A new era for colon cancer testing and treatment
Chaoyuan Kuang, MD, PhD, Co-Leader, GI Clinical and Translational Research, at Montefiore Einstein Comprehensive Cancer Center, and Othon Wiltz, MD, Colon and Rectal Surgeon, for Montefiore Einstein
Colon cancer is on the rise in younger people, which is why testing guidelines recommend testing starting at 45 for those at average risk. To stop colon cancer, it’s important to know when and how to be tested, based on your risk. When caught early, colon cancer has a survival rate higher than 90%, and it is even preventable. While colonoscopy remains the gold standard for testing and prevention and includes the ability to remove polyps before they become cancer, stool tests and the new blood test provide more options and accessibility than ever before. More good news is that colon cancer treatments have advanced to become less invasive and more effective than in years past. Here’s what to know about colon cancer testing, treatment, and prevention.
Visual tests that can prevent colon cancer
Colonoscopy: Colonoscopy is recommended for those at high risk and for those who want to prevent colon cancer, as it allows doctors to find and remove precancerous polyps to stop colon cancer before it starts. It can also identify colorectal cancer at its earliest stages, when it’s most treatable.
Virtual colonoscopy (also known as CT colonography): Virtual colonoscopy is a noninvasive test that does not require sedation, allowing people to drive themselves home afterwards and even go back to work. It is an effective imaging tool that uses an advanced CT (computerized tomography) scan to generate a 3D image of the colon and surrounding organs. Radiologists look for any potential abnormalities, and if polyps are found, they can be removed during a traditional colonoscopy before they become cancer. Like the traditional colonoscopy, virtual colonoscopy can detect colon cancer at its earliest stages, when it is most treatable.
Testing options for those at low or average risk and with no symptoms
Stool tests and the new blood test are colon cancer screening options for those at low or average risk, offering more convenient and accessible alternatives. These tests help reach people that might otherwise skip screening, improving early detection and saving lives.
Blood testing: The new blood test is the latest advancement in colon cancer testing.It screens for colon cancer by detecting changes in DNA. The first colon cancer blood test was approved in July 2024, and others are in development. This test is appropriate for people at low or average risk of colorectal cancer who do not have any symptoms. It requires only a blood draw, which can be taken during routine blood panels ordered by healthcare providers. If test results are positive, a colonoscopy will be needed for definitive diagnosis.
Stool-based tests: Stool-based tests, available from your doctor,can be done in the comfort of one’s home. There are three types of stool-based tests, and like the blood test, each one can be a first option for individuals who are at low or average risk for colorectal cancer and have no symptoms.If a stool-based test is positive, a colonoscopy must then be performed.
- FOBT (fecal occult blood test): There are two types of FOBT that screen for colon cancer through the detection of blood in the stool. The gFOBT (guaiac-based fecal occult blood test) detects blood in the stool using a chemical called guaiac. The iFOBT, also known as the FIT (fecal immunochemical test), uses special antibodies to test the stool for blood. One advantage of the iFOBT/FIT is that it does not require a restriction in diet or medicines. Blood in the stool is a possible early sign of cancer.
- Multi-targeted stool test: This test identifies the presence of DNA mutations in the cells of a stool sample. If DNA mutations are detected, this could be an early sign of colorectal cancer.
Continued advancements are revolutionizing colon cancer treatment
If colon cancer is found, laparoscopic and robotic tools now support less invasive surgery for tumors at all stages, requiring smaller incisions and allowing successful cancer removal while preserving more of the colon. This type of surgery also leads to faster recovery time, allowing people to more quickly return to work or their daily routines. Some people can even go home the day of their colon cancer surgery.
Precision oncology has also evolved dramatically, allowing doctors to analyze the DNA in a person’s tumor and design a personalized treatment plan that can shrink or stop the cancer. With newer chemotherapy drugs and by using older drugs in new ways, doctors can provide more effective results with fewer side effects, so people can maintain more of their normal activities during treatment. For some people with rectal cancer, a combination of radiation and chemotherapy can lead to complete clinical response, where the tumor is no longer detectable. At that point, the site can be monitored, with no immediate surgery required.
When to start testing depends on your risk factors
For people at low or average risk for colorectal cancer, the recommendation is for screenings to now start at age 45, with testing repeated every ten years up through age 75. People at high risk, especially those with a family history of colorectal cancer, should start screenings earlier and repeat them more often, on average until age 85. Talk to your doctor about the screening plan that’s right for you.
Here’s the lowdown on risk and how it can affect your approach to beating and preventing colon cancer
Age: Age remains the number-one risk factor for colorectal cancer, and it is true that nearly 90% of all cases are diagnosed in individuals over the age of 50. However, in the past 15 years, colorectal cancer diagnoses have been on the rise among people in their 40s and even younger. Because of this change, the newest recommendation is for screening to start at age 45. People born after 1990 are twice as likely to be diagnosed with colon cancer — and four times as likely to develop rectal cancer — as people born in 1950. Doctors are still trying to understand why, but some think the western diet, obesity and lack of physical activity, which are known to increase colorectal cancer risk, may be a factor.
A personal or family history of colorectal cancer or colon polyps: An individual’s risk for developing colorectal cancer is two to three times greater when a parent, sibling, or child has the disease, and the risk goes up to six times greater when two such close relatives have colorectal cancer. Lynch syndrome is a heredity gene disorder that is associated with a significant increased risk for different types of cancer, including colorectal cancer. If an immediate family member has colorectal cancer, your doctor may recommend that you start screening at age 40 or 10 years earlier than the age at which the family member was diagnosed.
Racial and ethnic background: People who are of African, Hispanic, or Ashkenazi Jewish descent are at increased risk for colorectal cancer. In fact, Black Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the country. Early-onset colorectal cancer (occurring before age 50) is diagnosed up to two times more frequently in Black and Hispanic people than in people of European descent.
Other risk factors: There is also an increased risk for colorectal cancer if you:
- Have inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
- Have Type 2 diabetes
- Are overweight or obese
- Drink alcohol; moderate to heavy drinking increases risk
- Smoke tobacco
Reducing risk with healthy lifestyle habits
Diets rich in red meats, processed meats, and low-fiber and high-fat foods contribute to an increased risk of colorectal cancer. Focusing on eating a healthy diet with more fruits, vegetables, and dietary fiber can reduce that risk. If you drink, do so in moderation, and if you smoke, stopping as soon as possible will greatly reduce your risk for colorectal cancer. It’s also important to stay physically active. In one recent study, regular exercise was shown to reduce the risk of colorectal cancer by approximately 20%.
Talk to your doctor if you have any of these symptoms
In addition to staying on stop of screenings, people of all ages can watch for symptoms that may be associated with colon cancer. Any change in the size, shape, color, consistency, or frequency of bowel movements — or the presence of bright red of black blood in the stools — should be discussed with your doctor as soon as possible.
Montefiore Einstein Comprehensive Cancer Center is among the elite 1% NCI Comprehensive Cancer Centers in the U.S. and ranked in the top 1% of all U.S. hospitals for cancer care, according to U.S. News & World Report
Montefiore Einstein Comprehensive Cancer Center’s patient-centered and evidence-based cancer care addresses the unique needs of each individual patient. Our NCI-designated comprehensive cancer center brings the worlds of clinical care and academic research together and allows for the translation of novel cutting-edge scientific discoveries into improved clinical outcomes and new lifesaving treatments.
Our surgeons and physicians are internationally recognized experts who work collaboratively to develop treatment plans that use minimally invasive techniques to help maintain function wherever possible. With our novel treatment protocols, our multidisciplinary team can preserve sexual function and urinary continence and even eliminate the need for colostomy in most cases.
In addition to the state-of-the-art care provided at Montefiore Einstein, we have a robust research program that includes identifying novel targets or pathways critical for the growth of colon cancer. By identifying these potential targets, we can develop new drugs or combination treatments to slow the growth of, or eliminate, colon cancer. Our scientific investigators are also studying the genomics of colorectal cancer, as there is growing evidence that the molecular alterations differ across ethnicities. Montefiore Einstein Comprehensive Cancer Center researchers are also studying the underlying mechanisms that contribute to resistance to current treatments. Screening and early detection are still the best ways to ensure a positive outcome for colorectal cancer and have proven to save lives. Consult with one of our Patient Navigators about your risk, when you should start testing, and which test is right for you.