Colorectal Cancer

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What it is Colorectal Cancer?

 

According to the America Cancer Society, colorectal Cancer is the third most common cancer diagnoses in men and women in the United States. The American Cancer Society estimates the number of colorectal cancers in the United States for 2023 are 106,970 new cases of colon cancer and 46,050 new cases of rectal cancer. Colorectal cancers are expected to cause about 52,550 deaths during 2023. 

 

Colorectal Cancer starts in the colon or rectum (also called colon cancer or rectal cancer depending on where the cancer starts). These cancers are grouped together because they have a lot of features in common. Most colorectal cancers are adenocarcinomas. When doctors talk about colorectal cancer, they’re usually talking about this type.  

 

Other types of tumors can also start in the colon and rectum. These include: 

  • Carcinoid tumors 
  • Gastrointestinal stromal tumors (GISTs) 
  • Lymphomas 
  • Sarcomas  

Why is screening important?

 

Colorectal cancer screenings has lowered the overall colorectal cancer death rate the last several decades. In the last decade, improvements in colorectal cancer treatment have increased survival rates. 

 

Colonoscopies allow doctors to remove suspicious polyps before they become cancerous during screenings and screenings help detect cancers early when they are easier to treat.

 

According to the ACS the five-year relative survival rate for colon or rectal cancer is 80%. This means that people who have colorectal cancer are about 80% as likely to live at least five years after diagnosis as people who don’t have that cancer. This can also give you a better understanding of how likely treatment will be successful.

Screening for Colorectal Cancers  

 

Colonoscopies are often the type of colorectal preventative screenings most people think about, but they aren’t your only option. There are stool-based tests and other visual (structural) exams.  

These are the most common forms of colorectal cancer screening tests 

Colonoscopy

The doctor uses a long, thin, flexible, lighted tube to look for polyps and cancer inside the rectum and entire colon. During this test, the doctor can remove suspicious polyps and cancers. Colonoscopies may also be used as a follow up test for other tests in this list. 

  

You should get a colonoscopy every 10 years unless otherwise instructed by your care team. 

CT colonography (virtual colonoscopy)

This test uses x-rays of the entire colon. It’s also considered a “virtual colonoscopy.” 

  

Virtual colonoscopies should be repeated every five years. 

Flexible sigmoidoscopy

This test is similar to a colonoscopy, but instead flexible sigmoidoscopy only screens in the rectum and lower third of the colon. 

  

Flexible sigmoidoscopies should be repeated every five years. 

Stool tests

There are three types of stool-test: guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), and the FIT-DNA test.  

  

These tests check for blood or altered DNA in stool samples. 

  

How often should these tests be repeated? 

  • Highly sensitive fecal immunochemical test (FIT) every year  
  • Highly sensitive guaiac-based fecal occult blood test (gFOBT) every year  
  • Multi-targeted stool DNA test (mt-sDNA) every three years 
What is the difference between screening with a stool-based test and a colonoscopy?

Stool tests are DNA tests that detect cell changes or blood in the stool that may be caused by cancerous or precancerous polyps. Colonoscopies can prevent cancer from developing by removing polyps and can detect cancer at an early stage. 

Who should screen for colorectal cancer? 

 

All adults between ages 45 and 75 should regularly screen for colorectal cancer.  

 

Men have a 1 in 23 risk for developing colorectal cancer in their lifetime and women have a 1 in 26 risk. Each person’s risk may be higher or lower depending on their personal risk. 

 

The ACS says that people of average risk should start screening for colorectal cancer at age 45. People who are in good health with a life expectancy of more than 10 years should continue regular screening through age 75. Screening over the age of 75 should be based on personal choice and health history. 

 

People who are at increased risk for colorectal cancer should talk to their doctor about screening. 

People at average risk for colorectal cancer: 

 

  • Do not have a personal history of colorectal cancer or certain types of polyps. 
  • Do not have a family history of colorectal cancer. 
  • Do not have a history of inflammatory bowel disease, ulcerative colitis, or Chron’s disease. 
  • Do not have confirmed or suspected hereditary colorectal cancer syndrome (Familial adenomatous polyposis or Lynch Syndrome). 
  • Do not have a personal history of prior cancer that was treated with radiation to the abdomen or pelvic area. 

Insurance coverage for colorectal cancer screening

 

The Affordable Care Act (ACA) requires private insurers and Medicare to cover the costs of colorectal screening tests because these tests are recommended by the United States Preventative Services Task Force. The ACA states that there should be no out-of-pocket costs for patients like copays or deductibles. This law covers a range of colorectal cancer screening tests, not just colonoscopies.

 

Some private insurance companies may cover the cost of the screening test, but not other services rendered during the screening or screenings done by out-of-network providers. You should review your health insurance plan and call your insurer if you aren’t sure about what is covered.