Colorectal Cancer

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					Colorectal Cancer

What Is Colorectal Cancer?
Colorectal cancer is the third most common cancer in men and women. It begins in either the colon or rectum, which are both part of the digestive system (where food is processed).

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The American Cancer Society’s Estimates
In the United States during 2008:
•148,810 new cases of colorectal cancer will be diagnosed, including
 108,070 cases of colon cancer  40,740 cases of cancer of the rectum

• 49,960 deaths will occur as the result of colorectal cancer

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Who Is At Risk?
Two factors greatly influence the risk of developing colorectal cancer:
1. Age
More than 90% of colorectal cancers are diagnosed in people over age 50.

2. Racial or Ethnic Background
African Americans have the highest rates of colorectal cancer of all racial or ethnic groups in US. Ashkenazi Jews have a higher rate of colon cancer.

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Gender does not appear to be a risk factor. Men and women are similarly affected.

Other Risk Factors
Other factors that increase risk include:
 If you have ever had colorectal polyps, previously been treated for colorectal cancer, or had inflammatory bowel disease  Being physically inactive  Eating a diet high in fat (especially from red meat and processed meats, such as hot dogs, bologna and luncheon meat)  Obesity  Smoking  Heavy alcohol use  Having a family history of colorectal cancers, certain other cancers, and benign colon polyps (fewer than 10% of colorectal cancers are caused by inherited gene mutations)

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Reducing Your Risk
Early detection can help find and remove precancerous polyps (tissue growths.)

It also appears that the following behaviors may reduce risks:
 Maintaining a healthy weight  Getting regular physical activity  Eating plenty of fruits, vegetables, and whole-grain foods  Limiting high-fat foods, especially red meat and processed meats

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Warning signs include:
 Rectal bleeding

 Blood in the stool
 Change in bowel habits
 Cramping or abdominal pain (stomach area)

These are also warning signs for other, less serious illnesses, so if they appear, they should be discussed with a doctor.

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Colorectal cancers can almost always be cured if detected early. People of average risk with no symptoms should begin regular screening at age 50. People at increased risk should be screened earlier and more often.
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Traditional Detection Methods
Traditional methods for detecting colorectal cancer include:
 Flexible sigmoidoscopy – A doctor looks inside the rectum and the lower part of the colon (sigmoid colon) through a lighted tube.  Colonoscopy – A doctor exams the colon using a flexible, lighted instrument called a colonoscope.

 Double-contrast barium enema – X-rays are taken after the patient is given a barium enema. Barium helps to outline the intestines on the x-rays.
 Fecal occult blood test (FOBT) or fecal immunochemical test (FIT) – Tests for hidden blood in the stool
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Newly Recommended Detection Methods
Two new methods of detecting colorectal cancer are recommended:
• Virtual colonoscopy

• Stool DNA test with high sensitivity for cancer, timing uncertain

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The American Cancer Society’s Screening Recommendations
Colorectal screening guidelines issued in March 2008 group screening test options into two categories for persons ages 50+ or older who have no symptoms and are average risk:


Tests that can detect precancerous polyps and cancer
Tests that primarily detect cancer

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The American Cancer Society’s Screening OPTIONS
I. Tests that Detect Polyps and Cancer
• • • • Colonoscopy every 10 years Flexible sigmoidoscopy every 5 years Double-contrast barium enema every 5 years Virtual colonoscopy (CT Colonography) every 5 years

II. Tests that Primarily Detect Cancer
• • •
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Guaiac-based fecal occult blood test (gFOBT), annually Fecal immunochemical test (FIT) with high sensitivity for cancer, annually Stool DNA test with high sensitivity for cancer, timing uncertain

Treatment is most successful when cancer is detected early.

Surgery is the only method used for localized cancers; two or more treatment methods may be used for cancer that may have spread. Patients should thoroughly discuss treatment options with their doctors.
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Treatment Options
Surgery is generally used, and it usually cures colorectal cancer that has not spread.

Most patients whose cancer has spread receive chemotherapy or chemotherapy plus radiation before or after surgery. Regular follow-up exams and blood tests may be recommended.

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Survival Rates
Five-year relative survival rate for localized disease is about 90%. Localized cancer is cancer that, at the time of diagnosis, had not spread to additional sites within the body. Typically, the earlier a cancer is detected and diagnosed, the more successful the treatment, thus enhancing the survival rate. Five-year overall relative survival rate for colon cancer is 64%. The five-year relative survival rates represent persons who are living five years after diagnosis, whether disease-free, in remission, or under treatment. They do not imply that five-year survivors have been permanently cured of cancer.

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How Will Cancer Affect Me And My Family?
From the time of diagnosis, everyone is affected in some way, even family and friends. The American Cancer Society works to enhance aspects of life often challenged by this disease through:
• Reducing the physical toll of cancer
• Reducing barriers to allow those affected to continue with their day-to-day lives • Reducing the social and financial impact of cancer • Preserving the spiritual well-being of those affected
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Patient Concerns
People with colorectal cancer are often concerned about bowel problems, especially in social situations, as well as the effects of chemotherapy and radiation. Other concerns include:
 Fear of recurrence  Chronic and/or acute pain  Sexual problems  Fatigue
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Additional Concerns
 Changes in physical appearance  Depression  Sleep difficulties  Changes in what they are able to do after treatment  Impact of cancer on finances and loved ones  Guilt for delaying screening or treatment or for doing things that may have caused the cancer

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You Are Not Alone
In recent years, the quality of life for those who are living with cancer has received increased attention. No one has to make the cancer journey alone. The American Cancer Society provides sources of information and support to cancer patients, their families, and friends. These include access to secure and private online chats and support groups.

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Hope for the Future
Researchers are testing prevention methods, including whether fiber supplements, minerals, medicines, and vitamins can lower risk. Studies are expected to lead to new drugs and gene therapies to correct genetic problems and warn people most at risk. Scientists are also studying combinations of new chemotherapy drugs, new ways to combine proven drugs, and ways to combine chemotherapy with radiation therapy or immunotherapy.

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The Bottom Line
Screening tests offer a powerful opportunity for the prevention, early detection, and successful treatment of colorectal cancers.

You can reduce your risk by:
• • • • Getting screening for colon cancer starting at age 50 Eating healthy foods, including fruits and vegetables Limiting intake of red meat and alcohol Getting 30-60 minutes of physical activity at least five days per week

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Contact The American Cancer Society
Help from the American Cancer Society is available 24 hours a day, 7 days a week. To reach us:
 Visit the American Cancer Society Internet Web site at  Call toll free, 1–800–227–2345.

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Additional Resources
National Cancer Institute Cancer Information Service Telephone: 1–800–4–CANCER (toll free) Internet Web site: American Gastroenterological Association Telephone: 301–654–2055 Internet Web site: Colon Cancer Alliance Telephone: 1–877–422–2030 (toll free) Internet Web site:
Colorectal Cancer