In the U.S., colorectal cancer is the third leading cause of cancer-related deaths in men and in women, and the second most common cause of cancer mortalities when the numbers for men and women are combined. Fortunately, thanks to medical advances, it also is one of the more commonly diagnosed cancers through screenings.
Dr. Yesenia Rojas-Khalil, assistant professor of surgery in the Division of Surgical Oncology, specializes in robotic and minimally invasive surgery, colon and rectal cancer, inflammatory bowel disease and complex pelvic and abdominal surgery. She recently shared insights about colorectal cancer symptoms, treatments and the life-saving importance of screening.
Question: What causes colorectal cancer?
Answer: The causes for colon cancer are multifactorial. Most cases occur sporadically, developing in patients whose only risk factor is age. Patients at high risk are those with personal history of colon cancer, polyps, inflammatory bowel disease such as Crohn’s or ulcerative colitis. A smaller number of cases are those in patients with a genetic defect such as polyposis syndromes or Lynch syndrome. For other sporadic cases, meaning non-genetic, the cause is uncertain. There is some literature that has linked diet with colon cancer, but it is inconclusive.
Q: Are there early symptoms of the disease?
A: Unfortunately, there are no early symptoms, which is why screening is so important. When the cancer is more advanced many patients will experience bloating, abdominal pain, cramping or blood in the stool. There may also be changes in bowel habits, such as constipation. If any of these symptoms are new or changing, it probably warrants a visit to your medical provider.
Q: How is it diagnosed?
A: Colorectal cancer screening for an average-risk person now begins at age 45 instead of 50 in the United States. The age recommendation changed in 2021 because during the past two decades we have seen increased instances of colon and rectal cancer in younger patients. Screening is effective, even for patients who have no risk factors such as a family history of colon cancer or inflammatory bowel disease.
There are two ways to screen for colorectal cancer. One way is through a colonoscopy, and the other is a stool screening test that can be done at home. Your medical provider may recommend doing one instead of the other. In general, I recommend patients get screened through colonoscopy. If they can tolerate the procedure, it can help identify polyps—small clumps of cells that form on the lining of the colon—that can then be removed during the same procedure. If the polyps are left to grow inside the colon, they could eventually turn into a cancer.
Q: Can colon cancer be cured with surgery?
A: Surgery alone can cure cancer without the need for additional treatments such as chemotherapy or radiation if the cancer is diagnosed at an early stage. We typically measure the risk of recurrence at five years from your initial diagnosis. If the cancer does come back, it typically shows up in the colon. However, if you’ve been cancer-free for five years the chances of it coming back are much smaller.
Q: Are other treatments available?
A: We tend to group colon and rectal cancer together because they are part of the same organ. However, there are differences in how they are treated, the chances of recurrence and the treatment options.
Rectal cancer is different in that it happens in the most distal part of the colon, and this type of cancer has a higher risk of recurrence. The areas where rectal cancers occur also can be difficult to operate on, so radiation therapy is often used as an adjunct treatment. As science has advanced, there are select rectal cancer patients who can be treated with radiation and chemotherapy alone. It’s not considered the standard of care in the United States; however, there are many institutions that use it, especially for patients that are high-risk for surgery.
Q: How can you lower your overall risk?
A: The primary means of prevention is to stay on top of your cancer screening. Additionally, we advise patients to stay active and have a healthy diet high in fiber. You can also reduce risk by not smoking, maintaining a healthy body weight, reducing alcohol consumption and avoiding processed foods and foods with a lot of preservatives. Lifestyle choices that improve your heart health are also very good for your colon.
Patients who are high-risk and have one of the conditions already mentioned or have had a personal history of polyps discovered in previous colonoscopies follow a different set of guidelines with regards to frequency of colonoscopy. It is important that they follow their providers recommendations.
-By Bertie Taylor, senior writer in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine