The causes of colorectal cancer and the recommended guidelines for advanced screening to put time on your side
Catching Colorectal Cancer Early
By Holly Morse-Ellington
While the thought of a colonoscopy can seem unpleasant, delayed screening can put you at greater risk for developing colorectal cancer. Lacking obvious symptoms in its early and more treatable stages, timely detection is essential.
You may have heard that colorectal cancer is something to think about when you’ve reached your 50s. While that’s true, what’s also true is that colorectal cancer is increasingly affecting people in their 40s, sometimes younger. And unfortunately, only half of those in the targeted age range are getting screened. In fact, it’s estimated that 58% of all colorectal cancer deaths in 2020 will result from “non-screening.”
With advances in technology and more accessible options, the value of early detection outweighs possible excuses for putting screening off another year. The bottom line: Early detection and healthy lifestyle choices can decrease, even prevent, the risk of developing this life-threatening disease.
What Is Colorectal Cancer?
Dr. Eric Nelson Medical Director, Gastrointestinal-Colorectal Center of Excellence at CHI Memorial
As the name suggests, colorectal cancer can start in either the colon or the rectum. Since both cancers share common features, the two are combined by name as one specific type of cancer that originates from an abnormal growth called a polyp. Not all polyps are cancerous, as their classification (neoplastic vs. non-neoplastic), location, and size all contribute to the likelihood. As a general rule, the larger the polyp, the greater the likelihood it’s cancerous. And considering their hiding places, precancerous polyps can grow unnoticed for months or years.
Colorectal cancer is the third most commonly diagnosed cancer in men and women in the United States. “About 1 in 20 people in the United States will develop colorectal cancer,” says Dr. Eric Nelson, medical director of the Gastrointestinal-Colorectal Center of Excellence at CHI Memorial. “Those over age 50 are much more likely to get it, but up to 10% of new cancers are found in those younger than 50.” In fact, experts document a startling rise – 2 to 3% annually – among Gen Xers and Millennials. While no specific cause has been named, a connection between the obesity epidemic and these generations may be partly to blame.
Signs to Look For
Physical symptoms don’t typically show up until colorectal cancer has advanced and spread. The reason? Polyps can begin as small clumps of cells that don’t necessarily attract attention to alert there’s a problem. “The most common symptom is no symptoms at all,” explains Dr. Shauna Lorenzo-Rivero, a colorectal surgeon with University Surgical Associates. “That being said, changes in bowel movements, diarrhea, and constipation can all be indicators.” Colorectal cancers can also bleed into the digestive tract, and as this continues, the blood loss can lead to anemia. Yet another reason it’s important to stay up-to-date with blood work, the first sign of colorectal cancer may be a blood test showing a low red blood cell count.
Dr. Shauna Lorenzo-Rivero Colorectal Surgeon, University Surgical Associates
Other possible signs can be bowel discomfort or cramping, fatigue, and unexplained weight loss. But don’t jump to the worst-case scenario – these can also be signs of hemorrhoids, irritable bowel syndrome, or a type of infection. Depending on your personal history, you may want to keep an eye on symptoms that can overlap.
You should be especially vigilant of signs if you’re at higher risk for colorectal cancer. “Individuals at high risk include those with inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease), those who have a known family history of colorectal cancer, and those with potential genetic abnormalities that make them susceptible for developing colorectal cancer,” explains Dr. Maikel Botros, a radiation oncologist with the Sarah Cannon Cancer Institute at Parkridge Medical Center.
Approximately 9 out of 10 people whose colorectal cancer is found early and treated accordingly are still alive five years later. Unfortunately, only 59% of people age 50 and older are current with recommended screenings.
Approximately 9 out of 10 people whose colorectal cancer is found early and treated accordingly are still alive five years later. Unfortunately, only 59% of people age 50 and older are current with recommended screenings. “Screening is important to find cancer before it is advanced, but when someone is not having symptoms, they can forget about it or feel like it’s not important,” says Dr. Nelson. Beyond that, people don’t want to deal with the logistical hassles involved with screening. “Many individuals consider colonoscopies to be especially frustrating since they require you to take a day off of work, and they require bowel preparation, which involves drinking a laxative to clear out the colon, the night before the procedure,” explains Dr. Botros.
Dr. Maikel Botros Radiation Oncologist, Sarah Cannon Cancer Institute at Parkridge Medical Center
So what should you do? The medical community views colonoscopies as “The Gold Standard” for detection, though there are various tests approved for routine colorectal screening. “Colonoscopy is both diagnostic and therapeutic, which means if a polyp is found, it can be removed to prevent cancer,” explains Dr. Lorenzo. People who are average risk, with no cancer or polyps in their family, should start colonoscopy screening at age 50 and repeat every 10 years. Those with colon cancer or polyps in the family should begin screening 10 years younger than the youngest person to be diagnosed and repeat every five years or less. “Newer preparations are now available so that patients don’t have to drink a gallon of liquid to perform an adequate prep,” adds Dr. Botros.
Other visual exam options include CT colonography, which is a virtual colonoscopy using special X-ray equipment to examine the large intestine for cancerous polyps, and flexible sigmoidoscopy, a procedure done with a tiny video camera. Both are recommended every five years.
Less invasive measures are also available, though testing needs to be completed more regularly. Stool-based tests such as fecal immunochemical test (FIT), guaiac-based fecal occult blood test (gFOBT), and stool DNA tests check for trace amounts of blood that can be an early sign of cancer. There are even at-home versions of stool sample screenings available by prescription.
There are advantages and limitations to each test, so talk to your doctor about which method is right for you. They’ll take into consideration your age, medical history, and family history to pursue your best course of action. The American Cancer Society recommends screening through age 75, at which time patients can discuss factors such as overall health and prior medical history to determine if further screening is necessary.
Treating Colorectal Cancer
If abnormalities are identified, additional testing or polyp removal will be required to determine if the growth is malignant or benign. In the case that a cancerous polyp is diagnosed, treatment options are available and vary depending upon the stage of cancer. “Small polyps can be removed with a colonoscopy, while larger polyps and early-stage colon cancer require surgery,” says Dr. Lorenzo. “If cancer has progressed to the lymph nodes, chemotherapy is necessary for a cure in addition to surgery. Chemotherapy and radiation together are used for rectal cancer only. If the cancer has spread to other organs, chemotherapy may be used with or without surgery to prevent the progression of disease.”
Prevention Through Lifestyle
While keeping up with regular screenings is the most important action to take for early detection, there are lifestyle adjustments you can make to minimize risk factors associated with colorectal cancer. Extra pounds, particularly around the waistline, have been linked to an increased risk. Maintaining a healthy diet and exercise regimen are proactive steps, especially considering that a sedentary lifestyle can also contribute to a greater chance for colorectal cancer. “Lifestyle is integrally related to the development of colorectal cancer,” says Dr. Nelson. “Avoid smoking, alcohol, and processed meats. Eating a high-fiber diet will significantly reduce an individual’s risk of developing colorectal cancer.” With a combination of healthy living and regular screening, colorectal cancer can be something you prevent instead of fear.