Colorectal Cancer Screening

What is screening?

Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.

Scientists are trying to better understand which people are more likely to get certain types of cancer. They also study the things we do and the things around us to see if they cause cancer. This information helps doctors recommend who should be screened for cancer, which screening tests should be used, and how often the tests should be done.

It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test. Screening tests are given when you have no cancer symptoms. Screening tests may be repeated on a regular basis.

If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.

Colorectal cancer is a disease in which malignant (cancer) cells form in the tissues of the colon or the rectum.

The colon and rectum are parts of the body's digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The digestive system is made up of the mouth, throat,esophagus, stomach, and the small and large intestines. The colon (large bowel) is the first part of the large intestine and is about 5 feet long. Together, the rectum and anal canal make up the last part of the large intestine and are 6-8 inches long. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).

Anatomy of the lower digestive system, showing the colon and other organs.

Cancer that begins in the colon is called colon cancer, and cancer that begins in the rectum is called rectal cancer. Cancer that begins in either of these organs may also be called colorectal cancer.

Colorectal cancer is the second leading cause of death from cancer in the United States.

The number of new colorectal cancer cases and the number of deaths from colorectal cancer are decreasing a little bit each year. But in adults younger than 50 years, there has been a small increase in the number of new cases each year since 1998. Colorectal cancer is found more often in men than in women.

Age and health history can affect the risk of developing colon cancer.

Anything that increases a person's chance of getting a disease is called a risk factor. Risk factors for colorectal cancer include the following:

• Being older than 50 years of age.


• Having a personal history of any of the following:
  
  
  
  • Colorectal cancer.
  
  
  • Polyps in the colon or rectum.
  
  
  • Cancer of the ovary, endometrium, or breast.
  
  
  • Ulcerative colitis or Crohn disease.
  
  
  
  

Polyps in the colon. Some polyps have a stalk and others do not. Inset shows a photo of a polyp with a stalk.

• Having a parent, brother, sister, or child with colorectal cancer.


• Having certain hereditary conditions, such as familial adenomatous polyposis (FAP) and hereditary nonpolyposis colon cancer (HNPCC; Lynch Syndrome).

Screening tests have risks.

Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying from cancer.

False-negative test results can occur.

Screening test results may appear to be normal even though colorectal cancer is present. A person who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if there are symptoms.

False-positive test results can occur.

Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn't) can cause anxiety and is usually followed by more tests (such as biopsy), which also have risks.

The following colorectal cancer screening tests have risks:

Fecal occult blood testing

The results of fecal occult blood testing may appear to be abnormal even though no cancer is present. A false-positive test result can cause anxiety and lead to more testing, including colonoscopy or barium enema with sigmoidoscopy.

Sigmoidoscopy

There can be discomfort or pain during sigmoidoscopy. Women may have more pain during the procedure, which may lead them to avoid future screening. Tears in the lining of the colon and bleeding also may occur.

Colonoscopy

Serious complications from colonoscopy are rare, but can include tears in the lining of the colon, bleeding, and problems with the heart or blood vessels. These complications may occur more often in older patients.

Virtual colonoscopy

Virtual colonoscopy often finds problems with organs other than the colon, including the kidneys, chest,liver, ovaries, spleen, and pancreas. Some of these findings lead to more testing. The risks and benefits of this follow-up testing are being studied.

Your doctor can advise you about your risk for colorectal cancer and your need for screening tests.

Tests are used to screen for different types of cancer.

Some screening tests are used because they have been shown to be helpful both in finding cancers early and decreasing the chance of dying from these cancers. Other tests are used because they have been shown to find cancer in some people; however, it has not been proven in clinical trials that use of these tests will decrease the risk of dying from cancer.

Scientists study screening tests to find those with the fewest risks and most benefits. Cancer screening trials also are meant to show whether early detection (finding cancer before it causes symptoms) decreases a person's chance of dying from the disease. For some types of cancer, finding and treating the disease at an early stage may result in a better chance of recovery.

Clinical trials that study cancer screening methods are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site.

Studies show that screening for colorectal cancer helps decrease the number of deaths from the disease.

Four tests are used to screen for colorectal cancer:

Fecal occult blood test

A fecal occult blood test (FOBT) is a test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing. Blood in the stool may be a sign of polyps or cancer.

Fecal Occult Blood Test (FOBT) kit to check for blood in stool.

A new colorectal cancer screening test called immunochemical FOBT (iFOBT) is being studied to see if it is better at finding advanced polyps or cancer than the FOBT.

Sigmoidoscopy

Sigmoidoscopy is a procedure to look inside the rectum and sigmoid (lower) colon for polyps, abnormal areas, or cancer. A sigmoidoscope is inserted through the rectum into the sigmoid colon. A sigmoidoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.

Sigmoidoscopy. A thin, lighted tube is inserted through the anus and rectum and into the lower part of the colon to look for abnormal areas.

Barium enema

A barium enema is a series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.

Barium enema procedure. The patient lies on an x-ray table. Barium liquid is put into the rectum and flows through the colon. X-rays are taken to look for abnormal areas.

 Colonoscopy

Colonoscopy is a procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope is inserted through the rectum into the colon. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.

Colonoscopy. A thin, lighted tube is inserted through the anus and rectum and into the colon to look for abnormal areas.

Studies have not shown that screening for colorectal cancer using digital rectal exam helps decrease the number of deaths from the disease.

A digital rectal exam (DRE) may be done as part of a routine physical exam. A digital rectal exam is an exam of the rectum. A doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual. Study results have shown that there is no evidence to support DRE as a screening method for colorectal cancer.

New screening tests are being studied in clinical trials.

Virtual colonoscopy

Virtual colonoscopy is a procedure that uses a series of x-rays called computed tomography to make a series of pictures of the colon. A computer puts the pictures together to create detailed images that may show polyps and anything else that seems unusual on the inside surface of the colon. This test is also called colonography or CT colonography. Clinical trials are comparing virtual colonoscopy with commonly used colorectal cancer screening tests. Other clinical trials are testing whether drinking acontrast material that coats the stool, instead of using laxatives to clear the colon, shows polyps clearly.

DNA stool test

This test checks DNA in stool cells for genetic changes that may be a sign of colorectal cancer.

Screening clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site.