A study published recently in the Journal of the National Cancer Institute found that while overall rates of colorectal cancer have been declining for decades in the United States, the rates for people in their 20s and 30s have increased dramatically over the same time.

If not caught early, the cancer is often deadly. Every year about 140,000 Americans are diagnosed with colorectal cancer and more than 50,000 die. Some doctors, such as Dr. Andrew H. Rosenstein, a gastroenterologist at University of Maryland St. Joseph Medical Center, say people need to be aware of symptoms and some may need to be screened before they turn 50, the typical age to begin receiving such an exam.


What is colon cancer and how significant of a problem is it?

Colon cancer is a common and lethal disease. It occurs when abnormal cells grow in the colon and eventually spread to other parts of the body. Colon cancer results in over 50,000 deaths per year in the United States and is the second-leading cause of cancer deaths for men and the third leading cause of cancer deaths for women.

What are the symptoms and the risk factors?

Symptoms that are consistent with colon cancer include rectal bleeding, anemia or loss of red blood cells, abdominal pain and narrowing or thinning of the stool. Factors that increase the risk of colon cancer include obesity, smoking, alcohol use, red meat consumption and diabetes. Genetic factors such as family history also play a very important role in the development of colon cancer.

How is colon cancer diagnosed and what are the different types of screening?

The gold standard for diagnosis is colonoscopy. It is the most accurate and versatile test that allows for tissue biopsy, location of tumors and polyp removal. Other, less optimal options for diagnosis or screening include barium enema and CT colonography. Other screening tests include fecal occult blood tests [that look for blood in stool], fecal stool tests for cancer DNA, and flexible sigmoidoscopy [which examines the rectum and lower colon].

Who should be screened and how does family history play into this?

Anybody over the age of 50 should be screened for colorectal cancer. Patients who have a parent or a sibling under the age of 60 with a history of colon cancer or colon polyps should be screened at age 40 or 10 years earlier than the time of their relative's diagnosis. Talk to your doctor about your family history of cancer or polyps so they can find out if you need to be screened earlier.

What is a polyp and why should people be concerned if screening finds them?

A colon polyp is a growth occurring inside the lining of the colon or rectum. Polyps may be benign but over time some can change into colon cancer. Having polyps can increase your risk for colon cancer, so patients should have a colonoscopy at specific intervals suggested by their gastroenterologist.

How is colon cancer treated?

The treatment for colon cancer depends on the location of the tumor and whether or not it has spread to other organs. A cancer stage is obtained by the treating physician. The stage is usually decided upon by the surgeon and the pathologist to determine how far the cancer has progressed. For some patients, surgery can be a cure and may be the only treatment they receive. Other patients with more advanced staging may require a combination of surgery and chemotherapy.

What are the survival rates?

The five-year survival rate for people with Stage 1 colon cancer is about 92 percent. That means they had a very localized tumor with no spread to any other organs. For patients whose stage of colon cancer becomes more advanced, the survival rates diminish. If a patient has advanced disease or Stage IV disease, which means the cancer has spread to other organs, the survival rate is about 11 percent at five years.


A recent study showed rates of colon cancer increasing among Generation X and the millennial population after years of declining rates. Why is this happening?

It is unclear why this is happening, but it is certainly an alarming trend. Of note, a lot of these cancers happen to be rectal cancers in nature. Some theories include the increase in obesity rate among young people and also the possibility that HPV may be playing a role in rectal cancer. Nonetheless, we do not know the exact reasons, but one thing is certain: If any young person has a history of rectal bleeding, abdominal pain or change in bowel habits, they should see their physician immediately and insist on a colonoscopic evaluation.