Colorectal Cancer: The More You Know

March is Colorectal Cancer Awareness Month, and a time to shine a light on a disease that many people don’t like to discuss. But talking is important because the disease is highly treatable if diagnosed early. 

The American Cancer Society (ACS) at Cancer.org estimates that nearly 153,000 new cases of colon and rectal cancer will occur this year in the United States. ACS estimates that about 53,000 people will die from the disease in 2024.

Elizabeth Myers, DO, a BayCare Medical Group colorectal surgeon with the St. Joseph’s Hospitals Cancer Institute, said that she is seeing more and more younger people being diagnosed with colorectal cancer each year. Since the mid-1990s, the incidence of patients ages 55 and younger suffering from this disease has risen 1% to 2% each year. Meanwhile, the incidence for Americans 55 and older is decreasing due to aggressive colonoscopy screening since the early 2000s.

Dr. Myers, who has been a colorectal surgeon with BayCare for nearly eight years, said she has even treated a 29-year-old for the disease. One of her recent patients, 35-year-old Alex Mojica, shared his story to help young patients learn more about the disease.

Dr. Myers recently discussed the signs and symptoms of the disease, the importance of screening, treatment and survivorship. 

Discussing colorectal cancer can often be difficult for people. How do you get patients to open up to you on what is often seen as a very private issue?

Dr. Myers: First and foremost, I try to get them in to see me within a week of their diagnosis given the anxiety this often generates. The initial visit is usually a long one where we review the work up and treatment algorithm and we get them set up for all their necessary exams before they leave the office. Having a timely plan of care helps put the patient's mind at ease. I try to have patients follow with me throughout all steps of their treatment so we have time to get to know one another. When you think about it, patients put their trust in a complete stranger who is going to operate on them. As a surgeon, I see patients with colorectal cancer in their most vulnerable state. We talk about intimate personal issues – the need for a possible colostomy/ileostomy, potential urinary and sexual dysfunction, and changes in bowel function. As a surgeon, I try to help them in many ways as they go through this difficult journey – being the doctor, the mentor, or the friend sometimes.

What signs and symptoms are most common for colorectal cancer?

Dr. Myers: The most common symptom is being asymptomatic. This is why screening colonoscopies are important. When symptoms do occur, typically these include persistent rectal bleeding; change in the bowel habits often with constipation and diarrhea; abdominal cramping/pain; and unintentional weight loss. These are also symptoms of more benign conditions like hemorrhoids, irritable bowel syndrome, etc. which many people attribute their symptoms to initially.

Are there certain people who are more susceptible to colorectal cancer?

Dr. Myers: Yes, certainly patients with a family history of the disease or other hereditary conditions. However, most colorectal cancers (CRCs) are sporadic, meaning there is no family history or such hereditary condition at play. We think a lot of it has to do with our diet here in the United States in particular. You know, we eat a lot of processed foods that are fried or fatty and often have preservatives.

We also have a rising obesity problem, sedentary lifestyle, smoking, alcohol – all in more than moderation. I think we are now a generation that grew up in this sort of environment, eating these sorts of foods rather than many generations in the past who sat down at the table to eat fresh foods and things like that. Fresh food is also more expensive than processed preservative-laden food choices these days. We also work too much, and we don't take care of ourselves the way we should.

Is there a specific age that you would encourage people to get screened?

Dr. Myers: Around 2018, the ACS started recommending average risk screening starting at age 45. This was lowered from the age of 50 given the rise of CRC in younger patients. It took until 2021 for this to be universally recommended by most gastrointestinal societies and for insurance companies to routinely cover this.

If there is a family history, we typically recommend starting screening at the age of 40 or 10 years earlier than the age of diagnosis of the affected individual.

Colorectal cancer has now become the leading cause of cancer death in men under age 50 and the second leading cause in women of the same age group. Young people are often diagnosed with more advanced cancers due to delays in detection. 

A recent national story indicated that physicians are seeing younger people who are diagnosed with colorectal cancer. Are you seeing this?

Dr. Myers: Yes, I have personally cared for quite a few patients between the age of 35-45 with CRC. We’ve been seeing for many decades that the incidence of cancers in this age or age population has decreased. But during that same time period over the past 20 years, we've actually seen a rise in the incidence of colorectal cancers in patients under the age of 50 and even under the age of 40. A good friend of mine was diagnosed with colon cancer at the age of 42. I went out and got a colonoscopy a month later – I’m the same age. It hit way too close to home.

Is it important for people who have a family history of colorectal cancer to get screened earlier?

Dr. Myers: Yes, absolutely. We typically recommend starting screening at the age of 40 or 10 years earlier than the age of diagnosis of the affected individual in this group.

Please tell us about the tests that have been shown to detect colorectal cancer.

Dr. Myers: Colonoscopy is absolutely the gold standard. There are also stool tests such as fecal immunohistochemical testing and stool DNA screening. However, while these are convenient, they can miss small polyps. The goal of a screening test should be to detect polyps before they become a cancer. This is why colonoscopy is important!

Some people are a little afraid of the colonoscopy. What do you tell patients who might be worried about doing it?

Dr. Myers: I tell them almost no one should die from colorectal cancer over the age of 45 because routine screening colonoscopy to remove polyps before they become a cancer is completely preventative.

I also tell them if they develop a CRC they will be having much more frequent colonoscopy exams.

Lastly, I often share with them as their doctor that I have personally had a colonoscopy and survived the experience. I provide some tips and tricks to the process. I think it helps them to know that someone is telling them to do this who's actually gone through it. And I think I'm pretty persuasive. I don't think I have encountered a patient yet that I have not been able to convince. It's just something that we all need to do and it’s really, really important.

What are the various treatment options?

Dr. Myers: Colon cancer and rectal cancers have some nuances to their treatments. Colon cancer is typically treated with surgery with or without chemotherapy following surgery depending on lymph node status on the pathology. Rectal cancer often requires preoperative chemotherapy and radiation to shrink the tumor followed by surgery to remove the cancer. Most patients avoid a permanent colostomy which is something many patients fear when they learn they have a colorectal cancer. In 2024, many CRCs are surgically removed using a robotic surgery approach which affords patients a speedy recovery. I do the large majority of my CRC operations using a robotic platform with open surgery reserved for more selective cases that warrant this.

Once patients have completed treatment, what is the next step in the healing process?

Dr. Myers: Following treatment, patients enter into a surveillance program over a minimum of 5 subsequent years. This involves more frequent imaging studies, colonoscopy exams, blood work, and physical exam often done by a medical oncologist and surgeon.

Most of my patients continue to follow with me years after their treatment. It is a long journey for us together. This is especially true for very young patients who develop CRC. CRC survivors have gone through a very disruptive event in their lives and it is a lengthy process to recovery – physically, emotionally and spiritually. So many of my patients who are at the end of their journey want to help other patients going through this and/or want to share their story to help other people. It is a beautiful thing and it empowers them with purpose. I love being part of this and making a positive impact on lives – it enriches me as a person every day. 

BayCare offers information on colorectal cancer symptoms, screening, treatment and recovery. Learn more: BayCare.org Colon and Rectum Cancer page.