Colorectal Cancer: Your GoodRx Guide

Most colorectal cancers are adenocarcinomas. This is a type of cancer that starts in a specific cell type, like the cells that line the inside of the colon and rectum. Other types of colorectal cancer are possible, such as carcinoid tumors or lymphomas, but these are less common. 

Adenocarcinomas usually start as a precancerous growth — called a “polyp” — that protrudes into the inside of the intestine. And with time they can grow into the walls of the intestine and beyond.

Colorectal cancer is the second most common cause of cancer-related death in the U.S. The rate of colorectal cancer has been declining in recent years overall, but it is actually increasing in adults under 50 years of age. 

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Causes

As with many cancers, the exact cause of colorectal cancer isn’t known. But years of research have uncovered many risk factors. These are things that increase your likelihood of developing colorectal cancer. 

Risk factors for colorectal cancer include:

• Obesity

• Not getting enough exercise

• Drinking alcohol

• Smoking 

• Eating a lot of red and processed meats

• Type 2 diabetes

• Age greater than 50 years

• African or Ashkenazi heritage

• Family history of colorectal cancer or polyps

• Personal history of polyps, ulcerative colitis, or Crohn’s disease

• Rare, inherited syndromes such as familial adenomatous polyposis or Lynch syndrome

Research is ongoing into why these factors increase the likelihood of colorectal cancer. This will help experts understand the cause(s) and, possibly, how it can be prevented.

It’s important to know that having risk factors doesn’t mean you’re guaranteed to get cancer, and some people with no risk factors will get cancer. Some risk factors can’t be changed, such as your age or family history. But many risk factors are related to lifestyle and can be changed. 

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Symptoms

The most common signs and symptoms of colorectal cancer include: 

• Change in bowel habits, such as diarrhea or constipation

• Change in stool shape, color, or size

• Bleeding from the rectum

• Bloody or dark black stools

• Abdominal pain

• Anemia (low red blood cell count)

• Fatigue (feeling extra tired and weak)

• Unexplained weight loss

Symptoms are usually due to tumor growth into the inside of the colon or nearby structures. In its early stages, colorectal cancer may not cause symptoms. This highlights the importance of screening for colorectal cancer (more on this below). Early detection of colorectal cancer allows for more effective treatment. 

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Diagnosis

Colorectal cancer is typically found in one of three ways:

1) You have signs and symptoms (most common).

2) You don’t have symptoms, but a screening test finds it.

3) It causes a sudden problem, such as gastrointestinal bleeding, that puts you in the hospital.

If you have symptoms, it’s best to see your provider right away. They can help determine the next best step. In most cases, you will be referred for a colonoscopy. This is a procedure that allows a specialist to look inside your rectum and colon with a camera. It also allows them to remove precancerous polyps or small tumors. 

If you don’t have symptoms, but you’re 45 years old or older, it’s time for a screening test. Screening tests help look for cancer before they cause symptoms. Colorectal cancer screening tests include:

• Colonoscopy: looks inside the entire colon and rectum

• Flexible sigmoidoscopy: looks inside the lower third of the colon and rectum

• Stool tests: test for blood in your stool

• CT or colonography (virtual colonoscopy): uses radiation imaging to create pictures of your colon and rectum

If you have any risk factors for colorectal cancer, you might benefit from a screening test earlier than age 45. Your healthcare provider can guide you through the screening process. 

Know that if you don’t have a primary care provider or health insurance, colorectal cancer screening is still available to you.

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Treatments

Treatment for colorectal cancer depends on the stage. For cancer that is localized (hasn’t spread elsewhere), surgery is often curative. Surgery also plays an important role in more advanced cancer. But it’s often combined with medical treatments, such as chemotherapy (FOLFOX) or targeted therapy. When cancer has spread (metastasized) to other organs, surgery may not be an option: 

• Stage 0: polyp removal via colonoscopy

• Stage 1: surgery via colectomy or colonoscopy in some cases

• Stage 2: surgery with or without medical treatment

• Stage 3: surgery and medical treatment with or without radiation

• Stage 4: medical treatment with or without surgery, depending on the location and size of metastases

Surgery involves removing the affected portion of the colon (called a “colectomy”), as well as nearby lymph nodes. In most cases, this can be done via a laparoscopic or robotic surgery, which are minimally invasive. These allow for faster recovery. But there is still a role for colectomy through a large abdominal incision, called an “open” colectomy in some cases.

It’s important to know that many people have a stoma after colectomy. After the cancer is removed, the remaining portion of the intestine is rerouted to an opening in the abdominal wall. This allows waste to leave the body in a different way while the colon heals. The stoma may be temporary – the surgeon may reattach the intestine and rectum after a healing period – or permanent. 

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Living with

If you or your loved one has colorectal cancer, you probably have a lot of questions. Living with this type of cancer is certainly an adjustment. Common concerns include:

• Living with a stoma

• Managing side effects from chemotherapy

• Changing eating habits during or after treatment

• Dealing with changes in bowel habit 

• Wondering if treatment will affect intimacy or relationships

• Worrying about cancer recurrence

You may not feel comfortable talking about these things with others, especially at first. But don’t be afraid to discuss your concerns with your cancer care team. They’ve heard it all before, and they’re happy to answer any and all questions. They can also direct you to resources to help with nutrition advice, mental health support, various therapies, nursing guidance, and even supplies you need at home. So don’t hesitate to ask for help when you need it.

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Prevention

There’s no proven way to completely prevent colorectal cancer. But knowing your risk factors, and addressing the ones you can change, can certainly help. Also, it helps to know that some factors may decrease the risk of colorectal cancer, including regular physical activity, diets high in fiber, and daily aspirin (for some people).

Some steps you can take to help prevent colorectal cancer include:

• Get screened at age 45, or earlier if you have risk factors.

• Ask your provider about testing if you have a personal or family history of polyps or colon cancer.

• Eat more fruits and vegetables and less meat.

• Exercise regularly. 

• Don’t smoke.

• Cut back on alcohol, or don’t drink at all.

• Ask your provider if it’s safe to take a daily aspirin.

Many of the lifestyle measures above can also decrease your risk for other cancers and medical conditions, so there’s no harm in trying them. As for aspirin, long-term use (10 years or more) is recommended for adults over 50 years old who don’t have a risk of increased bleeding. Aspirin may not be beneficial if you start taking it after age 70.

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