What should I know and do for early colorectal (colon and rectal) cancer diagnosis?

Colorectal (colon and rectal) cancers are among the most common cancers worldwide. National statistics place them as the 3rd most common cancer in both women and men in our country. They can occur at any age but are most common after 50.

The colon, following the small intestine, and its final segment, the rectum, together form the large intestine, a long muscular tube averaging 1.5 m. The rectum, averaging 15 cm, is the digestive tract’s final portion, formed by widening of the large intestine.

I should know the risk factors increasing my likelihood of colorectal cancer!

Colon and rectal cancer rates in developed countries are 4 to 10 times those in developing countries. Causes include lifestyle, changes in environmental factors and inherited genetic factors.

Genetic factors

People with a family history have increased risk. Inherited factors increase risk: both familial adenomatous polyps and hereditary nonpolyposis colorectal cancer, also called Lynch syndrome, raise colon cancer risk. Although inherited colorectal cancers account for only %5-10, carriers develop disease younger than other colon cancer patients and face greater mortality risk.

Hereditary nonpolyposis colorectal cancer (Lynch syndrome) is the most common inherited form. It results from an inherited gene mutation associated with mismatched DNA pairing. Average diagnosis age is 45. This mutation predisposes to cancers of the endometrium, ovaries, small intestine, ureter and renal pelvis.

If you are at risk, share your family history with your doctor and protect and monitor your health through routine screening from an early age.

Other risk factors

Age: Although possible at any age, it occurs mainly above 50.

Intestinal inflammation: There are two main types. First, ulcerative colitis involves ulcers occurring at sites in the colon lining because of infection. Second, Crohn’s disease causes intermittent inflammation anywhere from mouth to anus or in several different segments simultaneously. Although chronic and long-lasting, it can be treated. Because cancer risk is increased, colorectal screening should be more frequent.

Diet: Red meat and alcohol increase risk, while foods rich in fruits, vegetables, legumes, chicken and grains reduce it.

Obesity: Excess weight increases colon cancer risk in both women and men.

Smoking: Many studies report an association between smoking and colon cancer.

I should know colorectal cancer symptoms!

Rectal bleeding: The most common finding bringing people to the doctor.

Changes in bowel habits: For example, constipation followed by diarrhea, or feeling incomplete relief despite passing stool (rectal fullness).

Abdominal pain: Common and not cancer-specific, but persistent symptoms should raise consideration.

Weight loss: Loss of more than %10 over a short period is particularly important.

Anemia–pallor: Anemia in someone above age 50 should raise suspicion of colorectal cancer and requires appropriate investigation.

Bloating: Large colon and rectal tumors may partly or completely obstruct the intestine. Inability to pass stool or gas with worsening daily bloating may be life-threatening and requires emergency medical attention. Complete cancer-related obstruction may cause bowel rupture and death quickly, so emergency surgery should be considered.

What should I do for early colorectal cancer diagnosis?

Reducing risk factors lowers cancer risk, and regular tests aid early diagnosis. Average-risk people are recommended to start routine screening at age 50. Tests include fecal occult blood testing, flexible sigmoidoscopy, colonoscopy and double-contrast barium enema. Frequency depends on the method. Those with a family history of hereditary nonpolyposis colorectal cancer, adenomatous polyps, colorectal cancer or chronic intestinal inflammation benefit from earlier screening. Discuss options with your doctor to select the most suitable test.

Predictive genetic testing: With a family history of hereditary nonpolyposis colorectal cancer or adenomatous polyps, your doctor may suggest genetic testing. Detecting associated mutations allows precautions according to the identified cancer risk.

What should I do to prevent colorectal cancer?

Although risk cannot be eliminated completely, attention to unhealthy diet, inactivity, obesity, smoking and alcohol can reduce it.

Diet: Foods rich in fruits, vegetables and legumes help reduce risk. Red meat and alcohol should be moderate because they increase risk. Healthy eating and low-fat foods help maintain weight.

Exercise: Research shows regular exercise reduces colon and rectal cancer risk, as for many other cancers.

Consult your doctor before starting exercise; they can help choose a suitable program. Exercise on 5 or more than 5 days weekly for 30 minutes is recommended. From 45 minutes to 1 hour may provide greater benefit.

-Moderate activities: brisk walking, cycling on level ground.

-Vigorous activities: climbing and running.

Activities approved by your doctor and suited to your health will help you feel better and fitter.

Nonsteroidal anti-inflammatory medicines such as aspirin: Research suggests they reduce colorectal cancer risk and may benefit regular users. However, where a potential risk exists, use under medical supervision is advisable; otherwise stomach bleeding may cause harm.

Calcium: It may provide a small colorectal cancer benefit. Daily intake of 1200mg calcium is known to reduce colorectal adenoma formation by %20 and advanced adenoma formation by %45. Combined vitamin D and calcium have also been found to reduce adenoma formation.

Vitamin D: A fat-soluble vitamin found in fortified milk, cereal and dietary foods including certain fish such as mackerel, salmon and tuna, and in sunlight. It is thought to play an important role in preventing some cancers, including colon cancer.

Screening and treating precancerous polyps: Cancer screening, as particularly in breast cancer, does not prevent development but improves success through early diagnosis. Screening for precancerous polyps can prevent cancer development. Removing identified polyps may prevent future cancer.

Preventive surgery: Preventive surgery may be recommended for people at high colorectal cancer risk. The colon, and sometimes rectum and other relevant organs, are removed before cancer develops. Such surgery applies only to high-risk patients. Discuss its benefits and consequences with your doctor before deciding.

Screening recommendations for early colorectal cancer diagnosis

Those with a family history of hereditary nonpolyposis colorectal cancer, adenomatous polyps, colorectal cancer or chronic intestinal inflammation benefit from starting screening earlier.

Consult a physician about abnormalities in any test; the physician should determine screening frequency.

Colorectal screening is recommended for both men and women from age 50.

Fecal occult blood test: 1 time yearly

Flexible sigmoidoscopy (endoscopic examination of the final large intestine through the anus): Once every 5 years

Double-contrast barium enema (contrast imaging of the large intestine): Once every 5 years

Colonoscopy (endoscopic examination of the entire large intestine through the anus): Once every 10 years

CT colonography (contrast imaging of the large intestine): Once every 5 years is recommended

Note: Although choosing one test may appear sufficient, decide with your physician which screening method is most appropriate for you.