Six Things to Know About Colorectal Cancer

March is Colorectal Cancer Awareness Month, a good time to shine a light on the disease, which is the third most common cancer (excluding skin cancers) for both men and women, and the second leading cause of cancer-related deaths in the U.S. 

The American Cancer Society estimates that 152,810 new cases of colorectal cancer – 106,590 colon cancer cases, 46,220 rectal cancer cases – will be diagnosed in 2024 and 53,010 will die from the disease.

While colorectal cancer rates have dropped in recent decades due to increased screening and better awareness about lifestyle-related risk factors, that downward trend has generally been seen in older adults. 

In people under age 55, colorectal cancer rates have been on the rise since the mid-2000s, increasing by 1% annually. 

Which is why routine screening tests, such as colonoscopy are so important for the prevention and early detection of colorectal cancer. 

Through colonoscopy, colorectal polyps can be found and removed before developing into cancer. Colonoscopy can also detect cancer at an earlier stage, when it is easier to treat. 

Mandeep S. Saund, MD, a colorectal surgeon at the Dana-Farber Brigham Cancer Center at South Shore Health, answers six common questions on colorectal cancer screening, prevention and treatment.

Why is colorectal cancer screening so important and at what age should people start?

Colorectal cancer is the second most common cause of cancer death worldwide and the number of younger adults diagnosed with colon cancer has been increasing in recent years.

All adults should start screening by colonoscopy at age 45. Screening should be performed earlier than age 45, if there is a strong family history of early colon cancer, a family member was diagnosed with colon cancer under age 50, or if they have certain specific syndromes/conditions.

What kind of screening tests are available for colorectal cancer?

Colonoscopy is the most common screening test used in the U.S. It allows examination of the colon for polyps, and removal of polyps for analysis. 

Alternative non-invasive options for low risk individuals that do not require bowel preparation include the FIT Test (every year), or FIT-DNA Test Cologuard (every 3 years). Testing with Cologuard requires mailing a stool sample collected at home. If a FIT or FIT-DNA test results are positive, a colonoscopy is recommended.  The bottom line, get tested. 

What are some of the risk factors for colorectal cancer and are there lifestyle changes that can lower someone’s risk?

Age, having a family history of colon or rectal cancers, or inflammatory bowel disease – such as Crohn’s disease or ulcerative colitis – and certain inherited syndromes can all increase the risk for colorectal cancer.

Lifestyle factors that can increase the risk of colon and rectal cancer include tobacco use, alcohol consumption, having a diet high in red or processed meats, physical inactivity, and being overweight or obese.

Most colon and rectal cancers are random events and a result of lifestyle factors mentioned above; modifying these factors can reduce your cancer risk. 

What are some symptoms of colorectal cancer that should raise concern and be discussed with your healthcare provider?

If you notice blood in your stool, have difficulty moving your bowels for several days/weeks, have narrower stool, unexplained bloating, unexplained weight loss, and especially if you are over 45 and have not undergone colon cancer screening, you should speak to your healthcare provider and undergo an evaluation.

The most common cause of passing blood with a bowel movement is hemorrhoids, but this symptom should not be ignored and you should be evaluated.

What kind of treatment options are available for someone diagnosed with colorectal cancer?

Most patients with colon cancer undergo surgery for treatment. Chemotherapy plays a role in the treatment of patients when cancer has spread from colon to lymph nodes or to liver and lungs. 

If diagnosed early, most patients are cured. This is why we strongly promote colon cancer screening.

How have advancements in the detection and treatment of colorectal cancer improved patient care and outcomes?

A stitch in time saves nine. This is why screening is so very important; it allows us to diagnose patients at earlier stage of disease. 

Outcomes are improved the earlier patients are diagnosed; treatments are easier and shorter, with less risk and fewer potential complications. 

Advancements in the science of detection, endoscopic removal of polyps and early cancers, improved surgical technique, less invasive interventions, improved chemotherapy regimens, immunotherapy when possible, advanced radical resections for advanced tumors/cancers have all improved survival rates.  In addition, there is now an increased focus on improving patients’ quality and function of life.

Mandeep S Saund, MD is a colorectal surgeon at the Dana-Farber Brigham Cancer Center at South Shore Health.  Learn more about colorectal cancer care at South Shore Health.