14501 Colorectal Colon Cancer

Overview

Colorectal cancer is a type of cancer that starts in the colon or the rectum. The colon and rectum are parts of your large bowel, the lower part of your digestive system that removes water and creates stool. Cancer begins when cells in these areas grow out of control and form a mass or tumor. If found early, colorectal cancer is often very treatable.

Yes. Colorectal cancer is one of the most common types of cancer worldwide. In the UK, it is the fourth most common cancer, with around 42,000 people diagnosed each year. It affects both men and women.

It mostly affects adults over 50, but it can occur in younger people too. Men are slightly more at risk than women. You may have a higher risk if a close relative has had colorectal cancer or if you have certain bowel conditions such as Crohn's disease or ulcerative colitis.

Symptoms

Common symptoms

• A persistent change in your normal bowel habit, such as going more often, looser stools, or constipation
• Blood or mucus in your stool, which may make it look red or black
• Belly pain, discomfort, or bloating always felt
• Feeling that you have not fully emptied your bowels after going to the toilet
• Unexplained weight loss
• Feeling very tired or weak for no clear reason

Symptoms in children

• Colorectal cancer is extremely rare in children. If a child does develop it, symptoms are similar to those in adults, but these symptoms are far more likely to have a non-cancerous cause, such as an infection or a bowel condition.

Symptoms in older adults

• In older adults, symptoms may be less specific and may include progressive tiredness and breathlessness due to anemia (low iron from hidden blood loss).
• You might also notice a greater change in bowel habits, such as becoming constipated or having thinning stools.
• Sometimes older adults may not report symptoms early, so it's important to mention any changes to a doctor promptly.

Causes

Main causes

• Most colorectal cancers start from abnormal changes (mutations) in the DNA of cells lining the colon or rectum.
• Certain inherited gene changes can run in families and greatly increase the risk.
• Having a long-term inflammatory bowel disease like ulcerative colitis or Crohn's disease can raise your risk.
• Dietary factors, such as eating lots of red or processed meat, may contribute, though the exact cause is not always clear.

Risk factors

• Age 50 or older
• A personal or family history of colorectal polyps or cancer
• Inherited syndromes like Lynch syndrome or familial adenomatous polyposis (FAP)
• A diet high in red and processed meat and low in fiber
• Being overweight or obese
• Lack of regular physical activity
• Smoking cigarettes
• Heavy alcohol use
• Having type 2 diabetes

When to see a doctor

See a doctor urgently if:

• If you notice any blood in your stool, or your stool is black and tarry
• If your bowel habits have changed and lasted more than three weeks
• If you have new, persistent belly pain or bloating
• If you have unexplained anemia (low iron) or weight loss

Book a routine appointment if:

• If you are 50 or older and due for colorectal cancer screening, even if you feel well
• If you have a strong family history of colorectal cancer and have not yet discussed screening with your GP
• If you have regular heartburn or digestive problems that are controlled but have not been checked for a while

Diagnosis

To diagnose colorectal cancer, your doctor will first ask about your symptoms, your general health, and your family history. They will press on your belly and may do a digital rectal examination. If they think you need more checks, they will refer you to a specialist for a colonoscopy or other tests.

Tests that may be done

• A feces test (called FIT or fecal immunochemical test) to look for hidden blood in your stool
• A colonoscopy – a thin, flexible tube with a camera is used to look at the whole large bowel
• A flexible sigmoidoscopy – a shorter tube that examines the lower part of the bowel
• A biopsy – small tissue samples taken during a colonoscopy and checked under a microscope
• Imaging scans like a CT scan to see whether the cancer has spread

What to expect at your appointment

If you are referred for a colonoscopy, you will receive clear instructions on how to empty your bowel beforehand. The procedure is usually done while you are sedated or asleep so you feel calm and little or no discomfort. If a suspicious area is found, the doctor will take a biopsy. You will usually get the results within a week or two, and a specialist will explain what they mean and discuss next steps if needed.

Treatment

Treatment for colorectal cancer depends on the size, location, and stage of the cancer, as well as your overall health. Your medical team, which may include surgeons, oncologists, and specialist nurses, will talk with you about the best plan for you. You will be given support to help you understand your options and make decisions together.

Self-care at home

• Follow your treatment plan as advised by your care team
• Stay physically active at a level that feels right and that your doctor approves
• Eat a balanced diet with plenty of fruits, vegetables, and whole grains if you can
• Drink enough fluids, especially if you have diarrhea or constipation
• Get plenty of rest and ask for help when you need it
• If you have a stoma (a bag attached to your belly), learn how to care for it with the help of a stoma nurse
• Report any new symptoms or side effects to your healthcare team right away

Medical treatments

Treatments may include surgery to remove the cancer and part of the surrounding healthy bowel, chemotherapy, radiotherapy, and targeted therapies that aim to act on specific abnormalities in cancer cells. For early-stage cancer, surgery alone may be enough. For more advanced cancer, treatments are often combined. The exact medicines, combinations, and schedules vary from person to person, and your doctor will explain what is recommended for your situation.

When is surgery considered?

Surgery is the most common treatment for localized colorectal cancer that has not spread to distant organs. During the operation, the surgeon removes the part of the bowel containing the cancer and some nearby lymph nodes. In many cases, the two healthy ends of the bowel are joined back together. Sometimes, a temporary or permanent stoma is needed, but this is often easier to manage than people expect.

Living with this condition

Living with colorectal cancer involves adjusting to a new routine. You may have to manage side effects from treatment, such as tiredness, changes in appetite, and changes in bowel function. Many people find it useful to keep a diary of how they feel and to bring that to appointments. Remember that support from friends, family, and healthcare professionals is there to help you through each step.

Lifestyle tips

• Try to do light physical activity most days if you are able, like walking or gentle yoga
• Stop smoking and limit alcohol, as this can help you recover and reduce the risk of other health problems
• Prioritize sleep and rest to help your body heal
• Ask your doctor about activities that are safe for you, especially after surgery

Diet and exercise

Aim for a well-balanced diet that includes a variety of fruits, vegetables, and whole grains. Some people find that eating smaller, more frequent meals helps if they feel full quickly or have bowel changes. Drink plenty of fluids, especially if you have diarrhea. Gentle exercise like walking can help improve energy and mood, but always check with your care team before starting a new exercise routine, especially soon after surgery or during chemotherapy.

Mental health and emotional wellbeing

A colorectal cancer diagnosis can bring strong emotions such as anxiety, sadness, anger, and fear. It is completely normal to feel this way. Having cancer can also affect your body image and intimate relationships, especially if you have a stoma. Talking to a counselor, psychologist, or a peer support group can help you process these feelings. Your care team can point you to mental health services.

Prevention

You cannot completely prevent colorectal cancer, but you can greatly lower your risk. Eating a diet high in fiber, lowering your intake of red and processed meats, staying at a healthy weight, being active, not smoking, and limiting alcohol can all help. Also, having regular screening can stop colorectal cancer before it starts, because pre-cancerous polyps can be found and removed.

Vaccines

There is no vaccine specifically to prevent colorectal cancer. However, some viruses such as human papillomavirus (HPV) are not strongly linked to bowel cancer, but vaccination against HPV is still recommended for other cancers. Talk to your doctor about any recommended vaccines for your general health.

Screening programmes

Screening means checking for early signs of a disease in people who have no symptoms. In many countries, including the UK, adults around age 50 to 60 are invited to take a home stool test every two years. If this test finds hidden blood, you will be offered a follow-up test like a colonoscopy. Screening can find pre-cancerous polyps, which can be removed before they become cancer. If you are at higher risk due to family history, your doctor may recommend starting screening earlier.

Complications

If left untreated

• The cancer can grow deeper into the bowel wall and spread to nearby lymph nodes
• It may spread to other organs, most commonly the liver or lungs, which makes treatment more difficult
• It can cause a blocked bowel, needing emergency surgery
• Ongoing blood loss can lead to severe anemia and tiredness
• Overall survival is much better when the cancer is found early, before it has a chance to spread

Long-term outlook

The outlook for colorectal cancer is often very good, especially when it is found early. More than 9 out of 10 people survive for five years or more when stage 1 bowel cancer is treated. Even for later stages, treatments continue to improve, and many people live long, fulfilling lives. It is important to remember that every person is different and your care team can give you more tailored information based on your situation.

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