• What is cancer?
• What is colorectal cancer?
• Risk factors
• Screening tests
• Symptoms to watch for
• Treatment of colorectal cancer
• Prevention tips

Benign tumors are not cancer. They do not invade nearby tissue or spread to other parts of the body. Benign tumors can be removed and usually are not life threatening. Malignant tumors are cancer. They can invade and damage nearby tissues and organs. Sometimes cells from the tumor may break off and travel through the bloodstream or the lymphatic system and start tumors in other parts of the body.

What is Colorectal Cancer?
The colon and rectum form a long, muscular tube called the large intestine or large bowel. The colon is the upper 5 to 6 feet of the large intestine and the rectum is the last 6 to 8 inches. The large intestine, along with the esophagus, stomach, and the small intestine, are part of the body's digestive system. The digestive system removes nutrients (minerals, proteins and vitamins) from the food you eat and stores the waste until it passes out of the body.

Tumors can develop anywhere in the colon or rectum. Sometimes a benign growth, called a polyp, may start to grow on the wall of the colon or rectum. Colorectal polyps should be removed because they can become cancerous. These can be easily removed in a doctor's office during a sigmoidoscopy or colonoscopy examination. If not removed, these cancer cells can spread outside of the colon or rectum to the nearby lymph nodes. These cells can also spread to other parts of the body such as the liver and lungs. People who have had one polyp are more likely to develop others, so it is very important they have regular screening check-ups to prevent the start of cancer.

Colorectal cancers are the third most common cancer in men and women. In 1998, there will be an estimated 131,600 new cases of colorectal cancer and about 56,500 individuals will die from the disease. Like most health problems, colorectal cancer responds best to treatment when it is diagnosed and treated as early as possible, especially before it has a chance to spread outside of the colon.

Risk Factors
Studies have found that certain factors may increase a person's risk of developing colorectal cancer. These include being over 50 years of age; having a history of polyps in the colon, ulcerative colitis, or Crohn's disease; and having a family history of colon cancer or familial polyposis syndrome. Recent studies indicate diet, especially a diet high in fat and low in fiber, may also contribute to the development of colon cancer. Other risk factors include smoking, consumption of alcoholic beverages, and an inactive lifestyle.

Screening Tests
You can take an active role in the prevention and early detection of colorectal cancer by following the screening guidelines established by the American Cancer Society.

• Starting at age 40 you should have a digital rectal exam at your annual check-up. For this exam, the doctor gently inserts a gloved lubricated finger into the rectum and feels for abnormal areas. Fifteen percent of colorectal cancers can be detected by digital rectal examination.
• Beginning at age 50, the American Cancer Society recommends men and women have an annual fecal occult blood test. Sometimes colorectal cancers may cause bleeding that cannot be seen. The fecal occult blood test checks for hidden (occult) blood in the stool. For this test, a small amount of stool is placed on a plastic slide or on special paper. The stool may be tested in the doctor's office or sent to a lab.
• Beginning at age 50, you should have a sigmoidoscopy exam every 3 to 5 years. During this exam, the doctor inserts a small, flexible, lighted tube into the rectum and lower colon to directly inspect up to 25 inches of the lower bowel. Polyps can be easily removed during this exam. Approximately 72% of all colorectal cancers occur in this area.
• If polyps are found during a sigmoidoscopy, your doctor may recommend a colonoscopy examination. During this exam, the doctor is able to inspect the entire colon with an instrument that is similar to a sigmoidoscope, but longer. Any suspicious growths as well as polyps can be removed during this exam.
• Sometimes a barium enema with air contrast examination will be recommended. For this exam, barium sulfate, a chalky substance that shows up on x-rays, is given in enema form. X-rays are then taken of the colon. To make small tumors easier to see, the doctor may carefully pump in air to expand the colon. This examination can be helpful in finding cancers in the upper colon.

Persons who have symptoms or are at high risk for developing colorectal cancer may require more frequent screening examinations. Your doctor can advise you which screening tests you need to have and how often you need to complete them.

Symptoms To Watch For
Colorectal cancer can cause a wide range of symptoms. Warning signs to watch for include:

• a change in usual bowel habits, (constipation, diarrhea or both)
• stools that are narrower than usual
• blood in or on the stool
• general stomach discomfort, such as bloating, fullness and/or cramps
• frequent gas pains
• a feeling that the bowel does not empty completely
• weight loss with no known reason, and
• constant tiredness

These same symptoms may be caused by problems other than cancer. Only a physician can determine the cause. If you have any of these symptoms you should see your doctor.

Treatment of Colorectal Cancer
If you are diagnosed with colorectal cancer, you will need more tests to find out if the cancer has spread to other parts of the body. This is called staging the disease. Your doctor needs to know stage of the disease in order to plan the treatment best for you.

There are treatments for all patients with cancers of the colon or rectum. Four kinds of treatment used include surgery, radiation therapy, chemotherapy, or biological therapy.

• Surgery is the most common treatment for colorectal cancer. The type of operation depends on the location and the size of the tumor. Most patients have a partial colectomy, where the surgeon takes out the part of the colon or rectum that contains the cancer and a small amount of healthy tissue around it. Surgery is often the only treatment needed for early stage colorectal cancer. Less than 15% of patients will need a permanent colostomy. During a colostomy, the doctor creates an opening in the abdomen through which solid waste leaves the body.
• Chemotherapy uses medications to kill cancer cells. Chemotherapy is sometimes given after surgery to try to prevent the disease from spreading. This additional therapy is called adjuvant therapy.
• Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing. Radiation therapy is a local therapy because it affects only the cancer cells in the treated area. It might be used before, during (intraoperative radiation) or after surgery.
• Biological therapy tries to get your own body to fight the disease. It uses materials made by your own body or made in a laboratory. Sometimes biological therapy will be combined with chemotherapy.

Prevention Tips
There are steps you can take to help prevent colorectal cancer.

1. Decrease the amount of fat in your diet.
   Studies indicate that cancer risk is higher in persons with a diet high in fat (40-45% of total caloric intake) than those whose fat intake accounts for only 10% of their total calories.
2. Increase fiber in your diet, especially the fiber found in vegetables.
   Studies suggest that diets high in fiber, especially from vegetables, has a protective role against colorectal cancer.
3. Maintain adequate calcium levels in your diet.
   A diet with adequate levels of calcium, found in milk and dairy products, salmon or shellfish, and dark green vegetables lowers your risk.
4. Increase your activity level.
   Some studies have linked a sedentary or inactive lifestyle with an increased risk of colorectal cancer.
5. Limit your consumption of alcohol.
   Studies indicate a positive correlation between alcohol intake and colorectal cancer. This may be particularly significant for men in the prevention of rectal cancer.
6. Stop smoking.
   Most studies indicate smokers have an elevated risk colorectal cancer.
7. Have regular screening examinations.
   Complete screening examinations as recommended by the American Cancer Society and your physician. Polyps can be removed before they ever have a chance to become cancerous.

For more information:

Healthbeat: Colorectal Cancer