March is Colorectal Cancer Awareness Month

by Jane Ashley

March is Colorectal Cancer Awareness Month

One In23

Colorectal cancer is the third most diagnosed cancer, after lung and breast cancer (excluding skin cancer). Approximately 140,000 people were diagnosed with colorectal cancer in the past year — 97,220 new cases of colon cancer (49,690 men and 47,530 women) and 43,030 new cases of rectal cancer (25,920 men and 17,110 women). Ninety percent (90%) of all colorectal cancer occurs in people over 50. Colorectal cancer accounts for just over 50,000 deaths annually in the U.S.

Risk Factors

Age. For colon cancer, the average age at diagnosis is 68 for men and 72 for women. For rectal cancer, it is 63 for both men and women. An alarming trend is developing. Rates in people under 50 are rising at about 2 percent a year, especially for rectal cancer. Experts don’t know why.

Gender. Men are slightly more likely to develop colorectal cancer than women.

Family history. Colorectal cancer can run in families, especially if first-degree relatives (parents, brothers, sisters, and children) or several family members (grandparents, aunts, uncles, nieces, nephews, grandchildren, and cousins) have had colorectal cancer. This is especially true if the relatives were diagnosed at younger ages.

Inflammatory bowel disease (IBD). People who have ulcerative colitis or Crohn’s disease are at increased risk of developing colorectal cancer.

History of adenomatous polyps. This kind of polyp can develop into colorectal cancer. Unfortunately, if you’ve had a polyp, you’re more likely to develop more.

Personal history of certain kinds of cancer. Women who have had ovarian or uterine cancer are more likely to develop colorectal cancer.

Race. Colorectal cancer is the leading cancer-related cause of death in African-Americans. African-Americans are more likely to be diagnosed at a younger age. The American College of Gastroenterology recommends that black people begin screening with colonoscopies at age 45.

Physical inactivity and obesity. Being inactive and overweight increases risk of developing colorectal cancer.

Nutrition. Eating large amounts of red meat and processed meat increases your risk of developing colorectal cancer.

Smoking. Smokers are more likely to die from colorectal cancer than non-smokers.
To help lower your risk, eat more fruits and vegetables and lose weight. Exercise — a daily walk will do. Follow your doctor’s recommendations about a colonoscopy and other screening methods.

Anatomy Of Colorectal Cancer

Symptoms

The symptoms are varied and may be vague. Be your own advocate. Press for more testing if symptoms persist.
A change in bathroom habits
Diarrhea or constipation or a feeling that your bowel hasn’t completely emptied
Narrow or thin stools
Anemia
Feeling bloated
Losing weight, without trying to lose
Fatigue
Blood (either red or dark) in your stools

Related Article - Living With Colorectal Cancer

No, it wasn’t “probably hemorrhoids” as my primary care physician speculated when I told him about my rectal bleeding. It was Stage IV rectal cancer. Although he knew that my medical history included a benign rectal polyp, he did not recommend that I consult with a gastroenterologist. All that he wanted to do was write me a prescription for steroid suppositories. I asked for a referral to a colorectal surgeon for further evaluation.

Don’t take a chance. Ask for a referral to a gastroenterologist if you have lingering symptoms that don’t go away. If you have had a polyp in the past, ask for a referral to a colorectal surgeon or other specialist who is skilled in working with patients who are at higher risk for colorectal cancer.

Treatments for Colorectal Cancer

Depending on the stage and location of your tumor, treatment options include surgery, chemotherapy and radiation. Metastatic colorectal cancer have a variety of specialized treatments for brain, liver and lung tumors — including ablations, SBRT and the CyberKnife radiation, radioactive beads and VATS lung surgery.

Latest Research

Colorectal Cancer In Younger Adults

There are still many challenges in the diagnosis and treatment of colon and rectal cancer. Rectal cancer is sometimes more challenging to treat — treatment usually includes radiation, chemotherapy and surgery, sometimes resulting in a permanent colostomy.

Better diagnostic and screening methods. While the colonoscopy is the gold standard of finding polyps and removing them before they become cancerous, too many people avoid this potentially life-saving procedure. A stool sample test to detect genetic changes consistent with colorectal cancer is being developed. Then a colonoscopy could be used to remove polyps earlier when there is a better chance of cure.

Tests to predict the chance of recurrence. Some genetic markers are associated with an increased risk of recurrence. This helps doctors and patients decide whether chemotherapy after surgery would be beneficial.

Immunotherapy. Research continues to identify checkpoint inhibitors that will be effective for colorectal cancer patients who are microsatellite high (MSI-H).

BRAF mutations. About 10 percent of colorectal cancer patients have the BRAF mutation. Clinical trials and more research is being conducted to help this subset of patients.

Colon and Rectal Cancer Is Rising in Younger Adults

Studies show that since 1974, colorectal cancer rates have been rising in younger adults, ages 20-39 and 40-54. For colon cancer, rates are increasing by about 1 percent a year.

However, rectal cancer rates in younger adults are rising at twice the rate of colon cancer, roughly 2 percent annually since the early 1990s. Three in ten rectal cancer diagnoses are now in patients under 55. Experts don’t know why.

Rectal cancer rates have been declining in people over 55 for the past 40 years. Educational efforts aimed at young adults are underway along with discussions of methods to increase screening efforts toward younger adults.

The sad news is that many of these younger adults are diagnosed with advanced stage disease because physicians thought that they were too young for this diagnosis. Educational efforts are also targeted toward the medical community to ensure that a diagnosis of colorectal cancer should be considered in younger adults who have the classic symptoms of colon and rectal cancer.

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