Colorectal Cancer: Risk Factors, Symptoms, and Screening Guidelines

27 Mar, 2024

Colorectal cancer, a formidable adversary in the domain of oncology, remains a significant health concern globally. Despite advancements in medical science, its prevalence underscores the importance of understanding its risk factors, recognizing its symptoms, and adhering to screening guidelines. As one of the most common cancers worldwide, its impact reverberates through countless lives, emphasizing the critical need for proactive measures in its prevention and early detection.

In this blog, we delve into the intricate web of factors contributing to colorectal cancer, explore its telltale signs, and unravel the importance of screening protocols in combating this disease. Through knowledge and awareness, we empower ourselves and our communities to confront colorectal cancer with vigilance and resolve.

What are the Risk Factors of Colorectal Cancer?

Understanding the risk factors associated with colorectal cancer is crucial for early detection and prevention. While these factors may not directly cause cancer, they significantly influence a person's likelihood of developing the disease. It's important to note that having one or more risk factors doesn't guarantee the development of colorectal cancer, just as the absence of risk factors doesn't eliminate the possibility. Let's explore the various factors that can increase one's susceptibility to colorectal cancer:

• Age: Colorectal cancer predominantly affects older adults, with the risk increasing as individual’s age. While most cases are diagnosed in people over 50, there has been a concerning rise in diagnoses among younger adults.
• Race: Black individuals in the United States face a higher risk of colorectal cancer compared to other racial groups. Black men, in particular, are at a heightened risk, with colorectal cancer being a leading cause of cancer-related death in this demographic.
• Sex: Men have a slightly higher risk of developing colorectal cancer than women.
• Family History: A family history of colorectal cancer, especially among first-degree relatives diagnosed before age 60, significantly increases an individual's risk. Inherited genetic mutations can also contribute to familial cases.
• Rare Inherited Conditions: Certain uncommon inherited conditions, such as Lynch syndrome and familial adenomatous polyposis (FAP), elevate the risk of colorectal cancer within affected families.
• Inflammatory Bowel Disease (IBD): Conditions like ulcerative colitis and Crohn's disease, which cause chronic inflammation of the large intestine, are associated with an increased risk of colorectal cancer.
• Adenomatous Polyps: Adenomas, a type of polyp found in the colon, can potentially develop into colorectal cancer over time. Removal of these polyps during a colonoscopy can mitigate the risk.
• Personal History of Cancer: Individuals with a personal history of colorectal cancer, ovarian cancer, or uterine cancer are at a higher risk of developing colorectal cancer.
• Physical Inactivity and Obesity: Sedentary lifestyles and obesity have been linked to an increased risk of colorectal cancer.
• Dietary Factors: Consumption of red and processed meats, along with certain dietary patterns, may elevate the risk of colorectal cancer. However, further research is needed to establish clearer associations.
• Smoking: Recent studies indicate that smoking is linked to a higher risk of dying from colorectal cancer.
• Diabetes: Type 2 diabetes has been identified as a potential risk factor for colorectal cancer.

Top Symptoms of Colorectal Cancer

Symptoms of colorectal cancer may not manifest in the early stages, but when they do, they can vary widely. It's important to be vigilant about any changes in bowel habits or unusual sensations in the abdominal area. Here are some common symptoms to be aware of:

1. Changes in Bowel Habits: This may include experiencing diarrhea or constipation persistently, or feeling like the bowel does not completely empty after a bowel movement.
2. Presence of Blood: Blood in feces, which may appear dark brown or black, or bright red blood from the rectum, could indicate colorectal bleeding.
3. Abdominal Discomfort: This can manifest as abdominal pain or bloating, often accompanied by a sensation of fullness even after a long period since eating.
4. Fatigue and Weight Loss: Unexplained fatigue or tiredness, as well as sudden weight loss without any apparent reason, could be indicative of underlying health issues, including colorectal cancer.
5. Anemia: Anemia, characterized by a deficiency of red blood cells or hemoglobin, may be detected during routine medical check-ups and could prompt further screening for colorectal cancer.

It's crucial to note that while these symptoms may raise concern, they can also be associated with various other health conditions. However, if any of these symptoms persist or worsen over time, seeking medical advice is highly recommended.

In some cases, colorectal cancer may only be diagnosed after symptoms become more pronounced, particularly if the cancer has advanced. Symptoms in later stages of the disease may vary depending on which organs or areas are affected:

• Liver Involvement: Jaundice, characterized by yellowing of the whites of the eyes, may occur if the cancer spreads to the liver.
• Lung Involvement: Difficulty breathing or a persistent cough may develop if the cancer spreads to the lungs.

Colorectal Screening Guidelines

Regular screening is paramount in the early detection of colorectal cancer, especially for individuals at higher risk. The American College of Physicians recommends screening for individuals who fall under the following categories:

• Personal or Family History: Individuals with a personal or family history of colorectal cancer should undergo regular screening to detect any potential signs of the disease.
• Age and Ethnicity: Black Americans aged 45 years or over are advised to undergo screening due to their higher risk of colorectal cancer. For those who are not Black and are over 50 years old with an average risk, regular screening is also recommended.
• Underlying Conditions: Individuals with Crohn's disease, Lynch syndrome, or adenomatous polyposis should also undergo regular screening due to their increased susceptibility to colorectal cancer.

A healthcare service provider will devise a specific screening schedule tailored to individual needs. This may include a combination of stool tests, such as stool immunochemistry, and invasive procedures like colonoscopy or sigmoidoscopy. Stool tests are typically recommended every 2 years, while colonoscopies or sigmoidoscopies may be advised every 10 years.

It's important to distinguish between precancerous lesions or polyps and cancerous polyps during screening. While everyone aged 50 or older has a risk of developing precancerous lesions or polyps, a colonoscopy remains the gold-standard approach for their removal and detection of cancerous polyps. Other screening methods include blood stool tests and stool DNA tests, which can provide valuable insights into potential colorectal cancer risks.

What is the Diagnosis?

Early detection through screening can identify polyps before they become cancerous or detect colorectal cancer in its initial stages. Colonoscopy is the primary diagnostic tool, allowing for precise localization of tumors. Other diagnostic procedures include blood stool tests, flexible sigmoidoscopy, barium enema X-ray, CT colonography, and imaging scans. These tests aid in detecting and staging colorectal cancer.

What is the Treatment?

Treatment options depend on factors such as tumor size, location, stage, and the individual's overall health. Surgery is often the primary treatment for localized cancer, ranging from local excision to colectomy. Chemotherapy, targeted therapy, immunotherapy, radiation therapy, and ablation techniques may also be used. In cases where cancer has metastasized or cannot be cured, palliative care focuses on symptom management, pain relief, counseling, and hospice care.

In a nutshell, early detection through routine screening plays a crucial role in identifying colorectal cancer at its earliest stages, offering the best chances for successful treatment and improved outcomes.