When someone says the word “cancer,” what pops into your head? For many people, it’s a well-known form of the disease, like skin cancer or breast cancer.
But colorectal cancer, which can develop either in your colon or rectum, should be on that list, too. A did-you-know fact: According to the American Cancer Society, it’s estimated that 150,000 people in the U.S. get diagnosed annually, making colorectal cancer the third most common cancer in both men and women. It’s also the second leading cause of cancer-related deaths, with about 50,000 deaths occurring each year.
What’s more, it’s not just an “old person’s” problem: Recent research suggests that colorectal cancer is now being diagnosed in adults under the age of 50 at record rates.
But the good news is that screening has allowed for early detection and, in many cases, prevention of colorectal cancer. Indeed, the earlier colorectal cancer is identified, the higher the likelihood of successful treatment. What’s more, the Janssen Pharmaceutical Companies of Johnson & Johnson are committed to the development of innovative therapies to not only treat the cancer but also potentially prevent the disease from developing.
For National Colorectal Cancer Awareness Month, we rounded up the latest science-backed information on who’s most at risk, how best to prevent the disease and why there’s growing hope for people who receive a diagnosis.
1.
It’s never too early to watch out for symptoms.
Colorectal cancer is generally first spotted in the form of polyps, or abnormal growths, on the inner lining of the colon or rectum; these polyps may eventually turn into cancer.
The American Cancer Society recommends that all adults begin screening for colon cancer at age 45. The gold standard test is a colonoscopy, during which your doctor uses a flexible lighted tube to check for polyps in your rectum and colon while you’re under sedation. During a colonoscopy, doctors can remove any precancerous polyps that are spotted before they turn into cancer. These screenings should be repeated at least once every 10 years if no abnormal findings are discovered; if you have polyps, you’ll need to go in for colonoscopies at shorter intervals. Depending upon your family history, your doctor may also recommend additional screening tests, such as stool tests.
According to one study published in the Journal of the National Cancer Institute, adults born around 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer compared to those born around 1950.
If you’re younger than 45, it’s still important to be watchful for symptoms that may indicate colon cancer, including rectal bleeding or blood in your stool; persistent changes in bowel habits, including constipation or diarrhea; stomach pains, aches or cramps; or unexplained weight loss. In fact, according to one study published in the Journal of the National Cancer Institute (NCI), adults born around 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer compared to those born around 1950.
“We don’t really have a good sense as to why; we suspect rising obesity rates may play a role, as well as diet, but those don’t seem enough to explain it entirely,” says Eduardo Vilar-Sanchez, M.D., Ph.D., associate professor of Cancer Prevention and Population Sciences at The University of Texas MD Anderson Cancer Center in Houston.
In any case, the NCI study found that people younger than 55 are nearly 60% more likely to be diagnosed with late-stage disease than older adults, often because they aren’t aware of the symptoms. So if you have any concerning signs of illness, like the ones mentioned, don’t delay in getting them checked out.
2.
Certain diseases can raise your risk—as can your family tree.
Almost one-third of all people with colorectal cancer have a family history of the disease. And about 5% have inherited gene syndromes that can lead them to develop the disease, with the most common ones being Lynch syndrome, historically known as hereditary nonpolyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP). If colorectal cancer runs in your family, talk to your doctor about whether genetic testing might make sense for you.
You also have an increased risk of developing colorectal cancer if you’re overweight or have type 2 diabetes; high levels of insulin in your body may, over time, speed up the production of precancerous colon cancer cells, according to one theory.
Inflammatory diseases of the colon, such as ulcerative colitis and Crohn’s disease, can raise your risk, too, says Kurtis Bachman, Ph.D., Vice President, Colorectal Cancer Interception, Janssen, since chronic inflammation causes DNA damage and the cells in the intestinal lining to continuously turn over, increasing the chances you’ll develop a mutation that could potentially morph into cancer.
Doctors recommend that anyone who has had an inflammatory bowel disease for more than eight years gets a colonoscopy every year or two so any suspicious polyps that have developed can be removed before they could potentially turn cancerous.
3.
Lifestyle changes have great potential to protect you.
There are specific things you can do to help lower your odds of developing colorectal cancer, which isn’t true of all types of cancer, says Dr. Vilar-Sanchez. A few tips:
Try to maintain a healthy weight. Women who are overweight or obese have up to twice the risk of developing colorectal cancer before age 50 compared to women who are at a normal BMI, according to a Washington University study published in 2018.
Women who are overweight or obese have up to twice the risk of developing colorectal cancer before age 50 compared to women who are at a normal BMI.
Eat a fiber-rich diet. The more fiber the better—for each 10 grams you consume daily (the equivalent of around a cup of beans), you can help reduce your risk of colon cancer by 10%, according to a 2011 study. For extra credit, sub out deli meat sandwiches for hummus or peanut butter between bread instead. Processed meat has been linked to an increased risk of colon cancer, while fish and plant-based proteins appear to be protective.
Break a sweat. And the more active you are, the greater the benefits: One analysis of over 50 studies found that the most physically active folks had a 24% lower risk of colon cancer than the least active.
Cut back on cigarettes and alcohol. Women who have smoked (even if they’ve since quit) have an almost 20% increased risk for colon cancer, compared to those who’ve never taken a puff, according to a 2013 study. And skip that nightcap: People who have more than three drinks a day have a 50% increased risk of developing colon cancer, while a drink or two daily carries a 20% increased risk, according to a French study published in the Annals of Oncology.
4.
There are better treatments now than ever before.
Despite the news about younger demographics being diagnosed with the disease in increasing numbers, rates of colorectal cancer deaths overall have been declining for decades, thanks to an uptick in screening. But innovations in treatment have helped, too.
Product innovations like the ones Ethicon, a Johnson & Johnson MedTech Company, is pioneering are crucial in helping to ensure that patients who receive colon resection—a surgical procedure that’s used to treat colon cancer—have a reduced risk for potential complications, like surgical site infection, bowel content leaks or postoperative bowel obstruction.
“Surgical resection is a curative modality for localized colon cancer"—that is, a way to treat it, explains Raymond S. Fryrear II, M.D., Vice President and Integrated Leader, Preclinical, Clinical & Medical Affairs, Ethicon. “Our goal is to optimize outcomes and help reduce the risk of complications at every critical moment during surgery through tools like the Echelon CircularTM Powered Stapler” (shown above).
5.
New ways to treat, and even catch, the disease before it progresses are also on the horizon.
One advance in the treatment of colon cancer is related to the discovery of biomarkers, which include DNA, proteins and genetic mutations. These biomarkers can be used to help diagnose colorectal cancer, choose the best treatment and predict how patients may respond to treatment.
Janssen is also currently conducting an early-stage trial to study a medication for colorectal cancer patients that’s currently approved to treat another inflammatory disease. “We are hoping we can address the elevated inflammation within the GI tract that has been shown to cause the disease to progress,” says Dr. Bachman. “We are also focused on bringing forward new therapeutic approaches to eliminate the majority of colorectal cancers by intercepting the disease before it starts.” These studies are also looking at the role of the gut microbiome (seen above)—the mix of good and bad bacteria that live in your digestive tract—in causing inflammation.
A 2018 study published in Science found that two types of bacteria commonly found in the gut—Bacteroides fragilis and E. coli—release toxins that can damage cell DNA, making the polyps found in the colon more likely to turn precancerous. These bacteria are often found in the guts of people with FAP, a condition that causes people to develop polyps in their colon—often as many as 100-plus—that can lead to cancer. “Eventually, we hope to be able to use some of these gut bacteria as biomarkers,” or physical signs of a person’s medical state, “either to help predict who may be at higher risk to go on to develop colorectal cancer or to determine who may respond better to certain types of treatment,” adds Dr. Vilar-Sanchez.
Advanced and metastatic colorectal cancer—that is, when the cancer has spread to other parts of the body—is also an area where Janssen is focusing its research efforts. About 20% of patients have metastatic cancer when they are diagnosed and another 40% have recurrence of their cancer with metastases after initial treatment. “Patients with metastatic colorectal cancer who have progressed after two lines of therapy have limited effective treatment options,” says Meena Thayu, M.D., Executive Medical Director, Janssen. “Janssen is committed to investigating innovative therapies in the metastatic setting as well as in earlier stages of disease, with the ultimate goal of prolonging remission and improving survival.”
