Colorectal CancerAwareness Month

Questions & Answers about Colorectal Cancer

What is colorectal cancer?

Colorectal cancer begins in the colon or rectum. The colon is a muscular tube -approximately five feet long - that connects the small intestine to the rectum. Cancer can begin in any part of the colon, but before cancer develops, changes usually occur in the organ's lining. One change is a tissue growth called a polyp. Colorectal cancer most often starts as a benign polyp or growth that becomes malignant over time. Once detected, a polyp may be removed, preventing it from becoming cancerous later.

How many people are affected by colorectal cancer?

Colorectal cancer is the third most commonly diagnosed cancer in America. About 98,200 new cases of colon cancer and 37,200 new cases of rectal cancer will be diagnosed in 2001.

An estimated 56,700 Americans (48,100 colon; 8,600 rectum) will die of colorectal cancer in 2001, making it the second leading cause of cancer death in America, behind lung cancer. The death rate from colorectal cancer has been going down for the past 25 years, probably because there are fewer cases, more of the cases are found at an early stage, and treatments have improved.

What causes colorectal cancer? Who is at risk?

While the exact cause of colorectal cancer is not known, researchers have found several risk factors that increase a person’s chance of developing colorectal cancer:

Aging: About nine out of 10 people with colorectal cancer are older than 50.
A family history of colorectal cancer or intestinal polyps: People who have a history of either colorectal cancer or polyps in any first-degree relative (e.g., father, mother, brother, or sister) before age 60, or in two or more relatives at any age.
A personal history of colorectal cancer: People who have had colorectal cancer earlier may develop new cancers in other areas of the colon and rectum.
A personal history of intestinal polyps: Certain types of polyps increase the risk of colorectal cancer, especially if they are large or if there are many of them.
A personal history of chronic inflammatory bowel disease: This condition also is called ulcerative colitis or Crohn’s colitis.
Diet: The American Cancer Society recommends eating at least five servings of fruits and vegetables every day and six servings of other food from plant sources such as breads, cereals, grain products, rice, pasta, or beans. A diet made up mostly of foods that are high in fat, especially from animal sources, can increase the risk of colorectal cancer.
Physical inactivity: Being even somewhat active lowers the risk of colon cancer.
Use of tobacco products: People who smoke regularly have been recently linked to colorectal cancer risk.
Familial adenomatous polyposis (FAP): This condition results in a person having hundreds or even thousands of polyps in the colon and rectum. The polyps usually first appear during the teenage years. Between the ages of 30 and 50, cancer nearly always develops in one or more of these polyps.
Gardner’s syndrome: Like FAP, this condition results in polyps and colorectal cancer that develops at a young age. It can also cause benign tumors of the skin, soft connective tissue, and bones.
Hereditary nonpolyposis colorectal cancer (HNPCC): People with this condition tend to develop cancer at a young age without first having many polyps.
Familial colorectal cancer in Ashkenazi Jews: Some Jews of Eastern European descent have an inherited change in their DNA that causes a slightly increased risk of developing colon cancer.

What are the signs and symptoms of colorectal cancer?

Signs and symptoms of colorectal cancer typically occur only in advanced stages of the disease. The absence of symptoms should never be a reason to delay or ignore colorectal cancer screening. If you have any of the following symptoms, be sure to tell your doctor, especially if you are over 40 years old or if other members of your family have had the disease. Note, just because you have these symptoms does not mean you have cancer. But you need to talk to your doctor to be sure.

A change in bowel habits such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days
A feeling that you need to have a bowel movement that doesn't go away after you do
Bleeding from the rectum or blood in the stool
Cramping or gnawing stomach pain
Decreased appetite
Weakness and fatigue
Jaundice (yellow-green color of the skin and white part of the eye)

Can colorectal cancer be prevented?

In many cases, yes. Even though the exact cause of colorectal cancer is not known, there are some steps you can take to reduce your risk:

Follow the screening guidelines (see below) set by the American Cancer Society. Screening finds pre-cancerous polyps. Removing these polyps can help prevent most colorectal cancers. Screening also can help detect colorectal cancer early, when the chances for successful treatment are greatest.
Eat plenty of fruits, vegetables, and whole grain foods and limit the intake of high-fat foods.
Get plenty of exercise. Even small amounts of exercise on a regular basis can be helpful.

When and how should I be screened for colorectal cancer?

According to the American Cancer Society guidelines for the early detection of colorectal cancer, starting at age 50, both men and women should have:

Yearly fecal occult blood test (FOBT) and flexible sigmoidoscopy every five years; or
FOBT yearly (acceptable but not preferred); or
Flexible sigmoidoscopy every five years.
Double contrast barium enema every five years; or
Colonoscopy every 10 years.

Note: Flexible sigmoidoscopy together with FOBT is preferred when compared to FOBT or flexible sigmoidoscopy alone. All positive tests should be followed up with colonoscopy. People at moderate or high risk should talk with their doctor about a different screening schedule.

What types of tests are used to screen for colorectal cancer?

It is possible to have colon or rectal cancer and not have any symptoms. For that reason, screening tests are used. These tests can find many cancers early and greatly improve the chances of successful treatment. Some of these tests are listed below.

Rectal Exam (digital rectal exam or DRE): The doctor or health care provider inserts a gloved finger into the rectum to feel for anything not normal. This simple test, which is not painful, can detect many rectal cancers. However, DRE is not a stand-alone test for colorectal cancer and should only be done prior to flexible sigmoidoscopy, colonoscopy, or barium enema.
Fecal Occult Blood Test (FOBT): A sample of stool is examined for blood. A test kit will explain how to take samples at home. It is then returned to the doctor's office, or lab to be checked.
Sigmoidoscopy: A slender, lighted flexible tube is placed in the rectum. This allows the doctor to look at the inside of the rectum and part of the colon for cancer or polyps.
Colonoscopy: A longer, flexible tube is placed through the rectum into the colon. It is long enough to reach the full length of the colon. The tube is linked to a video camera and display. The doctor can look at the picture to find cancer or polyps. Because the tube is longer, the doctor is able to see much more of the colon's lining. Polyps can be removed using a wire loop that goes through the tube. Pieces of the polyp can be sent to a lab to see if cancer cells are present. If the doctor sees anything unusual, a biopsy may be done. A small piece of tissue is taken out through the colonoscope. The tissue is sent to the lab to see if it is cancerous or benign.
Barium Enema (double contrast barium enema or barium enema with air contrast): An enema of a chalky substance is used to partly fill up and open the colon. Air is then added to expand the colon. After that, x-ray films are taken.

Who survives colorectal cancer?

The five-year survival rate is 90 percent for people whose colorectal cancer is found and treated in an early stage, before it has spread. But, only 37 percent of colorectal cancers are found at that early stage. Once the cancer has spread to nearby organs or lymph nodes, the five-year survival rate goes down to 65 percent. For people whose colorectal cancer has spread to distant parts of the body such as the liver or lungs, the five-year survival rate is eight percent.

What is the American Cancer Society doing in the area of colorectal cancer research?

Since 1990, the American Cancer Society has funded 204 colorectal cancer research grants totaling $37.6 million; this is in addition to the nine grants totaling more than $3 million awarded as of January 2000. American Cancer Society researchers have been linked to many breakthroughs in cancer research, including the development irinotecan, a chemotherapy drug approved by the Food and Drug Administration in 2000 for the treatment of advanced colon cancer.

Where can I find more reliable and accurate information on colorectal cancer?

The American Cancer Society has a toll-free National Call Center, fully staffed 24 hours a day, seven days a week, to provide you with comprehensive information about colorectal cancer and cancer resources in your area. Call the toll free number at 1-800-ACS-2345 or visit the American Cancer Society web site at www.cancer.org.