What is Colorectal Cancer?

Colorectal cancer is a cancer that develops in the colon or the rectum. These parts of the digestive system are also called the gastrointestinal (GI) tract. The digestive system processes food for energy and rids the body of solid waste. Colorectal cancer usually develops slowly over a period of many years. Before a cancer develops, it usually begins as a non-cancerous polyp. A polyp is an abnormal growth of tissue lining the colon or rectum. One specific type of polyp, called an adenoma, has the greatest risk of becoming a cancer.

Once a colorectal cancer is found, the cancer must be staged. Staging tells your doctor and you if the cancer has spread from the original site to other parts of the body. It is important to know the stage of the disease to plan the best treatment.

CRC Key Statistics

• Colorectal cancer is the third most common cancer diagnosed in men and in women in the United States, excluding skin cancers. Colon cancer is the second-leading cause of cancer-related deaths in the United States and is expected to cause about 52,180 deaths (26,000 men and 26,180 women) during 2007. The good news is that this number has decreased. In 2005, approximately 56,000 people died from colorectal cancer.
• The death rate from colorectal cancer has been dropping for the past 15 years. One reason for this is probably because polyps are being found by screening before they can develop into cancers. Also, colon cancer is being found earlier when it is easier to cure, and treatments have improved. There are approximately one million survivors of colorectal cancer in the United States, and this number continues to grow.
• Ninety percent of people whose colorectal cancer is found at an early stage are alive five years after the diagnosis. However, once the colorectal cancer has spread to nearby organs or lymph nodes, the likelihood of remaining alive five years after the diagnosis is much lower. Only 39 percent of colorectal cancers are found at that early stage.

Signs & Symptons of Colorectal Cancer

Colorectal cancer is often present in people without symptoms. This is why screening for colon cancer is so important. The following signs or symptoms, however, might indicate colorectal cancer:

• Blood in your stools
• Narrower than normal stools
• Unexplained abdominal pain
• Unexplained change in bowel habits
• Unexplained anemia
• Unexplained weight loss

These symptoms may be caused by other benign diseases such as hemorrhoids, inflammation in the colon or irritable bowel syndrome. If you experience any of these symptoms for more than a few days, talk with a gastrointestinal specialist about them. Using our Find a Doctor feature, you can locate a qualified gastrointestinal endoscopist in your area.

Certain people are at higher than average risk of developing colon cancer and should pay particular attention to these symptoms. A family history of colorectal cancer, multiple family members with certain other cancers (uterus, bladder, stomach, etc.) or a history of inflammatory bowel disease are examples of risk factors for developing colon cancer.

Screening/Early Detection

Regular screening can help prevent colorectal cancer through diagnosis at an early, curable stage or through removal of precancerous polyps. Beginning at age 50, both men and women at average risk for developing colorectal cancer should have a screening colonoscopy and then repeat the procedure every 10 years. Colonoscopy, when performed by a well-trained endoscopist, gastroenterologist or surgeon, is the most effective screening test for colon cancer because it allows for the detection and removal of precancerous polyps before they turn into cancer.

Risk Factors

Age
Although colorectal cancer can strike at any age, 91 percent of new cases and 94 percent of deaths occur in individuals older than 50. The incidence rate of colon cancer is more than 50 times higher in people aged 60 to 79 than in those younger than 40.

Gender
Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in men and in women in the United States. The American Cancer Society estimates that about 112,340 new cases of colon cancer (55,290 men and 57,050 women) and 41,420 new cases of rectal cancer (23,840 men and 17,580 women) will be diagnosed in 2007.

Colorectal cancer is the second leading cause of cancer-related deaths in the United States and is expected to cause about 52,180 deaths (26,000 men and 26,180 women) during 2007.

Ethnic background and race
Colorectal cancer incidence and mortality rates are currently highest in African American men and women. Those of Eastern European Jewish descent currently also have a higher rate of colon cancer than Caucasian men and women. However, because of disproportionate screening, minorities, particularly African Americans and Hispanics, are more likely to be diagnosed with colon cancer in advanced stages. As a result, death rates are higher for these populations.

Diet
There is increasing evidence that obesity is associated with an increased risk of colorectal cancer. A diet made up mostly of foods that are high in fat, especially from animal sources, can increase the risk of colon cancer. Eating a varied diet, choosing most foods from plant sources and limiting the intake of foods high in saturated fat will help protect people from developing colorectal cancer.

Exercise
People who are not active have a higher risk of colorectal cancer. Engaging in at least moderate activity for 30 minutes or more on five or more days per week will reduce colon cancer risk.

Smoking and alcohol
Recent studies show that smokers are 30 to 40 percent more likely than nonsmokers to die of colorectal cancer. Moderate to heavy use of alcohol, or four or more drinks per week, has also been linked to colorectal cancer.

Personal history of bowel disease
A personal history of colon cancer or intestinal polyps and diseases such as inflammatory bowel disease -- both chronic ulcerative colitis and Crohn's disease -- increase a person's risk of developing colorectal cancer. Patients with both inflammatory bowel disease and a specific liver disease called primary sclerosing cholangitis (PSC) are at very high risk of colorectal cancer.

Family history/genetic factors
A person who has a specific inherited gene syndrome, such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC), is at increased risk for developing colorectal cancer. People with a strong family history of colon cancer are also at increased risk for developing colorectal cancer. Family history is defined as cancer or polyps found in a parent, brother or sister younger than 60 or two relatives of any age. However, it is important to remember that 85 percent of colorectal cancers occur in people with no family history of colon cancer.

Specific At-Risk Populations

All men and women are at risk for colorectal cancer. However, according to research, African Americans and Hispanic Americans are at a higher risk for the disease than other populations. If you have questions about other ethnicities that may be at risk, please call ASGE at 866-305-ASGE (2743).

African Americans

• The risk of colorectal cancer is higher among African Americans than among any other population group in the United States.
• Death rates from colon cancer are higher among African Americans than any other population group in the United States.
• Colorectal cancer is the third most common cancer among African Americans, with more than 16,000 cases estimated to be diagnosed in 2007. Approximately 7,000 deaths among African Americans are expected to occur in 2007.
• There is evidence that African Americans are less likely than Caucasians to have screening tests for colon cancer.
• African Americans are less likely than Caucasians to have colorectal polyps detected when they can easily be removed.
• African Americans are more likely to be diagnosed with colorectal cancer in advanced stages when there are fewer treatment options available. They are less likely to live five or more years after being diagnosed with colon cancer than other populations.
• Body mass index, tobacco use and a lack of access to equal medical treatment options may increase African Americans' risk of developing colon cancer.
• There may also be genetic factors that contribute to the higher incidence of colorectal cancer among some African Americans. Learn your family's medical history, and tell your health care professional if a parent, brother, sister or child has had colon cancer or colorectal polyps.
• African American women have the same probability of getting colorectal cancer as men, and they are more likely to die of colon cancer than are women of any other population group.
• African American patients experience a larger number of polyps on the right side of the colon, versus the left. A screening endoscopy must cover the entire colon, as is performed with a colonoscopy.

Hispanic Americans

• Colorectal cancer is the second most diagnosed cancer in Hispanic Americans, accounting for more than 2,300 deaths per year.
• Hispanic Americans are less likely to get screened for colon cancer than either Caucasians or African Americans. Starting at age 50, all men and women should begin having colorectal cancer screening tests. Some people are at higher risk for the disease because of age, lifestyle or personal and family medical history. However, colon cancer affects men and women alike.
• Tell your health care professional if you have a personal or family history of colorectal cancer, colorectal polyps or inflammatory bowel disease. Then ask which test you should have and when you should begin colon cancer screening.
• There are many obstacles to colon cancer screening, including reluctance to talk about colon cancer and embarrassment about having procedures involving tests that require stool samples.

Treatment

Treatment for colorectal cancer is most effective when the cancer is found early. Colorectal cancer treatment may include a combination of surgery, radiation and/or chemotherapy, with surgery being the first line of defense. Some patients may also have radiation and/or chemotherapy before or after surgery. The treatment is usually managed by a medical cancer doctor (oncologist), a cancer surgeon and sometimes a radiation oncologist.

Colorectal Cancer Survival Rates

Nine out of 10 people whose colorectal cancer is found and treated at an early stage live at least five years. Once the cancer has spread to nearby organs or lymph nodes, the five-year survival rate is lower. (The five-year survival rate is the percentage of patients who are alive five years after diagnosis, leaving out those who die of other causes.) Of course, many patients live more than five years after diagnosis.

Medicare Coverage

Not long ago, Medicare started paying for colonoscopy for people age 50 and older. In the past, Medicare only covered the exam for people at high risk. The American Cancer Society led the efforts to expand coverage of this test. People on Medicare now have more choices for screening tests.

For people on Medicare, this is what is covered:

• Stool blood test (FOBT or FIT) each year for those 50 and over
• Flexible sigmoidoscopy (flex-sig) every four years for those 50 and over at average risk
• Colonoscopy every two years for those at high risk
• Colonoscopy once every 10 years for those 50 and over at average risk
• Barium enema with air contrast instead if a doctor believes that it is as good as or better than flex-sig or colonoscopy
• Virtual colonoscopy is not covered by Medicare as an initial screening test