I.

Anatomy and Physiology

The large intestine is a hollow tube that makes up the last 6 feet of the

digestive tract. It is often referred to as the large bowel or colon (which is

technically just one part of the large intestine). The large intestine consists of the
cecum (a pouch-like structure at beginning of the large intestine), colon, rectum and
anus. The colon and rectum are next to other organs, including the spleen, liver,
pancreas, and reproductive and urinary organs. Each of these organs can be
affected if colorectal cancer spreads beyond the large intestine.

Structure
The colon begins at the cecum, where it joins the end of the small intestine (ileum).
The colon changes to rectal tissue in its last 6 inches. Because there is not a clear

border between the colon and rectum, colon and rectal cancers are grouped
together as colorectal cancer.

The colon is divided into 4 parts:

ascending colon begins at the cecum, where it joins the end of the small
intestine, and travels upward along the right side of the body to the
transverse colon

transverse colon connects the ascending colon to the descending colon and
lies across the upper abdomen

descending colon connects the transverse colon and the sigmoid colon and
lies along the left side of the body

sigmoid colon connects the descending colon and the rectum

The colon and rectum are made up of a number of different tissues organized into
layers:

mucosa

inner lining (epithelium), lamina propria (connective tissue) and thin

layer of muscle (muscularis mucosa)

submucosa
o

connective tissue, glands, blood vessels, lymphatic vessels and nerves

muscularis propria (muscular layer)

serosa (serous layer)

o

outer lining of the colon but not the rectum

Mesentery is a fold of tissue that connects organs to the body wall. Part of the
colon is connected to the abdominal wall by mesentery. The upper two-thirds of the
rectum is also covered by mesentery called the mesorectum. The mesentery is
made up of fatty connective tissue that contains the blood vessels, nerves, lymph
nodes and lymphatic vessels that supply the colon. When surgeons remove part of
the colon or rectum to treat cancer in these areas, they will remove the mesentery
next to these organs as well. The lymph nodes within the removed mesentery will
be examined to see if they contain cancer.
Function

The main functions of the colon and rectum are to absorb water and nutrients from
what we eat and to move food waste out of our body.

The colon receives partially digested food, in a liquid form, from the small
intestine.

Bacteria (bowel flora) in the colon break down some materials into smaller
parts.

The epithelium absorbs water and nutrients. It forms the remaining waste
into semi-solid material (feces or stool).

The epithelium also produces mucus at the end of the digestive tract, which
makes it easier for stool to pass through the colon and rectum.

Sections of the colon tighten and relax (peristalsis) to move the stool to the
rectum.

The rectum is a holding area for the stool. When it is full, it signals the brain
to move the bowels and push the stool from the body through the anus.

http://www.cancer.ca/en/cancer-information/cancer-type/colorectal/anatomy-andphysiology/?region=on#ixzz3SgBpnIFN

Abnormal
Rectal cancer is a malignant tumour that starts in cells of the rectum.
Malignant means that it can spread, or metastasize, to other parts of the body. The
rectum is a part of the digestive system. Together, the colon and rectum make up
the large intestine, or large bowel. The colon takes up water and nutrients from food
and passes waste to the rectum. Cells in the colon and rectum sometimes change
and no longer grow or behave normally. These changes may lead to benign tumors
such as polyps, which are not cancerous.

Changes to cells of the colon and rectum can also cause precancerous
conditions. This means that the cells are not yet cancer but there is a higher chance
these abnormal changes will become cancer. The most common precancerous
conditions of the colon are adenomatous polyps (also called adenomas) and
polyposis syndromes. In some cases, changes to colon and rectum cells can cause
colorectal cancer.
Most often, rectal cancer starts in glandular cells, which make mucus and
digestive fluids. These cells line the inside of the colon. This type of cancer is called
adenocarcinoma of the rectum. Rare types of rectal cancer can also develop. These
include carcinoid tumor, lymphoma and sarcoma.