a polypectomy procedure, you may need surgery to remove it. The most common type of surgery for cancer of the cecum is called a right hemicolectomy—this surgery removes the right side of your colon and re-attaches the remaining portion to your small intestine. Depending on the stage and grade of your cancer, your doctor might also encourage adjuvant treatments, including chemotherapy and radiation.

    Prognosis

    Compared with left-sided colon cancers, right-sided colon cancers, such as those of the cecum, have somewhat poorer survival rates. This could be due to greater difficulty in diagnosing these tumors and a higher stage of disease at the time of diagnosis.

    Despite this prognosis, right-sided colon cancers are less likely to spread (metastasize) to the liver and lungs than left-sided colon cancers.

    A Word From Verywell

    Relative to other colon cancers, cancer of the cecum can be more difficult to diagnose, based on both symptoms that differ from colon cancers further along in the colon, and greater difficulty visualizing this area on screening tests. Early symptoms often include iron deficiency anemia due to microscopic bleeding. Iron deficiency anemia should always be investigated, especially in men and in postmenopausal women.

    Screening colonoscopies are the best way to detect the disease, but do not always reach to the region of the cecum. When this occurs, virtual colonoscopy is an option that may help visualize the upper right colon. 

    The prognosis is somewhat poorer for cancers of the cecum than for other colon cancers, most likely related to the greater difficulty in diagnosing the disease in the early stages. If you have any signs or symptoms suggestive of cancer of the cecum, talk to your doctor. Some of these symptoms raise concern about other serious conditions as well. Fortunately, while there is controversy over screening for other types of colon cancer, screening colonoscopies for colon cancer are saving lives, and hopefully will improve survival rates in the future.

    Sources:

    Amri, R., Bordeianou, L., Sylla, P., and D. Berger. Variations in Metastasis Site by Primary Location in Colon Cancer. Journal of Gastrointestinal Surgery. 2015. 19(8):1522-7.

    National Cancer Institute. Colon Cancer Treatment (PDQ)—Health Professional Version. Updated 02/16/18. https://www.cancer.gov/types/colorectal/hp/colon-treatment-pdq

    Suttie, S., Shaikh, T., Mullen, R. et al. Outcome of Right- and Left-sided Colonic and Rectal Cancer Following Surgical Resection. Colorectal Diseases. 2011. 13(8):884-9.