What is Colorectal Cancer?

Colorectal cancer occurs in the colon or rectum. The term colorectal cancer is used to describe colon cancer, rectum cancer or both. The colon is part of the large intestine or large bowel. The rectum is the passageway that connects the colon to the anus.

Most colorectal cancers develop first as polyps, which are abnormal growths inside the colon or rectum that may later become cancerous if not removed.

Who Does it Affect?

Colorectal cancer is the third most common cancer in the US, and the second leading cause of cancer death. It affects men and women of all racial and ethnic groups, and is most often found in people 50 years or older. However incidence in those younger than 50 is on the rise.

Why Should I Get Screened?

Colorectal cancer, when discovered early, is highly treatable. Even if it spreads into nearby lymph nodes, surgical treatment followed by chemotherapy is highly effective. In the most difficult cases — when the cancer has spread to the liver, lungs or other sites — treatment can help make surgery an option for many, as well as prolonging and adding to one’s quality of life.

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Screening and Prevention

If you’re 50 or older, getting a colorectal cancer screening test could save your life.

Here’s How:

  • Colorectal cancer usually starts from precancerous polyps in the colon or rectum. A polyp is a growth that shouldn’t be there.
  • Over time, some polyps can turn into cancer.
  • Screening tests can find precancerous polyps, so they can be removed before they turn into cancer.
  • Screening tests also find colorectal cancer early, when treatment works best.

Who Should Be Screened and When?

All men and women should be screened for colorectal cancer. Your individual risk factors – such as ethnicity, lifestyle and family history – will determine when you should start getting checked. For most adults, it is recommended that colorectal cancer screening should begin at age 50.

Advantages

  • Most complete screening method available, identifies and removes polyps in one session
  • Sedation is given to patient to minimize discomfort
  • Examines full colon
  • Depending on results, may only need to be re-screened every 10 years

Disadvantages

  • Requires one day of clear liquids and laxative preparation
  • Small risk of perforation or bleeding
  • Will need to set aside a day for procedure and have a ride home in order to leave the medical facility

Will my insurance cover it?

Under the Patient Prevention and Affordable Care Act (PPACA), all insurers are required to cover preventive screening tests, like colonoscopies. However, you may still owe a copay or deductible.

The Facts

You’ll often hear colonoscopies referred to as the “gold standard” of screening. This is because they can both find cancer and remove potentially precancerous growths called polyps. Since most cases of colorectal cancer start as polyps, colonoscopies essentially allow you to stop colorectal cancer before it even starts!

The Procedure

During a colonoscopy, you will lie on your left side on an examination table. In most cases, your doctor will give you a light sedative, and possibly pain medication, to help you stay relaxed. The doctor will then insert a long, flexible, lighted tube called a colonoscope, or scope, into the anus and slowly guide it through the rectum and into the colon. The scope inflates the large intestine with carbon dioxide gas to give the doctor a better view. A small camera mounted on the scope transmits a video image from inside the large intestine to a computer screen, allowing the doctor to carefully examine the intestinal lining. Once the scope has reached the opening to the small intestine, it is slowly withdrawn and the lining of the large intestine is carefully examined again.

Risk Factors

Risk Factors You CAN Change

Being Overweight or Obese

If you are overweight or obese (very overweight), your risk of developing and dying from colorectal cancer is higher. Being overweight (especially having a larger waistline) raises the risk of colon and rectal cancer in both men and women, but the link seems to be stronger in men.

Physical Inactivity

If you’re not physically active, you have a greater chance of developing colon cancer. Being more active can help lower your risk.

Diets High in Red & Processed Meats

A diet that’s high in red meats (such as beef, pork, lamb, or liver) and processed meats (like hot dogs and some luncheon meats) raises your colorectal cancer risk.

Smoking

People who have smoked tobacco for a long time are more likely than non-smokers to develop and die from colorectal cancer. Smoking is a well-known cause of lung cancer, but it’s linked to a lot of other cancers, too.

Heavy Alcohol Use

Colorectal cancer has been linked to moderate to heavy alcohol use. Limiting alcohol use to no more than 2 drinks a day for men and 1 drink a day for women could have many health benefits, including a lower risk of many kinds of cancer.

 

Risk Factors You Can’t Change

Your Age

Your risk of colorectal cancer goes up as you age. Younger adults can get it, but it’s much more common after age 50.

Personal History of Colorectal Polyps or Colorectal Cancer

If you have a history of adenomatous polyps (adenomas), you are at increased risk of developing colorectal cancer. This is especially true if the polyps are large, if there are many of them, or if any of them show dysplasia.

If you’ve had colorectal cancer, even though it was completely removed, you are more likely to develop new cancers in other parts of the colon and rectum. The chances of this happening are greater if you had your first colorectal cancer when you were younger.

Personal History of Inflammatory Bowel Disease (IBD)

If you have inflammatory bowel disease (IBD), including either ulcerative colitis or Crohn’s disease, your risk of colorectal cancer is increased.
If you have IBD, you may need to start getting screened for colorectal cancer when you are younger and be screened more often.

Family History of Colorectal Cancer

Most colorectal cancers are found in people without a family history of colorectal cancer. Still, nearly 1 in 3 people who develop colorectal cancer have other family members who have had it.

People with a history of colorectal cancer in a first-degree relative (parent, sibling, or child) are at increased risk. The risk is even higher if that relative was diagnosed with cancer when they were younger than 45, or if more than one first-degree relative is affected.

If you have a family history of adenomatous polyps or colorectal cancer, talk with your doctor about the possible need to start screening before age 45. If you’ve had adenomatous polyps or colorectal cancer, it’s important to tell your close relatives so that they can pass along that information to their doctors and start screening at the right age.

 

Frequently Asked Questions

How does screening save lives?

Screening for colorectal cancer works in two ways:
By finding cancers early when treatment is most effective
By finding growths (polyps) inside the colon and removing them before they become cancer

If screening works, why aren’t more people doing it?

  • According to the Centers for Disease Control and Prevention, only 1 in 3 adults who need to be screened are actually doing it. Why so few? There are many reasons, including:
  • Insurance coverage and paying for the test
  • Fears about the test or preparation
  • A primary care doctor hasn’t suggested it. (Please be your own advocate! Know your options!)
  • Too busy/don’t think they have time

Why remove polyps if you don’t have cancer?

Polyps are growths that may turn into colorectal cancer over time. While not every polyp turns to cancer, it is difficult to know which ones will. Also, almost every colorectal cancer begins as a small non-cancerous polyp. The good news is that during colonoscopy, these polyps can be identified and removed, preventing a possible colorectal cancer diagnosis. If a polyp is large enough, tissue can be taken and sent for biopsy to determine the exact type of polyp.

Why does the type of polyp matter?

Not all polyps are created equal. There are four types of polyps that commonly occur within the colon and rectum:

  • Inflammatory – Inflammatory polyps are most often found in patients with ulcerative colitis or Crohn’s disease. Often called “pseudopolyps” (false polyps), they are not true polyps, but just a reaction to chronic inflammation of the colon wall. They are not the type that turns to cancer. They are usually biopsied to verify type.
  • Hyperplastic – Hyperplastic polyps are common, usually very small and often found in the rectum. They are considered to be low risk for cancer.
  • Tubular adenoma or adenomatous polyps – These are the most common type of polyp and are the ones referred to most often when a doctor speaks of colon or rectal polyps; about 70% of polyps removed are of this type. Adenomas carry a definite cancer risk that rises as the polyp grows larger. Patients with a history of adenomatous polyps must be periodically reexamined.
  • Villous adenoma or tubulovillous adenomas – Villous and tubulovillous adenomas polyps account for about 15% of the polyps that are removed. These are the most serious type of polyps with a very high cancer risk as they grow larger.

“Colorectal cancer is the second-leading cancer killer--but it doesn’t have to be. Colonoscopy helps find cancer early when treatment can be most effective.”

– Ronn A. Grandia, MD, General Surgeon