The death of actor Chadwick Boseman should be a wakeup call. He was diagnosed with Stage III cancer four years ago and passed away on Aug. 28, 2020. The Black Panther in Marvel’s movie franchise was 43 years old.
Boseman’s breakout film role was in 42, a 2013 movie about the legendary Black baseball player Jackie Robinson. Ironically, Boseman died on “Jackie Robinson Day,” major league baseball’s annual remembrance of the Hall of Famer.
He played the character T’Challa in four Marvel films: Captain America: Civil War, Black Panther, Avengers: Infinity War, and Avengers: Endgame.
The message is that cancers in the colon or rectum – called colorectal cancer (CRC) – are not just “old people” cancers. In 2020, there will be an estimated 104,610 new colon cancer cases and 43,340 rectal cancer cases in the United States. Most CRC incidents are among adults 50 years of age and older. However, 17,930 (12%) will be people under 50, with 49 new cases per day.
CRC almost always starts as a polyp, a growth in the lining of the colon or rectum. Common polyps, found in about half of high-risk individuals 50 years of age or older who underwent colonoscopy, have a higher prevalence in older men. Still, less than 10% of polyps develop into non-invasive cancer. This process usually occurs over 10 to 20 years, and the polyps likely will increase in size.
Cancers in the colon or rectum have many lifestyle risks, including alcoholism, obesity, poor diet, sedation, and smoking. CRC often has no symptoms, which is why testing is so important. As the tumor grows, it can bleed or block the bowels. The most common symptoms are:
• Bleeding from the rectum
• Blood in the toilet after bowel movements
• Black stool
• Changing bowel habits or bowel movements
• Stiffness, pain, or discomfort in the lower abdomen
• The desire to have bowel movements when the gut is empty
• Constipation or diarrhea lasting for more than a few days
• Decreased appetite
• Unintentional weight loss
To check for CRC, doctors perform a colonoscopy. This exam can detect abnormalities in the large intestine and rectum. The doctor will insert a flexible tube with a video camera at the tip into your rectum. The camera gives a view inside the colon and, if necessary, polyps or other abnormal tissue can be removed. [1]
According to the American Cancer Society’s Facts & Figures 2020-2022, approximately one in 23 men (4.4%) and 1 in 25 women (4.1%) will be diagnosed with CRC. Like most cancers, the risk of CRC increases with age. [2]
An estimated 53,200 people will die of CRC this year, including 3,640 men and women under 50. Unfortunately, reliable statistics on the deaths of colon and rectal cancers separately are not available. It is estimated that about 40% of deaths from rectal cancer are classified as colon cancer. [3] The high level of misconceptions is partly due to the widespread use of “colon cancer” to refer to both colon and rectal cancer in educational messaging.
CRC deaths vary with age. Among older adults, death decreased from 1% annually (2004-2013) to 0.6% (2013-2017) at 50-64 and from 3.3% to 2.6% at 65 and older. In contrast, CRC mortality rates have increased for people under 50 by 1.3% since 2004.
CRC survival rate is 64% in five years following diagnosis and 58% in 10 years. The most important predictor of CRC survival is the diagnostic phase. The five-year survival rate is 90% for 39% of patients diagnosed with a local stage disease. Survival falls in those found to have regional (71%) and remote (14%) cancer.
Rectal cancer is found in the closest segment more often than colon cancer, 41% compared to 38%, probably due to early-onset symptoms. In part, it means a complete five-year survival (67% compared to 63%). Factors associated with the diagnosis of CRC include low socioeconomic status, Black race, and age.
Surgery is the primary treatment for rectal cancer, often accompanied by chemotherapy and radiation before or after surgery to reduce recurrence risk. (The chemo drugs used to treat rectal cancer are very similar to those used for colon cancer.)
When part of the colon or rectum is removed during surgery, the healthy parts often are reconnected, allowing the patient to dispose of the waste naturally. When implantation does not occur immediately, the surgeon attaches the colon to an opening (stoma) made in the abdominal skin, allowing waste to leave the body.
A surgical procedure to make a hole in the body to remove waste is called an ostomy. When a stoma is attached to a colon, it is called a colostomy. It is called an ileostomy when the stoma is connected to the small intestine. Usually, a flat bag goes over the stoma to collect waste.
Many CRC patients who require a colostomy need the bag only temporarily until the colon or rectum has healed after surgery. Then, usually within six to eight weeks, the surgeon reconnects with the colon and closes the stoma. A permanent colostomy is required more often by rectal patients than those with colon cancer.
Citations
[1] Colonoscopy. https://www.mayoclinic.org/tests-procedures/colonoscopy/about/pac-20393569
[2] Facts About Cancer and Prices. https://www.cancer.org/research/cancer-facts-statistics/colorectal-cancer-facts-figures.html
[3] Consequences of the undiagnosed cause of death in living standards for colon and skin cancer. https://pubmed.ncbi.nlm.nih.gov/21697545/