Colorectal Cancer

Other than skin cancer, colorectal cancer is the 3rd most common cancer diagnosed in the US and the third leading cause of cancer death. It affects people in all racial and ethnic groups and is most often found in people age 50 and older. African Americans are at a higher risk of developing the disease.

Cancers that start in the colon (colon cancer) or in the rectum (rectal cancer) are also called colorectal cancer. It often starts as a non-cancerous polyp (growth on the inner wall of the colon or rectum) or as a precancerous polyp that can turn in to cancer. These polyps can be present in the colon for years before invasive cancer develops. The two most common types of polyps are adenomas and hyperplastic polyps. Adenomatous polyps have a higher likelihood of developing in to cancer
Colorectal Cancer

Some risk factors for colorectal cancer are:

Age: Chances of being diagnosed with colorectal cancer increase as a person gets older.

Family history: Having close relatives with colorectal cancer or a history or precancerous colorectal polyps increases a person’s risk. Certain genetic syndromes such as Familial Adenomatous Polyposis (FAP) or Hereditary Non-Polyposis Colorectal Cancer (Lynch Syndrome) can cause an increased risk.

Medical History: Having Inflammatory Bowel Disease, Crohn’s Disease, or Ulcerative Colitis can be a risk factor.

Diet: Diets high in fat and low in calcium, folate and fiber may increase one’s risk.

Smoking: Smoking may increase risk of developing polyps and colorectal cancer.

Alcohol: Heavy use of alcohol has been linked to the disease. (More than 2 drinks a day for men and 1 drink a day for women)

Lack of exercise: People who are not active have a higher risk of colorectal cancer.

Weight: People who are overweight or are obese are at a higher risk of developing colorectal cancer.

Signs & Symptoms

Signs and symptoms are often not present until the disease is more advanced. They are different for each patient. It’s important to discuss any questions or concerns you may have with your physician.
  • Change in bowel habits including constipation, diarrhea, change in stool size or diameter, or mucous in the stool.
  • Blood in or on the stool
  • Abdominal discomfort such as cramps, gas pains, or bloating
  • Unexplained weight loss
  • Fatigue
  • Nausea and vomiting

Screening & Diagnostic Testing

The National Comprehensive Cancer Network recommends that people with an average risk begin colorectal screening at age 50. If there is a family history of cancer or Lynch syndrome and/or a personal history of polyps or inflammatory bowel disease, screening before the age of 50 may be recommended by your physician.

In May of 2018, the American Cancer Society (ACS) changed the age of colorectal screening for individuals at an average risk to age 45. While the number of diagnoses for colorectal cancer for adults aged 55 and over has declined over the last 20 years, a disturbing increase of 51% in colorectal diagnoses has been noted for adults under the age of 50 since 1994 (American Cancer Society, 2018). Furthermore, death rates from colorectal cancer in the younger age group are also rising. Based on these statistics, the ACS funded a modeling study that used the age 45 to begin screening rather than at the age of 50. The ACS found that it is more likely that adults will have more favorable outcomes at the lowered age.
ACS’s new screening recommendation is considered a “qualified recommendation” because the hard-scientific data isn’t yet there. The previous recommendation to begin screening at the age of 50 was considered a “strong recommendation” because the scientific evidence is there to support it. It is important to also know that there is more than one organization that makes cancer screening recommendations including the U.S. Preventative Services Task Force. Additionally, whenever screening recommendations change, it is important for you to check with your insurance provider to see which screening guidelines they use as it may affect which screenings are covered as well as your costs and copays.
The ACS recommends people, who are in good health, with a life expectancy of more than 10 years, continue regular colorectal cancer screening through the age of 75. After age 75, through age 85, consideration for screening should include a person’s preferences, life expectancy, overall health, and prior screening history.
A complete physical exam and medical history should be done. The exam will check for any unusual physical signs. A complete medical history is also important to fully understand a person’s health habits, family history, previous illnesses, and past exposure. Additional testing may include:
  • High-sensitivity fecal occult blood tests (FOBT)
  • Stool DNA test (FIT-DNA)
  • Flexible Sigmoidoscopy
  • Standard (or optical) colonoscopy
  • Virtual colonoscopy
  • Biopsy

Helpful Patient Resources:

We understand that receiving a cancer diagnosis can be a very scary and it is an emotional time for the patient and their families. It is very important to discuss any questions or concerns you may have with your oncologist. We highly recommend that if you do any research about your disease, that you do so only with reputable sources. For your convenience, we’ve listed some below.

National Cancer Institute:

American Cancer Society