Each year there are more than 200,000 cases of colon cancer (also called colorectal cancer) in the United States. March is National Colorectal Cancer Awareness Month where thousands of patients, survivors, caregivers and advocates throughout the wear blue to increase the awareness for colon cancer and the benefits of early detection.
The risk of colorectal cancer goes up as you age. Younger adults can get it, but it’s much more common after age 50. Colorectal cancer is rising among people who are younger than age 50 and the reason for this remains unclear.
What is colorectal cancer?
When food is chewed and then swallowed, it travels down the esophagus and into the stomach. The stomach partially breaks the food down which then enters the small intestines. The small intestine is the longest part of the digestive system (about 20 feet). Its function is to continue breaking down the food particles and absorb most of the nutrients.
The broken down particles that remain go into the colon (large intestine) which then absorbs water and more nutrients from the food particles and also serves as a storage place for waste matter (stool). The colon begins at the end of the small intestine on the right side of the body at a place called the cecum. Your waste matter moves from the colon into the rectum, which is the last 6 inches of the digestive system.
Colorectal cancer is cancer that starts in either the colon or the rectum. Most colorectal cancers start as a polyp (pah-lip) – a growth that starts in the inner lining of the colon or rectum. Most polyps are not cancerous. However, polyps called ‘adenomas’ have a greater probability of becoming cancerous. Adenocarcinomas represent over 95% of colon and rectal cancers in the United States. These cancers form in gland cells inside the colon and rectum.
The key to a higher cure rate for colon cancer is early detection. Resection of the polyp will prevent the polyp from developing into a cancer. The resection can be done endoscopically, at the time of colonoscopy, or if the polyp is too large it can be removed surgically.
Who is at risk for colon and rectal cancer?
According to Cancer.net, about 150,000 Americans will be diagnosed with colon or rectal cancer this year. Each year, about 50,000 people die from colorectal cancer, with men and women at equal risk. It is the third leading cause of cancer death in men and women. One might think that only older people are at high risk of colorectal cancer, but that is not necessarily the case. Colorectal cancer is actually the fourth most commonly diagnosed cancer in men and women age 30 to 39. So colon and rectal cancer can affect both young and old.
The good news is that when colorectal cancer is found early, it can often be cured. The death rate has decreased over the last 20 years due to improvements in treatment and better screening, which can detect cancer earlier. Currently, there are over 1.5 million colorectal cancer survivors in the United States.
Risk factors include the following:
- AGE: The risk of colorectal cancer increases as people get older. Colorectal cancer can occur in young adults and teenagers, but the average age when colon cancer is detected is around 70.
- RACE: Black people have the highest rates of colorectal cancer, not linked to family history.
- FAMILY HISTORY: You may have higher risk of colo-rectal cancer if first-degree relatives (parents, brothers, sisters, children) have had colon or rectal cancer.
- INFLAMMATORY BOWL DISEASE: Those who have syndromes like ulcerative colitis or Crohn’s disease, may develop chronic inflammation of the large intestine which can raise the risk of colorectal cancer. (Note, many people experience Irritable Bowel Syndrome (IBS) which does NOT increase your risk of colorectal cancer.)
- POLYPS: Polyps are abnormal growths in the colon and are discovered during a colonoscopy. Polyps are not cancer, but some types of polyps called adenomas can develop into colorectal cancer over time. Polyps can be removed during a colonoscopy which can lessen your risk of colorectal cancer.
- OBESITY: Those who are obese and spend excessive time sitting or having a sedentary lifestyle are at increased risk of colorectal cancer.
- DIET: Research has link diets high in red meat or processed meat to be linked to colon cancer.
- SMOKING: Smokers are more likely to die from colorectal cancer than non-smokers.
How do you screen for colorectal cancer?
Screening for colorectal cancer is most commonly done with a colonoscopy, where an instrument is inserted into the rectum to enable the physician to examine the large intestine and remove any polyps. The patient prepares in advance by drinking a substance that cleanses the colon and is sedated during the procedure which takes about 30 minutes. The American Cancer Society recommends men and women at AVERAGE RISK of colorectal cancer should have a colonoscopy beginning at age 50 and then every 10 years until age 70. Those people with a family history of colorectal cancer or at HIGH RISK often are recommended to have a colonoscopy at a much younger age and at more frequent intervals. Those at HIGH RISK should visit with their primary care physician on when a colonoscopy should be done.
An option for those individuals who cannot have a colonoscopy for various reasons, or are at low risk, there is a new screening called Cologuard, which the person requests from their primary care physician. Cologuard is intended to screen those 45 years or older who are at AVERAGE RISK for colorectal cancer by detecting cancer DNA markers or blood in the stool. Cologuard is not for those who are at HIGH RISK, or have a family history of colon cancer. The nice thing about Cologuard is that there is no doctor visit or procedure. The company ships to your house the Cologuard kit, the patient defecates in a receptacle (following instructions provided) and ships the kit back to the company which then analyzes the sample and reports back to your physician within two weeks. Your primary care physician office then contacts you with the results of the test. Those with positive tests are then recommended to have a colonoscopy. Beginning in 2019, Medicare began paying for the Cologuard screening for people 50 to 85, every 3 years. Other private insurance companies are starting to follow accordingly as the test is non-invasive and less expensive than a colonoscopy.
What is the treatment for colorectal cancer?
Surgery is the typical treatment for early-stage colon cancers. The type of surgery used depends on the stage (extent) of the cancer and where it is in the colon.
Polypectomy and local excision are two common surgical methods that can be done through the rectum to avoid an abdominal incision. Using a colonoscope cancerous polyps can be removed through the rectum. Local excision is also done through the colonoscope to remove small cancers on the inside lining of the colon.
Other surgical procedures may be necessary depending on the stage of the cancer, and may be done laparoscopically or through an abdominal incision. The surgeon may need to remove the cancerous part of the colon.
If the cancer has progressed, other cancer treatments like radiation and chemotherapy may be necessary.
How to find a colorectal surgeon?
General surgeons trained in surgical oncology and colorectal surgeons are typically the specialists involved in surgical treatment of colon and rectal surgery. A person should look for a board-certified surgeon with significant experience and training in the area of cancer surgery.
Dr. Charles Portera at Alaska Surgical Oncology is Board-Certified in General Surgery and Fellowship-Trained in Surgical Oncology and Cancer Biology. Dr. Portera completed his fellowship in surgical oncology and cancer biology at the prestigious MD Anderson Cancer Center, which is one of the top cancer referral centers in the world. This training makes Dr. Portera well qualified to deal with the surgical removal of cancerous and noncancerous tumors. Dr. Portera has done more than 10,000 successful cancer surgeries over his career.