Colorectal cancer is the second most common cause of cancer-related deaths in the United States, with only lung cancer causing more fatalities. According to the NIH’s National Cancer Institute, an estimated 152,810 people in the United States were diagnosed with colon or rectal cancer in 2024, and approximately 53,010 lost their lives to the disease.

Colorectal cancer is a disease in which malignant, or cancerous, cells form in the tissues of the colon or the rectum. The colon and rectum are parts of the body's digestive system, which removes and processes nutrients from foods and helps pass waste material out of the body. The colon – or 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.

Approximately 4% of men and women will be diagnosed with colorectal cancer at some point during their lifetime. However, different factors can increase or decrease the risk of getting colorectal cancer. Anything that increases your chance of getting a disease is called a risk factor. Anything that decreases your chance of getting a disease is called a protective factor.

The following risk factors increase the risk of colorectal cancer:

• Age.
• The risk of colorectal cancer increases after age 50, and most cases of colorectal cancer are diagnosed after age 50.
• Family history of colorectal cancer.
• Having a parent, brother, sister or child with colorectal cancer doubles an individual’s risk of colorectal cancer.
• Personal history.
• Having a personal history of previous colorectal cancer, high-risk adenomas, ovarian cancer or inflammatory bowel disease increases the risk of colorectal cancer.
• Inherited risk.
• The inheritance of certain gene changes linked to familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon cancer (HNPCC or Lynch Syndrome) increases the risk of colorectal cancer.
• Alcohol.
• Drinking three or more alcoholic beverages per day increases the risk of colorectal cancer. Drinking alcohol is also linked to the risk of large colorectal adenomas – or benign tumors.
• Cigarette smoking.
• Cigarette smoking is linked to an increased risk of colorectal cancer and death from colorectal cancer. Smoking cigarettes is also linked to an increased risk of forming colorectal adenomas. Cigarette smokers who have had surgery to remove colorectal adenomas are at an increased risk for the adenomas to recur – or come back.
• Race.
• Black individuals have an increased risk of colorectal cancer and death from colorectal cancer compared to other races.
• Obesity.
• Obesity is linked to an increased risk of colorectal cancer and death from colorectal cancer.

Colorectal cancer is being diagnosed more frequently in people under 50, a pattern known as “early-onset” colorectal cancer. Since 1994, the incidence of these cases has been increasing by about 2% annually.

“The recommended age for screening is now younger, which is great news,” said Carla Justiniano, MD, MPH, a clinical researcher at the Cancer Center and assistant professor in the Department of Surgery. “45 is the new 50, so any patient aged 45 or older qualifies for a screening regardless of family history.”

Carla Justiniano, MD, MPH Associate Member, Experimental Therapeutics Pathways Research Program University of Cincinnati Cancer Center Assistant Professor, Division of Colon & Rectal Surgery Department of Surgery, University of Cincinnati College of Medicine

Tests are used to screen for various types of cancer when a person does not have symptoms. Studies show that some screening tests for colorectal cancer help find cancer at an early stage and might decrease the number of deaths from the disease.

The following types of tests are used to screen for colorectal cancer:

• Fecal occult blood test.
• Sigmoidoscopy.
• Colonoscopy.
• DNA stool test.

“While stool tests are fairly effective at detecting existing colon cancers, they are less reliable at identifying advanced polyps, which could potentially develop into cancer,” Justiniano explained. “Colonoscopies detect both cancers and polyps, and any polyps found can be removed during the procedure, preventing them from ever turning into cancer. Think of it as a preventive ‘tune-up’ for your colon. Plus, colonoscopies are not painful – you’ll be comfortably sedated, take a short nap and wake up when it’s done.”

In 2024, the Cancer Center’s Office of Community Outreach & Engagement (COE) distributed educational materials on colorectal cancer at 34 community outreach events. Additionally, the COE Office facilitated a meeting between Inuk Zandvakili, MD, PhD – a specialist in the treatment of gastrointestinal disorders and weight management – and the Cancer Center’s Community Advisory Board to review and improve the preparation materials given to patients scheduled to undergo a colonoscopy.

Dr. Zandvakili aimed to address a common issue in clinical practice – when colonoscopy preparation is done incorrectly, the procedure must be canceled and rescheduled. However, many patients do not follow through with rescheduling, leading to lower adherence to colorectal cancer screening guidelines. The Community Advisory Board provided valuable feedback to make the preparation instructions more patient-friendly, clear and easy to follow.

Upon diagnosis, different types of treatments are available for those with colorectal cancer. Patients will work together with their cancer care team to decide the treatment plan, which could include more than one type of treatment, and many factors will be considered, such as the stage of the cancer, the patient’s overall health and the patient's preferences.

The following types of treatment may be considered:

• Surgery.
• Radiation therapy.
• Chemotherapy.
• Chemoradiation therapy.
• Targeted therapy.
• Immunotherapy.

“Immunotherapy is now used for an increasing number of indications for patients with susceptible mutations and characteristics that would’ve otherwise just gotten chemotherapy,” Justiniano said. “Remember that not all colorectal cancers need chemotherapy. Often, early cancers can just be cured by removing the affected portion.”