March is Colorectal Cancer Awareness Month: Understanding the Risk Factors: Igryl S. Cordero, MD, Medical Oncologist

As we observe Colorectal Cancer Awareness Month this March, it’s an important opportunity to reflect on the significance of early detection and the factors that can increase the risk of colorectal cancer.

At Virginia Cancer Specialists, we are committed to helping you understand the risk factors and take proactive steps to improve your health. Early detection and screening can make a major difference in outcomes.

What is colorectal cancer?

Colorectal cancer refers to cancer that begins in the colon or rectum. It is one of the most common cancers in the United States, but it is also one of the most preventable types of cancer, particularly with early detection through screening. The good news is that the survival rate for colorectal cancer is much higher when the disease is found early. That’s why knowing your risk factors and discussing them with your physician is so important.

Who is at risk for colorectal cancer?

Several factors can influence your risk of developing colorectal cancer. These factors can’t be controlled but understanding them can help guide you and your healthcare provider in making informed decisions about screening and prevention strategies.

• Age: The risk of colorectal cancer increases with age. While colorectal cancer can occur in younger people, it is far more common in those over the age of 50. The average age for a colon cancer diagnosis is 68 for men and 72 for women, while the average age for rectal cancer is 63 for both genders. The incidence of early-onset colorectal cancer (in patients aged 50 or younger) has been rising at an alarming rate in recent years. As a result, U.S. screening guidelines now recommend starting colorectal cancer screening at age 45 for individuals at average risk, down from the previous starting age of 50.
• Race: In the U.S., Black individuals have the highest rates of non-hereditary colorectal cancer. They are also more likely to be diagnosed at a younger age, which is why early screening is especially important for this population.

• Gender: Men have a slightly higher risk of developing colorectal cancer compared to women, though both genders are at risk, especially as they age.

What lifestyle choices can help reduce my risk of colorectal cancer?

Your lifestyle plays a significant role in your overall health and cancer risk. Certain habits and behaviors have been linked to an increased risk of colorectal cancer. By making healthier choices, you can reduce some of these risks.

• Diet: A diet rich in red or processed meats has been linked to a higher risk of colorectal cancer. High-fat, low-fiber diets may also contribute to the development of this cancer.
• Smoking: Smoking is a well-known cause of many cancers, including colorectal cancer. Long-term smoking significantly increases the risk of developing this disease.
• Alcohol: Drinking alcohol in excess or on a regular basis has been linked to an increased risk of colorectal cancer. It’s important to limit alcohol consumption and follow recommended guidelines.
• Weight: Obesity is another risk factor. Excess body fat, particularly abdominal fat, can increase your risk of developing colorectal cancer. Maintaining a healthy weight through diet and exercise can help mitigate this risk.
• Lack of Exercise: Physical inactivity is associated with a higher risk of colorectal cancer. Regular exercise can help reduce your risk by promoting healthy digestion, controlling weight, and improving overall well-being.

What hereditary factors increase my risk for colorectal cancer?

In addition to lifestyle factors, your family history can also influence your risk. If colorectal cancer runs in your family or if you have inherited certain genetic conditions, you may be at a higher risk. Be sure to share your family medical history with your doctor.

• Family History of Colorectal Cancer: If a close family member—such as a parent, sibling, or child—has had colorectal cancer, especially before the age of 60, your risk is increased. In these cases, you may need earlier and more frequent screenings.
• Inherited Conditions: Certain rare inherited syndromes can significantly increase the risk of colorectal cancer, including:

• • Lynch Syndrome
  • Familial Adenomatous Polyposis (FAP)
  • Attenuated Familial Adenomatous Polyposis (AFAP)
  • Gardner Syndrome
  • Juvenile Polyposis Syndrome (JPS)
  • Muir-Torre Syndrome
  • MYH-associated Polyposis (MAP)
  • Peutz-Jeghers Syndrome (PJS)
  • Turcot Syndrome

If you have a family history of these conditions, genetic counseling and early screenings may be necessary.

Genetic Counseling at Virginia Cancer Specialists: Our Certified Genetic Counselors can evaluate patients who may have genetic predisposition to cancer. Factors that may indicate the need for genetic counseling include:

• Age at cancer diagnosis (early-onset)
• Family history of colorectal cancer
• Tumor-specific molecular alterations

Not all patients require genetic counseling. The decision is individualized, and it is made by the treating team (Medical Oncologist or Surgeon) based on the patient’s unique situation.

What other health conditions increase my risk for colorectal cancer?

Certain health conditions can also increase your risk of colorectal cancer. If you have one or more of these conditions, discuss them with your doctor to determine the appropriate screening and prevention measures.

• Inflammatory Bowel Disease (IBD): Conditions such as Crohn’s disease or ulcerative colitis, which cause chronic inflammation of the colon, are associated with a higher risk of colorectal cancer.
• Adenomatous Polyps: These benign growths in the colon or rectum can develop into cancer over time. Regular screenings like colonoscopies can detect and remove polyps before they become cancerous.
• Previous Cancer: If you have had colorectal cancer before, or if you have a history of ovarian or uterine cancer, you may be at higher risk of developing colorectal cancer again.

The Importance of Early Detection and Screening for Colorectal Cancer

While some risk factors for colorectal cancer cannot be avoided, such as age or family history, the good news is that early detection through screening can significantly reduce the risk of developing cancer or detect it at an early, more treatable stage. Regular screening is crucial for those at higher risk and should begin at age 45 for individuals with average risk. If you have one or more risk factors, your healthcare provider may recommend starting screening earlier or at more frequent intervals.

At Virginia Cancer Specialists, we encourage you to speak with your doctor about your individual risk and develop a personalized screening plan. By taking proactive steps and staying informed, you can reduce your risk and increase your chances of successful treatment if colorectal cancer is detected.

Who typically treats colorectal cancer?

At Virginia Cancer Specialists, our multidisciplinary team of experts will work with you to design an individualized treatment plan that best fits your lifestyle and goals

Cancer care usually combines different types of treatments; therefore, multidisciplinary cancer care teams often include various types of physicians and surgeons who collaborate and ensure care is managed seamlessly.

For colorectal cancer, physician collaborators may include:

• A surgical oncologist who specializes in using surgery to treat cancer or a colorectal surgeon who uses surgery to treat colon and rectal diseases.
• A radiation oncologist who treats cancer with radiation therapy.
• A medical oncologist who treats cancer with chemotherapy, immunotherapy, or targeted therapies.
• A gastroenterologist who treats disorders of the gastrointestinal tract.

At Virginia Cancer Specialists, 360-degree care means that your care extends well beyond your medical needs, taking into account your physical, social/emotional, financial, nutritional needs, and much more. Our cancer care team includes other clinical professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, and dietitians.

How is colorectal cancer treated?

Treatment options for colorectal cancer depend on the type and stage of cancer, as well as your preferences and overall health. At Virginia Cancer Specialists, we will work with you to choose a treatment plan that’s individualized and unique, to fit your goals and preferences.

Chemotherapy

Chemotherapy uses drugs to stop the growth of cancer cells and can be taken either by mouth or by injection. Chemotherapy can be used after surgery to treat any remaining cancer cells, before surgery to shrink the tumor so it is easier to remove, or to treat cancer that has spread to other organs.

Radiation Therapy

Radiation therapy uses high energy x-rays or other forms of radiation to treat cancer cells and stop their growth. External radiation therapy uses a machine to focus radiation onto the area of the body with cancer from outside of the body. Internal radiation therapy places the radiation directly into or near the tumor.

Radiation therapy is not commonly used for colon cancer but may be used before surgery to help shrink the tumor for easier removal, during or after surgery to treat any remaining cancer cells, in conjunction with chemotherapy to help control the cancer, and to ease symptoms of advanced colon cancer.

Radiation therapy is more commonly used for rectal cancer. It may be used before, after, or during surgery to treat additional cancer cells, or along with chemotherapy to keep cancer from returning. It may also be used either alone or with chemotherapy if you are not healthy enough for surgery, or to relieve symptoms. It can also be used to treat tumors that have spread to other parts of the body.

Targeted Therapy

Targeted therapies use drugs or other substances to identify and then treat specific cancer cells. These therapies may be used along with chemotherapy or if chemotherapy is no longer working. Many targeted therapies for colorectal cancer work by targeting and inhibiting proteins that help cancer cells grow.

Immunotherapy

Immunotherapy uses the patient’s immune system to fight cancer cells by boosting, directing, or restoring the body’s natural defenses. The body’s immune cells have proteins that serve as “checkpoints” that need to be turned on or off to start an immune response; this is how the body keeps itself from attacking healthy cells. Some colorectal cancer cells use these checkpoints to avoid being attacked by the immune system. Drugs targeting these proteins help restore the immune response against those cancer cells.

Surgery

Surgical removal of the tumor and some surrounding tissue is the most common treatment for colorectal cancer. It can be used as the primary treatment for your cancer or given in conjunction with chemotherapy, radiation therapy, or other treatments. Your surgical oncologist or colorectal surgeon will determine the appropriate type of surgery for you based on location and size of your cancer. Your surgeon may remove the cancer with one of the following types of surgery:

Local Excision: Early-stage cancers may be removed without cutting through the abdominal wall. Your surgeon may cut the cancer out by inserting a tube with a cutting tool through the rectum into the colon.

Resection: Your surgeon may remove both the cancer and a small amount of healthy tissue around it, then connect the healthy parts of the colon together; this procedure is called anastomosis. If the surgeon is not able to connect the healthy parts of the colon, an opening, called a stoma, is made outside of the body for waste to pass through. A bag is placed around the stoma to collect the waste. This procedure is called a colostomy, and it can sometimes be reversed after the lower colon has healed. If the lower colon is entirely removed, the colostomy may be permanent.

Ablation

If the colorectal cancer has spread to other parts of the body, such as the liver or lungs, small tumors may be removed using ablation techniques.

• Radiofrequency ablation uses tiny electrodes to treat cancer cells. A special probe is inserted into the affected area either directly through the skin or through an incision in the abdomen.
• Microwave ablation treats cancer that has spread to the liver with electromagnetic microwaves. A needle-like probe is inserted into the tumor using imaging as a guide.
• Ethanol ablation injects concentrated alcohol directly into the tumor through a needle injected into the skin and guided by ultrasound or CT scans.
• Cryosurgery, also known as cryotherapy or cryoablation, treats the tumor by freezing it with very cold gas inserted by a probe. The probe is guided by ultrasound. This can be used to treat larger tumors than other ablation techniques.

Are there clinical trials available for colorectal cancer?

Our specialists may recommend patients to a clinical trial in order that they may access promising, investigational treatments that are not currently available to the public.

The Virginia Cancer Specialists Research Institute Team is comprised of more than 150 dedicated team members. At any given time, the Institute has approximately 150+ actively accruing clinical trials, including Phase I studies. These include studies in gastrointestinal cancer.

The Institute has enrolled more than 3,400 patients across various cancer types, including more than 440 new enrollments in 2023 alone through a joint venture with Fairfax’s NEXT Oncology. Combined, the two programs offer the largest and most comprehensive oncology research program in the Mid-Atlantic.

Its 2024 partnership with the renowned Sarah Cannon Research Institute opens the door to hundreds of new studies and increases access to care for more patients, offering hope and promise for further breakthroughs and improved outcomes.

To learn more about clinical trials, our Clinical Trials Nurse Navigators can assist:

Phone: 703.636.1473
Email: VCSResearchReferrals@USOncology.com

Schedule Your Colorectal Screening Today

If you’re concerned about your risk for colorectal cancer or need guidance on appropriate screening, please contact your primary care provider to schedule an exam or colonoscopy. Our team is here to support you every step of the way, from screening to prevention and treatment. Early detection saves lives.

About Virginia Cancer Specialists

At Virginia Cancer Specialists, we are dedicated to providing the highest quality care to our patients. Our team of experienced oncologists, nurses, and support staff is committed to offering the latest advancements in cancer care, personalized to each patient’s needs. We believe in empowering our patients with the knowledge and tools they need to make informed decisions about their health.

Disclaimer: The information in this article is not intended to replace medical advice. Please consult with your healthcare provider for personalized recommendations and screening options.