By Deborah Jeanne Sergeant
Colorectal cancer is the third most common type of cancer in the world, according to the International Agency for Research on Cancer with more than 1.9 million cases diagnosed in 2022.
It’s also the second most common cause of cancer death, amounting to more than 900,000 deaths annually worldwide.
The American Cancer Society predicts that 52,900 patients in the US will die from this colorectal cancer this year.
Knowing the risk factors, early signs and prevention tools can help lower these numbers. According to the Centers for Disease Control and Prevention, risk factors include:
• Inflammatory bowel disease such as Crohn’s disease or ulcerative colitis
• A personal or family history of colorectal cancer or colorectal polyps
• A genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome)
• Lack of regular physical activity
• A diet low in fruit and vegetables
• A low-fiber and high-fat diet, or a diet high in processed meats
• Overweight and obesity
• Alcohol consumption and tobacco use.
Although symptoms of colorectal cancer are important to note, “the most important thing to know is most of the time, there are no symptoms,” said Hannah Farley, manager of the Cancer Services Program of the Finger Lakes Region, affiliated with URMC. “It’s a pretty quiet disease. Someone could have colon cancer or precancerous polyps and have no signs.”
When colorectal cancer presents symptomatically, patients may experience blood in their stool.
“It won’t be just one time but over the course of a few weeks and months,” Farley said. “It might not be every bowel movement, but they’ll look at their stool and see a little blood present. That is a very common symptom.”
Sometimes hemorrhoids — inflamed veins in the anus and lower rectum — may bleed during a bowel movement. However, hemorrhoids typically resolve with at-home care within a week. If blood during a bowel movement continues, Farley encourages people to set up a doctor’s appointment to have it checked out.
Another possible sign of colorectal cancer is a change in bowel habits.
“They maybe have pretty reliable time when they go ‘number two,’ but they have stringy, tarry stool and can’t empty their bowels,” Farley said. “It’s especially concerning if there’s also blood in the stool.
“If you have a family history of colon cancer or personal history of polyps which can be a precursor for colon cancer, make an appointment with your primary care provider to talk about what’s going on and maybe get a referral to a gastroenterologist. You have to have a referral to see them.”
Slow growing
According to the American Cancer Society, it takes about 10 to 15 years for abnormal cells to develop into cancerous polyps. Screening can help detect polyps so healthcare provider can remove them before they become malignant.
The old standard was to begin screening at age 50. However, an uptick in earlier age diagnoses has caused that to shift to age 45. For people with a first-degree relative who experienced colorectal cancer, that age may be even younger.
Colonoscopy is considered the gold standard test, as providers can remove suspicious polyps during the procedure. Most providers would urge patients with any risk factors to screen with colonoscopy. Patients dislike the preparation process, which includes clearing the bowels with medication or enemas. The procedure involves inserting a lighted tube in the anus, rectum and colon after air has been pumped inside. It’s generally recommended every 10 years.
Virtual colonoscopy (CT colonoscopy) scans the colon and rectum through a small tube inserted just a small distance into the anus, but the patient must still prep the bowel and have air pumped into the rectum and colon. Any suspicious polyps will require a second appointment for removal. This procedure is recommended every five years.
Non invasive tests include stool sampling, the fecal immunochemical test (FIT) to find small amounts of blood in the stool, a sign of polyps. It’s recommended annually.
The guaiac-based fecal occult blood test (gFOBT) can also find hidden blood in the stool. Patients can take the sample at home. Beforehand, patients must avoid certain foods and medications for a few days before the test. The gFOBT is an annual test.
Recommended for every three years, at-home stool DNA testing looks for DNA or gene changes in cells that migrate from polyps into stool. It can also detect blood in the stool. The FDA-approved DNA test is Cologuard.