Colorectal Cancer: Catch it Early

Routine screening can stop this cancer before it starts

Most cancers can be diagnosed and treated at an early stage, but colorectal cancer—the third most common cancer in the U.S.— can actually be prevented. “Early screening and timely intervention can prevent cancer in both average-risk populations and high-risk individuals,” says Pavan Sachan, MD, a gastroenterologist with Robert Wood Johnson University Hospital (RWJUH) Rahway.

That’s because screening can detect abnormal cells that have grown into polyps (small lumps of cells that grow on the lining of the colon). It generally takes 10 to 15 years for polyps to develop into cancer, but screening can determine whether they should be removed. Screening can also lead to better cancer outcomes, because it can find the disease when it’s small and more easily treated.

With more than 145,000 new cases diagnosed each year and more than 50,000 deaths attributed to colorectal cancer annually, the importance of screening can’t be stressed enough, experts say. “The incidence of colorectal cancer has been declining at the rate of 2 percent every year due to screening,” says Dr. Sachan.

Dr. Sachan recommends that patients have an early risk assessment for colorectal cancer by their primary care physician at around age 20. That will help determine whether a patient has high or average risk. After that, he advises a reassessment every five years. Starting about age 40, Dr. Sachan says, everyone should have a yearly digital rectal exam (an examination performed manually by a healthcare provider). Screening tests should begin at age 50 and continue through age 75, he says.

How screening is done

There are a number of ways to screen for colorectal cancer. “For a healthy average-risk patient, any of the tests can be recommended, but the gold standard test is colonoscopy,” says Dr. Sachan. In a colonoscopy, a flexible, lighted tube is inserted into the rectum and entire colon while the patient is sedated. Polyps can be removed during this procedure. Other tests may be recommended for people for whom colonoscopy is not an option for physical or medical reasons. These screenings may include:

Virtual colonoscopy: An examination of the colon via computed tomography  (CT or CAT) scan.

Sigmoidoscopy: A flexible, lighted tube is inserted into the rectum to look for polyps, cancer and abnormalities.

Fecal occult blood test: A patient’s stool samples are tested once a year for traces of blood.

Stool DNA test: Stool samples are tested for DNA biomarkers associated with colorectal cancer.

Who's at risk?

Some risk factors for colorectal cancer are within a person’s control. These factors include smoking; heavy alcohol use; a diet high in red meat or processed meat; being overweight; and being physically inactive. Other factors that put a person at higher risk include:

  • Family history of colon cancer or genetic colon cancer syndromes
  • A personal history of chronic colitis syndromes, such as ulcerative colitis or Crohn’s disease
  • Having had radiation to the abdomen due to childhood cancers
  • Having Type 2 diabetes.

“African-American males are at higher risk and should have early screening,” says Dr. Sachan. Jews of Eastern European descent and HIV-infected males also have higher risk.

Possible symptoms

Screenings are important because many people in the early stages of colon cancer don’t have symptoms. However, patients should be aware of signs that could be possible symptoms. Cancer can be diagnosed only by a physician, of course, but you’ll want to speak with your doctor about any of the following:

  • Rectal bleeding
  • Unintended weight loss
  • Chronic abdominal pain
  • Change in bowel movement pattern or quality of stool
  • Iron deficiency anemia
  • Weakness and fatigue

Many of these symptoms are common and occur for reasons not related to cancer. For example, rectal bleeding, often the most worrisome symptom for patients, may be due to hemorrhoids, unintended weight loss also can be caused by other conditions, including thyroid disorders and uncontrolled diabetes, and so shouldn’t be assumed to be caused by cancer.

In general, public awareness and availability of colorectal cancer screening should be increased, Dr. Sachan says. “I’d like to see more employers offer screening for common cancers,” he says, “with incentives and paid leaves to encourage participation.”

How much do you know about colorectal cancer?

This simple true/false quiz takes aim at common misconceptions about the disease. Test your knowledge (and learn what’s behind the correct answers in the article on these pages).

1. Colorectal cancer can often be prevented.
True or False?

2. Colorectal cancer isn’t a big problem  in the U.S.
True or False?

3. I only need to get tested for colorectal cancer if something seems wrong.
True or False?

4. Lifestyle choices, like alcohol use, exercise and smoking, have an impact on colorectal cancer risk.
True or False?

5. Colonoscopy is the only test used to screen for colorectal cancer in people who have no symptoms of it.
True or False?


1. True 2. False 3. False 4. True 5. False

RWJUH Rahway provides a full range of screenings for colorectal and other cancers. To learn more or make an appointment, call 888.724.7123.