Recognizing the Signs of Colorectal Cancer
- A pregnant woman who initially assumed blood in her stools was due to hemorrhoids, but she later learned she had stage 3 colon cancer. Her diagnosis is just one of many as the nation sees a rising trend of cases in people diagnosed with colorectal cancer under 50.
- New JAMA data show colorectal cancer is now the leading cause of cancer death for adults under 50, with diagnoses in this age group increasing by 2.4% annually.
Dr. John Marshall, director of the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown University, says early theories blamed lifestyle factors like poor diet or obesity, but that no longer matches what he’s seeing. “These are healthy patients,” he said. - Dr. Marshall tells SurvivorNet that he suspects the answer may lie in the gut microbiome — the community of bacteria, viruses, and other microorganisms that live in the digestive tract.
- Standard treatment for stage 3 colon cancer typically includes surgery followed by chemotherapy, and experts note that patients should be prepared to discuss chemo as part of their care.
- Advances in colon cancer care are increasingly powered by targeted therapies that use tumor biomarkers—distinct molecular patterns—to match patients with treatments designed specifically for their cancer.
- “We can start looking at people’s genetic mutations and think about how they might respond to different drugs,” Dr. Heather Yeo, a colorectal surgeon and surgical oncologist, explains.
- Colorectal screenings are generally advised starting at age 45, but individuals with higher risk factors, such as a family history of colon cancer, may need earlier testing. Consulting a doctor about screening options is recommended.
A new JAMA report shows colorectal cancer is now the leading cause of cancer mortality for men and women under 50 combined — a sharp rise from the 1990s, when it ranked fifth.
Read MoreView this post on InstagramDr. John Marshall, director of the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown University and Chief Medical Consultant at the Colorectal Cancer Alliance, says this shift has unfolded over the past decade or so.
“When I started 34 years ago, patients under 50 were extremely rare unless they had an inherited syndrome,” he said. “Now, in a relatively young city, about half of my patients are under 50.”
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While colorectal cancer remains most common in adults over 55 — with an average diagnosis age of 66 — cases in that older group are declining. But the American Cancer Society reports that diagnoses among people under 50 rose by 2.4% each year from 2012 to 2021.
Behnke told the Today Show she had read that hemorrhoids often appear in the second trimester, so she reassured herself that it was nothing more. After her daughter was born, the bleeding stopped briefly, reinforcing her assumption. But when the symptoms returned, she sought medical care.
“It turns out hemorrhoid bleeding is usually just droplets,” she said. “I was having bloody mucus.”
Testing revealed stage 3 colon cancer. “I knew nothing about colorectal cancer,” she said as she prepared to begin chemotherapy.
Dr. Daniel Labow, Chief of Surgical Oncology at Mount Sinai Health System, notes that stage 3 patients should expect to discuss chemotherapy as part of treatment.
“Stage 3 cancers have about a 50% to 60% five‑year survival,” he said.
Behnke’s most recent scans show no evidence of disease.
Why Colorectal Cancer Cases Are On the Rise Among Younger Adults?
Rising cases among younger adults have already prompted a shift in screening guidelines. People at average risk are now advised to begin colorectal cancer screening at 45 instead of 50, and anyone with symptoms or a family history should start even earlier.
Advocacy groups first pushed for this change in 2018, and the U.S. Preventive Services Task Force formally adopted it in 2021 — a move that has helped more people get screened sooner.
Dr. Marshall says early theories blamed lifestyle factors like poor diet or obesity, but that no longer matches what he’s seeing. “These are healthy patients,” he said. “It doesn’t fit the original story, so we need to understand what’s really driving this.”
He suspects the answer may lie in the gut microbiome — the community of bacteria, viruses, and other microorganisms that live in the digestive tract. Researchers are exploring whether shifts in the microbiome, potentially influenced by diet, microplastics, antibiotics, or other environmental factors, could be contributing to the rise in colorectal cancer. More research is needed to pinpoint the cause.
Expert Resources on Colorectal Cancer
What Treatment Looks Like for Stage 3 Colon Cancer
At this stage 3, the colon cancer has spread to nearby lymph nodes, signaling a more aggressive disease that requires a comprehensive treatment approach.
“Stage 3 means that there’s some cancer in the lymph nodes,” explains Dr. Heather Yeo, a colorectal surgeon and surgical oncologist, in an interview with SurvivorNet. She emphasizes that patients facing this diagnosis should seriously consider chemotherapy as part of their treatment plan.
“Colon cancer patients with stage 3 should at least have a conversation about undergoing chemotherapy,” she says.
WATCH: Stage Three Means Cancer Has Spread Outside the Colon Wall
Despite the seriousness of the diagnosis, there is reason for optimism.
“Stage 3 cancers have probably a 50% to 60% survival at five years,” Dr. Yeo adds, underscoring the potential for long-term recovery when treatment is timely and effective.
The standard protocol for stage 3 colon cancer typically begins with surgery to remove the tumor and affected lymph nodes. This is followed by adjuvant chemotherapy—treatment administered after surgery to eliminate any remaining cancer cells that may have spread beyond the colon.
Adjuvant chemotherapy usually begins within six to eight weeks after surgery, once the patient has recovered. One of the most widely used regimens is FOLFOX, a combination of fluorouracil, oxaliplatin, and leucovorin. However, other chemotherapy options may be considered based on individual patient needs and emerging research.
“Now, for the chemotherapy, there certainly are newer agents and newer choices that could be integrated into a clinical trial,” notes Dr. Daniel Labow, Chief of the Surgical Oncology Division at Mount Sinai Health System. He adds, “Patients with stage 3 are often cured, with both surgery and chemotherapy.”
Even with successful treatment, vigilance remains essential. The risk of recurrence within five years is estimated to be between 20% and 25%, making follow-up care and monitoring a vital part of survivorship.
Chemotherapy After Surgery: A Critical Step in Treating Stage 3 Colon Cancer
The goal: reduce the risk of recurrence and improve long-term survival.
“Once a person completes that chemotherapy, we expect that they’re done,” says Dr. Paul Oberstein, a medical oncologist specializing in gastrointestinal cancers.
“They need to be watched very closely so that if there are signs that this has come back, we detect it early.”
WATCH: Using Chemo to Treat Stage 3 Colon Cancer
Post-surgical chemotherapy typically lasts between three and six months and involves a regimen of medications proven in clinical trials to be most effective at preventing the cancer from returning. The most widely used combination is known as FOLFOX—a protocol that includes three drugs:
- 5-fluorouracil (5-FU)
- Leucovorin
- Oxaliplatin
These medications are administered intravenously, usually every two weeks. Patients are connected to an IV pole during treatment sessions, which take place in a clinical setting. The process may feel routine, but its impact is anything but.
FOLFOX works by attacking cancer cells at multiple levels—disrupting DNA synthesis, enhancing drug effectiveness, and damaging cancer cell structures. While side effects like fatigue, neuropathy, and nausea are common, the regimen remains a cornerstone of colon cancer care due to its proven ability to reduce recurrence and extend survival.
Colon Cancer Is Treatable and Curable When Caught Early
Colon cancer is very treatable and curable if caught early. Colon cancer screenings can involve at-home tests such as Cologuard, but a colonoscopy is more effective, according to SurvivorNet experts.
The cancer starts when abnormal lumps called polyps grow in the colon or rectum. It takes up to 10 years for a colon polyp to become full-blown cancer, according to SurvivorNet experts.
When you have a colonoscopy, the gastroenterologist looks for polyps inside your intestine. Although polyps can’t be felt, they can be picked up by screening tests before they cause a problem, such as colon or rectal (colorectal) cancer.
A polyp found during a colonoscopy can be removed, which can prevent the development of cancer. Almost all polyps that are removed are precancerous, meaning that they have not yet progressed to cancer.
The American Gastrointestinal Association lowered the recommended initial age for a colorectal screening from 50 to 45. However, experts recommend screening earlier for some people who may be at an increased risk of developing colon cancer, such as those with a family history of the disease.
WATCH: Debunking misconceptions about colon cancer.
The most poignant signature of colon cancer is a change in bowel habits. Changes in the size or shape of bowel movements may cause constipation or diarrhea. A change in stool color, particularly black or tarry stools, can indicate bleeding from a tumor deep in the colon.
Other symptoms can be harder to pinpoint, such as abdominal pain and unintentional weight loss. Finally, some tumors bleed a small amount over a long period of time, resulting in anemia (low red blood cell count) that is picked up on blood work.
A Colonoscopy Explained
A colonoscopy is a procedure doctors use to screen for colon cancer by looking inside the colon.
This procedure requires your colon to be “cleaned out.” To clear out your colon, your doctor will prescribe a “bowel prep,” a liquid you drink the night before the procedure. The prep acts as a laxative that causes you to have multiple loose stools before your procedure.
Once your colon is cleared, the gastroenterologist performing the procedure can have a clear look to evaluate if any polyps or masses are present.
Depending on the size and number of polyps found, it is recommended that patients undergo a repeat colonoscopy within three to five years.
WATCH: What Doctors Look for During Colonoscopies
Dr. Zuri Murrell, a colorectal cancer surgeon and Director of the Cedars-Sinai Colorectal Cancer Center, previously explained the colonoscopy procedure to SurvivorNet.
“When we see a polyp, we actually physically take the polyp out through the colonoscope,” he explained.
“What does that mean? That means we basically put a wire through with a little bit of a flange at the end, and we pull the polyp out. Now, note there is no pain with that. Inside the colon, there are no pain fibers. So there’s no pain,” Dr. Murrell added.
The advantage of a colonoscopy is that your doctor can remove any polyps found during the test. Many colon cancers can be caught on a colonoscopy before they develop or when the polyps are small enough to be removed without surgery.
What Treatment Options Exist for Colon Cancer?
“There are a lot of advances being made in colorectal cancer,” Dr. Yeo previously told SurvivorNet.
Colon cancer treatment is more targeted, meaning doctors often test for specific changes or genetic mutations that cause cancer growth.
Biomarkers are key to tailoring specific treatments. Biomarkers are molecular patterns becoming more commonly used in colon cancer diagnosis, prognosis, and management. According to the National Cancer Institute, a biomarker is “a biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or a condition or disease,” such as cancer.
“In colon cancer, we’re starting to look more and more at people’s biomarkers, so we’re starting to take the cancers, sequence them, understand where the different mutations are to figure out whether or not someone has a normal gene here or an abnormal gene,” Dr. Yeo explained.
“Those are the areas that people want to be able to target a little bit more. We’re getting close to more of what we would call precision medicine, meaning we can start looking at people’s genetic mutations and think about how they might respond to different drugs.”
There are different types of biomarkers, including DNA, proteins, and genetic mutations found in blood, tumor tissue, or other body fluids. The biomarkers most commonly used in colon cancer management are:
- Genetic mutations within the tumor, such as MMR/MSI, KRAS, BRAF, and HER2
- Bloodstream carcinoembryonic antigen (CEA)
CEA is a protein produced by most tumor cells (but not all) and can be picked up in the bloodstream. High CEA levels do not establish a colon cancer diagnosis. However, higher CEA levels correlate with a worse prognosis and potential metastasis. Carcinoembryonic antigen is important for post-treatment follow-up to ensure the cancer hasn’t returned. Be sure to check with your doctor before treatment starts to ensure a CEA blood sample has been obtained.
More on Treating Colon Cancer
Surgery and chemotherapy are common approaches to colorectal cancer.
Some examples of Food and Drug Administration (FDA) approved chemotherapy drug treatments include:
- FOLFOX: leucovorin, 5-FU, and oxaliplatin (Eloxatin)
- FOLFIRI: leucovorin, 5-FU, and irinotecan (Camptosar)
- CAPEOX or CAPOX: capecitabine (Xeloda) and oxaliplatin
- FOLFOXIRI: leucovorin, 5-FU, oxaliplatin, and irinotecan
- Trifluridine and tipiracil (Lonsurf)
WATCH: Understanding Your Options with Metastatic Colon Cancer
Among metastatic colon cancer patients, multiple treatment options exist, including surgical and non-surgical options.
One treatment option includes an oral treatment called Fruquintinib, which is a targeted therapy for adults with metastatic colorectal cancer who have tried other treatments. Results from a trial published last year showed the drug improved overall survival and progression-free survival, which measures the amount of time before the cancer returns or spreads. It works by blocking the growth of blood vessels, which increases tumor growth.
Once you get to the metastatic setting, many patients “just run out of options,” Jennifer Elliott, head of solid tumors at Takeda, explained to SurvivorNet at the ASCO Annual Meeting. So it was critically important for Takeda to do this deal to in-license fruquintinib. We hope to give patients another option.”
Fruquintinib has been approved in China since 2018 and was originally developed by the Chinese biopharmaceutical company HUTCHMED. In January 2023, Takeda Oncology acquired the exclusive worldwide license for the drug outside of mainland China, Hong Kong, and Macau.
Questions to Ask Your Doctor
If you are facing a colon cancer diagnosis, here are some questions you may ask your doctor.
- What are my treatment options based on my diagnosis?
- If I’m worried about managing the costs of cancer care, who can help me?
- What support services are available to me? To my family?
- Could this treatment affect my sex life? If so, how and for how long?
- What are the risks and possible side effects of treatment?
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Contributing: SurvivorNet Staff
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