What to know about colorectal cancer

Colorectal cancer is the second leading cause of cancer-related deaths in the United States, according to the National Cancer Institute. Although colorectal cancer death rates are declining overall, the American Cancer Society (ACS) estimates deaths among people younger than 50 rose about 3 percent every year from 2013 to 2022. Early detection and regular screenings can help prevent the disease and often cure it.

What is colorectal cancer?

Colorectal cancer is cancer that starts in the inner lining of the colon (the large intestine) or rectum (the last several inches of the large intestine). The cancer usually begins as a polyp (a small growth of irregular tissue) inside the intestine, which eventually develops into cancer cells that can break free and spread to other parts of the body. It's important to remember that polyps are often benign (not cancer), but some may lead to cancer.

Who’s at higher risk for colorectal cancer?

Studies show that certain factors may increase your risk of developing colorectal cancer, but why and how they affect the disease is still being explored. For example, American Indian, Alaska Native, and Black people have higher rates of the disease than white, Hispanic, or Asian people in the United States.

Being overweight or inactive, eating a diet rich in red or processed meats, smoking, and heavy drinking can all increase your risk. People over age 50 or those with inflammatory bowel disease (chronic inflammation of the digestive tract) have an increased risk, too.

Most cases of colorectal cancer are found in people who do not have a family history of colorectal cancer. But up to one-third of people with colorectal cancer have a family history of the disease.

“Patients who had family members with colon cancer, rectal cancer, or polyps are most at risk," says Theodoros Voloyiannis, MD, a colon and rectal surgeon in Webster, Texas.

Are there any symptoms?

Colorectal cancer is sometimes called a "silent killer" because it often has no symptoms until the disease has progressed and become more advanced or spread to other areas of the body. “The symptoms can sometimes be confused with other conditions, and in general, many patients have no symptoms or warning signs until the cancer has advanced,” says Dr. Voloyiannis.

Here are some symptoms that may indicate colorectal cancer:

• Prolonged bowel problems like diarrhea and constipation
• Feeling like you still have to go to the bathroom after a bowel movement
• Rectal bleeding, which may be seen on toilet paper or in stool (poop)
• Blood in the stool, which can appear dark red or black like tar
• Decreased stool quality, such as narrowing of the stool
• Unintended weight loss
• Weakness and fatigue
• Abdominal discomfort, pain or cramping
• Anemia, or low red blood cells that carry oxygen throughout your body

What are the screening options?

Screening can help healthcare providers (HCPs) find polyps and remove them early before cancer develops, or to diagnose cancer and suggest treatment. Both the U.S. Preventive Services Task Force (USPSTF) and the ACS recommend screenings beginning at age 45 for people with an average risk of colorectal cancer. Earlier screenings may be recommended for those who have an increased risk, Voloyiannis adds.

Here are some of the most common types of screenings:

• Colonoscopy: “This is the preferred method of screening,” notes Voloyiannis. During the procedure, a flexible tube with a camera is inserted into the colon and rectum to check for irregular growths. If polyps are found, they are usually removed for testing. Should be done every 10 years, or earlier depending on the findings.
• Stool tests: These tests look for blood or cancer cells in stool. You collect a sample at home and mail it in for analysis. Should be done every 1 to 3 years, depending on the test.
• Flexible sigmoidoscopy: A flexible tube is inserted into the rectum and lower part of the colon to check for irregular growths. Should be done every 5 years.

Many people put off getting their colonoscopies due to concerns about the process. While the bowel preparation the night before can be uncomfortable and time-consuming—it requires drinking a solution that causes diarrhea to clean out the colon—the actual colonoscopy procedure is short and usually painless.

That said, the prep has improved. “Nowadays, the bowel preparation and fluid you drink to clean up the bowels prior to the colonoscopy is more tolerable than it used to be. You don’t have to drink as much fluid and you can drink water in between,” explains Voloyiannis. Most colonoscopies today are also being done under IV anesthesia, which administers medication to make you sleepy directly into a vein. “You’re completely asleep so you don’t feel the pain or cramps, then you wake up right after the procedure, and only have to take one day off of work.”

What are the treatment options?

If you are diagnosed with colorectal cancer, the cancer’s stage, location, and type of cancer cells will be used to find a treatment option that is right for you. Options include:

• Surgery
• Radiation therapy (high-dose X-rays)
• Chemotherapy (chemo, or drugs that go throughout the body to kill cancer cells and can also damage healthy cells)
• Targeted therapy (drugs that target cancer cells for killing and minimize damage to healthy cells)
• Immunotherapy (drugs that work on the immune system to help it fight cancer)
• Combination therapy, using more than one cancer therapy

How can you lower your risk?

While you can’t control your genes, there are steps you can take to help lower your risk of colorectal cancer. In addition to the recommended screenings, here are some strategies:

• Aim to maintain a healthy weight.
• Quit smoking if you smoke.
• Stay active and exercise regularly, as you are able.
• Avoid red meat, deli meat like hot dogs and cold cuts, and limit processed foods; try to include plenty of fresh fruits, vegetables, and whole grains in your diet
• Limit alcoholic beverages to no more than two drinks a day for men, and one drink a day for women.

If detected early, polyps can be removed before they turn into cancer. Keeping your appointments for your personal screening recommendations is the best way to prevent colorectal cancer. Taking care of your overall health can also lower your risk.