Colorectal cancer is the third most common cancer in the United States. It is estimated that in 2024 there will be over 81,000 new cases of colorectal cancer in men and 72,000 cases in women. Of those, almost 29,000 men and 27,000 women will die from the disease. However, the good news is that colorectal cancer is highly preventable with proper screening.
Screening tests can detect precancerous polyps in the colon and rectum, which can be removed before they turn into cancer. In addition, screening can detect colorectal cancer early, when it is most treatable. The American Cancer Society recommends that people at average risk of colorectal cancer begin regular screening at age 45. Those with a family history of colorectal cancer or other risk factors may need to start screening earlier or be screened more frequently.
Key Takeaways:
- Colorectal cancer is highly preventable with proper screening.
- Screening tests can detect precancerous polyps and colorectal cancer early, when it is most treatable.
- The American Cancer Society recommends that people at average risk of colorectal cancer begin regular screening at age 45.
What is Colorectal Cancer
Definition and Statistics
Colorectal cancer is a type of cancer that develops in the colon or rectum, which are part of the large intestine. It usually starts as a noncancerous growth called a polyp, but over time, it can develop into a cancerous tumor. According to the American Cancer Society, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, with an estimated 149,500 new cases and 52,980 deaths in 2021 alone.
Risk Factors and Prevention
Several factors can increase a person's risk of developing colorectal cancer, including age, family history, and certain genetic syndromes such as familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC). Other risk factors include a diet high in red and processed meats, smoking, and heavy alcohol consumption. However, many cases of colorectal cancer occur in people with no known risk factors.
Prevention of colorectal cancer involves making lifestyle changes that can reduce the risk of developing the disease. These include maintaining a healthy weight, exercising regularly, limiting alcohol consumption, and following a diet that is high in fiber and low in red and processed meats. Regular screening is also essential for detecting and preventing colorectal cancer.
Symptoms and Early Detection
In the early stages, colorectal cancer may not cause any symptoms. As the cancer grows, however, it can cause symptoms such as rectal bleeding, changes in bowel habits, abdominal pain, and unintended weight loss. These symptoms can also be caused by other conditions, so it is essential to consult a doctor if any of these symptoms persist.
Early detection of colorectal cancer is crucial for successful treatment. Screening tests can detect polyps and other abnormalities in the colon and rectum before they develop into cancer. The American Cancer Society recommends that people at average risk of colorectal cancer begin regular screening at age 45. People with a family history of colorectal cancer or other risk factors may need to begin screening earlier or undergo more frequent screening. Screening options include colonoscopy, fecal immunochemical test (FIT), and stool DNA test.
In summary, colorectal cancer is a type of cancer that develops in the colon or rectum and can be prevented through lifestyle changes and regular screening. Knowing the risk factors and symptoms of colorectal cancer can help individuals take steps to reduce their risk of developing the disease and detect it early.
Screening Tests Overview
Colorectal Cancer Screening ICD 10 Code
The ICD-10 code for colorectal cancer screening is Z12.11. This code is used to indicate that the patient is undergoing screening for colorectal cancer, even if no abnormalities are found.
Types of Screening Tests
There are several types of screening tests for colorectal cancer. These include:
- Colonoscopy: This is the most common screening test for colorectal cancer. It involves inserting a flexible tube with a camera into the rectum and colon to look for abnormalities.
- Fecal immunochemical test (FIT): This test checks for blood in the stool, which can be a sign of colorectal cancer.
- Stool DNA test: This test checks for DNA changes in the stool that may indicate the presence of colorectal cancer.
- CT colonography: This test uses a CT scan to create images of the colon to look for abnormalities.
- Sigmoidoscopy: This test involves inserting a flexible tube with a camera into the rectum and lower colon to look for abnormalities.
- Guaiac-based fecal occult blood test (gFOBT) and fecal occult blood test (FOBT): These tests check for blood in the stool, which can be a sign of colorectal cancer.
Comparing Test Efficacy
Each screening test has its advantages and disadvantages. Colonoscopy is the most effective test for detecting colorectal cancer, but it is also the most invasive. Stool-based tests, such as FIT and stool DNA tests, are less invasive but may be less accurate. CT colonography and sigmoidoscopy are also effective but may not be as widely available.
Screening Guidelines
The U.S. Preventive Services Task Force (USPSTF) recommends that adults aged 50 to 75 years be screened for colorectal cancer. The American Cancer Society recommends starting screening at age 45 for people at average risk of colorectal cancer. People with a family history of colorectal cancer or other risk factors may need to start screening earlier and more frequently.
It is important to talk to a healthcare provider about which screening test is right for you and when to start screening. Regular screening can help detect colorectal cancer early, when it is most treatable.
Preparation and Procedure
Before the Test
Before undergoing a colorectal cancer screening test, the patient needs to prepare for the procedure. The preparation process usually involves cleansing the colon to ensure that the doctor gets a clear view of the colon and rectum during the test. There are different bowel prep methods, and the doctor will provide instructions on which method to use. The bowel prep method may include a liquid diet, laxatives, or enemas.
For colonoscopy and sigmoidoscopy, the patient may need to stop taking certain medications that can increase the risk of bleeding during the procedure. The doctor will provide instructions on which medications to avoid and for how long.
During the Test
The procedure for colorectal cancer screening depends on the type of test being performed. For colonoscopy and sigmoidoscopy, the patient will be given a sedative to help them relax during the procedure. The doctor will then insert a long, flexible tube with a camera called a colonoscope or sigmoidoscope into the rectum to examine the colon and rectum for any abnormalities. The procedure usually takes 30 minutes to an hour.
For virtual colonoscopy, the patient will lie on a table while a CT scanner takes images of the colon and rectum. The procedure usually takes 10 to 15 minutes.
After the Test
After the colorectal cancer screening test, the patient may experience some mild discomfort, bloating, or cramping. The doctor will provide instructions on when the patient can resume their normal activities and when they can eat and drink again.
Complications from colorectal cancer screening tests are rare but can occur. The risks of colonoscopy include bleeding, infection, and perforation. However, complications occur in only 1 out of 1,000 colonoscopies at UCLA Health [UCLA Health]. The risks of virtual colonoscopy include radiation exposure, but the amount of radiation is low and not considered harmful [CDC]. If any complications occur, the patient should contact their doctor immediately.
In summary, preparation for a colorectal cancer screening test involves cleansing the colon, stopping certain medications, and following the doctor's instructions. During the test, the patient will undergo either a colonoscopy, sigmoidoscopy, or virtual colonoscopy. After the test, the patient may experience mild discomfort and should follow the doctor's instructions for resuming normal activities.
Screening for Specific Populations
Average-Risk Adults
For average-risk adults, screening for colorectal cancer is recommended starting at age 50 and continuing until age 75. The most common screening tests include colonoscopy, fecal immunochemical tests (FIT), and stool DNA tests. The choice of test depends on patient preference, availability, and other factors. The US Preventive Services Task Force recommends that average-risk adults undergo screening for colorectal cancer every 10 years using colonoscopy or every one to three years using FIT or stool DNA tests.
High-Risk Individuals
Individuals with an increased risk of colorectal cancer, such as those with a family history of colorectal cancer, should begin screening at an earlier age and undergo more frequent screening. High-risk individuals may also need to undergo more extensive screening, such as a colonoscopy with biopsies to look for precancerous polyps. The American Cancer Society recommends that individuals with a family history of colorectal cancer begin screening at age 40 or 10 years earlier than the age at which their relative was diagnosed, whichever comes first.
Screening in Older Adults
For older adults with a life expectancy of less than 10 years, screening for colorectal cancer may not be necessary. However, for those with a longer life expectancy, screening can be beneficial in detecting and preventing colorectal cancer. The US Preventive Services Task Force recommends that adults between the ages of 76 and 85 undergo screening for colorectal cancer on an individualized basis, taking into account their overall health and previous screening history.
In summary, screening for colorectal cancer is recommended for both men and women, with the choice of screening test depending on patient preference and other factors. For average-risk adults, screening should begin at age 50 and continue until age 75, while high-risk individuals and older adults may need to undergo more frequent or extensive screening. By following these guidelines, individuals can reduce their risk of developing colorectal cancer and improve their overall health.
Insurance and Cost Considerations
Colorectal cancer screening is an essential test that helps detect cancer early. However, it is important to consider the cost of screening, especially for those who do not have health insurance.
Fortunately, the Affordable Care Act (ACA) requires both private insurers and Medicare to cover the costs of colorectal cancer screening tests, because these tests are recommended by the United States Preventive Services Task Force (USPSTF) [1]. This means that most health insurance plans cover the cost of screening.
Coverage varies across insurers, and depending on the plan, patients may be responsible for their deductible and any co-insurance costs [2]. It is important for patients to check with their insurance plan to find out what benefits are covered for colorectal cancer screening.
For high-risk patients, screening is called surveillance rather than screening. The American Cancer Society provides information about insurance coverage for colorectal cancer screening [3].
Patients who do not have health insurance and cannot afford screening may be eligible for free or low-cost screening through various programs. The National Colorectal Cancer Roundtable provides a list of programs that offer free or low-cost screening [4].
In summary, cost should not be a barrier to colorectal cancer screening. The Affordable Care Act requires most health insurance plans to cover the cost of screening, and there are programs available for those who do not have health insurance. Patients should check with their insurance plan or healthcare provider to determine their eligibility for screening and the associated costs.
[1] https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/screening-coverage-laws.html [2] https://fightcolorectalcancer.org/colorectal-cancer-screening/ [3] https://www.cdc.gov/cancer/colorectal/basic_info/screening/index.htm [4] https://nccrt.org/resource/free-colorectal-cancer-screening-resources/
Interpreting Test Results
After completing a colorectal cancer screening test, patients receive the results within a few weeks. It is important to understand the results and what they mean for follow-up care and treatment.
Positive Results and Follow-Up
If a patient receives a positive result, it means that blood or abnormal cells were found in their stool sample. A positive result does not necessarily mean that the patient has cancer, but it does warrant further testing. The patient's doctor will recommend a timely colonoscopy to determine if cancer or precancerous polyps are present. It is important that patients follow through with their doctor's recommendations for follow-up care to ensure timely detection and treatment if necessary.
False Positives and Negatives
Colorectal cancer screening tests are not perfect, and there is a chance of false-positive or false-negative test results. A false-positive test result occurs when the test indicates the presence of cancer or precancerous polyps, but further testing shows that no cancer or precancerous polyps are present. A false-negative test result occurs when the test indicates that no cancer or precancerous polyps are present, but further testing shows that cancer or precancerous polyps are present. It is important for patients to understand the possibility of false-positive and false-negative test results and to follow their doctor's recommendations for follow-up care.
Impact of Results on Treatment
The results of a colorectal cancer screening test can impact the patient's treatment plan. If cancer or precancerous polyps are detected, the patient's doctor will recommend treatment options such as surgery, radiation therapy, or chemotherapy. If the test results are negative, the patient may still be at risk for developing colorectal cancer in the future and should continue with regular screening.
In conclusion, understanding the results of a colorectal cancer screening test is important for follow-up care and treatment. Patients should follow their doctor's recommendations for further testing and treatment if necessary. False-positive and false-negative test results are possible, and patients should be aware of these possibilities. The results of the screening test can impact the patient's treatment plan, and regular screening is important for early detection and treatment of colorectal cancer.
Advancements in Screening
Colorectal cancer screening has undergone significant advancements in recent years, thanks to emerging technologies and clinical trials and research. These advancements have led to the development of new screening methods that are more accurate, less invasive, and more convenient for patients.
Emerging Technologies
One of the most promising emerging technologies in colorectal cancer screening is DNA biomarkers. These biomarkers can be detected in stool samples and can help identify patients who may be at a higher risk of developing colorectal cancer. The FIT-DNA test, for example, combines the fecal immunochemical test (FIT) with DNA analysis to provide a more accurate screening result. Studies have shown that the FIT-DNA test is more effective in detecting colorectal cancer and precancerous polyps than FIT alone.
Another emerging technology in colorectal cancer screening is the use of CT scans. CT colonography is a non-invasive screening method that uses a CT scan to create detailed images of the colon and rectum. This method is less invasive than a traditional colonoscopy and does not require sedation. However, it may not be suitable for patients with certain medical conditions, such as inflammatory bowel disease.
Clinical Trials and Research
Clinical trials and research have also led to the development of new screening methods for colorectal cancer. One such method is the Cologuard test, which analyzes stool samples for DNA biomarkers and blood. The test has been shown to be highly effective in detecting colorectal cancer and precancerous polyps, and it is less invasive than a traditional colonoscopy.
Another area of research in colorectal cancer screening is the use of artificial intelligence (AI) and machine learning. These technologies can help analyze large amounts of data and identify patterns that may be indicative of colorectal cancer. Researchers are also exploring the use of blood tests to detect colorectal cancer, although this method is still in the early stages of development.
In conclusion, advancements in screening for colorectal cancer have led to the development of new, more accurate, and less invasive screening methods. Emerging technologies such as DNA biomarkers and CT scans, as well as clinical trials and research, have played a significant role in these advancements. As research continues, it is likely that even more effective screening methods will be developed, leading to earlier detection and better outcomes for patients.
Living with Colorectal Cancer
After a colorectal cancer diagnosis, patients may feel overwhelmed and uncertain about their future. However, it is important to remember that colorectal cancer is treatable, and with proper care, many patients can go on to live long, healthy lives.
After Diagnosis
After being diagnosed with colorectal cancer, patients will work with their healthcare team to develop a treatment plan. Treatment options may include surgery, chemotherapy, radiation therapy, or a combination of these treatments. The specific treatment plan will depend on the stage and location of the cancer, as well as the patient's overall health.
Following treatment, patients will need to have regular follow-up appointments with their healthcare team to monitor their condition and ensure that the cancer has not returned. These appointments may include physical exams, blood tests, imaging tests, and other diagnostic tests.
Support and Resources
Living with colorectal cancer can be challenging, both physically and emotionally. Patients may find it helpful to join a support group or seek out other resources to help them cope with their diagnosis and treatment. Support groups can provide a safe and supportive environment for patients to share their experiences, ask questions, and connect with others who are going through similar challenges.
There are also many resources available to help patients and their families navigate the complex world of cancer care. These resources may include educational materials, financial assistance programs, and referrals to other healthcare providers and support services.
In addition, patients should be aware of the signs and symptoms of colorectal cancer recurrence, as well as the risk factors for cancer death. By staying informed and working closely with their healthcare team, patients can take an active role in their care and improve their chances of a successful recovery.
Frequently Asked Questions
What are the recommended guidelines for colorectal cancer screening?
The American Cancer Society recommends that individuals at average risk of developing colorectal cancer start regular screening at age 45. The screening can be done either with a sensitive test that looks for signs of cancer in a person's stool (a stool-based test), or with an exam that looks at the colon and rectum (a visual exam). People with a family history of colorectal cancer or other risk factors may need to start screening earlier or more frequently.
At what age should individuals start colorectal cancer screening?
Most people should begin screening for colorectal cancer soon after turning 45, then continue getting screened at regular intervals. However, individuals with a family history of colorectal cancer or other risk factors may need to start screening earlier or more frequently.
What are alternative tests to a colonoscopy for colorectal cancer screening?
There are several alternative tests to a colonoscopy for colorectal cancer screening. These include stool-based tests, such as the fecal immunochemical test (FIT) or the guaiac-based fecal occult blood test (gFOBT), and imaging tests, such as a CT colonography or a flexible sigmoidoscopy. The choice of test depends on the individual's preference, medical history, and risk factors.
How does family history affect colorectal cancer screening guidelines?
Individuals with a family history of colorectal cancer or other risk factors may need to start screening earlier or more frequently. The American Cancer Society recommends that individuals with a first-degree relative (parent, sibling, or child) who has had colorectal cancer or an adenomatous polyp before age 60 start regular screening at age 40, or 10 years before the age at which the youngest affected relative was diagnosed, whichever is earlier.
What are the early warning signs of colorectal cancer?
The early warning signs of colorectal cancer include changes in bowel habits (such as diarrhea or constipation), rectal bleeding or blood in the stool, abdominal pain or cramping, and unexplained weight loss. However, these symptoms can also be caused by other conditions, so it is important to talk to a doctor if any of these symptoms persist for more than a few days.
How can I find a colorectal cancer screening facility near me?
Individuals can find a colorectal cancer screening facility near them by contacting their primary care physician or using the American Cancer Society's online tool to find a screening facility in their area. It is important to talk to a doctor about the best screening options based on individual risk factors and medical history.