Colon Cancer | Symptoms and Risk Factors | MedStar Health
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Advanced colon cancer treatment delivered by an experienced, multidisciplinary team

At MedStar Health, our colon cancer team consists of doctors and other providers who are experts in different fields. This multidisciplinary approach ensures our patients receive personalized treatment plans that address their cancer and any other related needs from every angle. Through our partnership with the Georgetown Lombardi Comprehensive Cancer Center, the only National Cancer Institute-designated comprehensive cancer center in Washington, D.C., our patients benefit from state-of-the-art research, technology, and clinical trials before they're widely available elsewhere.

The colon makes up the first five feet of the large intestine. It's part of the digestive system, responsible for absorbing food and water and storing waste. When a mass of cells develops in the colon, it's called colon cancer or colorectal cancer, when it's grouped with rectal cancer. Most often this cancer begins with small abnormal growths called polyps, which can be removed promptly during screenings via colonoscopy. That's why it's more important than ever to know how to manage your risk and take steps to prevent the disease, even if you don't have a family history.

From genetic counseling and risk management to minimally invasive robotic surgery and advanced targeted therapies and radiation therapies, we offer the latest treatment options designed to precisely target cancer and preserve the quality and longevity of our patients' lives. We're here to help our patients thrive during and after treatment.

Symptoms and risk factors

Talk to your doctor if you notice anything abnormal.

People with colon polyps or cancer may have no symptoms at all, especially at first. By the time most symptoms appear, cancer may already be growing, making it harder to treat. At that point, symptoms may include:

  • Diarrhea, constipation, or the feeling that the bowel has not emptied
  • Unusually narrow stools
  • Bloody stool
  • Bloating, cramping, fullness, and/or frequent gas pains
  • Unexplained weight loss
  • Continuous fatigue
  • Vomiting

These symptoms can also be caused by other health conditions, so it's important to consult with your doctor if you notice something concerning. A primary care doctor or gastroenterologist can help further diagnose your condition.


Watch: Colorectal Cancer Symptoms with Dr. Abhijit Bhatia

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Your risk level may affect when you begin colorectal cancer screening.

Research has shown that people with certain risk factors are affected more than others. Knowing your risks will help you and your doctor make the best decisions for your health.

Risk factors may include:

  • Age: Your risk increases as you age, although increasingly, we're finding younger patients being diagnosed. We recommend scheduling your first colonoscopy at the age of 45 if you have an average risk.
  • Race or background: People who are African-American or Jewish with Eastern European background are at a higher risk.
  • Medical history: People with ulcerative colitis, Crohn’s disease, type 2 diabetes, or previous cancers have a higher risk of developing this disease.
  • Family medical history: You have an elevated risk if you have close family members diagnosed or other related conditions passed down through genetics, such as Lynch syndrome.
  • Lifestyle: Your risk is more directly linked to diet and exercise than any other type of cancer. Some evidence suggests that this type of cancer may be associated with a diet high in fat and calories and low in foods with fiber, such as whole grains, fruits, and vegetables. In addition, smoking and alcohol consumption can increase your risk.

For patients who have a high risk of the disease, we take a proactive approach to managing and lowering their disease risk. Through genetic counseling services and our High-Risk Gastrointestinal Cancer program, we provide individualized plans which may include earlier and/or more frequent screenings, medications, and other strategies to reduce your risk.

Are you 45 years of age or older?

If you answered yes, it may be time to get a colon cancer screening. Research has shown new cases of colorectal cancer are occurring at an increasing rate among younger adults. Experts have concluded colon cancer screening should begin at the age of 45 for adults of average risk. Take our free colon cancer risk assessment to learn if you are eligible for a colon cancer screening.

Colon cancer is one of the most preventable cancers.

Some people inherit this sort of cancer but for most people, there is no identifiable cause. However, there are lifestyle changes that can reduce your risk, including:

  • Eating a high fiber diet

  • Exercising regularly
  • Maintaining a healthy weight
  • Limiting alcohol consumption to no more than one drink per day
  • Avoiding smoking
  • Getting regular screenings, starting at the age of 45 (if you have an average risk)

The best way to prevent this cancer is through routine colorectal cancer screenings. When discovered early, it is 90 percent treatable. We recommend beginning screenings at the age of 45 if you have an average risk of the disease. There are several tests available to detect cancer early, including:

  • Colonoscopy, the best (and only) way to find and remove signs of cancer early through a painless and quick procedure. If the test is negative, you don’t need another one for ten years.
  • At-home screening kits, such as ColoGuard, which detects signs of the disease through stool samples. These tests need to be repeated more frequently and vary by test.
  • A flexible sigmoidoscopy, which uses a flexible, lighted tube to look at the interior walls of the rectum and part of the colon, every five years. It requires different bowel prep than a colonoscopy, and you will be awake during the procedure.
  • A high-sensitivity fecal occult blood test (FOBT), which checks for hidden blood in the stool. This test must be completed annually.

Each of these tests have benefits and disadvantages, and for most patients, the alternatives should not be a replacement for colonoscopy.


Watch: Preventing colon cancer with Gastroenterologist Dr. Jasmine Barrow

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If your doctor finds a polyp during a colonoscopy, they can remove it immediately, reducing your risk of cancer.

Most commonly, healthcare providers suggest screening with a colonoscopy. During a colonoscopy, a gastroenterologist uses a lighted instrument called a colonoscope to inspect the entire large intestine (colon and rectum) for abnormal growths, called polyps. A polyp is not cancer, but it can change over time into cancer. If polyps are found, they will be removed during the procedure, reducing your risk. The procedure is painless, as you will receive sedation and are asleep during the 20-minute procedure. Many patients report that prep is much easier than it used to be, especially given its potentially lifesaving benefits.

Learn More About Colonoscopy

Diagnosis

We use advanced technology to understand the specific features of your cancer.

At MedStar Health, we understand how difficult a diagnosis can be for you or your loved one. If you’ve been diagnosed, you can rely on our devoted and specialized teams, from treatment to follow-up care. Our knowledgeable doctors and nurses will answer any questions you may have during the diagnosis and be with you every step of the way.

Our goal is to complete the diagnostic phase promptly so that you can begin treatment as soon as possible. We use the most advanced diagnostic technology to diagnose and stage your cancer because we know that the more accurate your diagnosis, the more precise your treatment regimen will be.

Our doctors use a variety of tests to diagnose and determine if this type of cancer has spread (metastasized) to other parts of your body. These tests may also help your doctor determine which treatment will be most effective. In most cases, a biopsy is the only way to make a definitive diagnosis. Your MedStar Health doctor will consider several factors when deciding which diagnostic test is right for you: your age, medical history, type of cancer suspected, symptoms, and previous tests.

  • Colonoscopy - A colonoscopy allows your doctor to see inside your rectum and colon to find polyps or other signs of cancer

  • Biopsy - During a biopsy, your doctor will remove a small amount of tissue from your rectum or colon and examine it under a microscope to determine if cancer is present. Other tests can be used to suggest whether or not cancer is present, but only a biopsy can definitively diagnose it
  • Molecular testing - Your MedStar Health doctor may use molecular testing to determine if your treatment options include targeted therapy
  • Computed tomography (CT or CAT) scan - A CT scan may be used to help your doctor determine if it has spread to other parts of your body

In addition to these tests, your doctor may use a blood test, MRI, ultrasound, or other tests.

Colon cancer stages

Once your diagnostic tests are complete, your doctor will review the results. If the tests show that the cancer is present, the results of your tests will help your doctor determine the stage of cancer and which treatment options will be most effective. Staging helps us understand how far cancer has spread and ranges from zero to four:

  • Stage 0: Cancer is only found in the mucosa, the innermost lining of the colon.
  • Stage I: Cancer has spread beyond the inner lining but is contained to the colon. It has not spread to lymph nodes.
  • Stage II: Cancer has spread to the outer layer of the colon but has not spread to the lymph nodes.
  • Stage III: Cancer has spread through the colon and to one or more lymph nodes.
  • Stage IV: Cancer has spread to other organs, making it an advanced, metastatic disease.

Types of cancer

We used to treat colorectal cancer universally as the same type of cancer. Now, with the help of tumor DNA profiling, we know there are significant differences in tumors that come from the right side of the colon (closer to the liver), the left side of the colon (closer to the rectum), and the rectum itself. These distinctions are important because they impact how effective treatments may be for patients with advanced disease.

Most men and women who are diagnosed with colon cancer have adenocarcinoma, which begins as a growth in the colon, called a polyp. There are other types of colorectal cancer, although extremely rare. These may include:

  • Gastrointestinal carcinoid tumors, which begin in hormone-producing cells
  • Colon leiomyosarcomas, in which the tumor begins in the layers of muscle in the colon
  • Colorectal lymphomas, which typically develops in the lymph nodes but can begin in the colon
  • Familial adenomatous polyposis (FAP), which is a hereditary condition that results in hundreds or thousands of polyps in the colon or rectum

Treatments

Your personalized treatment plan will consider the least invasive and most effective options to target your cancer.

Once you’ve been diagnosed, you need a care team with the experience and technology to treat you with the most advanced, comprehensive, and personalized care. That’s why every case is reviewed by a team of medical, surgical, and radiation oncologists alongside other specialists, such as interventional radiologists, working to aggressively treat your tumor and prevent it from returning.

Our recommendations typically depend on:

  • The tumor’s location and whether it’s fully removable with surgery
  • The cancer’s stage (whether it’s just in the lining of the colon or rectum, or has spread to the tissue wall, lymph nodes, or other parts of the body)
  • Whether the cancer has blocked the colon or made a hole in it
  • Whether the cancer is a new diagnosis or has returned
  • Your overall health

Many patients benefit from a combination of treatment modalities. From the beginning, your treatment options will consider what offers the best potential for minimizing the risk of recurrence. For those with the greatest risk of recurrence, we offer an innovative surveillance approach following treatment. Using advanced technology, we can look for a specific biomarker circulating in the bloodstream, which can help us detect signs of recurrence early.

Surgery

Surgery is often the cornerstone of any colon cancer treatment plan. The goal of surgery is to remove the entire tumor—or as much of it as possible. During surgery, a surgical oncologist will remove the cancerous tumor and surrounding tissue. Your surgical options will vary depending on the thickness of your tumor and whether or not it has spread, or metastasized.

In most cases, we can perform minimally invasive surgery to remove the cancer, which results in a shorter hospital stay, faster recovery, and less pain than traditional open surgery. Some minimally invasive surgeries are performed laparoscopically while others are performed robotically, using an advanced robotic-assisted platform to enhance precision. In either case, patients experience excellent outcomes thanks to Enhanced Recovery After Surgery (ERAS) protocols which help our patients effectively prepare for and recover from surgery.

Many patients are concerned about needing a colostomy bag, but few patients need permanent-—or even temporary⁠—colostomy bags. Most patients are able to resume normal bathroom function after surgery.

Learn More About Colon Cancer Surgery

Chemotherapy

Chemotherapy uses drugs to destroy cancerous cells and is typically used to treat colon cancer as a supplement to surgery. During chemotherapy, your oncology specialists will use special medication to destroy cancerous tumors in the colon. You may take a pill, or it may be injected by a needle into a vein or muscle—and sometimes both.

In some cases, you may receive chemotherapy before surgery, as chemotherapy can help to increase the effectiveness of surgery, especially if it has spread to nearby lymph nodes. In other instances, patients may receive chemotherapy after surgery to reduce the chances of the cancer returning.

We also may give chemotherapy by itself to relieve late-stage symptoms, including a promising approach for otherwise incurable tumors called hyperthermic intraperitoneal chemotherapy, or HIPEC. While colorectal cancers can quickly develop a tolerance to today’s chemotherapies, we’re working to tailor care for individual tumors.

Learn More About Chemotherapy

Immunotherapy and targeted therapy

Over the past few decades, immunotherapy has emerged as an effective treatment for metastatic colon cancer. Immunotherapy is designed to retrain your body's own immune cells to go after and attack cancer cells. It doesn't work for all patients, but it can be more effective than chemotherapy for some patients or combined with chemotherapy.

Learn More About Immunotherapy

Another approach for treating colorectal cancers with certain genetic mutations (e.g. BRAF or HER2 mutations) is targeted therapy. These drugs and other substances can potentially provide a less toxic but still potent treatment to stabilize the tumor. We offer both approved therapies and clinical trials, including:

  • Monoclonal antibodies, which are made from immune system cells (an immunotherapy). These target specific substances on cancer cells and then kill them, block their growth, or keep them from spreading.
  • Angiogenesis inhibitors, which stop the growth of new blood vessels needed by tumors.

Learn More About Targeted Therapy

Interventional radiology

Some patients with advanced, metastatic cancer benefit from minimally invasive procedures performed by specialists in interventional radiology. This approach involves imaging, such as CT scans and MRIs, to kill cancer cells that have spread to the liver through:

  • Ablation techniques that use extreme heat, cold, electrical currents, or radio waves to target tumors
  • Embolization techniques in combination with chemotherapy (chemoembolization) and radiation therapy (radioembolization)

Learn More About Interventional Radiology

Radiation therapy

Radiation therapy uses targeted high-energy rays to kill cancer cells. However, this treatment option is more commonly used in treating rectal cancer.

Learn More About Radiation Therapy

Looking for expert cancer care?

With multiple locations throughout the region, patients have access to many of the nation’s renowned cancer specialists offering high quality care, second opinions and a chance for better outcomes close to where they live and work. Georgetown Lombardi Comprehensive Cancer Center, one of the nation’s comprehensive cancer centers designated by the National Cancer Institute (NCI), serves as the research engine allowing patients access to clinical trials that often lead to breakthroughs in cancer care.

Why choose us

Our comprehensive colon cancer services provide easy access to the latest diagnostic and treatment options available at convenient locations across the Washington, D.C., and Maryland region. Our approach combines the latest treatment options with individualized care that involves:

Experts meet regularly to discuss your best treatment options. Our colorectal team brings the best of surgical and medical oncology together to deliver personalized treatment to address your unique needs. Our experts meet regularly in a tumor board to discuss each cancer case and consider every aspect of care, including physical, emotional, spiritual, and financial needs, and any others that arise. The tumor board allows specialists across several disciplines to provide input into a comprehensive treatment plan and may involve:

  • Colorectal surgeons
  • Medical oncologists
  • Radiation oncologists
  • Gastroenterologists
  • Interventional radiologists
  • Pathologists
  • Nurse practitioners
  • Physical therapists
  • Genetic counselors
  • And others

Excellent surgical care held to rigorous standards set by our innovative Colorectal Surgery Clinical Practice Council. With ten hospitals and dozens of outpatient facilities, we strive to deliver integrated and streamlined colorectal cancer care wherever you see us in Washington, D.C., and Maryland. Through our Colorectal Surgery Clinical Practice Council, our physicians and leaders from across MedStar Health work together to maximize patient outcomes, from increasing colorectal screening rates to protocols that reduce surgical site infections. This commitment to collaboration ensures our patients benefit from the most rigorous clinical best practices for colorectal surgery at our academic and community-based facilities.

A compassionate team who is invested in your recovery. "It's how we treat people" is not just our tagline—it's the guiding principle we live by every day. Our entire care team is dedicated to treating patients with the same respect, empathy, and kindness we'd want for our family members. You can expect us to sit with you and answer all of your questions, engage in conversation about what's meaningful to you, and be genuinely invested in your journey to and through survivorship.

Awards and recognition

Recipient of an Accreditation with Commendation, the highest level of approval, from the American College of Surgeons’ Commission on Cancer (CoC)

Numerous colorectal surgeons, medical oncologists, and gastroenterologists recognized as "Top Doctors" by both Baltimore Magazine and the Washingtonian

Magnet® designation from the American Nurses Credentialing Center (ANCC)

Clinical trials and research

Clinical trials

Clinical trials offer patients the treatment of tomorrow, today. We offer a variety of clinical trials for colon cancer treatment at any given time, from using immunotherapy in combination with chemotherapy agents to identifying new targeted therapies.

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Research

Through the Ruesch Center for the Cure of Gastrointestinal Cancers, we're exploring new drugs or combinations that may improve the effectiveness of treatment for colon cancer and other gastrointestinal cancers. Currently, we're investigating the dramatic rise in the incidence of left-sided colon and rectal cancers in younger patients so we can take steps to reverse this trend.

Learn More

Patient stories

Support services

At MedStar Health, your care involves comprehensive support services that care for you as a whole person. Cancer affects more than just your body—it can affect your mind, spirit, finances, and more. Our goal is to help you navigate your cancer journey by meeting any need that arises. From spiritual care and counseling to nutritional support and educational resources, we're here to help, however we can.

Learn More About Cancer Support Services

Genetic counseling

Approximately five to ten percent of colon cancers are hereditary. For those that are, genetic counseling and testing can provide patients and their families with valuable information about managing their increased risk. Here, our board-certified genetic counselors offer a full range of genetic counseling services for patients who suspect inherited genetic mutations related to this type of cancer.

Learn More About Genetic Counseling

Personalized rehabilitation

Rehabilitation is important for helping you to rebuild the strength, endurance, and mobility that you had before your cancer diagnosis. Our physiatrists, physical therapists, occupational therapists, dietitians, and other specialists can help you maintain the best possible quality of life before, during, and after your surgery and treatment.

Learn More About Cancer Rehabilitation

Survivorship

We're here to help you thrive as you return to life cancer-free. Through our survivorship program, we'll continue to check in to help manage any long-term side effects and prevent cancer recurrence through a personalized plan that may involve screening and lifestyle modifications. In addition, your survivorship care team may also include counselors and psychologists who can help you process and navigate any life changes and emotions that come with recovery.

Learn More About Cancer Survivorship Program