Tall, lean Steffi Wessa of Landau, Germany, had never had a serious illness. So, in late 2013 after she turned 55, when her physician suggested they add a routine colorectal cancer screening by colonoscopy—regular screening for average-risk individuals begins at age 50—to her regular medical check-up, Steffi had no reason for concern. Colorectal cancer, often called colon cancer, is a malignancy in the large intestine, that “twisty tube” through which waste products leave through the anus. The last six or so inches of the colon is called the rectum.
During the colonoscopy—examination of the entire colon with an endoscope—the doctor found two polyps, benign growths in the intestinal wall that have the potential to turn cancerous if left untreated. The doctor removed these during the procedure. But there was something more: A five-centimeter growth in the rectal area. It appeared to be a carcinoma.
A biopsy confirmed the physician’s suspicions: Steffi had colorectal cancer. On hearing the news, Steffi was distraught. “My world collapsed. To me, cancer meant death.” (Here are more cancer myths that a lot of people believe.)
Steffi was just one of approximately 447,000 Europeans to be diagnosed with colon cancer that year, and the numbers are increasing annually, according to a 2013 report in the European Journal of Cancer. Globally, colorectal cancer is the third most common of all cancers, and in continental Europe, it is the second most common malignancy, after breast cancer which has about 464,000 annual diagnoses. It’s also the second most deadly, killing about 215,000 Europeans every year.
Colorectal cancer, when discovered in its early stages, is one of the most treatable cancers, according to the National Cancer Institute. And Steffi’s had been caught early before it could spread.
So, what puts individuals at risk of getting colon cancer? The risk increases with age—those older than 50 make up the vast majority of cases—but it can strike much younger people as well. In fact, it’s been striking more millennials recently.
“There can be genetic factors, environmental factors, or an interplay between the two,” says Jordan Karlitz, MD, FACG, associate professor of gastroenterology at Tulane University School of Medicine in New Orleans. He notes that ulcerative colitis and Crohn’s disease can lead to the development of colorectal cancer if the illness afflicts a significant portion of the colon. A sedentary lifestyle adds to the risk.
A diet heavy on meat, especially processed meats, and light on fruits, vegetables, and fiber, can predispose someone to colorectal cancer, as can smoking tobacco and drinking alcohol, says Luc Colemont, a Belgian gastroenterologist and managing director of the foundation Stop Colon Cancer. People who are obese or who have type 2 diabetes have a heightened risk as well.
A 2017 study published in JAMA Oncology suggests diet may affect colorectal cancer risk through changes in the gut microbiome, which is the population of microorganisms or healthy bacteria that live in the intestine. Researchers at Harvard University found that people who ate a fiber-rich, healthy diet tended to have a lower risk of developing colorectal cancer tumors linked to the gut bacterium Fusobacterium nucleatum, compared with those who had a Western-style, low-fiber diet. (Here’s how eating whole grains can help lower your risk as well.)
However, Dr. Colemont explains known risk factors still can’t account for all cases of colorectal cancer. “I saw people, 56 years of age, not overweight, never smoked, only a beer on the weekend, every day healthy food, and three times a week in fitness,” says Dr. Colemont. “But they have colon cancer.”
Doctors have even reported a rise in the incidence of colorectal cancer in people younger than 50—even among those in their 20s and 30s, in a 2017 study published in the Journal of the National Cancer Institute. This is why it’s crucial to see your doctor if you have any symptoms, even if they seem insignificant.
Also, early detection is the key to beating colon cancer. Every expert we spoke to stressed the importance of screening for colorectal cancer. Screening “could potentially save more than half of the people who are dying from colorectal cancer,” says Dr. Karlitz. That’s a potential of more than 100,000 lives saved per year in Europe alone.
There are several types of screening, including a fecal test, a CT scan, a sigmoidoscopy and a colonoscopy. In Europe, the most common/readily accessible one is the fecal test. It’s both simple and inexpensive. You get a kit from the doctor, follow the at-home directions for collecting a stool sample, and ship everything back. These tests look for blood in the sample that isn’t apparent to the naked eye. A positive result may be evidence of either pre-cancerous polyps or of cancer.
A positive result is usually followed by a colonoscopy, a test typically repeated every ten years. (Here are the best colonoscopy prep tips, according to doctors.) The individual fecal test can be less accurate than a colonoscopy, but because fecal tests are done more often, the likelihood of detection increases with each successive test.
A sigmoidoscopy, although similar to a colonoscopy, is not as extensive. In this procedure, the last 40 or so centimeters of the colon, plus the rectum, are examined with an endoscope, a lighted instrument, according to the National Cancer Institute. Typically it is repeated every five years. Another, less common screening method is CT colonography—essentially a CAT scan of the colon. And a test using a pill-sized camera that is swallowed and videos the lining of the colon is available in a number of countries for those who can’t undergo a colonoscopy.
However, a colonoscopy is considered the gold standard of screening. It can discover more abnormalities than any other screening test. It can detect more pre-cancerous polyps, and at an earlier stage, than fecal tests. However, it is a more invasive procedure and it can be difficult to persuade people to get screened this way. Screening rates vary dramatically by country—or even within the same country—but, compliance rates for colorectal cancer screenings are much lower than hoped for by doctors, a 2017 study in Annals of Gastroenterology reports.
Now 58, Steffi can attest to the value of screening. She might not be alive today without it. After her cancer was detected, she was treated with chemotherapy and radiation, which shrank the tumor, then surgery to remove it. Now cancer-free, she gets regular check-ups to ensure she stays that way.
Once you notice symptoms of colorectal cancer, putting off screening can be a bad decision.
In early 2013, Belgian Filip Luypaert, 44, was focused on his career as a high-powered executive for an international medical device company. In great physical condition, he had no known risks for cancer. But he’d recently noticed blood in his stool. When he mentioned this to his general practitioner, the doctor recommended a sigmoidoscopy, just as a precaution.
“I was running twice a week, ten kilometers, traveling around the globe for work,” Filip recalls. At his age and condition, neither he nor his doctor seriously believed he could have colorectal cancer.
So Filip put off screening for another six months, expecting the symptoms to pass. When he finally had a full colonoscopy in October 2013 it revealed that Filip had colorectal cancer. The tumor was too large to remove right away. Worse, further testing determined that the cancer had spread to his liver.
Filip searched the Internet for survival rates in stage four colorectal cancer. The best case scenarios gave him only an 11 to 12 percent chance of surviving five more years.
He’d had so many plans. His girlfriend was in the process of emigrating from Singapore to be with him. How could he now ask her to leave behind her family, her professional life—everything—when he probably wouldn’t be alive for much longer?
If a tumor is too large to remove immediately, surgery will be necessary to cut away the diseased section of the colon. “In some countries, 50, 60, 70 percent of colon cancer surgery can be done by laparoscopic surgery,” says Dr. Colemont. This less radical type of operation involves smaller incisions than traditional “open” surgery and often translates to faster healing.
Over five days’ time, Filip was given the equivalent of five weeks worth of radiation to shrink his main tumor enough so it could eventually be removed. Then came three months of chemotherapy, followed by surgery to remove the diseased section of his colon. At that point, to give his wound time to heal, surgeons redirected waste products from his lower colon to a stoma, a temporary opening in his abdomen. After another three months of chemo, it was time to operate on his liver. That was followed by more chemo.
It was almost exactly a year from the time of diagnosis to Filip’s last chemotherapy treatment. “I just had to live one day at a time, and that was, for me, very difficult, and especially to see the people around me suffering from my uncertainty and pain.”
After several setbacks, including two more surgeries to remove additional metastases on and near his liver, Filip finally got the news he’d been hoping for. At his last check-up, doctors found no trace of cancer.
And in April 2016 he ran again for the first time since his ordeal began, in a 10 kilometer race in Antwerp. His girlfriend plans to join him in Belgium.
Even if you’ve had colorectal cancer, the best way you can take to mitigate the risk of your cancer recurring is by staying vigilant. If you are over age 50 and have never had CRC and have no symptoms, talk to your doctor about screening. Those who have had colorectal cancer or are at risk for getting it should be screened more often than the general population. And if you experience any of the symptoms associated with the disease, even if they seem mild and inconsequential, tell your doctor. Check out the best foods to eat for cancer prevention.