March is Colorectal Cancer Awareness Month. Since the onset of the COVID-19 pandemic, screenings for colorectal cancer have plummeted. In 2021, this month is dedicated to getting those numbers back on track as well as raising awareness for other preventative measures. Colorectal cancer may not be the first cancer that comes to mind, but it’s fairly common. It is the third most common diagnosed cancer and is the second leading cause of cancer death in the United States. According to the Colorectal Cancer Alliance, 149,500 people will be diagnosed with Colorectal Cancer this year and 52,980 will die from the disease.

What exactly is colon cancer? Well, it starts in the colon or the rectum. To understand colorectal cancer, it helps to know a little bit about the anatomy of the colon and rectum. The colon and rectum make up the large intestine which is part of the digestive system. Most of the large intestine is made up of the colon. The colon is a 5 feet long muscular tube. The colon absorbs water and salt from the food that is remaining after it goes through the small intestine. The waste matter that is left after going through the colon goes into the rectum. The rectum is the final 6 inches of the digestive system. The waste is stored there until it passes through the anus. Most colorectal cancers start as a growth on the inner lining of the colon or rectum. These growths are called polyps. These growths can turn into cancer over time and it usually takes many years, but not all of them turn into cancer. The chance of these growths turning into cancer depends on the type of polyp. There are 3 types. Adenomatous polyps sometimes change into cancer and because of this they are a pre-cancerous condition. Hyperplastic and inflammatory polyps are more common, but in general they are not pre-cancerous. Sessile serrated polyps and traditional serrated adenomas are treated like adenomatous because they have a higher risk of colorectal cancer.

There are other factors that make these growths more likely to become cancerous. If a polyp is larger than 1 cm or if more than 3 are found it will increase the risk of developing colorectal cancer. Also, if dysplasia is seen after a polyp has been removed the risk increases. Dysplasia is when there is an area in the polyp or in the lining of the colon or rectum where the cells look abnormal, but have not become cancer.

If cancer does form in one of these growths, it can grow into the wall of the colon or rectum. The wall of the colon and rectum is made up of multiple layers. Colorectal cancer starts in the innermost layer called the mucosa. It can grow outward through some or all of the other layers. When cancer cells are in the walls, they can grow into blood vessels or lymph vessels. When this happens, they can then travel to lymph nodes or to other parts of the body. The stage of colorectal cancer depends on how deeply it grows into the wall and how far it spreads. Most colorectal cancers are adenocarcinomas. This means that it starts in cells that make mucus. This mucus lubricates the inside of the colon and rectum.

Your risk of colorectal cancer goes up as you age and your risk is higher if you are over 45. Younger adults can get it though and the rates for people younger than 45 are increasing. According to the Colorectal Cancer Alliance, rates for people under 55 have increased 2% each year from 2007-2016. Colorectal cancer is more common in men than women and men have a lower diagnosis age. According to the Colorectal Cancer Alliance, the median age of diagnosis is 68 for men and 72 for women. African Americans have the highest incidence and mortality rates. From 2009-2013 incidence rates were 20% higher for African Americans. The death rates were 40% higher. Jewish people of Eastern European descent have one of the highest risks of any ethnic group in the world.

There are a variety of lifestyle-related factors that could play a role in your risk for colorectal cancer. According to the American Cancer Society, the links between diet, weight, and exercise are the strongest when it comes to colorectal cancer. If you are overweight or obese, your risk of developing and dying from colorectal cancer is higher than those that are at a healthy weight. Being physically active is key and regular moderate to vigorous physical activity can help lower your risk. A diet that is high in red meats (beef, pork, lamb or liver) and processed meats (hot dogs and some lunch meats) could increase your risk. Cooking meats at high temps creates chemicals that could increase your cancer risks. Examples would be frying, broiling or grilling. Having a low vitamin D level could also increase your risk. Smokers are more likely to develop and die from colorectal cancer than non-smokers. Colorectal cancer has been linked to moderate or heavy alcohol use. If you do drink try not to surpass 2 drinks a day for men and 1 drink a day for women.

There are biological factors as well. People with a history of adenomas (discussed above) are at an increased risk. If you have had colorectal cancer in the past even if it has been completely removed, you have a greater risk of developing new cancers in other parts of your digestive tract. Inflammatory bowel disease also puts you at an increased risk. Most colorectal cancer is found in people with a family history of the disease. According to the American Cancer Society, 1 in 3 people who develop colorectal cancer have had family members who have had it. People who have had a first-degree relative get colorectal cancer are at an even greater risk. First degree relative just means a parent, sibling or child. Cancers can “run in the family” for various reasons including inherited genes, shared environment factors, etc. In fact about 5% of the people who develop colorectal cancer have inherited gene changes. The most common are Lynch Syndrome and familial adenomatous polyposis. People with type 2 diabetes are also at an increased risk and have a less favorable outlook after diagnosis.

Treating cancer is never an easy process. Depending on the severity and symptoms, screenings & tests will vary. From localized to regional spreading of cancer, each stage needs to be treated differently in order to permanently fight the cells into remission. When symptoms begin to develop in the body, first and foremost make sure to address these with your primary care provider. After addressing the symptoms, a sequence of different tests/screenings may take place to differentiate your symptoms and retract the possibility of other diseases such as Crohn’s Disease, Ulcerative Colitis, Diverticulitis and Irritable Bowel Syndrome among others.

For starters, colorectal cancer screening can include several blood-related tests ranging from a fecal occult blood test to other tests. Doctors may also use visual structural tests like sigmoidoscopies and colonoscopies, in which the patient is sedated and a scope with a camera is inserted into the rectum for the doctor to see any potential polyps or abscesses that may lead to cancerous cells. Colonoscopies are performed for the surgeon to see the colon in its entirety, as polyps and other issues may occur anywhere from the cecum (beginning of the colon) to the sigmoid (last part of colon just before rectum). A sigmoidoscopy is essentially the same as a colonoscopy, except the scope of the procedure involves solely the sigmoid, just past the rectum. These procedures should reoccur every 5-10 years after age 45 depending on previous symptoms or adenomas were found.

During the diagnostic procedures, doctors/surgeons may find something that could be dangerous to your health. If a cancerous polyp is found, the doctor will perform a biopsy to remove it for testing. Unfortunately the polyp and other tests may find cancer cells which need to be treated immediately. If the polyp’s cancer cells are localized, surgery would be the best option followed by chemotherapy if the cancer cells continue to grow. If the cancer is regionalized, surgery to remove the damaged part of the colon will be scheduled and followed up with chemotherapy. If the cancer is distant, surgery will not be impactful enough to remove cancer from the body. Intense chemotherapy is the only avenue to remove cancer in time and chemotherapy is still not a certain remedy to fully remove the cancer. Survival rates, if localized, are high at 91% but when the cancer spreads it can become the third deadliest form of cancer with a survival rate of 14% when distant. Rectal cancer statistics are relatively similar and correlate with a separation of 3% in total (all percentages provided by American Cancer Society).

In honor of Colorectal Cancer Awareness Month, we are encouraging individuals age 45 and older to schedule your baseline screening for colorectal cancer. Over 100,000 people will be diagnosed this year while over 50,000 will potentially die from colon or rectal cancer. Preventative care measures will be your greatest defense.  Following your primary care provider’s recommendations for screening and seeing a specialist if you develop abnormal symptoms during a bowel movement or digestion is crucial. The best way to prevent colon or rectal cancer is to act fast on your symptoms, even if you perceive this to be uncomfortable to confront.  

If you do not have a relationship with a specialist, consider Dr. Sachin Vaid of the Christiana Institute of Advanced Surgery. Dr. Sachin Vaid, MD, MS, MRCS, FACS, FASCRS is a board-certified colorectal surgeon who specializes in colorectal surgery both laparoscopically and robotically. Dr. Vaid has authored numerous publications in peer reviewed journals and presentations in national and international meetings. The American Surgery Center is Dr. Vaid's home outpatient surgery center. He is an active member of many national and international organizations, including the American Society of Colon and Rectal Surgeons (ASCRS), the American College of Surgeons (ACS), the Association of Surgeons of India, and the Royal College of Surgeons in Edinburgh. Dr. Vaid has received several honors and awards and has participated in a number of research and quality improvement projects to provide successful patient care. Reach out to Dr. Vaid at (302) 892-9900 to schedule your first appointment!