Learn about your colorectal cancer risk

black-patient-with-doctorFrom the Maya Angelou Center for Health Equity

Colorectal cancer (CRC) is the third most common cancer found in adults. According to The American Cancer Society (ACS) more than 141,000 people were diagnosed with colon or rectal cancer in 2012, of which more than 16,000 were African American.  Unfortunately, this resulted in about 49,000 deaths; 7,100 of those were African American. In North Carolina alone, African Americans accounted for nearly 25% of colorectal cancer deaths in 2012. The ACS estimates that more than 130,000 new cases of CRC will be diagnosed in 2014, and approximately 50,000 people will die from the disease.

African Americans are 20% more likely to be diagnosed with CRC and 45% more likely to die from the disease compared to Whites. Although rates of CRC continue to decrease, it is still one of the most common types of cancer diagnosed. The risk of developing colorectal cancer increases with age.  In fact, more than 90% of colorectal cancer cases occur in persons aged 50 years or older.

In general, the number of people developing and dying from colorectal cancer has been decreasing each year.   This decrease is largely due to successful screening tests that allow for the discovery and removal of pre-cancerous growths (polyps) before they turn into cancer.  Early detection and treatment can lead to improved medical outcomes.

What is colorectal cancer?

In order to understand what colorectal cancer is, it’s important to know what the functions are of these parts of the body. The colon and rectum are part of the digestive system (often called gastrointestinal, or GI, system) and work to process food for energy and excrete the waste the body does not need.

Colorectal cancer usually develops slowly over a period of years from the cells lining the inside of the colon and rectum.  It begins as a polyp (called an adenoma), then develops into an adenocarcinoma, which is cancerous.  Almost all adenomas of the colon and rectum develop into adenocarcinomas if left untreated.  Risk factors that contribute to the development of colorectal cancer include:

  • Family history of colorectal cancer or polyps, inflammatory bowel disease, or certain hereditary diseases
  • Personal history of inflammatory bowel disease
  • Age 50 years old or greater
  • Racial and Ethnic background – African Americans who have these risk factors, especially those who are age 50 or older, are at an even greater risk of developing colorectal cancer.
  • Lifestyle factors such as lack of exercise, poor diet, obesity, and alcohol and tobacco use contribute to an increased risk of CRC.
  • People with Type 2 Diabetes have an increased risk of developing CRC


How is colorectal cancer detected?
Routine screening for colorectal cancer is crucial for early detection. The ACS recommends that, beginning at age 50, both men and women have a yearly stool blood test (a test to find small amounts of hidden blood in the stool), plus one of the following exams: 

  • Flexible sigmoidoscopy (a procedure that allows the doctor to look at the inside of the rectum and part of the colon) every 5 years.
  • Double contrast barium enema (a series of X-rays of the colon and rectum which are taken after the patient is given a barium dye enema followed by an injection of air into the lower bowel) every 5 years.
  • Colonoscopy (a procedure that allows the doctor to look at the inside of the rectum and colon) every 10 years.

It is very important that you discuss these screening options with your physician. If you have a family history of colorectal cancer, you may need to be screened at a younger age. You should also see a physician immediately if you have any of the following symptoms:

  • Change in bowel habits such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days,
  • Feeling of needing to have a bowel movement that doesn’t go away after doing so,
  • Bleeding from the rectum or blood in the stool,
  • Cramping or steady stomach pain,
  • Unexplained weakness, fatigue and/or weight loss

Having these symptoms does not necessarily mean that you have cancer, but you should be evaluated to be sure.

How is Colorectal cancer treated?

The stage the CRC is when diagnosed will help your provider determine what might be the most effective treatments. According to the ACS, CRC staging is grouped into three main areas, called the TNM system:

  • T describes how far the main (primary) tumor has grown into the wall of the intestine and whether it has grown into nearby areas.
  • N describes the extent of spread to nearby (regional) lymph nodes.
  • M indicates whether the cancer has spread (metastasized) to other organs of the body.

Based on where the cancer is in the TNM system, it is then placed into a stage from 0, I, II, III, or IV based on how advanced the cancer is among the TNM system.

The most common treatments for CRC are Surgery, Radiation therapy, Chemotherapy and targeted therapy. For stages 0-III, surgery to remove the cancerous area is the first step in standard treatment, and for stages 0-I often no further treatment is needed. For stages II-III, chemotherapy and/or radiation therapy frequently follows surgery to address cancer cells potentially unable to be removed with surgery. For stage IV, surgery is unlikely to cure most of these cancers, and chemotherapy and/or radiation is frequently used to reduce the size of the cancerous areas to either 1) allow for surgery or 2) relieve symptoms of the disease. It is essential to talk with your health care provider to determine what course of treatment makes the most sense for you, given your cancer staging and overall health.

Is colorectal cancer curable?

The standard screening tests often find colorectal cancer at an early stage, thereby greatly improving the likelihood that it will be cured.  Cancers found early have a 75%-90% chance for cure with surgery, whereas cancers found at a more advanced stage have a less than 50% chance of cure and may require multiple therapies such as surgery, chemotherapy, and radiation therapy.  Again, early detection often results in less advanced cancer that can be cured.  In addition to a healthy lifestyle, routine screening should be done on a regular basis for those over the age of 50!

Do you need further information or have questions or comments about this article? See the American Cancer Society’s website at www.cancer.gov. For more information about the Maya Angelou Center for Health Equity or local resources in your area, please visit our website: www.wakehealth.edu/MACHE or call us toll-free at 1-877-530-1824.


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