National Colorectal Cancer Awareness Month: Promoting Early Detection and Treatment 

March marks National Colorectal Cancer Awareness Month, an annual campaign dedicated to raising awareness about colorectal cancer, a type of cancer that affects the colon and rectum. Despite being one of the most common and preventable cancers, colorectal cancer remains a significant health concern worldwide. This article aims to provide a comprehensive understanding of colorectal cancer, its symptoms, risk factors, prevention strategies, and the importance of early detection and screening. 

Understanding Colorectal Cancer 

Colorectal cancer is a type of cancer that begins in the colon or rectum, which are parts of the large intestine[1][2]. It typically starts as a non-cancerous growth called a polyp, which can develop into cancer over time if left untreated. Colorectal cancer is often referred to as colon cancer or rectal cancer, depending on the location where the cancer originates. 

Types of Colorectal Cancer 

There are several types of colorectal cancer, including[1][2][3]: 

1. Adenocarcinomas: This is the most common type, accounting for approximately 95% of all colorectal cancers. Adenocarcinomas develop from the glandular cells that line the inner surface of the colon and rectum. 
2. Mucinous Carcinomas: These cancers produce mucus and are more aggressive and harder to treat than adenocarcinomas. 
3. Signet Ring Cell Carcinomas: A rare and aggressive type of colorectal cancer characterized by distinct cell shapes under a microscope. 
4. Squamous Cell Carcinomas: These cancers arise from the flat squamous cells and are extremely rare in the colon and rectum. 

Symptoms of Colorectal Cancer 

Early-stage colorectal cancer may not present any noticeable symptoms, which is why regular screening is crucial for early detection. However, as the cancer progresses, some common symptoms may include[3]:

• Persistent changes in bowel habits, such as diarrhea, constipation, or a feeling of incomplete bowel movements. 
• Rectal bleeding or blood in the stool, which may appear bright red or dark in color. 
• Abdominal pain or discomfort, including cramps, gas, or a feeling of fullness. 
• Unexplained weight loss. 
• Fatigue or weakness. 

It’s important to note that these symptoms can also be indicative of other conditions, so it’s essential to consult a healthcare professional for proper diagnosis and treatment. 

Risk Factors for Colorectal Cancer 

Several factors can increase an individual’s risk of developing colorectal cancer. Understanding these risk factors can help in early detection and prevention[4]: 

Non-modifiable Risk Factors 

These are factors beyond an individual’s control, including: 

• Age: The risk of colorectal cancer increases with age, with most cases occurring in individuals over the age of 50. 
• Personal or Family History: People with a personal or family history of colorectal cancer, polyps, or certain inherited syndromes (such as familial adenomatous polyposis or hereditary non-polyposis colorectal cancer) have a higher risk. 
• Inflammatory Bowel Diseases: Conditions like Crohn’s disease and ulcerative colitis can increase the risk of colorectal cancer. 

Modifiable Risk Factors 

These are factors that individuals can control or modify to reduce their risk: 

• Diet: A diet high in red meat, processed meats, and low in fiber can increase the risk of colorectal cancer. 
• Obesity and Physical Inactivity: Being overweight or obese and leading a sedentary lifestyle are associated with a higher risk of colorectal cancer. 
• Smoking and Alcohol Consumption: Both smoking and excessive alcohol intake have been linked to an increased risk of colorectal cancer. 

Prevention and Early Detection 

Prevention and early detection are key in the fight against colorectal cancer. Here are some strategies that can help[5][9]:

Regular Screening 

Regular colorectal cancer screening is crucial for early detection and effective treatment. The American Cancer Society recommends that individuals at average risk for colorectal cancer begin regular screening at age 45. Several screening options are available, including: 

1. Colonoscopy: A procedure that allows a doctor to examine the entire colon and rectum using a flexible, lighted tube with a camera attached. 
2. Fecal Occult Blood Test (FOBT): A test that detects hidden blood in the stool, which can be an early sign of colorectal cancer. 
3. Sigmoidoscopy: A procedure that examines the lower portion of the colon using a flexible, lighted tube. 
4. Stool DNA Test: A non-invasive test that checks for genetic mutations in stool samples that can indicate the presence of colorectal cancer or precancerous polyps. 

Lifestyle Changes 

Adopting a healthy lifestyle can significantly reduce the risk of colorectal cancer: 

• Maintain a Healthy Diet: Eat a diet rich in fruits, vegetables, whole grains, and lean proteins, and limit the consumption of red meat, processed meats, and foods high in saturated fats. 
• Exercise Regularly: Engage in regular physical activity, aiming for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week. 
• Maintain a Healthy Weight: Achieve and maintain a healthy body weight through a balanced diet and regular exercise. 
• Limit Alcohol Consumption: Excessive alcohol consumption has been linked to an increased risk of colorectal cancer, so it’s advisable to limit or avoid alcohol. 
• Quit Smoking: Smoking is a risk factor for many types of cancer, including colorectal cancer. Quitting smoking can significantly reduce the risk. 

Treatment Options for Colorectal Cancer 

The treatment for colorectal cancer depends on various factors, including the stage and location of the cancer, the overall health of the patient, and personal preferences. Common treatment options include[5][6][7]: 

Surgery 

Surgery is often the primary treatment for colorectal cancer, especially in the early stages. The goal of surgery is to remove the cancerous tumor and nearby lymph nodes. Depending on the location and extent of the cancer, different surgical procedures may be performed, such as:

• Polypectomy: Removal of precancerous or non-cancerous polyps during a colonoscopy. 
• Colectomy: Removal of a portion of the colon. 
• Proctectomy: Removal of the rectum. 

Radiation Therapy 

Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors. It can be used before or after surgery, or in combination with chemotherapy, to improve treatment outcomes. 

Chemotherapy 

Chemotherapy involves the use of drugs to kill cancer cells and prevent their further growth and spread. It can be administered intravenously, orally, or directly into the abdominal cavity (intraperitoneal chemotherapy). 

Targeted Therapy 

Targeted therapies are newer treatments that target specific molecules involved in cancer growth and progression. These therapies are often used in combination with chemotherapy or as standalone treatments for advanced or metastatic colorectal cancer. 

Immunotherapy 

Immunotherapy harnesses the body’s immune system to fight cancer cells. Certain immunotherapy drugs, such as immune checkpoint inhibitors, have shown promising results in treating some cases of colorectal cancer. 

Advances in Colorectal Cancer Research[9] 

Colorectal cancer research has seen significant advancements in recent years, particularly in the realm of genetic testing and liquid biopsies. The COBRA trial, for instance, demonstrated the potential of circulating tumor DNA (ctDNA) testing to identify patients with stage IIA colon cancer who may benefit from additional chemotherapy after surgery. 

This approach could revolutionize post-surgery treatment decisions and improve patient outcomes. Additionally, ongoing trials are exploring the use of ctDNA in patients with stage II or III colon cancer to personalize chemotherapy based on the presence or absence of ctDNA, showcasing a move towards more targeted and effective treatment strategies. 

Furthermore, the integration of immunotherapy into colorectal cancer treatment regimens is a promising avenue of research. Studies are investigating the efficacy of immunotherapy for patients with Lynch syndrome or MSI-H colorectal cancer, aiming to provide more tailored and

effective treatment options for these specific subgroups. Combining immunotherapy with standard treatments and exploring new combinations in clinical trials offer hope for improved outcomes and a more personalized approach to colorectal cancer care. 

These advancements underscore the ongoing commitment of NCI-funded researchers to enhance the prevention, detection, and treatment of colorectal cancer through innovative research initiatives. 

Statistics and Clinical Trials in Colorectal Cancer Research[9] 

Colorectal cancer affects a significant portion of the population, with approximately 3% or less of individuals with advanced colorectal cancer having tumors that overexpress the HER2 protein. In the MOUNTAINEER clinical trial, more than one-third of patients who received the drug combination of ib (Tukysa) and trastuzumab (Herceptin) experienced tumor shrinkage or disappearance, highlighting the potential efficacy of targeted therapies in this subset of patients[9]. 

Clinical trials play a crucial role in advancing colorectal cancer research. Ongoing trials are investigating the use of liquid biopsies, such as ctDNA testing, to personalize treatment decisions for patients with stage II or III colon cancer. Additionally, studies are exploring the integration of immunotherapy, like atezolizumab, in combination with chemotherapy for patients with defective DNA mismatch repair or earlier-stage disease. 

These trials aim to improve treatment outcomes, expand treatment options, and enhance the overall management of colorectal cancer through innovative approaches and personalized medicine strategies. 

Survivorship and Quality of Life 

Colorectal cancer survivors may face various physical, emotional, and practical challenges after treatment. It’s essential to address these challenges to improve overall quality of life: 

• Physical Challenges: Treatment side effects, such as fatigue, pain, and changes in bowel function, can impact daily activities and physical well-being. 
• Emotional and Mental Health: Dealing with a cancer diagnosis and treatment can be emotionally taxing, leading to anxiety, depression, and stress. 
• Nutrition and Diet: Maintaining a balanced and nutritious diet can be challenging during and after treatment, but it’s crucial for recovery and overall health. 
• Social and Financial Support: Cancer treatment can be financially burdensome, and social support is essential for coping and maintaining well-being.

Support services, counseling, and survivorship programs can help cancer survivors navigate these challenges and improve their quality of life. 

A German Cohort Study On Health-Related Quality Of Life In Long-Term Survivors Of Colorectal Cancer And Its Association With All-Cause Mortality 

Here is a summary of the key parts of the study[8]: 

Stats: 

• 1294 long-term CRC survivors completed the EORTC QLQ-C30 HRQOL questionnaire on average 6 years post-diagnosis 
• Median HRQOL summary score was 87.3 
• 175 participants died during median 7 year follow-up 

Findings: 

• HRQOL was relatively high in the long-term, though slightly lower than general populations 
• Older age, lower education, rectal tumors, metastases, other cancers, chemo+radiation, and stoma were associated with lower HRQOL 
• Higher HRQOL summary scores and global/functional scales and lower symptom scales were associated with reduced mortality risk 
• The HRQOL-mortality association was stronger in those without chemo/radiation and with higher education 

Conclusion: 

• Various socio-demographic and clinical factors affected HRQOL cross-sectionally in long-term CRC survivors 
• Lower HRQOL prospectively predicted higher mortality 
• Monitoring HRQOL and individualized survivorship care, including interventions, may help further improve long-term outcomes 

Based on the findings of the study, here are some recommendations[8]: 

1. Routinely monitor HRQOL in long-term CRC survivor clinics and populations. Tracking changes over time can help identify those at risk of deteriorating HRQOL. 2. Develop targeted interventions to improve HRQOL domains negatively affected by certain clinical/socioeconomic risk factors identified, such as having a stoma or lower education. 
2. Incorporate psychosocial screening and support services into standard survivorship care plans. Providing resources for managing symptoms like fatigue can help boost HRQOL.
3. Evaluate HRQOL as a potential prognostic indicator. Identifying those with low scores may help stratify follow-up and tailor preventive efforts. 
4. Conduct randomized trials to test the effectiveness of various HRQOL intervention programs, such as exercise, education or counseling. This could help establish best practices. 
5. Expand longitudinal research to clarify relationships over time, including potential bidirectional effects between HRQOL and health outcomes. 
6. Collect detailed clinical data like comorbidities, recurrence and stage to better control for health status influences on HRQOL and survival associations. 
7. Replicate findings in more socioeconomically and ethnically diverse CRC survivor populations to strengthen generalizability. 

Conclusion 

National Colorectal Cancer Awareness Month serves as a reminder of the importance of early detection, prevention, and treatment of colorectal cancer. By raising awareness and promoting regular screening, healthy lifestyle habits, and timely medical care, we can work towards reducing the burden of this disease and improving patient outcomes. Together, we can make a difference in the fight against colorectal cancer. 

References: 

[1] What Is Colorectal Cancer? 2024, 

www.cdc.gov/cancer/colorectal/basic_info/what-is-colorectal-cancer.htm. 

[2] “What Is Colorectal Cancer? | How Does Colorectal Cancer Start?” Cancer.org, 2024, www.cancer.org/cancer/types/colon-rectal-cancer/about/what-is-colorectal-cancer.html. 

[3] What Are the Symptoms of Colorectal Cancer? 2024, 

www.cdc.gov/cancer/colorectal/basic_info/symptoms.htm. 

[4] “Colorectal Cancer Risk Factors | Hereditary Colorectal Risk Factors.” Cancer.org, 2024, www.cancer.org/cancer/types/colon-rectal-cancer/causes-risks-prevention/risk-factors.html. 

[5] “Colorectal Cancer Prevention.” National Cancer Institute, Cancer.gov, 25 Oct. 2023, www.cancer.gov/types/colorectal/patient/colorectal-prevention-pdq. 

[6] “8IGHTWAYS® Prevent Colon Cancer | Siteman Cancer Center.” Siteman Cancer Center, 6 Feb. 2024, siteman.wustl.edu/prevention/8-ways/8-ways-to-prevent-colon-cancer/. 

[7] “Colon Cancer Treatment.” National Cancer Institute, Cancer.gov, 6 Apr. 2022, www.cancer.gov/types/colorectal/patient/colon-treatment-pdq.

[8] Ratjen, Ilka et al. “Health-related quality of life in long-term survivors of colorectal cancer and its association with all-cause mortality: a German cohort study.” BMC cancer vol. 18,1 1156. 22 Nov. 2018, doi:10.1186/s12885-018-5075-1 

[9] “Advances in Colorectal Cancer Research.” National Cancer Institute, Cancer.gov, 4 Mar. 2024, www.cancer.gov/types/colorectal/research.