Each March, Colorectal Cancer Awareness Month highlights the prevalence of colorectal cancer, a disease of the colon or rectum that takes the lives of more than 50,000 Americans annually. According to the Centers for Disease Control and Prevention (CDC), colorectal cancer is the second leading cause of cancer deaths in the U.S. It is also the second leading cause of cancer deaths in women and the third in men.

Colorectal cancer is a type of cancer that begins in the colon, also known as the large intestine, where the digestive tract ends. The cancer usually starts as an abnormal growth called a polyp which can be easily removed before it becomes cancerous and spreads to other parts of the body. Because of this, colorectal cancer is highly treatable and often preventable when detected early with screenings. However, the cancer may develop without symptoms and is often associated with older adults, making it less likely for younger people to be aware of their risk.

Inequities in health care also contribute to the lack of early intervention, primarily for Black Americans. According to the CDC, Black Americans have the highest rates of colorectal cancer, followed by white and Hispanic people. Additionally, Black people are 20% more likely to develop colon cancer and almost 40% more likely to die from it. This is in part due to a lack of access to qualified health care facilities and insurance coverage. Structural racism also continues to play a role in health disparities as Black patients historically are less likely to feel listened to, be screened early or properly diagnosed, or receive adequate pain management options.

Even Hollywood’s superheroes are not immune to colorectal cancer. Fans and colleagues alike were shocked when news broke in August 2020 that actor Chadwick Boseman had passed away from stage III colon cancer after being diagnosed in 2016 (unbeknownst to people outside of his family). The actor, who was most famous for his on-screen portrayals of Jackie Robinson, James Brown, and Marvel’s Black Panther, had been in back-to-back blockbusters with seemingly no intention of slowing down. The sudden loss to colon cancer at age 43 of the handsome rising star and beloved warrior didn’t just seem unlikely, it felt impossible.

While middle-aged to older Americans are believed to be at most risk of colon cancer, the number of younger adults with the disease is rising. Yale Medicine surgeons report recently seeing younger people, including those as young as 18, being diagnosed with colorectal cancer after mistaking symptoms for something less serious. In a 2018 report, the American Cancer Society found that people born in 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer compared to people 40 years older.

Though the overall incidence of colorectal cancer has dropped significantly (45%) since the mid-1980s, this is largely in part due to the consistent push for routine screenings in older Americans. Because these screenings are not pushed as heavily among younger people, patients younger than 55 were found to be 58% more likely to be diagnosed with advanced stages of the disease. Now, it is recommended that people start screening at age 45 or even younger, depending on risk factors such as family history.

Symptoms and Risk Factors

It is unfortunately easy to mistake symptoms of colon cancer for something less serious because symptoms may mimic those of an infection, irritable bowel syndrome (IBS), or hemorrhoids. This is especially true for younger, generally healthy people and people who lack access to routine preventive health care, whether that is due to living in a health care desert or having limited or nonexistent insurance coverage.

Symptoms of colorectal cancer can include:

  • Abdominal pain, aches, or cramps that don’t go away.
  • Bloody stool.
  • Diarrhea, constipation, or feeling that the bowel does not empty all the way.
  • Feeling the need to go to the bathroom even if the bowel is empty.
  • Unexplained or unintended weight loss.
  • Lack of appetite.
  • Weakness and fatigue.

It is common for colorectal cancer to bleed into the digestive tract. Blood in the stool may make it appear darker, but otherwise normal. However, over time, the blood loss can build up and lead to low red blood cell counts (anemia). In this case, the first sign of colorectal cancer may be a blood test showing this low count.

If the cancer has spread to the liver, symptoms may include an engorged liver felt during the exam, jaundice (yellowing of the skin or whites of the eyes), or trouble breathing if the cancer has continued to spread to the lungs.

It’s also possible for colon cancer to have no symptoms at all, especially in the beginning.  This is why early screening is crucial, as young adults and Black Americans are more likely to be diagnosed with late-stage cancer because they are less likely to be screened early.

Having a risk factor for colorectal cancer, or several, does not guarantee an individual will get the disease. However, because several risk factors cannot be changed – such as age, family history, and personal history with colon and rectal problems – it’s important to focus on lessening the risks that are changeable.

Lifestyle-related factors linked to colorectal cancer include:

  • Being overweight.
  • Not being physically active.
  • Certain diets, including ones high in red meat, cooking meat at high temperatures, and low levels of vitamin D.
  • Smoking.
  • Alcohol use.

Making intentional and sustainable lifestyle changes in these areas can reduce the risk of colorectal cancer, as well as other types of cancer, and can have a positive impact on overall health and well-being.

Screening and Treatment Options

Though the cause of colon cancer in younger adults is unclear, experts believe genetics play a role. It’s recommended that people with a family history of colon cancer be screened as early as age 35, 10 years before the recommended age, as well as an additional screening for genetic mutations every few years.

However, there are barriers to earlier screenings, as insurance might not cover preventive measures due to the person being under the age of 50. It’s important to speak with insurance providers to confirm whether their policies cover early prevention screenings and if not, what options are available.

There are several different types of colon cancer preventive screenings and tests to diagnose and stage colorectal cancer. Some of the more common tests include a traditional colonoscopy (an exam of the entire colon), a virtual colonoscopy (a CT scan of the abdomen and pelvis), or a flexible sigmoidoscopy (an exam of the lower part of the large intestine). There are also tests that screen stool for signs of the disease, such as blood or altered DNA in the stool. It’s important that individuals discuss family history, medical history, and other risk factors (such as chronic IBS) with a doctor to decide which screening tool will be most effective.

During colonoscopies, patients are sedated and won’t feel pain or discomfort, according to the UT Southwestern Medical Center. A colonoscopy can easily catch cancer early and potentially save the patient’s life. If any polyps are found in the large intestine, they will be removed during the procedure. In the case that the polyps are already malignant, treatment is much easier in the early stage of cancer than it is in the later stage. The chances of surviving colon cancer are also significantly higher if the disease is discovered early.

After diagnosis, treatment usually consists of minimally invasive surgery, chemotherapy, and radiation. However, what treatment or combination of treatments is appropriate for the patient is decided on a case-by-case basis. In advanced stages of colon cancer, the cancerous part of the colon might be removed, and the patient’s lymph nodes may be removed and tested for cancer. Drug therapy, immunotherapy, and overall care focused on reducing pain and discomfort are also treatments for advanced colon cancer.

The Mayo Clinic outlines several pre-appointment considerations and questions to ask the doctor, should a person choose to undergo a colonoscopy. The American Cancer Society offers questions to consider asking related to understanding the diagnosis, deciding on a treatment plan, understanding treatment, and post-treatment expectations.

The American Cancer Society also provides detailed information regarding screening coverage under private insurance, Medicare, and Medicaid. Those who are uninsured can contact their state or local health department and ask if the department participates in the CDC’s Screen for Life program. Through this program, participating health departments are reimbursed for cancer screenings. If diagnosed, patients are able to work with the hospital to determine an affordable payment plan.

Being at risk for cancer can be frightening and overwhelming, especially if a personal or family history of the disease is painful and triggering. However, it’s important to not let fear prevent you from being curious about symptoms and risk factors and being proactive about colorectal (and overall) health.

The earlier cancer is caught, the easier it is to treat and the more likely a person is to survive. Individuals who have questions regarding symptoms, risk factors, preventive screenings, or any other aspect of their health should contact their doctor, local health department, or a community-based health center to learn more about options that are right for them.

In 2023, an estimated 153,020 people will be diagnosed with colorectal cancer. On Dress in Blue Day on March 3, 2023, wear blue to help raise awareness of colorectal cancer and honor 1.4 million colorectal cancer patients and survivors living today.

Learn more about colorectal cancer.