Risk Factors:

• Regular exercise has been shown to reduce the risk as well as showing an improved survival after treatment in stage III colorectal cancer.
• A low-fat diet that is rich in fruits and vegetables
• Limiting red meats and processed meats (hot dogs and lunch meats)
• Reduced risk with calcium rich foods or calcium supplements or vitamin supplementation including folate or vitamin D
• Discontinuation of smoking
• Weight loss can also be recommended for many reasons as well.

Colorectal Cancer Screening Guidelines:

• The ACG recommends starting screening in the African American population at age 45. The American Cancer Society (ACS) and the US preventative services task force (USPSTF) does not make that differentiation.
• The ACS recommends a fecal occult blood testing every year or flexible sigmoidoscopy every 5 years or a double contrast barium enema every 5 years as alternatives to a colonoscopy.
• The ACG recommends flexible sigmoidoscopy every 5 years as does the USPSTF but the ACG recommends as an alternative CT colonography every 5 years but the USPSTF did not find sufficient evidence to assess the benefit of CT colonography.
• The USPSTF also notes considerations for colorectal screening in individual basis between 76 and 85 and recommends against screening over the age of 85.
• People who have had surgery for colorectal cancer need a colonoscopy within one year and then repeat in 3 years
• People with a history of adenomatous polyps need a colonoscopy within 3 years
• People with a family history of colon cancer <60 should start screening at age 40 or 10 years younger than the age at diagnosis with colonoscopy intervals every 5 years.
• People with inflammatory bowel disease should have a colonoscopy every 1-2 years starting 8 years after the start of pancolitis or 12-15 years after the start of left-sided colitis
• People with a family history of hereditary non-polyposis colorectal cancer (HNPCC) should have a colonoscopy every 1-2 years starting at age 20-25 or 10 years before the age of diagnosis. Genetic counseling should be discussed and offered to first-degree family members. HNPCC should be considered in any family that has 3 people with colorectal cancer with 2 successive generations and at least one person with cancer younger than 50.
• People with familial adenomatous polyposis should have annual flexible sigmoidoscopy or colonoscopy starting at age 10-12. Genetic counseling and testing should be pursued as well.

Signs and Symptoms:

• A persistent change in bowel habits such as diarrhea or constipation or a change in stool appearance or character.
• Blood in the stool which would include bright red blood or dark stools should also be investigated.
• Abdominal pain or cramping and/or a feeling of urgency or incomplete emptying are also noteworthy abnormalities.
• Generalized fatigue and weight loss and/or unexplained anemia should also precipitate an evaluation.

Treatment Options:

• Surgery which would include an open surgical procedure, a laparoscopic procedure or any transanal surgery for rectal cancer.
• Radiation therapy, usually for rectal cancer, which may be given after surgery or as neoadjuvant therapy prior to surgery. It also may be used in patients who are not healthy enough for surgery and/or chemotherapy.
• Chemotherapy for colorectal cancer has made great progress in recent years with a number of regimens available over the standard 5 fluorouracil (5-FU) and leucovorin with the addition of oxaliplatin or irinotecan systemically. There are a number of other protocols available as well. There is also local hepatic infusion regimens for hepatic metastasis available.
• Targeted therapies with monoclonal antibodies to attacks vascular endothelial growth factor (Avastin) or epidermal growth factor receptors (Erbitux) can be used alone or in combination with other chemotherapeutic agents.