Colorectal Cancer
Overview
No one should go through cancer alone. MSK’s team of colorectal cancer experts can help.
You may be reading this because you or someone you care about has learned they have colorectal (KOH-loh-REK-tul) cancer. Maybe you need to learn more about lower gastrointestinal cancers. Or maybe you’re curious about your risk for getting colorectal cancer. We want to help you find answers.
This is a good place to start. This information will help you understand the best next steps for you or your loved one.
MSK’s Center for Young Onset Colorectal and Gastrointestinal Cancer is the first program of its kind. Our experts work together to care for the needs of young adults aged 50 and under with cancer. We offer treatment, mental health counseling, fertility and sexual health medicine, nutrition, and more.
Types of colorectal cancer
Gastrointestinal oncologist Dr. Andrea Cercek and nurse practitioner Natasha Pinheiro review patient scans on a computer.
What are the types of colorectal cancer?
- Colon cancer
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Colon cancer starts in the first 5 feet of the large intestine, called the colon.
Colon cancer grows slowly. It often starts as a small abnormal growth (not normal) on the inner lining of the colon. This growth is called a polyp. It can later become cancer.
- Rectal cancer
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Rectal cancer starts in the rectum, the last 6 inches of the large intestine.
Rectal cancer grows slowly. It often starts as a small abnormal growth (not normal) on the inner lining of the rectum. This growth is called a polyp. It can later become cancer.
What are colorectal cancers?
Colorectal cancer is a cancer of the large intestine. Most of the large intestine is called the colon. Roughly the last six inches before the anus are called the rectum. Colorectal cancer starts in the lining or inner tissue of the colon or rectum.
Most of the time, colorectal cancers start as a small abnormal (not normal) growth, called a polyp (PAH-lip). A polyp sticks out from the lining of the intestine, like a small stalk or stem.
MSK experts in colorectal cancer focus on treating cancers of the lower gastrointestinal (GAS-troh-in-TES-tih-nul) or GI tract. Along with colorectal cancer, examples are:
The digestive system, including the colon.
At MSK, our experts are committed to finding the right treatment plan for you or your loved one.
Innovations at MSK
Our experts are always exploring new ways to treat colorectal cancer and manage side effects. Explore the latest colorectal cancer news from MSK.
Risk factors and prevention
What causes colorectal cancer?
A risk factor is anything that raises your chance of getting a disease, such as cancer.
There are some risk factors you cannot control. These include your age, race, health history, and your genes.
For example, race is a risk factor in the United States. Colorectal cancers affect the Black community at a higher rate than any other race.
There are other risk factors that you may be able to change. Research shows that having healthy habits can lower your risk for cancer.
Examples of healthy habits are exercising and keeping your body at a healthy weight. You can eat a healthy diet that includes less red meat, and more vegetables with lots of fiber.
Having polyps raises your chances of getting colorectal cancer. Screening exams are very important. They can help prevent colorectal cancer, and find it early, when it may be easier to treat. This is also called early detection, and it can save your life.
This guide can help you:
- Learn about your risk for colorectal cancer.
- Know the symptoms and causes of colorectal cancer.
- Learn about screening for colorectal cancer with regular colonoscopies after you turn age 45.
What's Causing Cancer Rates to Rise in Gen X and Millennials?
MSK cancer experts talk about the troubling rise in cancer rates among younger people. Learn what may be causing more young people to get colon and rectal cancers.
MSK offers the latest colorectal cancer treatments available today. Our experts work to help people get the best treatment results possible.
Call 800-525-2225
Can I lower my risk for colorectal cancer?
Aside from having screenings for colorectal cancer, there’s no sure way to prevent the disease. But starting healthy habits can lower your risk.
- Eat lots of high fiber foods, such as whole grains, legumes (beans, nuts, and peas), fruits, and vegetables.
- Limit how much sugar and fat you eat and drink.
- Do not smoke or use tobacco products. Need help quitting?
- Limit how much alcohol you drink.
- Eat less processed, burned, blackened, or charred meats. Read our tips.
- Get regular check-ups with your doctor.
- Keep a healthy weight for your body.
MSK's Ralph Lauren Center offers free or lower cost cancer care, including referrals for colorectal cancer screenings. Some people do not get screened because they’re worried about the cost, say MSK researchers. New York residents who are uninsured or underinsured may be able to get screened with no out-of-pocket costs.
Screening for colorectal cancer
What is cancer screening?
Cancer screening is checking for cancer in people who do not have symptoms. Regular screenings can help find cancer early, when it’s easier to treat or even cure. Screening can save lives by lowering the chances of dying from cancer.
Colorectal cancer screening is checking for what could be precancerous lesions (polyps). Precancerous means it can become cancer. Screening also can check for small colorectal cancer tumors in people who do not have symptoms.
During a screening, we can remove polyps that could become a tumor. Screenings can find cancer early, so there’s less chance the cancer can cause future health problems.
MSK experts recommend a colonoscopy as the best screening for colon or rectal cancers. There are other types of colorectal cancer screening tests. You can even do a screening test at home. Talk with your care team about which test is right for you. The best test for screening is one that gets done.
How is colorectal cancer screened?
There are a few kinds of colorectal cancer screening tests and guidelines. Learn why MSK experts do not recommend the Shield blood test as a way to find colorectal cancer.
A colonoscopy is the most common way to screen for colorectal cancer. It’s the only screening test that can both find and remove small growths on the colon’s inner lining.
These growths in the colon or rectum are called polyps. They’re not cancer, but can become cancer. This means that a colonoscopy can both find and prevent colon cancer.
Your doctor will put a flexible tube with a camera through your anus. They’ll look at your rectum and colon.
A flexible sigmoidoscopy uses a shorter tube than a colonoscopy. Like a colonoscopy, your doctor can remove polyps. But they can only check the lower part of the colon.
A virtual colonoscopy, also called a CT colonography, is an imaging test. CT scan technology makes 2D and 3D images of the colon and rectum. You may still need a regular colonoscopy if we must get a sample or remove a polyp or other lesion.
Other tests are based on stool (poop) to indirectly look for signs of cancer or polyps. One example of a stool DNA test is known by its brand name, Cologuard. You’ll still need a colonoscopy if the test result suggests you may have polyps.
Learn more about screening tests for colorectal cancer.
When should I be screened for colorectal cancer?
When you start colorectal cancer screenings depends on your level of risk. Talk with your healthcare provider about your risk for colon cancer and your risk for rectal cancer.
These are MSK’s latest screening guidelines for colon cancer. They may be different from those of other groups of experts. We base your type of screening, and your screening schedule, on your personal risk for colorectal cancer and your health history.
MSK recommends people at average risk for colorectal cancer start getting screened at age 45.
We also recommend people at higher risk for colorectal cancer talk with their healthcare provider about when to start screening.
If you’re 75 or older, talk with your healthcare provider about whether screening is right for you. In general, we do not recommend routine screening after age 85.
From the moment you reach out, we help you make sense of your options and make a plan.
Contact our MSK CATCH clinic if you have a hereditary cancer syndrome, such as Lynch syndrome. We help people who are at high risk for colon and rectal cancers. Monitoring (watching) for health changes and regular cancer screenings can help find cancer early, when it’s easier to treat.
Signs and symptoms
What are colorectal cancer signs and symptoms?
Colon and rectal cancers often do not cause symptoms in the early stages. That’s why we recommend that you get regular screenings for colorectal cancer.
If you know the symptoms, you can pay attention to changes in your body.
Learn more about signs of colon cancer or signs of rectal cancer.
- You have bleeding from your rectum.
- There’s blood in your stool (poop).
- You have diarrhea (often have loose stool), constipation (not being able to poop), or narrow stool (thin like a pencil or flat like a belt).
- You feel an urge to poop that does not go away after pooping.
- You have pain or cramping in your abdomen (belly) that lasts a long time, but you don’t know why.
- You’re losing weight fast, without trying.
- You often feel tired, but you don’t know why.
- You have anemia, but don’t know why.
Visit your healthcare provider if you notice these symptoms and they last for 2 weeks or longer.
How colorectal cancer is diagnosed
Cancers in the colon and rectum can be very hard to diagnose at early stages. Many people have few symptoms, or none at all.
However, having signs or symptoms of colorectal cancers does not mean you have cancer.
But if you have symptoms, talk with your healthcare provider.
They may give you a physical exam and learn more about your family history. They may order a routine screening or other tests.
- Health record: If you have symptoms, your primary care provider will review your health record. They’ll ask questions to find out if you have any colorectal cancer risk factors. They may send you to an expert, such as a gastroenterologist. A gastroenterologist (GAS-troh-EN-teh-RAH-loh-jist) is a doctor with special training in the gastrointestinal (GI) system.
- Digital rectal exam and physical exam: Your doctor will use a finger to feel for any tumors or areas that are not normal in your rectum. They may check other parts of your body for health problems that are causing your symptoms.
- Colonoscopy: If they think you may have colorectal cancer, you’ll have a colonoscopy. This test checks for polyps in your colon and rectum.
- Biopsy: During a colonoscopy, the doctor may do a biopsy. This is a procedure to remove a polyp or small piece of tissue with a special instrument. The tissue sample will be examined under a microscope to look for cancer cells.
- Imaging tests: If cancer cells are found in your biopsy sample, your doctor will order imaging tests. They may include a computed tomography (CT) scan or a magnetic resonance imaging (MRI). These tests can show if the cancer has spread to other parts of your body.
- Genetic tests: Colorectal cancer can be caused by genetic changes (mutations or variants) that make normal cells become cancer. Your doctor may test your samples for mutations in genes called KRAS and BRAF. Mutations in these genes are common in colorectal cancer. We’ll also test for mutations in less common genes. We’ll also look for signs of a genomic condition called high microsatellite instability (MSI-H).
We use a testing tool only offered at MSK called MSK-IMPACT®. This test looks at about 500 genes for genetic changes and other tumor traits. Developed by MSK, it finds genetic changes in the tumor that other tests can miss. We use this test to learn which treatments are best for you.
Coming to the right place is the key to a fast and accurate diagnosis. A correct diagnosis at the start puts you on the best path for treatment. Our Rapid Diagnosis service helps you do just that.
Colorectal cancer treatment
How is colorectal cancer treated?
Treatment for colorectal cancers can include surgery, chemotherapy, targeted therapies, immunotherapy, and radiation therapy. Surgery is the most common treatment for colorectal cancer.
You may have 1 of these colorectal cancer treatments, or a few treatments together.
Your treatment is based on the size and stage of cancer, and where it’s located. It also depends on the tumor’s genetic profile.
Your MSK care team will talk with you about the best therapies for you.
Learn more about treatment for colon cancer
Learn more about treatment for rectal cancer
How does MSK care for people with colorectal cancers?
Our doctors do more advanced treatments than many other hospitals. That experience can mean more care options, and fewer side effects and complications (problems).
We’re also leaders in treating cancer without surgery, or with minimally invasive surgery methods.
- MSK leads the nation in doing the most colorectal robotic surgeries. MSK surgeons do more than 700 robot-assisted colorectal surgeries each year. Almost half of our surgeries for colorectal cancer are done robotically.
- MSK helped pioneer watch-and-wait therapy to treat rectal cancer through long-term monitoring. About half of our patients with rectal cancer avoid surgery to have their rectums removed.
- MSK’s groundbreaking immunotherapy clinical trial cured participants of a type of rectal cancer tumor. They avoided radiation therapy and surgery.
At MSK, everyone with advanced colorectal cancer has their tumor tested using MSK-IMPACT®. Test results guide treatments that work well on tumors with certain genetic mutations (changes).
Your MSK team will give you or your loved one the best possible cancer care.
Meet the experts
Are you worried about how to find the right cancer care team to support you?
At MSK, we’ll take time to understand your needs and goals before bringing together your team of colorectal cancer experts. Your care team will include colorectal cancer doctors, nurses, and other healthcare providers. They’ll use only the latest treatments. They’ll support you during and after your care.
Your care team will meet regularly to talk about your treatment. You’ll have a wide range of experts on your team. They’ll give you the best possible treatment and care.
Continued care
How does MSK provide follow-up and continued care for people with colon or rectal cancer?
We know you may have questions about what comes next. At MSK, we help you and your loved ones find the support you need.
Your physical, emotional, and mental health is very important to your MSK care team. We have follow-up care and support programs for as long as you need us. These programs and services are for people with colon cancer or rectal cancer. They’re here to support you and your loved ones.
Cancer treatment can cause late side effects months or years after treatment. If this happens, you’ll have a follow-up care plan from a team of MSK colorectal cancer experts. Our focus is making sure you have a full and healthy life after cancer treatment.
Your caregivers are a very important part of your care team. They need support, too. We have a Caregivers Clinic to help your loved ones cope with cancer.
We offer counseling and support to help you manage anxiety, depression, anger, or loneliness. There are individual and group counseling sessions, both in person and through telemedicine visits. Counseling is open to you and your family, separately or together.
We also run support groups and programs if you want to talk with other people going through a similar experience. Our social workers can offer information about how to talk about your diagnosis with family members, work colleagues, and friends.
Cancer treatment can affect your digestion (how your body breaks down the food you eat). It can change your taste, how you eat, and how hungry you are.
Our clinical dietitian nutritionists can help with:
- Planning healthy meals at home.
- Advice about special diets.
- Working around food allergies.
- Managing symptoms such as weight loss or gain.
- Managing loss of appetite (not feeling hungry).
- Lowering your risk for other health problems after treatment.
Managing pain from cancer and its treatment is an important part of cancer care. MSK was the first cancer center in the country to have a program just for treating pain in people with cancer.
Our pain experts will help relieve or manage pain after surgery. They can help while you’re still in the hospital, and after you’re home.
We have experts who manage the symptoms and side effects of cancer treatment, such as nausea during chemotherapy.
Our Integrative Medicine and Wellness Service offers complementary, natural, and holistic treatments. They include acupuncture, meditation, massage therapy, yoga, and exercise.
Cancer therapies can cause side effects. You may want support with:
- Pain.
- Fatigue (feeling very tired).
- Nerve problems.
- Nausea (feeling like throwing up).
- Insomnia (trouble with sleeping).
- Stress.
Without using prescription drugs, integrative therapies can help improve side effects of treatment.
Integrative medicine is available in New York City, New Jersey, Westchester, and on Long Island. We also offer virtual classes and workshops.
Cancer affects your sex life in both physical and emotional ways. It’s normal to think about how cancer treatment may affect your sex life.
Our sexual health programs can help. They have experts in the physical symptoms and emotional challenges that may affect your sex life. We can talk with you about physical changes that affect intimacy.
MSK has experts with special training in female sexual health and fertility. Perhaps you’re trying to have a child or think you may want to start a family someday. We can help you understand your options for having children.
Supportive care is an important part of how we improve your quality of life during and after treatment. These therapies can help with side effects that happen months or years later.
Supportive care can also improve your emotional and spiritual health. MSK’s supportive care experts work with all members of your care team. They make a personal plan for you based on your goals and values. Supportive care can help you with:
- Pain
- Fatigue (feeling very tired)
- Insomnia (trouble falling and staying asleep)
- Nausea (feeling like throwing up)
- Anxiety
Colorectal cancer before age 50
Our Center for Young Onset Colorectal and Gastrointestinal Cancer offers a community of people who know what you’re going through.
We have experts in the concerns of young adults with colorectal cancer. We offer practical advice on balancing the demands of work, children, and aging parents.
We counsel you on:
- Dating and intimacy
- Sexual health
- Financial and employment challenges
- Effects of cancer on the whole family
Our experts give our patients new hope by treating the disease and caring for the whole person.