Colorectal cancer; Cancer - colon; Rectal cancer; Cancer - rectum; Adenocarcinoma - colon; Colon - adenocarcinoma; Colon carcinoma; Colon cancer
Colorectal cancer is cancer that starts in the large intestine (colon) or the rectum (end of the colon). It is also sometimes simply called colon cancer.
In the United States, colorectal cancer is one of the leading causes of deaths due to cancer. Early diagnosis can often lead to a complete cure.
Colon cancer may not be talked about as often as other cancers, like breast cancer, prostate or lung cancer, but it's actually one of the leading causes of cancer deaths. It is for this reason it's very important to stay on top of your colon health. The colon is your large intestine, the long, upside-down U-shaped tube that is toward the end of the line for getting rid of waste in your body. Colon cancer can start in the lining of the intestine, or at the end of it, called the rectum. Let's try to better understand Colon cancer. You're more likely to get the disease if you're over age 60, especially if you have a family history of colon cancer, inflammatory bowel disease, diabetes, or obesity. Smoking cigarettes and drinking alcohol has also been found to increase your risk of getting colon cancer. Although the data are not consistent, eating red meat or processed meats may increase the risks of colon cancer as well. Lean, unprocessed red meat, may be associated with less risk. If you have symptoms, they may include pain in your abdomen, blood in your stool, weight loss, or diarrhea. But hopefully, you'll get diagnosed before you have any symptoms, during a regular screening test like a colonoscopy or sigmoidoscopy. These tests use special instruments to see inside your colon and rectum to look for any cancerous or pre-cancerous growths, called polyps. If your doctor discovers that you do have colon cancer, unfortunately, you'll need to have a few more tests, including scans of your abdomen to find out whether the cancer has spread, and if so, where in your body it's located. So, how is colon cancer treated? That really depends on how aggressive your cancer is and how far it's spread, but usually colon cancer is removed with surgery, or killed with chemotherapy or radiation. You may get one, or a combination, of these treatments. Colon cancer is one of the more treatable cancers. You can be cured, especially if you catch it early. Spotting colon cancer when it's still treatable is up to you. If you're over age 45, you need to get screened. And, regular physical activity and eating at least some fruits and vegetables daily, perhaps with unprocessed wheat bran, can help prevent it. If you want to prevent colon cancer, you'll also want to avoid processed and charred red meats, and smoking, and excess calories, and alcohol.
Nearly all colorectal cancers begin as noncancerous (benign) lumps (polyps) in the lining of the colon and rectum. These can slowly develop into cancer.
You have a higher risk for colorectal cancer if you:
- Are age 45 or older
- Drink alcohol
- Smoke tobacco
- Are overweight or have obesity
- Are African American or of eastern European descent
- Eat a lot of red or processed meats
- Eat a low-fiber and high-fat diet
- Have a diet low in fruits and vegetables
- Have colorectal polyps
- Have inflammatory bowel disease (Crohn disease or ulcerative colitis)
- Have a family history of colorectal cancer
Some inherited diseases also increase the risk of developing colorectal cancer. One of the most common is called Lynch syndrome.
Exams and Tests
Through screening tests, colon cancer can be detected before symptoms develop. This is when the cancer is most curable. Abnormal stool screening tests should be followed up with a colonoscopy, which can see the entire colon.
Your health care provider will perform a physical exam and press on your belly area. The physical exam rarely shows any problems, although your provider may feel a lump (mass) in the abdomen. A rectal exam may reveal a mass in people with rectal cancer, but not colon cancer.
Blood tests may be done for those diagnosed with colorectal cancer, including:
If you are diagnosed with colorectal cancer, more tests will be done to see if the cancer has spread. This is called staging. CT or MRI scans of the abdomen, pelvic area, or chest may be used to stage the cancer. Sometimes, PET scans are also used.
Stages of colorectal cancer are:
- Stage 0: Cancer is only on the innermost layer of the lining of the intestine
- Stage I: Cancer is in the inner layers of the colon
- Stage II: Cancer has spread through the muscle wall of the colon
- Stage III: Cancer has spread to the lymph nodes
- Stage IV: Cancer spread to other organs, such as the liver or lungs
Blood tests to detect tumor markers, such as carcinoembryonic antigen (CEA) may help your provider monitor your progress during and after treatment.
Treatment depends on many things, including the stage of the cancer. Treatments may include:
- Endoscopic surgery (less invasive surgery using a lighted, flexible tube)
- Radiation therapy
- Targeted therapy
Stage 0 colon cancer may be treated by removing the tumor using endoscopic surgery (colonoscopy). For stages I, II, and III cancer, more extensive surgery is needed to remove all or part of the colon and rectum that is cancerous. This surgery is called colon resection (colectomy).
Chemotherapy involves taking medicines that kill cancer cells. You may receive just one type of medicine or a combination of medicines.
Most people with stage III colon cancer receive chemotherapy after surgery for 3 to 6 months. This is called adjuvant chemotherapy. Even though the tumor was removed, chemotherapy is given to treat any cancer cells that may remain.
Chemotherapy is also used to improve symptoms and prolong survival in people with stage IV colon cancer.
Immunotherapy involves taking medicines that increase the ability of your own immune system to destroy cancer cells. Immunotherapy has different side effects than chemotherapy.
Radiation therapy involves using radiation to kill cancer cells. Radiation therapy is often used in the treatment of rectal cancer.
- Targeted treatment zeroes in on specific targets (molecules) in cancer cells. These targets play a role in how cancer cells grow and survive. Using these targets, the drug disables the cancer cells so they cannot spread. Targeted therapy may be given as pills or may be injected into a vein.
- You may have targeted therapy along with surgery, chemotherapy, or radiation treatment.
CANCER IN THE LIVER
For people with stage IV disease that has spread to the liver, treatment can be directed at the cancer tumors in the liver. This may include:
- Burning the cancer (ablation)
- Delivering chemotherapy or radiation directly into the liver
- Freezing the cancer (cryotherapy)
- Radioactive beads/spheres that deliver treatment to kill the cancer cells
- Alcohol (ethanol) injected into the liver tumor to kill cancer cells
With treatment stages 0, I, II, and III cancers often are cured, although higher stages of cancer are less likely to be cured. In most cases stage IV cancer is not curable, but there are exceptions, including sometimes when the spread of the cancer is limited to the liver. In order for a person to be cured, treatment must get rid of all of the cancer. But there is a chance that the cancer will come back. If this occurs, curing the cancer is much less likely than before.
Cancer treatment can cause problems such as:
- Bowel obstruction from surgical scarring.
- Many sorts of short- and long-term side effects from chemotherapy, immunotherapy, radiation, and therapy targeted to the liver.
When to Contact a Medical Professional
Contact your provider if you have:
- Black, tar-like stools
- Blood during a bowel movement
- Change in bowel habits
- Unexplained weight loss
Colon cancer can almost always be caught by colonoscopy in early stages, when it is most curable. All adults age 45 and older should have a colon cancer screening. How often you should have screening depends upon the test being used.
Colon cancer screening can often find polyps before they become cancerous. Removing these polyps may prevent colon cancer.
People with certain risk factors for colon cancer may need earlier testing (before age 45) or more frequent testing.
A healthy lifestyle also may help reduce your risk for colon cancer:
- Get regular physical activity.
- Don't smoke or use tobacco.
- Maintain a healthy weight.
- Eat a diet rich in fruits and vegetables and low in red and processed meats.
Centers for Disease Control and Prevention. What can I do to reduce my risk of colorectal cancer?
National Cancer Institute website. Colorectal cancer prevention (PDQ) - health professional version.
National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology (NCCN Guidelines). Colorectal cancer screening. Version 1.2023 - May 17, 2023.
Patel SG, May FP, Anderson JC, et al. Updates on age to start and stop colorectal cancer screening: recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2022;117(1):57-69. PMID: 34962727
Qaseem A, Crandall CJ, Mustafa RA, et al. Screening for colorectal cancer in asymptomatic average-risk adults: a guidance statement from the American College of Physicians. Ann Intern Med. 2019;171(9):643-654. PMID: 31683290
US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(19):1965-1977. PMID: 34003218
Last reviewed on: 4/18/2023
Reviewed by: John Roberts, MD, Professor of Internal Medicine (Medical Oncology), Yale Cancer Center, New Haven, CT. He is board certified in Internal Medicine, Medical Oncology, Pediatrics, Hospice and Palliative Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.