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. The American Cancer Society (ACS) estimates that nearly 3,080 Hoosiers will be diagnosed with colorectal cancer, and 1,110 will die as a result of the disease, during 2017 alone. The lifetime risk of developing colorectal cancer is 4.6 percent for men and 4.2 percent for women in the United States (one in 22 and one in 24, respectively). 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?

Although colorectal cancer incidence rates in young and middle-age adults are rising, sex and older age remain the two greatest risk factors for developing colorectal cancer. During 2010-2014, colorectal cancer incidence rates were 27 percent higher among Indiana men than women. Additionally, 90 percent of cases were diagnosed among Indiana residents ages 50 and older during that same time period.

Some additional risk factors for colorectal cancer include:

  • In Indiana, during 2010-2014, African-Americans had a 12 percent higher incidence rate (48.1 versus 42.9 cases per 100,000) and a 38 percent higher mortality rate (21.5 versus 15.6 deaths per 100,000 people) when compared with whites.
  • 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.
  • Studies show that individuals with type 2 diabetes are at higher risk.Although diabetes and colorectal cancer share similar risk factors, this increased risk remains even after those are taken into consideration.
  • Personal or family history. Although a majority of colorectal cancer cases occur when there is no family history, risk is increased by having a personal or family history of colorectal cancer or polyps, a personal history of chronic inflammatory bowel disease, or certain inherited genetic conditions – for example, Lynch syndrome (also known as hereditary nonpolyposis colorectal cancer) and familial adenomatous polyposis.
  • Modifiable risk factors. Overweight and obesity, physical inactivity, a diet high in red or processed meat, and alcohol consumption have been found to increase colorectal cancer risk.


Common Signs and Symptoms of Colorectal Cancer

During the early stages of colorectal cancer, there are often no symptoms, which is why screening is critical. As a tumor grows, it may bleed or obstruct the intestine.  Late stage signs and symptoms include:

  • Bleeding from the rectum
  • Blood in stool or in the toilet after having a bowel movement
  • Dark or black stools
  • Change in bowel habits or the shape of the stool (e.g. more narrow than usual)
  • Cramping or discomfort in lower abdomen
  • Urge to have a bowel movement when the bowel is empty
  • Constipation or diarrhea that lasts more than a few days
  • Decreased appetite
  • Unintentional weight loss

Concerns are now being raised over rising incidence rates among adults under 55, even as the overall incidence of colorectal cancer in the U.S. has been declining. A new study, completed by American Cancer Society (ACS) researchers and published in the Journal of the National Cancer Institute (JNCI), found colorectal cancer incidence rates are rising in young and middle-aged adults, including those in their early 50s. The study concluded that three in 10 rectal cancer diagnoses are now occurring in patients younger than age 55 across the nation. The rising rates in adults under age 50 highlight a need to respond to this trend, including raising awareness of preventive measures and risk factors.

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

  • The guaiac-based fecal occult blood test (gFOBT) – This is a test obtained from a health care provider for use at home. The gFOBT 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.
  • The fecal immunochemical test (FIT) – This test uses antibodies in order to detect blood in the stool. A test kit must be obtained from a health care provider for use at home. This test should be done once per year.
  • Multitargeted stool DNA test (FIT- DNA) – This test combines the FIT with a test to detect altered DNA in the stool. Obtained from a health care provider, the patient collects an entire bowel movement which is then sent to a lab to be checked for cancer cells. This test should be done once per year or once every three years.
  • 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, or every 10 years with a FIT annually.
  • Computed tomography (CT) colonography – Also called a virtual colonoscopy, the CT colonography test uses x-rays and computers to generate images of the entire colon, which the doctor then analyzes. This test should be done every five years.
  • 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 any other type of screening, a colonoscopy is used as a follow-up test. Individuals should talk to their doctors about which screening test is right for them. Those 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. Recent studies have shown that three in 10 rectal cancer diagnoses now occur in patients under 55 years of age. Therefore, timely evaluation of symptoms consistent with colorectal cancer in adults under age 50 is especially important.

Under the Affordable Care Act (ACA), many screening options may be covered by insurance. It is important to talk to your health care provider and your health insurance any about possible costs. For more information on the ACA, visit www.health.gov. Indiana residents can also visit http://www.in.gov/fssa/hip/ for information on the Healthy Indiana Plan, which covers colorectal cancer screenings. The public can also call 1-800-227-2345 to learn more about screening options in their community.


Prevention

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 at least 2 ½ cups of a variety of vegetables and fruit each day, includes whole grains in preference to processed grains, and has minimal processed and red meats
  • Supporting initiatives, such as the National Colorectal Cancer Roundtable’s 80% by 2018 campaign, that aim to increase colorectal cancer screening
  • Taking the 80% by 2018 Pledge!


Survivorship

Due to advances in treatment and earlier screenings, more and more people are living after a cancer diagnosis. The ACS defines a cancer survivor as any person who has been diagnosed with cancer, from the time of diagnosis through the balance of life. According to the Indiana State Cancer Registry, as of December 31, 2012, there were an estimated 286,973 cancer survivors for all cancers combined; the four highest-burden cancers in the state (breast, colorectal, lung and prostate) account for approximately 56 percent of these survivors. Survivorship, like cancer itself, is complex and can be difficult to navigate.

According to the Indiana Cancer Facts and Figures 2015 report, there are three phases of cancer survival – the time from diagnosis to the end of initial treatment, the transition from treatment to extended survival, and long-term survival. More often than not, the terms “survivor” and “survivorship” are associated with the transitional period after treatment ends; however, survivorship includes a wide range of cancer experiences and paths3, including:

  • Living cancer-free for the remainder of life;
  • Living cancer-free for many years, but experiencing one or more serious, late complications of treatment;
  • Living cancer-free for many years, but dying after a late recurrence;
  • Living cancer-free after the first cancer is treated, but developing a second cancer;
  • Living with intermittent periods of active disease requiring treatment; and
  • Living with cancer continuously without a disease-free period.

The preferred path for most cancer patients is to receive treatment and be “cured.” This is the primary goal of all cancer treatment, when possible. For many cancer patients, the initial course of treatment is successful and the cancer does not return.

Many cancer survivors must still cope with the mid- and long-term effects of treatment, as well as any psychological effects – such as fear of returning disease. It is important that cancer patients, caregivers, and survivors have the information and support needed to help minimize these effects and improve quality of life and treatment.

As of January 1, 2016, the ACS reports that there were 724,690 men and 727,350 women alive in the US with a history of colorectal cancer. Some were cancer-free, and others still had evidence of cancer and may have been undergoing treatment.

According to the ACS, the five-year relative survival rate varies depending on the cancer stage.  When detected at the local stage (cancer that has not spread beyond the colon or rectum), the five-year survival rate is 90 percent. If the cancer has spread regionally, the five-year survival rate is 71 percent. If the cancer has spread distantly, the five-year survival rate drops to only 14 percent. In Indiana, during 2010-2014, 37.1 percent of colorectal cancers were identified before or in the local stage.

There are multiple treatment options available for colorectal cancer patients including surgery, radiation, and chemotherapy – often these are done in combination. Side effects of colorectal cancer treatment can include pain, fatigue (possibly for an extended period of time), constipation or diarrhea, a temporary of permanent colostomy, sexual dysfunction (erectile dysfunction in men), skin irritation, nausea, hair loss, swelling and rashes, low blood cell counts, dry skin, high blood pressure, clots in arteries or veins, and kidney damage. Side effects vary based on the type of treatment, the type and dosage of drugs, and the length of treatment.

In 2006, the Institute of Medicine (IOM) issued a report titled From Cancer Patient to Cancer Survivor: Lost in Transition. The report recommends that every cancer patient receives an individualized survivorship care plan that includes guidelines for monitoring and maintaining their health. In response to the IOM recommendation, many groups have now developed various types of “care plans” to help improve the quality of life of survivors as they move beyond their cancer treatment.

A treatment summary is critical for cancer survivors. The summary should describe the cancer diagnosis and medical treatments that were received (or that may be needed moving forward). Not only does the treatment summary provide survivors with a record of cancer treatments, but it helps survivors talk with other health care providers who may not have been part of the cancer care team.

According to the ACS, in addition to a treatment summary, a survivorship care plan should include a description of what follow-up appointments and tests will be needed and when they will be needed, a description of preventive measures that can be taken to help stay well, a description of any possible side effects from cancer treatments and ways to manage those side effects, and a description of ways to manage physical and mental health.

There are several organizations that assist with the development of survivorship care plans, including the American Society of Clinical Oncology, Journey Forward and LIVESTRONG Care Plan. A list of additional organizations can be found on the ACS website.

 


Resources

Additional and online resources: