Colorectal Cancer

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Explore ACG's Colorectal Cancer Education Resources!

Screening for Colorectal Cancer (CRC)

Translations of ACG CRC Infographic

ACG Colorectal Cancer Awareness Infographic

New Age to Start CRC Screening: 45 is the New 50

Colorectal Cancer You Can Prevent It

ACG Colorectal Cancer Screening Options

Colorectal Cancer Screening Blood Test

Download Patient Education Information

Overview

• What is Colorectal Cancer?
  • Colon cancer is a disease in which cancer cells grow in the large intestine also called the colon.
  • Rectal cancer is a type of colon cancer that grows in the rectum which is the part of your intestine closest to the anus.
  • Colon and rectal cancers grow from abnormal tissue called polyps.
• How common is Colorectal Cancer?
  • In the United States, colon and rectal cancer is the third most common cancer.
  • The lifetime risk of colon and rectal cancer for men is 1 in 23 and for women is 1 in 25.
  • Around 50,000 people will die from colon and rectal cancer each year.
  • The risk of colon and rectal cancer appears to be rising in younger people.
• Who should get screened for Colon and Rectal Cancer?
  • Screening lowers your change of getting sick or dying from colon or rectal cancer.
  • Everyone ages 45 to 75 years old should be screened for colon and rectal cancer.
  • Some people have higher risks of cancer. For example, if you have family members with colon or rectal cancer or if you have an Inflammatory Bowel Disease you may need to be screened at a younger age.
• How can I get screened for Colon Cancer?

  ACG recommends colorectal cancer screening in average-risk individuals between age 45 and 75 years to reduce pre-cancerous growths called advanced adenomas, reduce colorectal cancer, and reduce death from colorectal cancer.

  Colonoscopy is a one-step test that looks for growths called polyps in your entire colon (large intestine) and rectum using a colonoscope. Your doctor can both detect and remove polyps during colonoscopy and prevent colorectal cancer. Colonoscopy is the most commonly performed gastrointestinal procedure in the United States. Colonoscopy with removal of polyps offers long term protection against developing colorectal cancer or dying from it.

  Two-Step Screening Tests: Stool-Based Tests
  These tests detect blood or altered DNA in the stool as a first step. A positive result would lead to the second step of colonoscopy for further examination.

  FIT Test
  Fecal Immunochemical Tests (FIT) detects hidden blood in the stool. The stool FIT test is typically performed on an annual basis. A positive test requires a follow-up colonoscopy.

  Multitarget Stool DNA (mtsDNA)
  Multitarget stool DNA test is a non-invasive screening for colorectal cancer. It looks for abnormal DNA associated with colon cancer or precancerous polyps. This test is more sensitive than the FIT test, but your chance of getting a false positive may increase with advancing age. According to the manufacturer's recommendations, if the mtsDNA test is negative, repeat screening occurs in three years. If the mtsDNA test is positive, the second step of colonoscopy is required. (At this time the only FDA-approved mtsDNA is Cologuard.®)

  Tests for Individuals Who Cannot or Will Not Have a Colonoscopy or FIT, or Are Not Candidates for Colonoscopy

  CT Colonography and Colon Capsule
  At this time, CT colonography and colon capsule are options for individuals unwilling or unable to undergo colonoscopy or FIT, provided that the tests are locally available and reimbursed by insurers for screening. It is important to note that both tests will still require a follow-up colonoscopy if positive.

  Source: ACG Clinical Guidelines: Colorectal Cancer Screening 2021

Screening

• Who should get screened for Colon and Rectal Cancer?
  • Screening lowers your change of getting sick or dying from colon or rectal cancer.
  • Everyone ages 45 to 75 years old should be screened for colon and rectal cancer.
  • Some people have higher risks of cancer. For example, if you have family members with colon or rectal cancer or if you have an Inflammatory Bowel Disease you may need to be screened at a younger age.
• How can I get screened for Colon Cancer?

  Colonoscopy:

  • Tier 1: A colonoscopy is a procedure where a camera looks inside the colon is called a colonoscopy.
  • During a colonoscopy, your doctor can find a cancer.
  • Your doctor also can find and remove polyps which can prevent cancer.
  • To prepare for a colonoscopy you will adjust your diet in advance and will drink medications (a bowel prep) to clear stool from your colon.
  • You are usually given medications to make sure you are comfortable and/or asleep during the colonoscopy and will need a ride home.

  Flexible Sigmoidoscopy:
  

  • A procedure where a camera looks inside part of the colon (the left side) and can diagnose a cancer or remove polyps in this area if seen.
  • It is done with or without medications to make you sleep.
  • It is a Tier 2 test that should be repeated every 5 years.

  Stool Tests:
  

  • There are two stool tests that can detect changes in the stool that may be from a cancer.
  • You collect a small stool sample at home in a kit or cup that has been given to you and then you return the sample to a laboratory either through the mail or in person.
  • If the test is abnormal (positive) you will need a colonoscopy.
  • FIT: One test is call called FIT which stands for “Fecal Immunochemical Test” and can detect blood in the stool.
    • This is one of the top recommended colon cancer screening tools (Tier 1).
    • This test should be done every year.
  • FIT-DNA: The other test is called a FIT-DNA test. The only current FDA approved test available is Cologuard®.
    • This test can detect blood or abnormal DNA in the stool.
    • This test should be done every three years.
    • This is a Tier 2 test.

  Computerized Tomography Colonography (CTC):

  • A radiology study where you drink medicine (bowel prep) to clear stool from your colon and then you go through a machine that takes pictures of your intestines to look for polyps or cancer. A small tube goes into the rectum to inflate the colon with air. You are awake during the study.
  • This is a Tier 2 test.
  • If the test is abnormal you will need a colonoscopy.
  • This test should be repeated every 5 years.

  Colon capsule:

  • A study where you swallow a small camera that takes pictures of your intestines from the inside and a physician will review the images and is looking for polyps or cancer.
  • This is a Tier 2 test.
  • If the test is abnormal you will need a colonoscopy.
  • This test should be repeated every 5 years.

Symptoms

• What are the symptoms of Colorectal Cancer?
  • Most early colon and rectal cancers do not cause symptoms. This is why screening for colorectal cancer is so important!
  • Sometimes people will see blood in the toilet or in their stool due to a cancer.
  • People can get belly (abdominal) pain or won’t be able to go to the bathroom (constipation) from a colon or rectal cancer.
  • Sometimes people will have low blood counts (anemia) from a cancer which makes them tired.
  • Weight loss that is not from another reason can also be from a cancer.
  • You should see your doctor right away if you have any of these symptoms.
• Why should you get checked for Colon and Rectal Cancer even if you have no symptoms?
  • Abnormal tissue (adenomas or polyps) can grow for years before turning into cancer.
  • Finding these adenomas before they turn into cancer you can prevent a cancer.
  • Finding a cancer in an early stage is easier to treat and can help you live longer than if you find a cancer that has spread.

Risk Factors

• What are the risk factors for colon and rectal cancer?
  • Age: The older you are the higher the risk of colon and rectal cancer. All people with no risk factors other than age, should get screened at age 45 years old.
  • A family history of colon or rectal cancer: If you have a first degree relative (mother, father, sister, brother, child) or multiple other relatives with colon or rectal cancer, or polyps called “advanced adenomas” you are at increased risk of colon or rectal cancer.
    • You may be recommended to get a colonoscopy at a younger age and have them done more frequently.
    • You should discuss your screening plan with your Gastroenterologist.
  • Inflammatory Bowel Disease (IBD): IBD in the colon such as Ulcerative Colitis or Crohn’s Disease can increase your risk of colon or rectal cancer.
    • If you have IBD you should discuss your colon and rectal cancer screening with your Gastroenterologist.

  Source: ACG Clinical Guidelines: Colorectal Cancer Screening 2021

Treatment Options

Please see the National Cancer Institute resource page for information on the stages of colon cancer, an overview of treatment options, and treatment options for each stage.

Audio Podcasts & Videos

ACG Experts Answer Your Most Common Questions on CRC and Colonoscopy