This topic will tell you about the initial testing, diagnosis, and treatment of colorectal cancer. If you want to learn about colorectal cancer that has come back or has spread, see the topic Colorectal Cancer, Metastatic or Recurrent.
Colorectal cancer happens when cells that are not normal grow in your colon or rectum. These cells grow together and form tumors.
This cancer is also called colon cancer or rectal cancer. It is the third most common cancer in the United States. And it occurs most often in people older than 50.
As with other cancers, treatment for colorectal cancer works best when the cancer is found early. Screening tests can detect or prevent this cancer, but only about half of people older than 50 are screened. According to the American Cancer Society, if everyone were tested, tens of thousands of lives could be saved each year.
Most cases begin as polyps, which are small growths inside the colon or rectum. Colon polyps are very common, and most of them do not turn into cancer. But doctors cannot tell ahead of time which polyps will turn into cancer. This is why people older than 50 need regular tests to find out if they have any polyps and then have them removed. And some people who are younger than 50 need regular tests if their medical history puts them at increased risk for colorectal cancer.
Colorectal cancer usually does not cause symptoms until after it has begun to spread. See your doctor if you have any of these symptoms:
If your doctor thinks that you may have this cancer, you will need a test, called a colonoscopy (say "koh-luh-NAW-skuh-pee"), that lets the doctor see the inside of your entire colon and rectum. During this test, your doctor will remove polyps or take tissue samples from any areas that don't look normal. The tissue will be looked at under a microscope to see if it contains cancer.
Sometimes another test, such as a sigmoidoscopy (say "sig-moy-DAW-skuh-pee"), is used to diagnose colorectal cancer.
Surgery is almost always used to treat colon and rectal cancer. The cancer is more easily removed when it is found early.
If the cancer has spread into the wall of the colon or farther, you may also need radiation or chemotherapy. These treatments have side effects, but most people can manage the side effects with medicines or home care.
When you first find out that you have cancer, you may have many feelings. You may feel scared or angry. Or you may feel very calm. There is no "right" way to react. It is normal to have a wide range of feelings. And it is normal for those feelings to change quickly.
Some people find that it helps to talk about their feelings with family and friends. You may also want to talk with your doctor or with other people who have had cancer. Your local American Cancer Society chapter can help you find a support group.
Screening tests can find or prevent many cases of colon and rectal cancer. They look for a certain disease or condition before any symptoms appear. Experts recommend routine colon cancer testing for everyone age 50 and older who has a normal risk for colon cancer. Your doctor may recommend earlier or more frequent testing if you have a higher risk for colorectal cancer. Talk to your doctor about when you should be tested.
These are the most common screening tests:
Learning about colorectal cancer:
Living with colorectal cancer:
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The exact cause of colorectal cancer is not known. Most cases begin as small growths, or polyps, inside the colon or rectum.
Colon polyps are very common. Very few of them turn into cancer. If they are found early, usually through routine screening tests, they can be removed before they turn into cancer.
Colorectal cancer in its early stages usually doesn't cause any symptoms. Symptoms occur later, when the cancer may be more difficult to treat. The most common symptoms include:
Colon cancer may not cause symptoms you notice in the early stages. When there are symptoms, they may depend on where the cancer is in your colon.
Having these symptoms does not mean you have cancer. A number of other medical problems could cause similar symptoms, including:
Cancer is the growth of abnormal cells in the body. These extra cells grow together and form masses, called tumors. In colorectal cancer, these growths usually start as polyps in the large intestine (colon or rectum). Colon polyps are quite common and most do not cause problems. But if they are not detected and removed, some of them can turn into cancer.
Cancers in the colon or rectum usually grow very slowly. It takes most of them years to become large enough to cause symptoms. If the cancer is allowed to grow, it eventually will invade and destroy nearby tissues and then spread farther. Colorectal cancer spreads first to nearby lymph nodes. From there it may spread to other parts of the body, usually the liver. It may also spread to the lungs, and less often, to other organs in the body.
The long-term outcome, or prognosis, for colorectal cancer depends on how much the cancer has grown and spread. Experts talk about prognosis in terms of "5-year survival rates." The 5-year survival rate means the percentage of people who are still alive 5 years or longer after their cancer was discovered. It is important to remember that these are only averages. Everyone's case is different. And these numbers do not necessarily show what will happen to you. The estimated 5-year survival rate for colorectal cancer is:1
These numbers are taken from reports that were done at least 5 years ago, before newer treatments were available. So the actual chances of your survival are likely to be higher than these numbers.
Colorectal cancer occurrence rates are highest among African Americans. Rates are slightly lower among whites and lowest for Asians, Pacific Islanders, American Indians, Alaskan Natives, and Hispanics.1
A risk factor is anything that increases your chance of getting a disease such as cancer. Risk factors for getting colorectal cancer include:
Everyone who is older than 50 has a risk of getting colorectal cancer. And the older you are, the greater the risk. Most cases of colorectal cancer are diagnosed in people older than 50. Most people who get colorectal cancer have no other risk factors besides being older than 50.
You are more likely to get colorectal cancer if one of your parents, brothers, sisters, or children has had the disease. This is considered a strong family history. Your risk depends on how old your family member was when he or she was diagnosed and on how many members of your family have had the disease.
You have a very strong family history if all of the following are true:
If you have a very strong family history of colorectal and related cancers, you may want to have genetic testing. Related cancers include ovarian cancer, stomach cancer, liver cancer, or cancer of the small bowel, among others. Genetic testing is done with a blood test that looks for changed genes (mutations).
The most common gene changes occur in two conditions: familial adenomatous polyposis (FAP) and Lynch syndrome, also called hereditary nonpolyposis colon cancer (HNPCC). Many people with these changed genes will develop colorectal cancer if they are not carefully watched. Genetic testing can tell you whether you carry a changed, or mutated, gene that can cause FAP or HNPCC.
Most people who get colorectal cancer do not have a personal or family history of the disease.
Your chances of getting colorectal cancer are higher if you have had:
Call your doctor if you have any symptoms of colorectal cancer, such as:
Because colorectal cancer often does not cause any symptoms, talk with your doctor about screening tests. Screening helps doctors find a certain disease or condition before any symptoms appear. Some screening tests for colorectal cancer can find and remove small precancerous growths in the colon and rectum called adenomatous polyps. If these are found and removed early, they cannot turn into cancer.
Watchful waiting refers to a period of time in which your doctor is checking you regularly but not treating you. It is also called observation or surveillance. Watchful waiting is not a reasonable option when you have symptoms of colorectal cancer.
Health professionals who can evaluate your symptoms of colorectal cancer include:
If your doctor thinks you may have colorectal cancer, he or she may advise you to see a general surgeon or a colon and rectal surgeon. Colorectal cancer is treated by surgeons, medical oncologists, and radiation oncologists.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
If your doctor thinks you may have colorectal cancer, he or she will ask you questions about your medical history and give you a physical exam. Other tests may include:
For people who have an increased risk for colorectal cancer, regular colonoscopy is the recommended screening test because it allows your doctor to remove polyps (polypectomy) and take tissue samples at the same time.
When you are diagnosed with colorectal cancer, your doctor may order other tests to find out whether the cancer has spread. These tests include:
Colorectal cancer has a much better chance of being successfully treated when it is found early. Most people who get colorectal cancer are older than 50 and have no other risk factors besides their age.
Routine screening can reduce deaths from colorectal cancer. Some screening tests find and remove polyps before they can turn into cancer. Other screening tests look for early signs of cancer, because that is when treatment works better. Screening methods include:
Stool tests look for signs of cancer. If used as recommended, these tests may find cancer early, when treatment works better. Sigmoidoscopy and colonoscopy are tests that find and remove polyps to stop them from turning into cancer. Virtual colonoscopy finds polyps. With stool tests and virtual colonoscopy, if there are abnormal findings, you will need to have a colonoscopy to remove any polyps.
Talk to your doctor about which test is right for you. People with a higher risk for colorectal cancer, such as African Americans and people with a strong family history of colon cancer, may need to begin routine testing before age 50 and have it more often.
If you have a very strong family history of colon cancer, you may want to talk to your doctor or a genetic counselor about having a blood test to look for changed genes. Genetic testing can tell you whether you carry a changed, or mutated, gene that can cause colon cancer. Having certain genes greatly increases your risk of colon cancer. But most cases of colon cancer are not caused by changed genes.
The first step in treating colorectal cancer is usually an operation to remove the tumor. Sometimes a simple operation can be done during a colonoscopy or sigmoidoscopy to remove small polyps and a small amount of tissue surrounding them. But in most cases a major operation, in which the cancer and part of the colon or rectum around it are removed, is needed. If cancer has spread to another part of your body, such as the liver, you may need more far-reaching surgery.
After the cancer has been examined under a microscope, it will be staged. Staging is a way for your doctor to tell how far, if at all, your cancer has spread. It also helps your doctor decide what your treatment should be.
There are several different types of staging systems, so it's important to ask your doctor to explain carefully what stage your cancer is in and what that means.
You and your doctor will work together to decide what your treatment should be. You will consider your own preferences and your general health, but the stage of your cancer is the most important tool for choosing your treatment.
Surgery is almost always used to remove colorectal cancer. Your doctor may use one of the following types of surgery:
Sometimes it is possible to have laparoscopic surgery to remove the cancer. This is surgery where very small incisions are made in the belly. A tiny camera and special instruments are used to remove the cancer. For the best results, it is important to have an experienced surgeon and to have this surgery at a hospital where many of these surgeries are done.3
Even after removing all the cancer that can be found with surgery, your doctor may say you need other treatment. This may be chemotherapy, radiation, or both (chemoradiation).
Chemotherapy uses medicines—given either as pills or through a needle—to destroy cancer cells throughout the body. Several medicines are often used together. Research studies continue to look for the best combinations of medicines. Your doctor will recommend treatment based on the type and stage of cancer that you have.
Radiation therapy, which uses X-rays to destroy cancer cells, is standard treatment for some types of cancer in the rectum. Radiation therapy is often combined with surgery or chemotherapy. Radiation may be given from a machine outside the body that targets the cancer (external radiation). Or it may be given inside the body, with radiation sealed in seeds or wires (internal radiation).
Compared to surgery alone, radiation therapy given before surgery for rectal cancer may reduce the risk that the cancer will return and may help you live longer.4
The side effects of treatment for colorectal cancer will depend on the type of treatment you have and your age and overall health. The side effects of surgery, chemotherapy, or radiation may be mild enough that you can do things at home to manage them. See the Home Treatment section of this topic for more information.
Some of the treatment side effects can be avoided. For example, your doctor may prescribe medicines to control nausea and vomiting caused by chemotherapy. Other problems may be more serious, such as pain or tingling in your hands or feet that gets worse (peripheral neuropathy). These problems may be a sign that your medicines need to be changed. Be sure to talk to your doctor about all the side effects that you have.
For more information about specific treatments, see the following topics:
After your treatment, you will need regular checkups by a family doctor, general practitioner, medical oncologist, radiation oncologist, or surgeon, depending on your case. During your follow-up visits you may have one or more of these tests:
Colorectal cancer comes back after surgery in about half of people who have surgery to remove the cancer.4 The cancer may be more likely to come back after surgery if it was not discovered in an early stage. Cancer that has spread or comes back is harder to treat. A cure is less likely, but treatment can help you feel better and live longer. For more information, see the topic Colorectal Cancer, Metastatic and Recurrent.
After you have had colorectal cancer, your chances of having it again go up. It's important to continue to see your doctor and be tested regularly to help find any returning cancer or new polyps early.
Clinical trials are designed to find better ways to treat people with cancer and are based on the most current information. Some people who meet the criteria for participation choose to enroll in such clinical trials.
Some tests can prevent colorectal cancer. Screening tests look for a certain disease or condition before any symptoms appear. Experts recommend routine colon cancer testing for everyone age 50 and older who has a normal risk for colon cancer. Your doctor may recommend earlier or more frequent testing if you have a higher risk for colon cancer. Talk to your doctor about when you should be tested.
Fewer than half of people who are older than 50 are screened for colorectal cancer. According to the American Cancer Society, if everyone were tested, tens of thousands of lives could be saved each year.
The following guidelines are for people who do not have an increased risk for colorectal cancer.
Stool test,* such as the fecal occult blood test (FOBT), fecal immunochemical test (FIT), or stool DNA test (sDNA)
Every year for the FOBT and FIT
Every 5 years for sDNA
|Every 5 years|
|Every 10 years|
Computed tomographic colonography (CTC), also called a virtual colonoscopy
Every 5 years
*Others recommend combining a stool test with a sigmoidoscopy.
For more information, see:
Here are other things you can do to help prevent colorectal cancer:
If you have a very strong family history of colon cancer, you may want to talk to your doctor or a genetic counselor about having a blood test to look for changed genes. Genetic testing can tell you whether you carry a changed, or mutated, gene that can cause colon cancer. Having certain genes greatly increases your risk of colon cancer.
You have a very strong family history if each of the following is true:
You can do things at home to help manage the side effects of colorectal cancer or its treatment. Be sure to follow your doctor's advice on any drugs you are taking. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms.
Learning that you have colorectal cancer and being treated for it can be very stressful. There are steps you can take to reduce your stress. You may want to talk with family or friends. Some people find that spending time alone is what they need.
Consider meeting with a counselor or joining a support group of others who have colorectal cancer. Your doctor may also be able to help you find other sources of support and information. Learning relaxation techniques, such as yoga or visualization exercises, may also help you reduce your stress.
Your feelings about your body may change after treatment. Dealing with your body image may involve talking openly about your worries with your partner and discussing your feelings with a doctor.
For more information about learning how to live with cancer, read "Taking Time: Support for People With Cancer" from the National Cancer Institute. This booklet is available online at www.cancer.gov/cancertopics/takingtime.
Chemotherapy is the use of drugs to control the cancer's growth or relieve symptoms. Often the drugs are given through a needle in your vein, and your blood vessels carry the drugs through your body. Sometimes the drugs are available as pills you can swallow. Sometimes they are given through a shot, or injection.
Several drugs are used to treat colorectal cancer. There are also several drugs available for treating side effects.
A combination of drugs often works better than a single drug in treating colorectal cancer. The most commonly used drugs are:
Hair loss, a side effect common with some types of chemotherapy, is usually not a side effect of these drugs.
Your doctor may prescribe medicines that can help relieve side effects of chemotherapy. These side effects can include mouth sores, diarrhea, nausea, and vomiting. Your doctor may prescribe medicines to control nausea and vomiting. These drugs may include:
There also are things you can do at home to manage side effects. See Home Treatment for more information.
Chemotherapy and radiation may be combined to treat some types of colorectal cancer. Radiation or chemotherapy given before or after surgery can destroy microscopic areas of cancer to increase the chances of a cure.
Surgery to remove cancer is almost always the main treatment for colorectal cancer. The type of surgery depends on the size and location of your cancer.
Side effects are common after surgery. You may be able to reduce the severity of your side effects at home. See Home Treatment for more information.
Your doctor may suggest radiation therapy or chemotherapy if he or she thinks the cancer may come back (recur). If the cancer has spread to nearby lymph nodes, you may need chemotherapy after your surgery. Or if your surgery shows that the cancer has spread outside your colon or rectum, you may need radiation therapy.
Polypectomy or local excision is used when the cancer has been caught in its early stages. Bowel resection is used when the cancer is larger. Sometimes after this major operation, the two ends of the colon or rectum cannot be sewn back together. When this happens, a colostomy is performed. Most people do not need a colostomy.
Radiation therapy uses X-rays to destroy colorectal cancer cells and shrink tumors. It is often used to treat rectal cancer, usually combined with surgery. It is used less often to treat colon cancer. It may also be combined with chemotherapy.
Radiation may be given:
Compared to surgery alone, radiation given before surgery may reduce the risk that rectal cancer will return and may help you live longer.4
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
Mind-body treatments like the ones listed above may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment, but they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.
You may be interested in taking part in research studies called clinical trials. Clinical trials are based on the most up-to-date information and are designed to find better ways to treat people who have cancer. People who do not want standard treatments or are not cured by standard treatments may want to take part in clinical trials. These are ongoing in most parts of the United States and in some other countries around the world for all stages of colorectal cancer.
|American Cancer Society (ACS)|
The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.
|American College of Gastroenterology|
|P.O. Box 342260|
|Bethesda, MD 20827-2260|
The American College of Gastroenterology is an organization of digestive disease specialists. The Web site contains information about common gastrointestinal problems.
|American Society of Colon and Rectal Surgeons|
|85 West Algonquin Road|
|Arlington Heights, IL 60005|
The American Society of Colon and Rectal Surgeons is the leading professional society representing more than 1,000 board-certified colon and rectal surgeons and other surgeons dedicated to treating people with diseases and disorders affecting the colon, rectum, and anus.
Cancer.Net is the information website of the American Society of Clinical Oncology (ASCO) for people living with cancer and for those who care for them. ASCO is the world's leading professional organization representing physicians of all oncology subspecialties. Cancer.Net provides current oncologist-approved information on living with cancer.
|National Cancer Institute (NCI)|
|6116 Executive Boulevard|
|Bethesda, MD 20892-8322|
|Web Address:||www.cancer.gov (or https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help online)|
The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people who have cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.
|National Institutes of Health: Health Information|
|9000 Rockville Pike|
|Bethesda, MD 20892|
The U.S. National Institutes of Health (NIH) conducts and supports medical research to improve people's health and save lives. NIH provides access to health and wellness information, free newsletters, current research, health databases, fact sheets, and many other resources.
- American Cancer Society (2008). Colorectal Cancer Facts and Figures 2008–2010. Atlanta: American Cancer Society. Available online: http://www.cancer.org/docroot/STT/content/STT_1x_Colorectal_Cancer_Facts__Figures_2008-2010.asp.
- Winawer S, et al. (2003). Colorectal cancer screening and surveillance: Clinical guidelines and rationale—Update based on new evidence. Gastroenterology, 124(2): 544–560.
- National Comprehensive Cancer Network (2010). Colon cancer. NCCN Clinical Practice Guidelines in Oncology, version 2. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.
- Lewis C (2007). Colorectal cancer screening, search date November 2006. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Other Works Consulted
- American Cancer Society (2009). Cancer Facts and Figures 2009. Atlanta: American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@nho/documents/document/500809webpdf.pdf.
- American Joint Committee on Cancer (2010). Colon and rectum. In AJCC Cancer Staging Manual, 7th ed., pp. 143–159. New York: Springer.
- Blanchard EM, Hesketh PJ (2008). Nausea and vomiting section of Management of adverse effects of treatment. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 2, pp. 2639–2646. Philadelphia: Lippincott Williams and Wilkins.
- Cherry NI (2008). Diarrhea and constipation. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 2, pp. 2646–2655. Philadelphia: Lippincott Williams and Wilkins.
- National Cancer Institute (2010). Colon Cancer PDQ: Treatment – Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/colon/HealthProfessional.
- National Cancer Institute (2010). Colon Cancer PDQ: Treatment – Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/colon/Patient.
- National Cancer Institute (2010). Genetics of Colorectal Cancer PDQ—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/genetics/colorectal/healthprofessional.
- National Cancer Institute (2010). Rectal Cancer PDQ: Treatment – Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/rectal/HealthProfessional.
- National Cancer Institute (2010). Rectal Cancer PDQ: Treatment – Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/rectal/Patient.
- National Comprehensive Cancer Network (2010). Rectal cancer. NCCN Clinical Practice Guidelines in Oncology, version 2. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.
|Primary Medical Reviewer||Kathleen Romito, MD - Family Medicine|
|Specialist Medical Reviewer||Arvydas D. Vanagunas, MD - Gastroenterology|
|Last Revised||April 29, 2011|
Last Revised: April 29, 2011
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