CANCER RESEARCH ASSIGNMENT

Reports on Colorectal Cancer

by

Archisman Nath
Grade 10/ SNC2D0/ SID-707493/Mr. Hill/ Semester 1/DATE-10/02/2021/T L Kennedy SS
Content:
1. Personal Connection: Why I am studying this Cancer and How it affects me?

2. Introduction of Colorectal Cancer: What is Colorectal Cancer?

3. Causes of Cancer: DNA and genetic explanation

4. What is Colorectal Cancer (CRC)?

5. How does colorectal cancer start? Polyps in the colon or rectum:

6. What Are the Symptoms of Colorectal Cancer?

7. Understanding Biopsy report of Colonoscopy

8. Staging and stages of Colorectal Cancer

9. Colorectal Cancer Treatment

10. Therapies using medication

11. Colorectal Cancer: Risk Factors and Prevention

12. Colorectal Cancer: Statistics and epidemiology

13. Colorectal Cancer: Latest Research and treatment

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Personal Connection: Why I am studying this Cancer and How it
affects me?
In this report, I am covering a detailed study
on Colorectal Cancer. Colorectal cancer is cancer that
occurs in the colon or rectum. It is commonly known
as colon cancer. The term Colorectal is coined because
cancer occurs in the rectum, the passageway that connects
the colon to the anus. Inside the colon or rectum wall,
sometimes abnormal growths, called polyps are formed

over time. Some polyps may turn into

cancer. Through colonoscopy screening
procedure this investigation of polyps is
carried out. If polyps are found, polyps can
be removed to avoid the polyps before
turning into cancer. This screening
procedure helps us to find colorectal cancer
at an early stage and can be treated with the
highest survival possibility. I am interested
to study in detail Colorectal cancer because
of personal reasons. It starts with my father
who had undergone three times
colonoscopy screening procedures since
2013. He has had hemorrhoids since a young age which sometimes bleeds. Our family physician
sent him to a gastroenterologist for further investigation in the year 2013. During this time, a doctor
sent him for a colonoscopy screening procedure. The screening result revealed one small polyp in
the sigmoid colon which was benign. The doctor removed this polyp. In the year 2017, my father
had undergone a colonoscopy procedure for the second time. There were two polyps removed from
the same area of the colon. The biopsy result revealed the benign nature of both polyps. Recently
in 2021, he had to undergo a colonoscopy procedure for the third time. This time doctor had
removed three polyps. These three polyps were benign as well. Since the number of polyps is
increasing, my father is a little worried about his health. The doctor has told my father that there
is a 10 percent possibility of occurrence of colorectal cancer. I am also worried about my father’s
health. If my father gets cancer, it will directly affect my family. That is why I have chosen to
study colorectal cancer in detail. Cancer is a lifestyle disease too. If I become knowledgeable about
this cancer, I could help him maintain a healthy lifestyle.

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Introduction of Colorectal Cancer: What is Colorectal Cancer?
Diagram: Cancer cell growth Fundamentals

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Cancer Fundamentals: What is cancer?

To understand colorectal cancer, I need to know the definition of cancer. Cancer is a

disease of body cells in which some of the body’s cells grow uncontrollably and spread to other
parts of the body. The human body is made up of more than 100 trillion cells. Cancer can start
almost anywhere in the human body cells. Normally, human cells grow and multiply through cell
division to form new cells as the body needs them. Normally those cells grow and die.
Sometimes this normal process is disturbed, and cells grow abnormally in some part of the body.
These cells may form tumors, which are lumps of tissue. Tumors can be cancerous or benign
(Not Cancerous). Cancerous tumors spread into or invade nearby tissues and can travel to distant
places in the body to form new tumors through a process called metastasis. Tumors are solid, so
cancerous tumors are solid. But blood cancers are not solid.

Causes of Cancer: DNA and genetic explanation

Cancer is a genetic disease—that is, it is caused by changes to genes that control the way
our cell’s function, especially how they grow and divide. Genetic changes that cause cancer can
happen because of errors that occur as cells divide and because of damage to DNA caused by
harmful substances in the environment, such as the chemicals in tobacco smoke and ultraviolet
rays from the sun.
Cancer is caused by changes in the DNA inside our cells. DNA is the chemical in our cells that
makes up our genes, which control how our cells function. We usually look like our parents
because they are the source of our DNA. But DNA affects more than just how we look. Some
genes help control when our cells grow, divide into new cells, and die:
• Certain genes that help cells grow, divide, and stay alive are called oncogenes.
• Genes that help keep cell division under control or cause cells to die at the right time are
called tumor suppressor genes.
So, I understand that mitosis is the process in the cell cycle of cell division. When there is an error
in mitosis, and chromosomes are not copied correctly, then the cells start rapidly growing, that is
what happens in the colon or rectum. Colorectal cells rapidly grow and start developing on the
inner lining of the colon or rectum. Colorectal cells then are genetically mutated – meaning their
DNA is altered and through mitosis it is passed on through the daughter cells. This rapid growth
creates polyps. The cells in the polyps are called tumor cells, if they stay together, they are called
benign tumor or polyps. Polyps can become
malignant/cancerous cells, metastatic (cancerous
cells that leave the surrounding areas and travel
elsewhere) or stay where they are unless they affect
other cells. These abnormal cells can invade the
adjacent tissues and migrate to other organs
through metastasis. Cancer that has grown into the
wall can also penetrate blood or lymph vessels.
Colorectal cancer cells usually spread first into
nearby lymph nodes, which are bean-shaped
structures that help fight infections. The molecular
biology behind colorectal cancer. During
interphase in mitosis, which is the first stage, DNA
is replicated in a very complicated process. Errors
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are no described here. t present most of the time and the replicated DNA is identical to the parent
cell DNA. Very rarely, mutations occur due to unexplained errors disrupting the entire cell cycle
and making cells grow uncontrollably with no proper DNA replication. This is when colorectal
cells begin to grow and form a tumor. CRC usually begins polyp that develops on the inner lining
of the colon or rectum and grows slowly, over a period of 10 to 20 years. An adenomatous polyp,
or adenoma, is the most common type. Adenomas arise from glandular cells, which produce mucus
to lubricate the colorectum. Causes of this may be smoking – which chemicals change or alter the
DNA making process. Foreign substances in the anus or colon, alcoholism, or other causes.

In case of colorectal cancer, cancers can be caused by DNA mutations (changes) that turn
on oncogenes or turn off tumor suppressor genes. This leads to cells growing out of control.
Changes in many different genes are usually needed to cause colorectal cancer. Some DNA
mutations can be passed on in families and are found in all a person's cells. These are called
inherited mutations. A very small portion of colorectal cancers are caused by inherited gene
mutations. Many of these DNA changes and their effects on the growth of cells are now known.
For example:

Familial adenomatous polyposis (FAP), attenuated FAP (AFAP), and Gardner

syndrome is this. During interphase in mitosis, which is the first stage, DNA is replicated in a
very complicated process. Errors are not present most of the time and the replicated DNA is
identical to the parent cell DNA. Very rarely, mutations occur due to unexplained errors disrupting
the entire cell cycle and making cells grow uncontrollably with no proper DNA replication. This
is when colorectal cells begin to grow and form a tumor. CRC usually begins polyp that develops
on the inner lining of the colon or rectum and grows slowly over 10 to 20 years. An adenomatous
polyp, or adenoma, is the most common type. Adenomas arise from glandular cells, which produce
mucus to lubricate the colorectum. Causes of this may be smoking – which chemicals change or
alter the DNA-making process. Foreign substances in the anus or colon, alcoholism, or other
causes.
In the case of colorectal cancer, cancers can be caused by DNA mutations (changes) that turn on
oncogenes or turn off tumor suppressor genes. This leads to cells growing out of control. Changes
in many different genes are usually needed to cause colorectal cancer. Some DNA mutations can
be passed on in families and are found in all a
person's cells. These are
called inherited mutations. A very small portion
of colorectal cancers is caused by inherited gene
mutations. Many of these DNA changes and
their effects on the growth of cells are now
known.

For example:
• Familial adenomatous polyposis
(FAP), attenuated FAP
(AFAP), and Gardner syndrome are caused
by inherited changes in the APC gene.
The APC gene is a tumor suppressor gene; it
normally helps keep cell growth in check. In
people with inherited changes in the APC gene,
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 this “brake” on cell growth is turned off, causing hundreds of polyps to form in the colon.
Over time, cancer will nearly always develop in one or more of these polyps.
• Lynch syndrome (hereditary non-polyposis colon cancer, or HNPCC) is caused by
changes in genes that normally help a cell repair damaged DNA. A mutation in one of the
DNA repair genes like MLH1, MSH2, MSH6, PMS2, and EPCAM, can allow DNA errors
to go unfixed. These errors will sometimes affect growth-regulating genes, which may
lead to the development of cancer.
• Peutz-Jeghers syndrome is caused by inherited changes in the STK11 (LKB1) gene, a
tumor suppressor gene.
• MUTYH-associated polyposis (MAP) is caused by mutations in the MUTYH gene.

• caused by inherited changes in the APC gene. The APC gene is a tumor suppressor gene;
it normally helps keep cell growth in check. In people with inherited changes in the APC
gene, this “brake” on cell growth is turned off, causing hundreds of polyps to form in the
colon. Over time, cancer will nearly always develop in one or more of these polyps.
• Lynch syndrome (hereditary non-polyposis colon cancer, or HNPCC) is caused by
changes in genes that normally help a cell repair damaged DNA. A mutation in one of the
DNA repair genes like MLH1, MSH2, MSH6, PMS2, and EPCAM, can allow DNA errors
to go unfixed. These errors will sometimes affect growth-regulating genes, which may lead
to the development of cancer.
• Peutz-Jeghers syndrome is caused by inherited changes in the STK11 (LKB1) gene, a
tumor suppressor gene.
• MUTYH-associated polyposis (MAP) is caused by mutations in the MUTYH gene.

What is Colorectal Cancer (CRC)?

Colorectal Cancer is the cancer of
the colon and rectum or referred to as
colorectal – which is the cancer of the large
intestine. It is the final part of the
gastrointestinal tract (GI) of the digestive
system in the body. The Colon is the first
part of the large intestine which is a
muscular tube about 1.5 meters (5 feet) long
and 5 centimeters (2 inches) in diameter.
The colon has 4 sections: Ascending,
Descending, Transverse, and Sigmoid
Colon in order. Cancer can occur in any of
these parts/sections. Colorectal Cancer
usually starts as noncancerous growths called polyps – which is a tumor in the colon that may or
may not be cancerous. If the polyp is cancerous then this can result in Colorectal Cancer or Colon
Cancer. Cells in the colon or rectum sometimes do not grow normally and become non-cancerous
tumor called hyperplastic and inflammatory polyps. This polyp can also be precancerous. That
means there is a chance that they may become cancer if they aren’t treated. These precancerous
polyps are called adenomas. When adenomas are turned into cancer, polyps are called
adenocarcinomas which are also called colorectal cancer. Most often, colorectal cancer starts in
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gland cells that line the wall of the colon or rectum. These gland cells make mucus that helps stool
move through the colon and rectum. Rare types of colorectal cancer can also develop. Some rare
colorectal cancer cells are called small cell carcinoma and squamous cell carcinoma.

How does colorectal cancer start? Polyps in the colon or rectum:

Most colorectal cancers start as a growth on the
inner lining of the colon or rectum. These growths
are called polyps. Some types of polyps can change
into cancer over time (usually many years), but not
all polyps become cancer. The chance of a polyp
turning into cancer depends on the type of polyp it
is. There are different types of polyps.
• Adenomatous polyps (adenomas): These
polyps sometimes change into cancer.
Because of this, adenomas are called pre-
cancerous conditions. The 3 types of
adenomas are tubular, villous, and
tubulovillous.
• Hyperplastic polyps and inflammatory
polyps: These polyps are more common, but in general they are not pre-cancerous. Some
people with large (more than 1cm) hyperplastic polyps might need colorectal cancer
screening with colonoscopy more often.
• Sessile serrated polyps (SSP) and traditional serrated adenomas (TSA): These polyps
are often treated like adenomas because they have a higher risk of colorectal cancer.

Other factors that can make a polyp more

likely to contain cancer or increase
someone’s risk of developing colorectal
cancer include:
• If a polyp larger than 1 cm is found
• If more than 3 polyps are found
• If dysplasia is seen in the polyp after
it's removed. Dysplasia is another pre-
cancerous condition. It means there's an area
in a polyp or in the lining of the colon or
rectum where the cells look abnormal, but
they haven't become cancer.
What Are the Symptoms of Colorectal Cancer?
Colorectal polyps and colorectal cancer don’t always cause symptoms, especially at first.
Some symptoms of colorectal cancer are:
A change in bowel habits.
• Blood in or on your stool (bowel movement).
• Diarrhea, constipation, or feeling that the bowel does not empty all the way.
• Abdominal pain, aches, or cramps that don’t go away.
• Losing weight and you don’t know why.

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They may be caused by something other than cancer. But we should go to the doctor and the doctor
may send for a screening test like a colonoscopy procedure.

How Colorectal Cancer is diagnosed?

A doctor may consider these factors when choosing a diagnostic test:
• The type of cancer suspected
• Your signs and symptoms
• Your age and general health
• Your medical and family history
• The results of earlier medical tests
In addition to a physical examination, the following tests may be used to diagnose colorectal
cancer.
• Colonoscopy: A doctor can visually check the inside of the colon and rectum through this
colonoscopy procedure. If a polyp is found, the doctor removes this tumor and sends it to
a pathologist for biopsy.
• Biopsy: A biopsy is the removal of a small amount of tissue for examination under a
microscope.
• Biomarker testing of the tumor: In this test, tumor sample is tested to identify specific
genes, proteins, and other factors unique to the tumor. This may also be called molecular
testing of the tumor.
• Blood tests: RBC count is done to detect cancer. Another blood test detects the levels of a
protein called carcinoembryonic antigen (CEA). High levels of CEA may indicate that
cancer has spread to other parts of the body.
• Computed tomography (CT or CAT) scan: A computer combines these pictures into a
detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be
used to measure the tumor’s size.
• Magnetic resonance imaging (MRI): MRI is the best imaging test to find where
colorectal cancer has grown.
• Ultrasound: An ultrasound uses sound waves to create a picture of the internal organs to
find out if cancer has spread. Endorectal ultrasound is commonly used to find out how
deeply rectal cancer has grown and can be used to help plan treatment.
• Chest x-ray: An x-ray is a way to create a picture of the structures inside of the body,
using a small amount of radiation. An x-ray of the chest can help doctors find out if cancer
has spread to the lungs.
• Positron emission tomography (PET) or PET-CT scan: PET scans are not regularly
used for all people with colorectal cancer, but there are specific situations when your doctor
may recommend one.
After diagnostic tests are done, the doctor will review the results of the Biopsy and decide the
course of treatment.
Understanding Biopsy report of Colonoscopy
After the colonoscopy procedure is carried out, polyps are removed and sent to a pathologist for
biopsy. The pathologist sends the doctor a report that gives a diagnosis for each sample taken.
Doctors start treatment as per this report. Polyps may be Adenomas.
Adenomas can have several different growth patterns that can be seen under the microscope by the
pathologist. There are 2 major growth patterns: tubular and villous. Many adenomas have a
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mixture of both growth patterns and are called tubulovillous adenomas. Most adenomas that are
small (less than ½ inches) have a tubular growth pattern. Larger adenomas may have a villous
growth pattern. Larger adenomas more often have cancers developing in them. Adenomas with a
villous growth pattern are also more likely to have cancers develop in them. The most important
thing is that your polyp has been completely removed and does not show cancer. The growth
pattern is only important because it helps determine when you will need your next colonoscopy to
make sure you don’t develop colon cancer in the future. Polyps that tend to grow as slightly
flattened; broad-based polyps are referred to as sessile. Serrated polyps (serrated adenomas) have
a saw-tooth appearance under the microscope.
There are 2 types, which look a little different under the microscope:
• Sessile serrated adenomas (also called sessile serrated polyps)
• Traditional serrated adenomas
Both types need to be removed from your colon.
These types of polyps are not cancer, but they are pre-cancerous (meaning that they can turn into
cancers). Someone who has had one of these types of polyps has an increased risk of later
developing cancer of the colon. Most patients with these polyps, however, never develop colon
cancer.
A pathologist checks Dysplasia in polyps. Dysplasia is a term that describes how much polyp looks
like cancer under the microscope:
• Polyps that are only mildly abnormal (don’t look much like cancer) are said to have low-
grade (mild or moderate) dysplasia.
• Polyps that are more abnormal and look more like cancer are said to have high-grade
(severe) dysplasia.
The most important thing is that polyp has been completely removed and does not show cancer. If
high-grade dysplasia is found in a polyp, it might mean you need to have a repeat (follow-up)
colonoscopy sooner than if high-grade dysplasia wasn’t found, but otherwise, you do not need to
worry about dysplasia in the polyp. After the removal of polyps, the doctor decides the next date
of the procedure. When the next colonoscopy should be scheduled depends on several things, like
how many adenomas were found, if any were villous, and if any had high-grade dysplasia. specific
case. Sometimes, though, the adenoma may be too large to remove during colonoscopy. In such
cases, the patient may need surgery to have the adenoma removed. If polyps are Hyperplastic,
these polyps are typically benign (they aren’t pre-cancers or cancers) and are not a cause for
concern.

Staging and stages of Colorectal Cancer

Through staging doctors describe cancer’s growth or spread. Staging is a way of describing
where the cancer is located, if or where it has spread, and whether it is affecting other parts of the
body. Doctors use diagnostic tests to find out cancer's stage. After knowing the stage, the doctor
recommends what kind of treatment is best and can help predict a patient's prognosis, which is the
chance of recovery. There are different stage descriptions for different types of cancer. For
colorectal cancer, doctors use T (Tumor) N (Nodes) M (Metastasis) staging system. After that
doctor follows group staging. These stages are extended from 0 to 4:

Stage 0: This is called cancer in situ. The cancer cells are only in the mucosa, or the inner lining,
of the colon or rectum.

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Stage I: Cancer has grown
through the mucosa and has
invaded the muscular layer of the
colon or rectum. It has not spread
into nearby tissue or lymph nodes
(T1 or T2, N0, M0).

Stage IIA: Cancer has grown

through the wall of the colon or
rectum but has not spread to
nearby tissue or the nearby lymph
nodes (T3, N0, M0).

Stage IIC: The tumor has spread through the wall of the colon or rectum and has grown into
nearby structures. It has not spread to the nearby lymph nodes or elsewhere (T4b, N0, M0).

Stage IIIA: Cancer has grown through the inner lining or into the muscle layers of the intestine.
It has spread to 1 to 3 lymph nodes or to a nodule of tumor cells in tissues around the colon or
rectum that do not appear to be lymph nodes but has not spread to other parts of the body (T1 or
T2, N1 or N1c, M0; or T1, N2a, M0).

Stage IIIB: Cancer has grown through the bowel wall or to surrounding organs and into 1 to 3
lymph nodes or to a nodule of tumor in tissues around the colon or rectum that do not appear to be
lymph nodes. It has not spread to other parts of the body (T3 or T4a, N1 or N1c, M0; T2 or T3,
N2a, M0; or T1 or T2, N2b, M0).

Stage IIIC: The cancer of the colon, regardless of how deep it has grown, has spread to 4 or more
lymph nodes but not to other distant parts of the body (T4a, N2a, M0; T3 or T4a, N2b, M0; or
T4b, N1 or N2, M0).

Stage IVA: Cancer has spread to a

single distant part of the body, such
as the liver or lungs (any T, any N,
M1a).

Stage IVB: The cancer has spread

to more than 1 part of the body (any
T, any N, M1b).

Stage IVC: The cancer has spread

to the peritoneum. It may also have
spread to other sites or organs (any
T, any N, M1c).

Recurrent: Recurrent cancer is cancer that has come back after treatment. The disease may be
found in the colon, rectum, or in another part of the body. If the cancer does return, there will be
another round of tests to learn about the extent of the recurrence.
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Colorectal Cancer Treatment
In cancer care, different types of doctors often work together to create a patient’s overall
treatment plan that usually includes or combines different types of treatments. The common types
of treatments used for colorectal cancer are described below.

Surgery: Surgery is the removal of the tumor and some surrounding healthy tissue during an
operation. It is often called surgical resection. This is the most common treatment for colorectal
cancer. Part of the healthy colon or rectum and nearby lymph nodes will also be removed.

Different type of Colorectal Surgery

• Laparoscopic surgery: Laparoscopic surgery is as effective as conventional colon surgery

in removing cancer.
• Colostomy for rectal cancer: This is a surgical opening, or stoma, through which the
colon is connected to the abdominal surface to provide a pathway for waste to exit the
body. This waste is collected in a pouch worn by the patient. Sometimes, the colostomy is
only temporary to allow the rectum to heal, but it may be permanent. With modern surgical
techniques and the use of radiation therapy and chemotherapy before surgery when needed,
most people who receive treatment for rectal cancer do not need a permanent colostomy.
• Radiofrequency ablation (RFA) or cryoablation: Some patients may have surgery on
the liver or lungs to remove tumors that have spread to those organs.

Radiation Therapy
• Radiation therapy for rectal cancer: For rectal cancer, radiation therapy may be used
before surgery, called neoadjuvant therapy, to shrink the tumor so that it is easier to remove.
It may also be used after surgery to destroy any remaining cancer cells. Both approaches
have worked to treat this disease. Chemotherapy is often given at the same time as radiation
therapy, called chemoradiation therapy, to increase the effectiveness of the radiation
therapy.
• Chemoradiation therapy is often used in rectal cancer before surgery to avoid colostomy
or reduce the chance that cancer will recur.
• Radiation therapy is typically given in the United States for rectal cancer over 5.5 weeks
before surgery. However, for certain patients (and in certain countries), a shorter course of
5 days of radiation therapy before surgery is appropriate and/or preferred.

Latest Radiation Therapy

A newer approach to rectal cancer is currently being used for certain people. It is
called total neoadjuvant therapy (or TNT). With TNT, both chemotherapy and
chemoradiation therapy are given for about 6 months before surgery. This approach is still
being studied to determine which patients will benefit most.

Therapies using medication

The types of medications used for colorectal cancer include:
• Chemotherapy: Chemotherapy is the use of drugs to destroy cancer cells, usually by
keeping the cancer cells from growing, dividing, and making more cells.
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 • Targeted therapy: Targeted therapy is a treatment that targets cancer’s specific genes,
proteins, or the tissue environment that contributes to cancer growth and survival. This type
of treatment blocks the growth and spread of cancer cells and limits damage to healthy
cells. Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process
of making new blood vessels. Because a tumor needs the nutrients delivered by blood
vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor.

• Immunotherapy: Immunotherapy, also called biologic therapy, is designed to boost the

body's natural defenses to fight cancer. It uses materials made either by the body or in a
laboratory to improve, target, or restore immune system function. Checkpoint inhibitors
are an important type of immunotherapy used to treat colorectal cancer.
Colorectal Cancer: Risk Factors and Prevention
Risk Factors

A risk factor is anything that increases a person’s chance of developing cancer. The
following factors may raise a person’s risk of developing colorectal cancer:

• Age. The risk of colorectal cancer increases as people get older. The majority of colorectal
cancers occur in people older than 50. For colon cancer, the average age at the time of
diagnosis for men is 68 and for women is 72. For rectal cancer, it is age 63 for both men
and women. Colorectal cancer declined by about 3.6% per year in adults 55 and older,
based on the latest statistics. Meanwhile, the incidence rate increased by 2% per year in
adults younger than 55. About 11% of all colorectal diagnoses are in people under age 50.

• Race. Black people have the highest rates of sporadic, or non-hereditary, colorectal cancer
in the United States. Black men are even more likely to die from colorectal cancer than
Black women.

• Gender. Men have a slightly higher risk of developing colorectal cancer than women.

• Family history of colorectal cancer. If a person has a family history of colorectal cancer,
their risk of developing the disease is nearly double. The risk further increases if other close
relatives have also developed colorectal cancer or if a first-degree relative was diagnosed
at a younger age.

• Inflammatory bowel disease (IBD). People with IBD, such as ulcerative colitis or
Crohn’s disease, may develop chronic inflammation of the large intestine.

• Adenomatous polyps (adenomas). Polyps are not cancer, but some types of polyps called
adenomas can develop into colorectal cancer over time. Polyps can often be completely
removed using a tool during a colonoscopy, a test in which a doctor looks into the colon
using a lighted tube after the patient has been sedated. Polyp removal can prevent colorectal
cancer. People who have had adenomas have a greater risk of additional polyps and
colorectal cancer, and they should have follow-up screening tests regularly.

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 • Physical inactivity and obesity. People who lead an inactive lifestyle, meaning no regular
exercise and a lot of sitting, and people who are overweight or obese may have an increased
risk of colorectal cancer.

• Food/diet. Current research consistently links eating more red meat and processed meat to
a higher risk of the disease.

• Smoking. Recent studies have shown that smokers are more likely to die from colorectal
cancer than nonsmokers.

Prevention

Polyp removal during a colonoscopy (see Screening) can help prevent colorectal cancer.
This procedure allows the doctor to look inside the large intestine to look for and remove polyps
that could turn into cancer. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)
can help to reduce polyp but there is a side effect. Food choices and supplements can help to
reduce colorectal cancer. A diet rich in fruits and vegetables and low in red meat may help
reduce the risk of colorectal cancer. Some studies have also found that people who take calcium
and vitamin D supplements have a lower risk of colorectal cancer.

Colorectal Cancer: Statistics and epidemiology

Colorectal Cancer: Statistics and epidemiology

Colorectal cancer is the second and third most common cancer in women and men,
respectively. In 2012, 614,000 women (9.2% of all new cancer cases) and 746,000 men (10.0% of
new cancer cases) were diagnosed with colorectal cancer worldwide. Combined, in both sexes,
colorectal cancer is third-most-common cancer and accounts for 9.7% of all cancers excluding
non-melanoma skin cancer. This year, an estimated 149,500 adults in the United States will be
diagnosed with colorectal cancer. These numbers include 104,270 new cases of colon cancer
(52,590 men and 51,680 women) and 45,230 new cases of rectal cancer (26,930 men and 18,300
women). In Canada, it is estimated that in 2020: 5 years net survival rate is 65%.
• 26,900 Canadians will be diagnosed with colorectal cancer. This represents 12% of all new
cancer cases in 2020.
• 9,700 Canadians will die from colorectal cancer. This represents 12% of all cancer deaths
in 2020.
• 14,900 men will be diagnosed with colorectal cancer and 5,300 will die from it.
• 12,000 women will be diagnosed with colorectal cancer and 4,400 will die from it.
• On average, 73 Canadians will be diagnosed with colorectal cancer every day.
• On average, 27 Canadians will die from colorectal cancer every day.

Colorectal Cancer: Latest Research and treatment

Doctors, scientists are researching colorectal cancer, how to prevent it, how to best treat it,
and how to provide the best care to people diagnosed with this disease. The research areas
are:
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 • Improved detection methods. Researchers are developing tests to analyze stool samples
to find genetic changes associated with colorectal cancer. By finding and removing polyps
or identifying cancer early, doctors have a better chance of curing the disease.

• Tests to predict the risk of cancer recurrence. Various genes play important roles in the
growth and spread of tumors. Tests to identify these genes can help doctors and patients
decide whether to use chemotherapy after treatment.

• Immunotherapy. In the past several years, researchers have discovered a class of drugs
that targets the ways that tumor cells avoid the immune system. These immunotherapy
drugs are called checkpoint inhibitors. The latest research has shown that certain
checkpoint inhibitors, called PD-1 or PD-L1 inhibitors, can be effective against a type of
metastatic colorectal cancer that is microsatellite high (MSI-H).

• Chemotherapy and targeted therapy. New types of chemotherapy and targeted therapy
are being studied for colorectal cancer, including advanced colon and rectal cancers. Most
of these newer drugs are only available through clinical trials.

• Palliative care/supportive care. Clinical trials are underway to find better ways of
reducing symptoms and side effects of current colorectal cancer treatments to improve
comfort and quality of life for patients.

Reference/Sources in APA format

1. Kuipers, E. J., Grady, W. M., Lieberman, D., Seufferlein, T., Sung, J. J., Boelens, P. G.,
van de Velde, C. J. H., & Watanabe, T. (2015, November 5). Colorectal cancer. Nature
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