Colon cancer is one of the leading cancer killers, and on Friday it claimed the life of beloved actor Chadwick Boseman. The disease mostly strikes older adults, but it’s on the rise in those under age 50 — like Boseman, who died at age 43 and had been fighting colon cancer for four years. Now, as young parents mourn the Black Panther, they’re also turning an eye to their own colon cancer risk.
This is everything you need to know about colon cancer risk, symptoms, screening, and treatment.
What Is Colon Cancer?
Colon cancer begins in the large intestine, also known as the colon. The cancer develops out of a small clump of noncancerous cells on the inside of the colon called a polyp. It can take up to 10 or 15 years for the polyps to become cancers. Not all polyps develop into colon cancer, according to the Mayo Clinic. But as a safety measure, doctors screen for polyps and remove them before they have the chance to become dangerous.
Experts often talk about colon cancer and rectal cancer using the term “colorectal cancer.” These two cancers combined are responsible for the third most cancer-related deaths in the U.S., according to the American Cancer Society (ACS).
In his lifetime, a man has a 4.4 percent chance of developing colorectal cancer. The ACS predicts that more than 100,000 people will be diagnosed with colon cancer in 2020 and more than 50,000 people with the disease will die. Over the past several decades, colon cancer has become less and less of a death sentence, mostly because doctors are catching polyps and cancer earlier and treatment has improved. However, the number of young people who die from the disease is on the rise.
Symptoms of Colon Cancer
Polyps may cause few symptoms if any. Because of this, experts recommend regular screening to identify and remove polyps to prevent colon cancer.
If a person has early-stage colon cancer, they may not experience symptoms. As the disease progresses and symptoms begin to appear, they vary depending on the size of the cancer and its location within the colon, according to the Mayo Clinic. People with the disease may experience:
- Changes in their pooping habits, such as more diarrhea or constipation
- Bleeding when they poop
- Blood in their poop
- Feeling like you still need to poop, even after you’ve pooped
- Cramps, gas, pain, and other abdominal issues
- Fatigue or weakness
- Weight loss
If you’re experiencing these symptoms, get in touch with your doctor.
Colon Cancer Screening
Most guidelines recommend that people at average risk for colon cancer start getting screened at age 50. However, the ACS recommends starting to get screened at age 45, which may be supported by new risk models. People who are at higher risk — because they have, for example, inflammatory bowel disease (not IBS), a hereditary syndrome related to colorectal cancer, or a strong family history of polyps or colorectal cancer — may need to get screened sooner. If you’re at high risk, talk to your doctor about when you should start.
There are many different options for screening. Though there are pros and cons to each, the most important thing is to get screened, no matter the method.
There are two main types of screening. The first is by testing your poop, called a stool-based test. This option is less invasive. But if you choose to go this easy route, you’ll need to do it more often. Visual tests are more invasive but don’t have to be done as frequently. If you choose a method other than a colonoscopy, you will have to get one if your test results are abnormal.
Your screening options are, according to the ACS:
- Fecal immunochemical test (FIT): This test looks for hidden blood in your poop that you may not be able to see with the naked eye.
- Pros: You can do it at home, and you don’t need to “bowel prep” by taking medicine to empty out your bowels.
- Cons: It requires a new test every year and can miss cancers and polyps.
- Guaiac-based fecal occult blood test (gFOBT): This test also looks for hidden blood in your poop, but it uses a different method than FIT.
- Pros: You can do it at home, and you don’t need to bowel prep.
- Cons: You have to eat a special diet before the test, have to get a new test every year, and it can miss cancers and polyps.
- Stool DNA Test: This test not only looks for hidden blood in your poop but also for DNA signs of cancer or polyps.
- Pros: You can do it at home, and you don’t need to bowel prep.
- Cons: It requires a new test every three years, it can miss cancers and polyps, and not all insurance plans cover it.
Visual Exams: These exams use either scanners or invasive procedures to look for abnormal areas of the colon and rectum.
- Colonoscopy: A thin, flexible tube is stuck up your butt to inspect your rectum and colon.
- Pros: It provides a picture of the whole colon, and doctors can remove polyps then and there. It only needs to be done once every 10 years.
- Cons: It requires a full bowel prep and usually requires sedation.
- CT colonography (virtual colonoscopy): X-rays and CT scans are used to make a 3D picture of your colon and rectum.
- Pros: It usually provides a picture of the whole colon and is quick and safe. It only needs to be done once every 5 years.
- Cons: It requires a full bowel prep, can give false positives, and not all insurance plans cover it.
- Flexible sigmoidoscopy: Like a colonoscopy, but it doesn’t go all the way into the colon.
- Pros: It’s quick and safe, doesn’t require a specialist, and only needs to be done every 5 years.
- Cons: It only provides a picture of a third of the colon and isn’t offered in many places in the U.S.
How to Decrease Your Colon Cancer Risk
Certain factors you can’t change increase your risk of colon cancer, such as being African-American or of Ashkenazi Jewish descent, being older, having type 2 diabetes, and having irritable bowel disease or hereditary conditions linked to colorectal cancer. Receiving treatment for testicular or prostate cancer and working the night shift may also increase colon cancer risk, though the research is inconclusive.
However, there are steps you can take to reduce your risk:
- Lose weight if you are overweight or obese
- Exercise for at least 30 minutes on most days of the week
- Limit your red meat and processed meat intake
- Take vitamin D if your blood level is low
- Eat a healthy diet with lots of fruits, vegetables, and whole-grain
- Quit smoking
- Limit alcohol to two drinks a day for men and one for women, or abstain altogether for lower risk
Colon Cancer Treatment
Most treatment plans for colon cancer involve surgery to remove the cancer, according to the Mayo Clinic. Depending on the size of the cancer, a doctor may be able to remove it during a colonoscopy. For polyps too large to be removed this way, a doctor may perform surgery by making several small incisions in the abdominal area. Other treatments include chemotherapy, targeted drug therapies, and radiation.
For more advanced cancers, doctors may remove part of the colon. They may be able to connect healthy parts of the colon so it can function as normal, or they may need to create a way for waste to leave your body from a hole in the abdomen that empties into a bag. Lymph nodes near the colon are often removed too. For advanced colon cancer, a doctor may use immunotherapy to hack the immune system to fight off the cancer.