Editor's note: Unedited video of Dr. Douglas Rosen speaking to this topic is available for media. Download 720p version here. Download the SD version here.
Nearly 135,000 people will be diagnosed with colorectal cancer in the U.S. this year, and more than 50,000 will die of the disease. Here are five things to know about colorectal cancer.
Recognize the signs and symptoms
“Colorectal cancer is the second leading cause of cancer-related deaths in both men and women, and it really shouldn’t be,” said Dr. Scott Choi, director of digestive disease at Novant Health UVA Health System Prince William Medical Center and Novant Health UVA Health System Haymarket Medical Center. "For the majority of cases, colorectal cancer is preventable, since it starts as a polyp that can be removed during a screening colonoscopy. Studies have shown that removing adenomatous polyps not only reduces the risk of colorectal cancer, but reduces the number of deaths from the disease by more than a half."
Choi said that symptoms tend to appear when someone already has an advanced stage of colon cancer.
According to the American Society of Colon and Rectal Surgeons, someone with colon cancer may experience the following:
- Change in bowel habits.
- General stomach discomfort.
- Diarrhea, constipation or feeling the bowel does not empty completely.
- Weight loss for no apparent reason.
- Constant tiredness.
Your lifestyle matters
Lifestyle-related risk factors for colorectal cancer include:
- Diets high in red and processed meat.
- Alcohol intake of more than two alcoholic beverages per day.
- A sedentary lifestyle.
- Obesity or being overweight.
“If you want to decrease your risk of colorectal cancer, you should exercise, eat plenty of foods with dietary fiber and be at a healthy weight,” said Mary Holland, oncology nutrition specialist with Novant Health Cancer Care.
Holland recommended getting at least five servings of fruit and vegetables combined per day.
“When planning a meal, you should try to have plant-based foods take up at least half or two-thirds of your plate,” Holland said.
Holland also recommended the following:
- Limit red meat intake to 18 ounces or less per week.
- Avoid processed meats.
- Limit alcohol intake to one drink a day or less for women and no more than two drinks a day for men
- Aim for a healthy weight.
- Exercise or move every day for at least 30 minutes or more.
Family history plays a big role in considering risk
“If there is a family history, particularly in a first-degree relative at age 60 or younger, a patient is at a higher risk for developing colorectal cancer,” said Dr. Douglas Rosen of Novant Health Charlotte Colon & Rectal Surgery.
First-degree relatives are considered siblings or parents.
Choi noted that those who have family members affected by colorectal cancer or polyps should get screened 10 years younger than the age at which the family member was diagnosed.
For example, if a family member was diagnosed at age 48, it’s a good idea to begin screening at the age 38.
Black men are perhaps the largest at-risk population. According to the American Cancer Society, African-American men have the highest incidence rates and highest mortality rates for colorectal cancer across the country – higher than both white men and women and Hispanic men and women.
Younger age does not rule out risk
In the next 15 years, more than 1 in 7 colon cancers and a quarter of all rectal cancer cases will be diagnosed in patients younger than the traditional screening age of 50, according to researchers at the University of Texas M.D. Anderson Cancer Center.
“In the past five to seven years, I’ve seen more patients that are younger and we still don’t know why,” Rosen said. “If you look at the national data, there has been an uptick of colorectal cancer in younger patients. The overall trend for colorectal cancer is a decrease in incidence, but if you look at patients that are younger than 50, the rate is actually increasing.”
The most common screening for colorectal cancer is a colonoscopy. Studies have shown that colonoscopies reduce deaths from colorectal cancer by about 60 to 70 percent. In fact, a new study suggests if more widespread screenings were conducted among older adults, there would be 21,000 fewer colon cancer deaths nationwide by 2030.
"Colonoscopies are considered the most thorough and the gold-standard for screening,” Rosen said.
If a patient has an average risk (no family history) of colorectal cancer, and no other risk factors, the current recommendation is to begin screening at age 50.
Rosen said if the colonoscopy is completely normal and there are no additional risk factors, a patient would have a colonoscopy every 10 years.
“Colonoscopy is not the big, bad procedure most people think it is,” said Dr. Jonathan Lamphier, gastroenterologist with Novant Health Gastroenterology Brunswick. “The sedation is thorough and efficient and patients don’t feel any discomfort. Plus, the prep is so much better than years ago when we used to basically give patients a gallon of saltwater to drink. Today, we have smaller volume preps and tasteless laxatives that can be mixed with other drinks so they’re palatable and effective.”
Because of the prep, some patients are reluctant to schedule their colonoscopy, Rosen said.
“I try to redirect them and indicate how painful and uncomfortable it would be to have surgery and chemotherapy for an advanced colorectal cancer that could have been prevented,” he said. “It’s really not as bad as they think.”
Novant Health is one of more than 650 organizations that has pledged support of a national effort to screen 80 percent of adults aged 50 and older for colorectal cancer by 2018. The initiative, called 80% by 2018, is led by the American Cancer Society, Centers for Disease Control and Prevention and the National Colorectal Cancer Roundtable.
Updated on: 3/6/2017