Colorectal cancer

The colon and rectum make up the large intestine, which is part of the digestive system (also called the gastrointestinal or GI tract).  

• The colon is a hollow, tube-like organ that’s around five feet long. Its job is to absorb water and certain nutrients from the food you eat and turn what’s left over into stool.  
• The rectum, the lowest part of the large intestine, stores stool until it passes through the anus (the opening at the end of the large intestine) and exits the body.  

Cancer occurs when cells in a certain part of the body begin to multiply uncontrollably or fail to die at the end of their typical lifespan. This happens when a cell’s DNA is damaged or experiences abnormal changes (mutations). (DNA is the hereditary material that instructs cells to function, reproduce, and die.) Eventually, abnormal cells can crowd out healthy cells or bind together to form tumors.  

Colorectal cancer starts in the cells of tissue that line the colon and rectum. Often, colorectal cancer begins as a benign (noncancerous) growth on the lining of the large intestine called a polyp. Polyps that are unusually large, found in multiples, or contain abnormal cells (an issue known as dysplasia) are more likely to become cancerous. 

An adenoma is a common type of precancerous polyp that forms in the lining of the large intestine. Around 5 percent of adenomas become cancerous over the course of roughly seven to 10 years. 

Colorectal cancer may also be called colon cancer or rectal cancer depending on where it originates. These cancers share many symptoms and risk factors, which is why they’re often grouped together as colorectal cancer.    

How common is colorectal cancer? 

Colorectal cancer is the fourth most common cancer in the U.S., accounting for 7.6 percent of all new cancer diagnoses in 2024. According to the ACS, the lifetime risk of developing colorectal cancer is around 1 in 23 for men and people assigned male at birth (AMAB) and 1 in 25 for women and people assigned female at birth (AFAB).  

Globally, colorectal cancer makes up around 10 percent of all cancer cases and is the second leading cause of cancer-related death. 

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Roughly 90 to 95 percent of all colorectal cancers are classified as adenocarcinomas. This type of colorectal cancer begins as an adenoma. Adenocarcinomas often develop in the left section of the colon (descending colon).  

Less common types of colorectal cancer include:  

• Gastrointestinal carcinoid tumor: A type of neuroendocrine tumor (NET) that begins in hormone-regulating nerve cells.  
• Primary colorectal lymphoma: A type of non-Hodgkin lymphoma that starts in the large intestine.  
• Gastrointestinal stromal tumor: Cancer that forms in cells of the rectum called interstitial cells of Cajal (ICCs).   
• Colon and rectal leiomyosarcomas: Cancer that starts in certain muscles of the digestive tract.   
• Colon and rectal melanomas: A type of skin cancer that spreads to or originates in the colon or rectum.  

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Colorectal cancer usually doesn’t cause noticeable signs or symptoms in its early stages. As the disease progresses, colorectal cancer symptoms may involve:  

• A change in bowel habits that lasts for more than a few days and may involve constipation, diarrhea, or narrowly shaped stool 
• A feeling like you can’t fully empty your bowels when you go to the bathroom  
• Abdominal pain, cramping, or bloating  
• Frequent gas pains  
• Stool that contains blood or looks unusually dark  
• Bright red blood from the rectum 
• Unexplained weight loss  
• Unusual fatigue or weakness 

Colorectal cancer that spreads, or metastasizes, to other areas of the body may cause shortness of breath or jaundice (yellowing of the skin or the whites of the eyes).   

Some symptoms of colorectal cancer can be produced by benign polyps. Only an HCP can determine the cause of your symptoms and provide appropriate care.  

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Visit an HCP if you experience possible symptoms of colorectal cancer for more than a few days. These symptoms are also linked to more common conditions such as hemorrhoids, irritable bowel syndrome (IBS), and gastroenteritis, but testing from an HCP is necessary to determine what’s causing your issues.   

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Changes or damage to a cell’s DNA can trigger rapid cell reproduction that leads to cancer. Colorectal cancer begins in cells of the mucosa, or the innermost layer of the walls of the colon and rectum. From there, cancer cells can travel to other areas of the body through nearby blood vessels, lymph vessels (small vessels that transport excess fluid and wastes), and lymph nodes (small, bean-shaped organs that are part of the immune system—the body’s defense against germs and illness).  

Colorectal cancer tends to grow slower than many other cancers. When it does spread, it most often travels to the liver, lungs, brain, or abdominal cavity.  

The exact cause of colorectal cancer isn’t clear. Experts believe a combination of genetic, behavioral, and environmental factors increases a person’s cancer risk.  

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A risk factor is something that can make you more likely to develop a certain condition. There are many well-established risk factors for colorectal cancer, including:  

Age: Colorectal cancer is most often diagnosed in people between the ages of 65 and 74, with 66 being the median age at diagnosis. Rates of colorectal cancer among people younger than 50 are on the rise, however.   

Racial and ethnic background: African Americans, Native Americans, and Alaska Native people have the highest rates of colorectal cancer in the U.S. Globally, Ashkenazi Jews (Jews of Eastern European descent) have the greatest colorectal cancer risk.   

Family medical history: Colorectal cancer may run in families. Around one in three people who develop colorectal cancer have a blood relative (such as a parent or sibling) with the condition.  

Inherited syndromes: Roughly 5 percent of people with colorectal cancer have an inherited syndrome that increases cancer risk. These syndromes include Lynch syndrome (hereditary non-polyposis colon cancer), familial adenomatous polyposis (FAP), cystic fibrosis, Peutz-Jeghers syndrome (PJS), and others.  

Body weight: People who have overweight or obesity are more likely to develop and die from colorectal cancer than people who have a healthy body weight.   

Alcohol use: Drinking alcohol, especially in excess, increases your risk of colorectal cancer and other cancers. Men and people assigned male at birth should limit their alcohol consumption to two drinks per day, while women and people AFAB should have no more than one drink per day. It’s best to avoid alcohol altogether if you want to lower your cancer risk.  

Smoking: Smoking is linked to a greater risk of several cancers, including colorectal cancer. People who smoke are also more likely to die from colorectal cancer than people who don’t smoke.   

Diet: Maintaining a diet that’s high in red meat (such as beef, pork, and lamb) and processed meat (such as bacon, sausage, and hot dogs) can make you more likely to develop colorectal cancer. Additionally, fried, grilled, and broiled foods that are cooked at high temperatures may contain chemicals that raise cancer risk.  

Certain medical conditions: Having a personal history of adenomas in the colon or rectum means you may be more likely to develop colorectal cancer. Other medical conditions, including type 2 diabetes, Crohn’s disease, and ulcerative colitis, are also associated with a greater risk of colorectal cancer.  

Radiation therapy: Receiving radiation therapy to the abdominal or pelvic area for a previous cancer can make you more likely to develop colorectal cancer in the future.  

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Screening is used to detect precancerous polyps or colorectal cancer before they produce noticeable symptoms. Colorectal cancer that’s found in an early stage is easier to treat and associated with better outcomes than late-stage cancer. Polyps that are detected during screening can be removed before they turn cancerous.  

The U.S. Preventive Services Task Force recommends periodic colorectal cancer screening for adults between the ages of 45 and 75 years. If you’re older than 75, talk to your HCP about your cancer risk and if you should consider screening.  

Your HCP may also recommend starting colorectal cancer screening before age 45 or receiving it more frequently if you have:  

• A personal or family medical history of colorectal polyps or colorectal cancer   
• A personal history of radiation therapy to the abdominal or pelvic area  
• Inflammatory bowel disease (ulcerative colitis or Crohn’s disease)   
• Lynch syndrome, FAP, or another genetic syndrome that increases cancer risk 

What type of colorectal cancer screening you should receive will depend on your risk factors and care preferences. There are several screening tests your HCP may recommend, including:   

Colonoscopy 

A colonoscopy is the most thorough and reliable screening method for colorectal cancer. During a colonoscopy, an HCP uses a thin, flexible instrument with a camera on the end (called a colonoscope) to examine the entire colon and rectum.  

A colonoscopy is usually done using sedation, so you shouldn’t feel any discomfort. Full bowel prep is needed, which means you’ll clear out your colon before the procedure by eating a low-fiber diet and drinking a laxative formula.   

People who have an average risk of colorectal cancer should receive a colonoscopy once every 10 years. If a blood, stool, or imaging test detects signs of colorectal cancer, your HCP will use a colonoscopy to examine the colon.  

Flexible sigmoidoscopy 

During a flexible sigmoidoscopy, an HCP uses a thin, flexible instrument with a camera on the end (called a sigmoidoscope, which is shorter than a colonoscope) to examine the rectum and lower third of the colon (where most colorectal cancers develop).  

A flexible sigmoidoscopy can be performed once every five years, or once every 10 years with a yearly FIT stool test (see more below). The procedure is typically brief

Computed tomography (CT) colonography 

A CT colonography (virtual colonoscopy) uses computer technology and X-ray imaging to create detailed images of the colon, which an HCP can review for irregularities. It’s usually performed once every five years. A CT colonography does not require sedation, but it may miss some polyps.  

Stool tests 

A guaiac-based fecal occult blood test (gFOBT) and fecal immunochemical test (FIT) are stool tests that screen for blood. Both tests involve using a home test kit to collect a small stool sample, which is sent to an HCP or diagnostic lab for evaluation. These screening methods are performed once every year.  

A FIT-DNA test, also called a stool DNA test (Cologuard), can be done once every three years. This stool test involves testing a larger stool sample in a lab for blood and altered DNA.   

Stool tests do not require bowel prep. However, they may provide false-positive results and miss some cancers and many polyps.  

Blood tests  

There are two blood tests for colorectal cancer that are approved by the U.S. Food and Drug Administration (FDA) for people at an average risk. These tests detect select DNA changes in blood that could indicate pre-cancerous or cancerous cells.  

During this screening test, a blood sample is taken from a vein in the arm at an HCP’s office and evaluated in a lab. Blood tests, like stool tests, may miss certain cancers and provide false-positive results.   

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If colorectal cancer screening shows signs of cancer, your HCP will perform a diagnostic colonoscopy to take a closer look at the intestines and remove a polyp or sample of suspicious-looking tissue (a procedure called a biopsy). This sample is collected using a colonoscope and evaluated for cancer cells under a microscope.  

If you haven’t received colorectal cancer screening but are experiencing possible symptoms, your HCP will likely ask you questions about your personal and family medical histories, symptoms, and any medications or supplements you’re taking. They may also perform a physical exam to check for swelling and tenderness around the abdomen and other signs of illness. This might include a digital rectal exam, which involves inserting a gloved, lubricated finger into the rectum to feel for masses.  

Other tests may then be performed to help rule out or pursue a diagnosis of colorectal cancer. These include:  

• Stool tests, including a gFOBT or FIT test, to check for blood in stool.  
• Blood tests to screen for anemia (a complication of colorectal cancer), assess liver function, and check for tumor markers (substances produced by cancer cells)   
• Imaging tests, including CT scans or magnetic resonance imaging (MRI), to view pictures of the colon and surrounding structures.  

If your HCP suspects colorectal cancer, they may perform a diagnostic colonoscopy to confirm a diagnosis. Another procedure called a proctoscopy, which examines the rectum with a thin instrument called a proctoscope, may also be performed in the case of rectal cancer.    

Additional tests will be conducted following a colorectal cancer diagnosis to determine the cancer’s type, stage, and ideal treatment approach.  

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Staging helps describe how much cancer is in the body and how far it has spread beyond its origin site. The American Joint Committee on Cancer TNM system is typically used to stage colorectal cancer. This system considers three key cancer characteristics:  

• The size of the tumor (T) 
• The spread to nearby lymph nodes (N)  
• If it has metastasized (M), or spread, to distant parts of the body  

Colorectal cancer is staged from 0 to 4. Stage 4 indicates the most advanced form of the disease.   

• Stage 0 colorectal cancer is the earliest stage. The cancer is confined to the innermost layer of the colon or rectum wall (mucosa). This stage is also known as intramuscular carcinoma or carcinoma in situ.  
• Stage 1 colorectal cancer has spread outside of the mucosa and into the second layer (submucosa) or possibly the third layer (musculus propria) of the colon or rectum wall. It has not reached nearby lymph nodes or other tissues.  
• Stage 2 colorectal cancer has spread to the musculus propria, the outermost layer of the colon wall (serosa), or through the wall and into surrounding tissues. It has not reached any nearby organs or lymph nodes.  
• Stage 3 colorectal cancer has reached nearby lymph nodes but has not spread to other parts of the body.  
• Stage 4 colorectal cancer has traveled to distant parts of the body through the blood and lymph systems. This stage is also known as metastatic colorectal cancer. Common sites for metastasis include the liver and lungs.   

Some HCPs also categorize colorectal cancer as localized, regional, and distant.   

• Localized colorectal cancer is confined to the original site.  
• Regional colorectal cancer has traveled to nearby lymph nodes.  
• Distant colorectal cancer has metastasized to other areas of the body.    

Most people with colorectal cancer are diagnosed in the regional stage (36 percent). Between 19 and 26 percent of patients have distant metastases at diagnosis, according to a 2023 study published in Seminars in Colon and Rectal Surgery.  

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Receiving a colorectal cancer diagnosis can be an overwhelming or frightening experience. Voicing any questions or concerns you may have to your HCP can help you better understand your condition and play a more confident role in your treatment. Remember, there are no stupid or silly questions when it comes to your health.  

Some common colorectal cancer questions you may have for your HCP include:   

• What type and stage of colorectal cancer do I have?  
• Where exactly is the cancer located?  
• What do you think caused the cancer?  
• What are my colorectal cancer treatment options? Can you explain the risks and benefits of each?   
• What is my prognosis (expected outcome)? 
• Should I seek a second or third opinion?  
• What are the goals of colorectal cancer treatment?  
• How can I manage colorectal cancer with other conditions I have?   
• How will colorectal cancer treatment affect my daily routine? Can I still work or attend school?  
• How can I tell if treatment is working?  
• What can I expect during colorectal cancer treatment?  
• Do I need to adjust my diet or activity levels during colorectal cancer treatment?  
• What are my options if treatment doesn’t work?   
• Should I contact you if I experience certain symptoms? When should I seek emergency medical care?  
• Should I consider speaking with a licensed mental health provider?  

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HCPs from multiple specialties treat colon and rectal cancers. Your colorectal cancer treatment team may include a:  

• Gastroenterologist: A medical doctor who specializes in conditions affecting the digestive tract 
• Medical oncologist: A medical doctor who uses chemotherapy, targeted therapy, and other drugs to treat cancer 
• Radiation oncologist: A medical doctor who uses radiation therapy to treat cancer 
• Surgical oncologist: A medical doctor who treats cancer with surgery 
• Colorectal surgeon: A medical doctor who specializes in surgically treating conditions of the colon and rectum 

Other professionals, including physician assistants, nurses, nutritionists, and mental health providers, may also be a part of your treatment team.   

A combination of therapies is used to treat colorectal cancer. Your ideal approach to treatment will depend on the type and stage of your cancer, your age and overall health, and your care preferences.   

Most colorectal cancer treatment plans include one or more of the following:   

Surgery  

Surgery is the primary form of treatment for many colorectal cancers. Several types of surgery may be used to remove or help manage cancers of the colon and rectum, including:  

Polypectomy and local excision: These procedures use a colonoscope to remove cancerous polyps and small amounts of surrounding tissue. It’s often done as part of a colonoscopy.  

Colectomy: A colectomy removes all or a portion of the colon as well as several nearby lymph nodes. The remaining ends of the intestine are then attached, if possible.  

In other cases, a colostomy procedure is performed after a colectomy to attach an end of the colon to an opening in the skin of the abdomen. This allows stool to exit through this opening and into a changeable colostomy bag instead of traveling through the colon and out of the anus. Some people may require an ileostomy, which attaches an end of the small intestine (the ilium) instead of the colon to an opening in the abdomen.  

A colostomy or ileostomy may be a temporary or permanent measure, depending on the treatment plan.  

Transanal excision: Some early-stage rectal cancers that are located near the anus can be removed through transanal excision. During the procedure, thin instruments are inserted through the anus and into the rectum to cut out the cancer and a small amount of surrounding healthy tissue.  

Transanal endoscopic microsurgery: Early-stage rectal cancers that are located further up in the rectum may be removed with transanal endoscopic microsurgery. This procedure uses a special magnifying scope that’s inserted through the anus and into the rectum to precisely remove cancerous growths.  

Low anterior resection: A low anterior resection may be performed to remove rectal cancer while preserving the anorectal sphincter (the muscular ring of the anus that opens during bowel movements). The procedure removes cancer from the rectum, along with nearby lymph nodes, and reattaches the remaining portion of the rectum to the colon. This is done through incisions in the lower abdomen. A temporary ileostomy may be necessary following this procedure. 

Total proctectomy: This procedure removes the entire rectum and all surrounding lymph nodes. A colo-anal anastomosis is then performed to attach the end of the colon directly to the anus to allow for normal bowel movements. A temporary ileostomy may be necessary after this procedure.  

Abdominoperineal resection: Rectal cancer that grows into the anorectal sphincter may be removed through abdominoperineal resection. This procedure makes incisions in the abdomen and around the anus to remove the sphincter, rectum, and surrounding tissues. A permanent colostomy is needed to pass stool following surgery.  

Pelvic exenteration: An uncommon procedure for rectal cancer, pelvic exenteration removes the entire rectum and other affected organs in the pelvic area (such as the uterus, prostate, or bladder). This is a major operation that requires a permanent colostomy and several months of recovery.   

Other types of surgery are performed to remove colorectal cancer that has spread to other parts of the body, such as the liver or lungs. The goals of surgery may be to cure the cancer, prevent complications, or help ease symptoms.  

Any surgery comes with some measure of risk. Your HCP can walk you through your options and help you weigh the risks and benefits of cancer surgery.   

Chemotherapy  

Chemotherapy (chemo) is a regimen of powerful, cancer-fighting drugs that can be given in several rounds. It may be used:  

• Before surgery to shrink tumors and make them easier to remove (neoadjuvant chemo)  
• After surgery to destroy remaining cancer cells (adjuvant chemo)   
• As treatment for tumors that can’t be surgically removed, with the goal of easing cancer symptoms  

Chemotherapy can be given as a swallowable pill or an intravenous (IV) injection. The most used chemo drugs for colorectal cancer include:  

• 5-Fluorouracil (5-FU) 
• Capecitabine  
• Oxaliplatin  
• Trifluridine-tipiracil  
• Irinotecan  

A combination of two or three drugs is typically used to treat colorectal cancer. Chemotherapy may be systemic, which means it travels through the bloodstream to attack cancer cells throughout the body, or regional, which involves injecting chemo drugs in an artery that feeds into a specific area of the body (this reduces side effects by limiting the amount of the drug used).  

Chemotherapy is a potent treatment that can affect healthy cells as well as cancer cells. As a result, side effects are common. Different chemo drugs cause different side effects, but many drugs are associated with:  

• Hair loss  
• Diarrhea  
• Loss of appetite  
• Weight loss 
• Mouth sores 
• Skin and nail changes  
• Fatigue  
• Increased risk of infection  
• Easy bleeding or bruising   

Radiation therapy  

Radiation therapy uses high-energy X-rays to damage or destroy cancer cells in a certain area of the body. It’s more commonly used to treat rectal cancer than colon cancer.  

Radiation therapy is often combined with chemotherapy (chemoradiation). It may also be used:  

• Before surgery to help shrink tumors and make them easier to remove 
• During surgery to directly expose the area to radiation (intraoperative radiation therapy) 
• After surgery to help prevent the cancer from returning  

There are two main types of radiation therapy:  

• External beam radiation: The most common type of radiation therapy for colorectal cancer, external beam radiation uses a machine outside of the body to direct high-energy X-rays to a precise location in the body.   
• Internal radiation therapy: Also called brachytherapy, internal radiation therapy places a small radiation source directly inside or next to a tumor.  

Possible side effects of radiation treatment for colorectal cancer include:  

• Skin irritation at the treatment site  
• Diarrhea, painful bowel movements, or blood in stool due to rectal irritation  
• Urinary urgency, painful urination, or blood in urine due to bladder irritation  
• Bowel incontinence  
• Fatigue 
• Nausea  
• Vaginal irritation  
• Erectile dysfunction  
• Scarring and adhesions (scar tissue that causes organs or tissues to stick together) at the treatment site  

Immunotherapy  

Cancer cells can dodge the advances of the immune system (the body’s defense against illness) and continue multiplying. Immunotherapy uses medicine to help the immune system better identify and fight cancer cells.  

Immunotherapy is often used to treat colorectal tumors with certain characteristics. It may be given to:  

• Help shrink tumors before surgery  
• Treat recurring colorectal cancer (cancer that comes back after treatment)  
• Treat metastatic colorectal cancer   

Medicines called PD-1 inhibitors and CTLA-4 inhibitors are used to promote a stronger immune response to cancer by targeting certain proteins on cancer cells. Examples of these medicines include:  

• Pembrolizumab (Keytruda) 
• Nivolumab (Opdivo) 
• Dostarlimb (Jemperli)  
• Ipilimumab (Yervoy)  

Immunotherapy is administered as an IV injection once every two to six weeks, depending on the type of medicine and the person’s treatment plan. Common side effects of immunotherapy include:  

• Cough  
• Fatigue  
• Skin rash  
• Itching  
• Joint pain 
• Reduced appetite  
• Nausea  
• Diarrhea  
• Constipation   

Targeted therapy   

Targeted therapy uses medicine to disrupt the various processes involved in cancer growth. These drugs, which are given as a swallowable capsule or IV infusion, travel through the bloodstream to address cancer throughout the body.  

Targeted therapy is sometimes used in conjunction with chemotherapy, which attacks cancer in other ways. These drugs can help people with late-stage colorectal cancer live longer.  

There are multiple targeted therapy drugs that target different aspects of colorectal cancer growth. For example, some drugs work to block blood vessel formation around tumors. Without a blood supply, a tumor can’t receive the nutrients it needs to continue growing. Other targeted therapy drugs are used to disable the growth of cancers without certain gene mutations.  

Ablation and embolization  

Ablation and embolization are used to treat recurring colorectal tumors or tumors that have spread to other areas of the body. These treatments may also be used to help shrink tumors that aren’t surgically removable. 

Ablation is a minimally invasive technique that uses imaging technology and needle-like probes to locate and destroy small tumors less than 4 centimeters across. There are several types of ablation procedures that use different methods to fight cancer:  

• Radiofrequency ablation uses high-energy radio waves  
• Alcohol ablation (percutaneous ethanol ablation) uses highly concentrated alcohol  
• Microwave ablation uses electromagnetic microwaves and heat 
• Cryoablation (cryosurgery) uses very cold gas  

Embolization may be recommended to treat colorectal cancer that has spread to the liver. This technique is sometimes combined with ablation to treat tumors larger than 5 centimeters across. It involves injecting small particles or beads into an artery in the liver to limit or block blood flow to a tumor.    

Clinical trials   

A clinical trial is a research study with human volunteers. Many clinical trials are currently underway to expand the medical community’s understanding of colorectal cancer and how it can be treated. Participating in a clinical trial may provide the opportunity to receive new treatments that aren’t yet widely available.  

Speak with your HCP to learn more about the potential benefits and risks of clinical trial participation. You can also browse National Cancer Institute-supported clinical trials or locate trials using the Colorectal Cancer Alliance clinical trial finder.   

Palliative care  

People with any stage of colorectal cancer can benefit from palliative care (supportive care). Rather than treating the disease itself, palliative care focuses on improving quality of life by easing emotional and physical stress. Examples of palliative care include:  

• Pain management   
• Counseling and mental health support 
• Spiritual guidance 
• Stress management  
• Nutritional guidance 

Palliative care professionals may also serve as liaisons between patients and their HCPs, helping to explain and coordinate treatments and recovery. When appropriate, they can help patients and their loved ones transition from treatment to hospice care.  

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Colorectal cancer and its treatment may lead to health complications. Some of the most common colorectal cancer complications include:  

• Bowel blockages caused by tumors in the intestine 
• Bowel perforation (a hole in the intestine) caused by a growing tumor 
• Chronic (long-term) diarrhea or other changes in bowel habits, such as incontinence  
• Anemia caused by bleeding in the intestine  
• Tingling or numbness in the fingers or toes (peripheral neuropathy) related to chemotherapy 
• Fatigue 
• Complications related to colon or rectal surgery, such as urinary incontinence  

Many of these complications can be treated or managed with surgery, medication, or self-care measures. 

These are not all the possible complications of colorectal cancer. Contact your HCP right away if you develop new, severe, or unexpected symptoms during cancer treatment.  

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Colorectal cancer is preventable with screening. Precancerous polyps and tissues can be identified and removed during a colonoscopy before they turn cancerous. All adults between ages 45 and 75 should receive periodic colorectal cancer screening.  

In addition to getting screened, there are other steps you can take to lower your risk of colorectal cancer. For example:  

• Avoid or quit smoking  
• Reach and stay at a healthy body weight 
• Be physically active and exercise regularly—aim to get 30 minutes of exercise, five days per week 
• Avoid or limit alcohol use 
• Maintain a nutrient-rich diet that includes plenty of vegetables, fresh fruit, and whole grains and limits red meats (such as beef and pork) and processed meats (such as hot dogs, lunch meats, bacon, and sausage) 

A 2021 study published in Cancer Discovery identified a link between frequent red meat consumption and a set pattern of DNA damage (called alkylating mutational signature) that’s present in colorectal tumors. Compounds produced by the body after eating red meat are thought to cause this DNA damage.  

Another 2021 review, published in JAMA Network Open, found convincing evidence connecting reduced colorectal cancer risk to higher intakes of dietary calcium, dietary fiber, and yogurt and lower intakes of red meat and alcohol.  

The Centers for Disease Control and Prevention (CDC) advises people to either avoid drinking alcohol or drink it in moderation. For men and people AMAB, this means consuming no more than two drinks per day. Women and people AFAB should limit their consumption to one drink per day.    

“One” drink is defined as:  

• 12 ounces of beer  
• 8 ounces of malt liquor, including malt-based seltzers 
• 5 ounces of wine  
• 1.5 ounces of distilled spirits, such as whiskey, vodka, gin, and rum   

Genetic counseling for colorectal cancer   

Genetic counseling provides insight into a person’s risk for cancer. It involves speaking with a genetic counselor, or an HCP with training in genetics, about your personal and family medical histories. From there, genetic testing may be performed to screen for family cancer syndromes or inherited gene changes that could lead to cancer. This may be a blood test, saliva test, or skin test. A genetic counselor can also suggest ways to help lower your cancer risk.  

You might benefit from genetic counseling for colorectal cancer if you have: 

• A strong family history of colorectal cancer  
• A family member who developed colorectal cancer before age 45   
• A family member with more than one type of cancer, especially if the cancers could be linked to hereditary cancer syndromes   
• Ashkenazi Jewish, African American, Native American, or Alaska native background or ethnicity (these groups have an elevated risk of colorectal cancer)  
• A personal history of colon polyps   

Keep in mind that genetic counseling has limitations. The results of genetic testing do not guarantee that a person will or will not get cancer. Moreover, testing positive for abnormal gene changes may cause undue stress or anxiety.  

To learn more about the risks and benefits of genetic counseling or to find a provider in your area, speak with your HCP or visit the National Society of Genetic Counselors website.  

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According to the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program, the five-year relative survival rate for colorectal cancer is 65 percent. This means that 65 percent of people with all stages of colorectal cancer combined were still alive five years after their diagnosis. By comparison, the five-year survival rate in 1975 was around 49 percent.   

Colorectal cancer is a dangerous disease. The earlier someone is diagnosed and treated, the greater the likelihood of a positive outcome. The five-year survival rate by stage at diagnosis is:  

• 91.1 percent for localized colorectal cancer   
• 73.7 percent for regional colorectal cancer  
• 15.7 percent for distant colorectal cancer  

Nearly half of all colorectal cancer deaths occur in people ages 65 to 84. The median age at death for someone with colorectal cancer is 72.    

It’s important to note that no two people are the same. You’re a unique individual, so your cancer prognosis will be, as well. Speak with your HCP to better understand your prognosis and what to expect during treatment.  

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Colorectal cancer disrupts many aspects of life, but it doesn’t define you. Following your treatment team’s guidelines and seeking sources of support can help you live well with colorectal cancer.   

Many people with colorectal cancer find it helpful to:  

Eat mindfully. Choose nutritious, calorie-rich snacks that contain protein, such as peanut butter, nuts, cheese, avocadoes, and hummus. Avoid consuming too much fiber and spicy or fried foods. Try to eat several small meals a day and eat and drink slowly.  

Hydrate. Don’t wait until you feel thirsty to drink. Stay hydrated by sipping water regularly. Electrolyte beverages may also be helpful—just avoid drinks with alcohol or lots of caffeine or sugar.      

Stay active. If you feel well enough and your HCP gives you approval, try doing some gentle yoga or taking a brief walk. Movement can help ease some physical and emotional side effects of cancer.   

Make time for fun. Continue enjoyable hobbies and activities to the best of your ability. This may include things like painting or sketching, watching classic movies, or tending to a garden. Relaxing activities that can ease stress, such as meditation and deep breathing, may also be helpful. Some people with cancer find fulfillment in volunteering and helping others.  

Express feelings. Use a journal or the listening ear of a friend to express your thoughts and concerns. Many people with cancer also benefit from joining in-person or virtual support groups, where they can connect with others who face similar challenges.   

Speak with your HCP if you’re interested in joining a colorectal cancer support group. They may be able to connect you to a group that meets in your area or online. You can also browse online communities from the Colorectal Cancer Alliance.  

Speak with a mental health provider. Mental health issues such as anxiety and depression are common among people with cancer. Research from a 2020 study, published in the American Journal of Clinical Psychology, suggests these issues can influence survival.  

Consider visiting a mental health provider such as a counselor, clinical social worker, or psychologist if you’re living with colorectal cancer. This professional can help you navigate the ups and downs of cancer treatment and teach you to cope with distressing emotions in a healthy way. Mental health support is also helpful for loved ones and caregivers of people with cancer.   

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Speak with your HCP to learn more about colorectal cancer, its symptoms, and how often you should receive screening based on your risk factors. You can also browse helpful information from organizations such as the Centers for Disease Control and Prevention and the American Cancer Society.   

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• Are you up to date on your colon cancer screening?   
• 11 things to know about colorectal cancer  
• What to expect if you’re diagnosed with colon cancer