Colorectal Cancer Toolkit

Colorectal cancer is cancer that starts in either the colon or the rectum. Colon cancer and rectal cancer have many features in common.

Colorectal cancer is the third most commonly diagnosed cancer and cause of cancer-related death among both men and women in Indiana. In 2014, the American Cancer Society estimates that 3,020 Hoosiers will be diagnosed with colorectal cancer, and 1,090 will die because of the disease. The lifetime risk of developing colorectal cancer is about five percent for both men and women in the United States. In Indiana, African-Americans have higher colorectal cancer incidence and mortality than whites, and men have higher rates than women.

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Who gets Colorectal Cancer Most Often?

Sex and age are the two greatest risk factors for developing colorectal cancer. During 2007-2011, colorectal cancer incidence rates were 29 percent higher among Indiana men than women. Additionally, during 2011, 90 percent of cases were diagnosed among Indiana residents ages 50 and older.

Some additional risk factors for colorectal cancer include:

  • Race. In Indiana, during 2007-2011, African-Americans had a 22 percent higher incidence rate (54.9 versus 45.0 cases per 100,000) and a 36 percent higher mortality rate (22.3 versus 16.4 deaths per 100,000 people) when compared with whites.
  • Personal or family history. Risk is increased by having certain inherited genetic conditions (for example, Lynch syndrome), a personal or family history of colorectal cancer or polyps, or a personal history of chronic inflammatory bowel disease.
  • Smoking. According to The Health Consequences of Smoking – 50 Years of Progress, smoking is a known cause of colorectal cancer. In addition, smoking increases the failure rate of treatment for all cancers.
  • Diabetes. Many studies have found an association between diabetes and increased risk of colorectal cancer. A recent study suggests that the association may be stronger in men than in women.
  • Modifiable risk factors. Obesity, physical inactivity, a diet high in red or processed meat, and alcohol consumption may increase colorectal cancer risk.

Common Signs and Symptoms of Colorectal Cancer

During early stages of colorectal cancer there are no symptoms. Late state signs and symptoms include:

  • Rectal bleeding
  • Blood in stool
  • Change in bowel habits
  • Cramping pain in lower abdomen
  • Weakness
  • Extreme fatigue

Early Detection

Colorectal cancer incidence rates have been decreasing for most of the past two decades in the United States. The decline accelerated from 1998 to 2007, which has largely been attributed to increases in the use of colorectal cancer screening tests that allow the detection and removal of symptomless colorectal polyps before they progress to cancer. A similar trend has been seen in Indiana.

Advanced disease might cause rectal bleeding, blood in the stool, a change in bowel habits, and cramping pain in the lower abdomen. In some cases, blood loss from the cancer leads to anemia, causing symptoms such as weakness and excessive fatigue.

When detected at the local stage (cancer that has not spread beyond the colon or rectum), the five-year survival rate is 90 percent. In Indiana, during 2007-2011, only 39 percent of colorectal cancers were identified in the local stage. If the cancer has spread regionally, the five-year survival rate drops to 70 percent. If the cancer has spread distantly, the five-year survival rate drops to only 12 percent.

The U.S. Preventive Services Task Force recommends colorectal cancer screening for adults ages 50-75 using one of the following tests:

  • High-sensitivity fecal occult blood test (FOBT) – This is a test obtained from a health care provider for use at home. The FOBT can detect small quantities of blood in the stool that may be caused by cancerous tumors or large polyps. This test should be done once per year.
  • Flexible sigmoidoscopy – This is a slender, flexible, hollow, lighted tube that is inserted by a trained examiner to provide a visual examination of the rectum and lower one-third of the colon (also known as the sigmoid colon). This test should be done every five years. (When done in combination with a high-sensitivity FOBT, the FOBT should be done every three years, as opposed to annually.)
  • Colonoscopy – Similar to flexible sigmoidoscopy, a colonoscopy allows for direct visual examination of the colon and rectum. This test allows for visualization of the entire colon, and allows for the removal of any polyps that may be present. This test should be done every 10 years.

It is important to note that if anything unusual is found during either the FOBT test or flexible sigmoidoscopy, a colonoscopy is used as a follow-up test. Individuals should talk to their doctors about which screening test is right for them. Individuals who have an increased risk of developing the disease should talk to their health care provider about whether earlier or more intensive screening is needed.

In recent years, an increase in colorectal cancer incidence among younger adults has been identified in the United States. Therefore, timely evaluation of symptoms consistent with colorectal cancer in adults under age 50 is especially important.

Under the Affordable Care Act (ACA), screening colonoscopies are now fully covered by Medicare and by many private insurers. Patients will still be responsible for co-insurance or some out-of-pocket costs if the colonoscopy is a diagnostic rather than screening procedure. Patients may also still be responsible for costs related to anesthesia. It is important to talk to your health care provider and your health insurance about possible costs. For more information on the ACA, visit The public can also call 1-800-4-CANCER (1-800-227-2345) to learn more about screening options in their community.


You can take charge of your own health! Some behaviors that can help reduce your risk include:

  • Obtaining regular screenings
  • Avoiding tobacco products
  • Maintaining a healthy weight throughout life
  • Adopting a physically active lifestyle
  • Limiting consumption of alcohol
  • Consuming a healthy diet that emphasizes plant sources, supports a healthy weight, includes five or more servings of a variety of vegetables and fruit each day, includes whole grains in preferences to processed grains, and has minimal processed and red meats.



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