March is Colorectal Cancer Awareness Month

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The following information is an excerpt from the American Cancer Society and is also available in printable format: http://www.cancer.org/acs/groups/cid/documents/webcontent/003096-pdf.pdf

What is colorectal cancer?

Colorectal cancer is a cancer that starts in the colon or the rectum. These cancers can also be named colon cancer or rectal cancer, depending on where they start. Colon cancer and rectal cancer are often grouped together because they have many features in common.

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. To learn more about how cancers start and spread, see What Is Cancer?

How does colorectal cancer start?

Most colorectal cancers begin as a growth on the inner lining of the colon or rectum called a polyp. Some types of polyps can change into cancer over the course of several years, but not all polyps become cancer. The chance of changing into a cancer depends on the kind of polyp. The 2 main types of polyps are:

    Adenomatous polyps (adenomas): These polyps sometimes change into cancer. Because of this, adenomas are called a pre-cancerous condition.

    Hyperplastic polyps and inflammatory polyps: These polyps are more common, but in general they are not pre-cancerous.

Dysplasia, another pre-cancerous condition, is an area in a polyp or in the lining of the colon or rectum where the cells look abnormal (but not like true cancer cells).

For more detailed information on the types of polyps and conditions that can lead to colorectal cancer, seeUnderstanding Your Pathology Report: Colon Polyps

If cancer forms in a polyp, it can eventually begin to grow into the wall of the colon or rectum.

The wall of the colon and rectum is made up of several layers. Colorectal cancer starts in the innermost layer (the mucosa) and can grow through some or all of the other layers. When cancer cells are in the wall, they can then grow into blood vessels or lymph vessels (tiny channels that carry away waste and fluid). From there, they can travel to nearby lymph nodes or to distant parts of the body.

The stage (extent of spread) of a colorectal cancer depends on how deeply it grows into the wall and if it has spread outside the colon or rectum. For more information on staging, see “Colorectal cancer stages

The normal colon and rectum

The colon and rectum are parts of the digestive system, which is also called the gastrointestinal (GI) system (see illustration). The colon and rectum make up the large intestine (or large bowel). Most of the large intestine is made up of the colon, a muscular tube about 5 feet long. The colon absorbs water and salt from the remaining food matter after it goes through the small intestine (small bowel).

The waste matter that is left after going through the colon goes into the rectum, the final 6 inches of the digestive system, where it is stored until it passes out of the body through the anus.

Types of cancer in the colon and rectum

Adenocarcinomas make up more than 95% of colorectal cancers. These cancers start in cells that form glands that make mucus to lubricate the inside of the colon and rectum. When doctors talk about colorectal cancer, they are almost always talking about this type.

Other, less common types of tumors can also start in the colon and rectum. These include:

Carcinoid tumors start from specialized hormone-making cells in the intestine. They are discussed inGastrointestinal Carcinoid Tumors.

Gastrointestinal stromal tumors (GISTs) start from specialized cells in the wall of the colon called the interstitial cells of Cajal. Some are non-cancerous (benign). These tumors can be found anywhere in the digestive tract, but it is unusual to find them in the colon. They are discussed in Gastrointestinal Stromal Tumor (GIST).

Lymphomas are cancers of immune system cells that typically start in lymph nodes, but they can also start in the colon, rectum, or other organs. Information on lymphomas of the digestive system is included in Non-Hodgkin Lymphoma.

Sarcomas can start in blood vessels, muscle layers, or other connective tissues in the wall of the colon and rectum. Sarcomas of the colon or rectum are rare. They are discussed in Sarcoma - Adult Soft Tissue Cancer.

How common is colorectal cancer?

Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. The American Cancer Society’s estimates for the number of colorectal cancer cases in the United States for 2016 are:

  • 95,270 new cases of colon cancer
  • 39,220 new cases of rectal cancer

Lifetime risk of colorectal cancer

Overall, the lifetime risk of developing colorectal cancer is: about 1 in 21 (4.7%) for men and 1 in 23 (4.4%) for women. This risk is slightly lower in women than in men. A number of other factors (described in Colorectal cancer risk factors) can also affect your risk for developing colorectal cancer.

Deaths from colorectal cancer

Colorectal cancer is the third leading cause of cancer-related deaths in the United States when men and women are considered separately, and the second leading cause when both sexes are combined. It is expected to cause about49,190 deaths during 2016.

The death rate (the number of deaths per 100,000 people per year) from colorectal cancer has been dropping in both men and women for several decades. There are a number of likely reasons for this. One is that colorectal polyps are now being found more often by screening and removed before they can develop into cancers or are being found earlier when the disease is easier to treat. In addition, treatment for colorectal cancer has improved over the last few decades. As a result, there are now more than 1 million survivors of colorectal cancer in the United States.

Statistics related to survival among people with colorectal cancer are discussed in What are the survival rates for colorectal cancer, by stage?

Visit the American Cancer Society’s Cancer Statistics Center for more key statistics.



Colorectal cancer risk factors

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can’t be changed.

But having a risk factor, or even many, does not mean that you will get the disease. And some people who get the disease may not have any known risk factors.

Researchers have found several risk factors that might increase a person’s chance of developing colorectal polyps or colorectal cancer.

Colorectal cancer risk factors you can change

Several lifestyle-related factors have been linked to colorectal cancer. In fact, the links between diet, weight, and exercise and colorectal cancer risk are some of the strongest for any type of cancer.

Being overweight or obese

If you are overweight or obese (very overweight), your risk of developing and dying from colorectal cancer is higher. Being overweight raises the risk of colon cancer in both men and women, but the link seems to be stronger in men.

Physical inactivity

If you are not physically active, you have a greater chance of developing colorectal cancer. Being more active might help lower your risk.

Certain types of diets

A diet that is high in red meats (such as beef, pork, lamb, or liver) and processed meats (such as hot dogs and some luncheon meats) can raise your colorectal cancer risk.

Cooking meats at very high temperatures (frying, broiling, or grilling) creates chemicals that might raise your cancer risk, but it’s not clear how much this might increase your colorectal cancer risk.

Diets high in vegetables, fruits, and whole grains have been linked with a lower risk of colorectal cancer, but fiber supplements have not been shown to help.

It’s not clear if other dietary components (for example, certain types of fats) affect colorectal cancer risk.

Smoking

People who have smoked for a long time are more likely than non-smokers to develop and die from colorectal cancer.Smoking is a well-known cause of lung cancer, but it is also linked to other cancers, like colorectal cancer. If you smoke and want to know more about quitting, see Guide to Quitting Smoking.

Heavy alcohol use

Colorectal cancer has been linked to heavy alcohol use. Limiting alcohol use to no more than 2 drinks a day for men and 1 drink a day for women could have many health benefits, including a lower risk of colorectal cancer.

Colorectal cancer risk factors you cannot change

Being older

Younger adults can develop colorectal cancer, but your chances increase markedly after you turn 50.

A personal history of colorectal polyps or colorectal cancer

If you have a history of adenomatous polyps (adenomas), you are at increased risk of developing colorectal cancer. This is especially true if the polyps are large or if there are many of them.

If you have had colorectal cancer, even though it has been completely removed, you are more likely to develop new cancers in other areas of the colon and rectum. The chances of this happening are greater if you had your first colorectal cancer when you were younger.

A personal history of inflammatory bowel disease

If you have inflammatory bowel disease (IBD), including either ulcerative colitis or Crohn’s disease, your risk of colorectal cancer is increased.

IBD is a condition in which the colon is inflamed over a long period of time. People who have had IBD for many years often develop dysplasia. Dysplasia is a term used to describe cells in the lining of the colon or rectum that look abnormal (but not like true cancer cells) when seen with a microscope. These cells can change into cancer over time.

If you have IBD, you may need to start being screened for colorectal cancer when you are younger and be screened more frequently.

Inflammatory bowel disease is different from irritable bowel syndrome (IBS), which does not increase your risk for colorectal cancer.

A family history of colorectal cancer or adenomatous polyps

People with a history of colorectal cancer in a first-degree relative (parent, sibling, or child) are at increased risk. The risk is even higher if that relative was diagnosed with cancer when they were younger than 45, or if more than one first-degree relative is affected.

The reasons for the increased risk are not clear in all cases. Cancers can “run in the family” because of inherited genes, shared environmental factors, or some combination of these.

Most people with colorectal cancer have no family history of colorectal cancer. Still, as many as 1 in 5 people who develop colorectal cancer have other family members who have been affected by this disease.

Having family members who have had adenomatous polyps is also linked to a higher risk of colon cancer. (Adenomatous polyps are the kind of polyps that can become cancerous.)

If you have a family history of adenomatous polyps or colorectal cancer, talk with your doctor about the possible need to begin screening before age 50. If you have had adenomatous polyps or colorectal cancer, it’s important to tell your close relatives so that they can pass along that information to their doctors and start screening at the right age.

Having an inherited syndrome

About 5% to 10% of people who develop colorectal cancer have inherited gene defects (mutations) that can causefamily cancer syndromes and lead to them getting the disease. The most common inherited syndromes linked with colorectal cancers are familial adenomatous polyposis (FAP) and Lynch syndrome (hereditary non-polyposis colorectal cancer, or HNPCC), but other rarer syndromes can also increase colorectal cancer risk.

Familial adenomatous polyposis (FAP): FAP is caused by changes (mutations) in the APC gene that a person inherits from his or her parents. About 1% of all colorectal cancers are due to FAP.

In the most common type of FAP, hundreds or thousands of polyps develop in a person’s colon and rectum, usually in their teens or early adulthood. Cancer usually develops in 1 or more of these polyps as early as age 20. By age 40, almost all people with this disorder will have developed colon cancer if the colon isn’t removed first to prevent it. People with FAP are also at increased risk for cancers of the stomach, small intestines, and some other organs.

In attenuated FAP, which is a subtype of this disorder, patients have fewer polyps (less than 100), and colorectal cancer tends to occur at a later age.

Gardner syndrome is a type of FAP that also has non-cancerous tumors of the skin, soft tissue, and bones.

Lynch syndrome (hereditary non-polyposis colon cancer, or HNPCC): Lynch syndrome accounts for about 2% to 4% of all colorectal cancers. In most cases, this disorder is caused by an inherited defect in either the MLH1 orMSH2 gene, but changes in other genes can also cause Lynch syndrome. These genes normally help repair DNA damage. (See Do we know what causes colorectal cancer? for more details.)

People with this syndrome develop cancers when they are relatively young, although not as young as in FAP. People with Lynch syndrome may have polyps, but they tend to only have a few, not hundreds as in FAP. The lifetime risk of colorectal cancer in people with this condition may be as high as 80%, although this depends on which gene is affected.

Women with this condition also have a very high risk of developing cancer of the endometrium (lining of the uterus). Other cancers linked with Lynch syndrome include cancer of the ovary, stomach, small intestine, pancreas, kidney, brain, ureters (tubes that carry urine from the kidneys to the bladder), and bile duct.

For more information on Lynch syndrome, see Do we know what causes colorectal cancer? and Can colorectal cancer be prevented?

Turcot syndrome: This is a rare inherited condition in which people have a higher risk of adenomatous polyps and colorectal cancer, as well as brain tumors. There are actually 2 types of Turcot syndrome:

  • One is caused by gene changes similar to those seen in FAP, in which cases the brain tumors are medulloblastomas.
  • The other is caused by gene changes similar to those seen in Lynch syndrome, in which cases the brain tumors are glioblastomas.

Peutz-Jeghers syndrome: People with this rare inherited condition tend to have freckles around the mouth (and sometimes on the hands and feet) and a special type of polyp in their digestive tracts (called hamartoma). These people are at greatly increased risk for colorectal cancer, as well as several other cancers, which usually appear at a younger than normal age. This syndrome is caused by mutations in the STK1 gene.

MUTYH-associated polyposis: People with this syndrome develop colon polyps which will become cancerous if the colon is not removed. These people also have an increased risk of cancers of the small intestine, skin, ovary, and bladder. This syndrome is caused by mutations in the MUTYH gene.

These syndromes often lead to cancer at a younger age than is usual. They are also linked to some other types of cancer. Identifying families with these inherited syndromes is important because it lets doctors recommend specific steps such as screening and other preventive measures when the person is younger.

Information on risk assessment, and genetic counseling and testing for these syndromes can be found in Colorectal Cancer Prevention and Early Detection.

Your racial and ethnic background

African Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the United States. The reasons for this are not yet understood.

Jews of Eastern European descent (Ashkenazi Jews) have one of the highest colorectal cancer risks of any ethnic group in the world. Several gene mutations leading to an increased risk of colorectal cancer have been found in this group. The most common of these gene changes, called the I1307K APC mutation, is present in about 6% of American Jews.

Having type 2 diabetes

People with type 2 (usually non-insulin dependent) diabetes have an increased risk of colorectal cancer. Both type 2 diabetes and colorectal cancer share some of the same risk factors (such as being overweight or obese). But even after taking these factors into account, people with type 2 diabetes still have an increased risk. They also tend to have a less favorable prognosis (outlook) after diagnosis.

Factors with unclear effects on colorectal cancer risk

Night shift work

Results of one study suggested working a night shift at least 3 nights a month for at least 15 years may increase the risk of colorectal cancer in women. The study authors suggested this might be due to changes in levels of melatonin (a hormone that responds to changes in light) in the body. More research is needed to confirm or refute this finding.

Previous treatment for certain cancers

Some studies have found that men who survive testicular cancer seem to have a higher rate of colorectal cancer and some other cancers. This might be because of the treatments they have received.

Several studies have suggested that men who had radiation therapy to treat prostate cancer might have a higher risk of rectal cancer because the rectum receives some radiation during treatment. Most of these studies are based on men treated in the 1980s and 1990s, when radiation treatments were less precise than they are today. The effect of more modern radiation methods on rectal cancer risk is not clear.

Do we know what causes colorectal cancer?

 .... to read more, please visit http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/

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