Frequently Asked Questions About Colon Cancer

What is the colon? The colon (sometimes called the “large bowel”) is part of the digestive tract, where food is processed to create energy and rid the body of waste matter. 

What is colon cancer?  Colorectal cancer (commonly referred to as “colon” cancer) develops in the colon or rectum. Before a cancer develops, there often are earlier changes in the lining of the colon or rectum. One type of change is a growth of tissue called a polyp. Removing the polyp early may prevent it from becoming cancer. 

How many people are affected by colon cancer? An estimated 145,290 new cases will be diagnosed in 2005 in the United States. Of these new cancer cases, 104,950 will be colon cancer and 40,340 rectal cancer. And an estimated 56,290 will die of the disease in 2005, making it the third leading cause of cancer and of cancer death in both men and women in the United States.

Who is at risk for colon cancer? If you are 50 or older, you are at risk for colon cancer, even if you have no symptoms and no family history of the disease. Ninety percent of cases are diagnosed in people older than 50. Both men and women are at risk for colon cancer.

Is colon cancer preventable? You can help prevent colon cancer by getting tested. Colon cancer almost always starts with a polyp, a small growth on the lining of the colon or rectum. Finding and removing polyps before they become cancerous can stop colon cancer before it starts.

Who survives colon cancer? The five-year survival rate is 90 percent for people whose colon cancer is found and treated at an early stage, before it has spread. But because many people are not being tested, only 39 percent of colon cancers are found at that early stage. Once the cancer has spread to nearby organs or lymph nodes, the five-year survival rate goes down to 67 percent. For people whose colon cancer has spread to distant parts of the body, such as the liver or lungs, the five-year survival rate is about 10 percent.

Are African Americans at greater risk of dying from colon cancer? African Americans have the highest death rate from colon cancer of any racial or ethnic group in the United States. And because African Americans are less likely to have colon cancer diagnosed in the earliest, most treatable stages, their survival is not as good as other racial or ethnic groups.  From 1992 to 2000, the five-year relative survival rate for colon cancer was 55 percent for African Americans compared with 64 percent for whites.

Are Hispanics/Latinos at greater risk of dying from colon cancer? According to a National Institutes of Health report (1992), while Hispanics/Latinos have lower rates of colon cancer diagnoses and deaths than other racial or ethnic groups in the United States, they are less likely to be tested for the disease.

What are the risk factors associated with colon cancer? Researchers have found several risk factors that increase a person’s chance of developing colon cancer:

• Aging: Simply being over the age of 50 is the most common risk factor for developing colon cancer.  About nine out of 10 people with colon cancer are older than 50.
• A personal history of colon cancer: People who have had colon cancer before are more likely to develop it again.
• A personal history of intestinal polyps: Certain types of polyps (adenomatous polyps) increase the risk of colon cancer.
• A personal history of chronic inflammatory bowel disease of significant duration (such as ulcerative colitis or Crohn’s colitis): The colon is inflamed over a long period of time and may have ulcers in its lining. Colon cancer occurs more often and at an earlier age in men and women who have been diagnosed with these conditions.
• A family history of colon cancer or intestinal polyps: People who have a history of either colon cancer or polyps in any first-degree relative (e.g., father, mother, brother, or sister) before age 60, or in two or more relatives at any age, have an increased risk of developing colon cancer.
• Familial adenomatous polyposis (FAP): This hereditary condition results in a person having hundreds or even thousands of polyps in the colon and rectum. The polyps usually first appear during the teenage years. Between the ages of 30 and 50, cancer nearly always develops in one or more of these polyps.
• Gardner’s syndrome: Like FAP, this hereditary condition results in polyps and colon cancer that develops at a young age. It can also cause noncancerous tumors of the skin, soft connective tissue, and bones.
• Hereditary nonpolyposis colorectal cancer (HNPCC): People with this hereditary condition tend to develop cancer at a young age without first having many polyps.
• Race: African Americans are at greater risk of developing colon cancer and of dying from the disease than any other racial or ethnic group in the United States.
• Familial colon cancer in Ashkenazi Jews: Some Jews of Eastern European descent have an inherited change in their DNA that causes a slightly increased risk of developing colon cancer.
• Smoking or use of other tobacco products
• Physical inactivity
• Diet: A diet made up mostly of foods that are high in fat, especially from animal sources, can increase the risk of colon cancer.

What are the signs and symptoms of colon cancer? Early colon cancer usually has no symptoms. Signs and symptoms typically occur only when the cancer is more advanced. The absence of symptoms should never be a reason to delay or ignore colon cancer testing. If you have any of the following symptoms, tell your doctor, especially if you are over 40 years old or if other members of your family have had the disease. Having these symptoms does not mean you have cancer.  But you need to talk to your doctor to be sure.

• A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
• A feeling that you need to have a bowel movement that doesn't go away even after you do have a bowel movement
• Bleeding from the rectum or blood in the stool
• Cramping or gnawing stomach pain
• Decreased appetite
• Weakness and fatigue
• Jaundice (yellow-green color of the skin and white part of the eye)

How can the risk for developing colon cancer be lowered?

• Follow the testing guidelines set by the American Cancer Society. Testing can find precancerous polyps. Removing these polyps can prevent most colon cancers. Testing also can help detect colon cancer early, when the chances for successful treatment are greatest.
• Know your family history. If colon cancer runs in your family, you may need to be tested earlier and more often.
• Avoid cigarettes and other tobacco products.
• Maintain a healthy body weight. Obesity is associated with an increased risk of colon cancer.
• Get plenty of exercise. Even small amounts of exercise on a regular basis can be helpful.
• Eat plenty of fruits, vegetables, and whole grain foods, and limit the intake of high-fat foods. 

What types of tests are used to detect colon cancer? It is possible to have colon cancer and not have any symptoms. For that reason, screening tests are used. These tests can find polyps, which when removed can prevent colon cancer.  Even if cancer is found, screening tests find many cancers early and greatly improve the chances of successful treatment. Some of these tests are listed below.

• Fecal Occult Blood Test (FOBT): Several stool samples are examined for blood. Your doctor or health care professional will explain how to collect samples at home. The test is then returned to the doctor's office or lab to be checked. This test is most effective if it is done every year. The Society guidelines note that it is preferential for patients to combine the FOBT option with a flexible sigmoidoscopy every five years, rather than be tested with annual FOBT alone.
• Flexible Sigmoidoscopy: A slender, lighted flexible tube is placed in the rectum. This allows the doctor to look at the inside of the rectum and part of the colon for polyps or cancer. Polyps can be removed using a wire loop that goes through the tube. Pieces of the polyp (a biopsy specimen) can be sent to a lab to see if cancer cells are present. If the doctor sees anything unusual, additional tests may be done. Because the sigmoidoscopy tube is short, only the lower third of the colon can be seen during this test. If no abnormalities are found, most experts recommend that this test be repeated every five years. Again, the Society recommends that it is preferential for patients who choose this option also have an annual FOBT, rather than undergo a flexible sigmoidoscopy alone.
• Colonoscopy: A longer, flexible tube is placed through the rectum into the colon. It is long enough to reach the full length of the colon. The tube is linked to a video camera and display. The doctor can look at the picture to find polyps or cancer. Because the tube is longer, the doctor is able to see much more of the colon’s lining. Polyps can be removed using a wire loop that goes through the tube. Pieces of the polyp can be sent to a lab to see if cancer cells are present. If no abnormalities are found, the Society recommends that this test be repeated every 10 years.
• Barium Enema (double contrast barium enema or barium enema with air contrast): An enema of a chalky substance is used to partly fill up and open the colon. Air is then added to expand the colon. After that, x-ray films are taken. If no abnormalities are found, the Society recommends that this test be repeated every five years.
• Rectal Exam (digital rectal exam or DRE): The doctor or health care provider inserts a gloved finger into the rectum to feel for anything not normal. This simple test, which is not painful, can detect some rectal cancers, and this test should be done at the time of a sigmoidoscopy, colonoscopy or barium enema. However, DRE is not a stand-alone test for colon cancer. 

Does my health insurance plan cover colon cancer screening? Most health insurance plans do cover some forms of colon cancer screening tests, but not all cover the full range of screening options recommended by the American Cancer Society for average risk individuals. Fortunately, Medicare does provide coverage for these tests. In addition, many of the larger Federal Employee Health Benefit Program health plans recently added the full range of colon cancer screening tests to each plans’ coverage.  Contact your personal health insurance carrier for more information.

Does Medicare cover colon cancer testing in individuals who have no symptoms? Yes. Medicare coverage includes colon cancer testing. Currently, for people 50 years or older who are at average risk of colon cancer, Medicare provides the following coverage:

• Yearly take-home fecal occult blood test (FOBT)
• Flexible sigmoidoscopy every four years
• Colonoscopy covered once every 10 years or four years after a flexible sigmoidoscopy
• Double-contrast barium enema as an alternative to the sigmoidoscopy or the colonoscopy if requested in writing by the provider

As of January 1, 2005 Medicare now covers a one-time physical for new beneficiaries.  The physical, referred to as the “Welcome to Medicare” benefit, is a great opportunity to discuss and schedule these screenings with your physician as well as discuss other disease prevention strategies and screening tools available (Medicare also covers screenings for breast, prostate and cervical cancers). 

Does Medicaid cover colon cancer testing in individuals who have no symptoms? States are authorized to cover colon testing under their Medicaid programs. Unlike Medicare, however, there is no federal assurance that all state Medicaid programs must cover colon cancer testing in individuals who have no symptoms. 

Medicaid coverage for colon cancer testing varies state by state. Some states cover fecal occult blood testing (FOBT); others cover colon cancer testing if a physician determines the test to be medically necessary; and in some states, coverage varies depending on which Medicaid managed care plan individuals are enrolled in.

How is colon cancer treated? The three main types of treatment for colon cancer are surgery, radiation therapy, and chemotherapy. Depending on the stage of the cancer, two or even three types of treatment may be used at the same time or one after the other. 

What can people expect after treatment of colon cancer? There are some important follow-up activities after treatment for colon cancer that can help you recover and stay healthy. For years after treatment ends, regular follow-up exams will be very important. These can detect recurrence, that is, the cancer coming back. Any new or persistent symptoms should be reported to the doctor right away. Follow-up tests usually include a careful general physical exam and rectal exam, colonoscopy, and blood tests for tumor markers such as carcinoembryonic antigen (CEA). CEA is a substance in the blood of some people with colon cancer. The CEA blood test is most often used with other tests for follow-up of patients who already have had cancer and have been treated. CEA may be useful to provide early warning of a cancer that has returned.

What support services are available for people who have been diagnosed with colon cancer? Many patients benefit from participating in education and support groups. For some, private counseling may be more helpful. If you are unsure about what kind of help you need, see your hospital social worker. Peer support services provide one-on-one patient support from someone who has already experienced the treatment. These services can help by answering questions about colon cancer, providing information about ways to cope with the disease and its treatment, and introducing you to people who have survived cancer and continue to lead full lives. Hospitals with peer support programs also train recovering cancer patients to be peer counselors. 

The American Cancer Society offers the Cancer Survivors NetworkSM (CSN), a first-of-its-kind Internet-based support service for cancer survivors, their families, caregivers, and friends. CSN was created by and for cancer survivors and their families to address their need to connect with others whose lives have been touched by cancer, share their experiences, and support one another. The Internet-based Cancer Survivors Network can be found on the American Cancer Society’s Web site at www.cancer.org.

For more information about cancer support services in your area, contact the American Cancer Society at 1-800-ACS-2345, 24 hours a day, seven days a week.

What should I remember to ask my doctor about colon cancer? If you are 50 years or older, talk with your doctor about colorectal cancer screening, even if you don’t have symptoms or a family history of the disease. You should feel free to ask any question on your mind, no matter how small it might seem. Here are some questions you might want to ask. Feel free to add your own to this list.

• I’m over 50 – should I get tested for colon cancer?
• I’ve read that there’s more than one way to be tested for colon cancer. Which one do you think is right for me?
• How is the test done? Will it be done in your office? Who will be in the room? How do I prepare for it? What will happen to me, and how will it feel?
• Now that I’m 50, what other tests should I have?

Where can I find reliable and accurate information on colon cancer? The American Cancer Society has a toll-free National Cancer Information Center (NCIC) staffed 24 hours a day, seven days a week, to provide comprehensive information about cancer and resources in your area. Call 1-800-ACS-2345 or visit the American Cancer Society Web site at www.cancer.org. 

What is the American Cancer Society doing about colon cancer? In addition to providing science-based early detection and prevention testing guidelines for colon cancer, the American Cancer Society uses a comprehensive strategy to combat this disease from every angle.

• Research: As of January 2005, the American Cancer Society has funded 97 colon cancer-related grants totaling approximately $50.8 million. The Society has also conducted national surveys to learn more about the public’s knowledge, attitudes, and practices associated with colorectal cancer screening.
• Education: The Society delivers health information to the public so that individuals can make informed personal decisions. Examples include printed materials, media coverage, community-based outreach programs, and free, nationwide services such as the www.cancer.org Web site and 24-hour information and support line at 1-800-ACS-2345. The Society also delivers health information to health care professionals, including screening guidelines.
• Awareness:  In February 2005, the Society will be kicking off a nationwide colon cancer public awareness advertising campaign to raise awareness of the personal need to get tested for colon cancer. The campaign will target both consumers and doctors and will appear in print, radio, television, and online.
• Advocacy:  With the help of grassroots volunteers in communities across the country, the Society advocates action at both the state and federal levels to ensure responsible health policies and to increase funding for research and access to testing and treatment. For example, the Society was instrumental in securing coverage of the full range of colon cancer screening tests for Medicare beneficiaries, for many federal employees, and for privately insured individuals in 15 states and the District of Columbia. Recently, the Society led a partnership with the American Heart Association and the American Diabetes Association to ensure that the new “Welcome to Medicare” physical was included in the Medicare Modernization Act of 2003. This physical, now available to new Medicare beneficiaries, is the first of its kind for the 40-year old healthcare program and is helping usher in a new preventative health focus for Medicare. The Society is continuing to lead the charge at the federal and state levels to ensure all Americans have coverage for the full range of colon cancer screening tests for people 50 and older.
• Service: The Society works to improve quality of life for people living with cancer through a variety of support services and programs helping patients and families cope with the disease.
• Collaboration: Along with the Centers for Disease Control, the Society established the National Colorectal Cancer Roundtable, an organization consisting of more than 50 organizations dedicated to working together to increase colorectal cancer screening.

How can someone volunteer with the American Cancer Society? Contact a local American Cancer Society office or call 1-800-ACS-2345 to learn about American Cancer Society volunteer programs. A wide variety of volunteer opportunities are available for anyone with a little time to give.