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 early signs can help lower these numbers, but colorectal cancer doesn’t always have symptoms.
“Often, early-stage colon cancer has no symptoms, but can be more easily treated if caught at this early time, which makes screening important,” said Kristina Go, colon rectal surgeon with Upstate Medical University. “Most patients get diagnosed with colorectal cancer once symptoms start.”
Unfortunately, any disease process is more challenging to treat the later it is discovered.
When colon cancer presents symptomatically, the person may notice “unintended weight loss, and abrupt change in their bowel habits,” said physician Shannon Spencer, MD with Colon Rectal Associates of Central New York in Liverpool. “It’s not just someone who’s constipated after eating poorly during the holidays, but they’ve had problems for several months.”
They key is noticing a pattern of change — not just a one-time occurrence that’s easily explained.
In addition, Spencer mentioned blood in the stools. 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, Spencer encourages people to set up a doctor’s appointment to have it checked out.
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 a healthcare provider can remove them before they become malignant.
Centers for Disease Control and Prevention lists risk factors, including: 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.
“We recommend regular screenings to look for polyps,” said Mohammad Ali, gastroenterologist with Oswego Health. “Removing them can prevent colon cancer.”
The old standard was to begin screening at age 50. However, Ali said that 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.
“Screening doesn’t necessarily have to be colonoscopy only,” Ali said. “It can be done through stool and blood-based tests.”
These less-invasive tools typically are for people with no risk factors but age. 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.