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Colorectal Cancer Prevention (PDQ®)

Patient Version
Last Modified: 07/29/2011

Colorectal Cancer Prevention

Key Points for This Section


Avoiding risk factors and increasing protective factors may help prevent cancer.

Avoiding cancer risk factors such as smoking, being overweight, and lack of exercise may help prevent certain cancers. Increasing protective factors such as quitting smoking, eating a healthy diet, and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer.

The following risk factors increase the risk of colorectal cancer:

Age

The risk of colorectal cancer increases after age 50. Most cases of colorectal cancer are diagnosed after age 50.

Family history of colorectal cancer

Having a parent, brother, sister, or child with colorectal cancer doubles a person's risk of colorectal cancer.

Personal history

Having a personal history of inflammatory bowel disease increases the risk of colorectal cancer.

Inherited risk

The risk of colorectal cancer is increased when certain gene changes linked to familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon cancer (HNPCC or Lynch Syndrome) are inherited.

Alcohol

Drinking 3 or more alcoholic beverages per day increases the risk of colorectal cancer. Drinking alcohol is also linked to the risk of forming large colorectal adenomas (benign tumors).

Cigarette smoking

Cigarette smoking is linked to an increased risk of colorectal cancer and death from colorectal cancer.

Smoking cigarettes is also linked to an increased risk of forming colorectal adenomas. Cigarette smokers who have had surgery to remove colorectal adenomas are at an increased risk for the adenomas to recur (come back).

Obesity

Obesity is linked to an increased risk of colorectal cancer and death from colorectal cancer.

The following protective factors decrease the risk of colorectal cancer:

Physical activity

A lifestyle that includes regular physical activity is linked to a decreased risk of colorectal cancer.

Aspirin

Taking aspirin every day for at least 5 years decreases the risk of colorectal cancer and the risk of death from colorectal cancer.

The possible harms of aspirin use include a higher than normal risk of bleeding in the stomach, intestines, or brain.

Hormone replacement therapy

Studies have shown that hormone replacement therapy (HRT) that includes both estrogen and progesterone lowers the risk of colon cancer in postmenopausal women. HRT with estrogen alone does not lower the risk. However, hormone use increases the risk of breast cancer, heart disease, and blood clots.

The use of hormone replacement therapy that includes both estrogen and progesterone has not been shown to lower the risk of rectal cancer.

Polyp removal

Most colorectal polyps are adenomas, which may develop into cancer. Removing colorectal polyps that are larger than 1 centimeter (cm) may lower the risk of colorectal cancer. It is not known if removing smaller polyps lowers the risk of colorectal cancer.

The possible harms of polyp removal during colonoscopy or sigmoidoscopy include a tear in the wall of the colon and bleeding.

The effect of the following factors on the risk of colorectal cancer is not known:

Nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin

It is not known if the use of nonsteroidal anti-inflammatory drugs or NSAIDs (such as celecoxib, naproxen, and ibuprofen) lowers the risk of colorectal cancer.

Studies have shown that taking the nonsteroidal anti-inflammatory drug celecoxib reduces the risk of colorectal adenomas (benign tumors) coming back after they have been removed. It is not clear if this results in a lower risk of cancerous tumors in the colon and rectum. Taking celecoxib also has been shown to reduce the number of polyps that form in the colon and rectum of patients with familial adenomatous polyposis (FAP).

The possible harms of NSAIDs include:

Diet

It is not known if a diet low in fat and meat and high in fiber, fruits, and vegetables lowers the risk of colorectal cancer.

Some studies have shown that a diet high in fat, proteins, calories, and meat increases the risk of colorectal cancer, but other studies have not.

For more information on diet and health, see the "Fruits and Veggies—More Matters" 1 Web site.

Vitamins

It is not known if taking vitamin D or high doses of folic acid lowers the risk of colorectal cancer.

Calcium

It is not known if taking calcium supplements lowers the risk of colorectal cancer.

Taking medicine to reduce cholesterol levels does not affect the risk of colorectal cancer.

Studies have shown that taking statins (cholesterol -lowering drugs) does not increase or decrease the risk of colorectal cancer.

Cancer prevention clinical trials are used to study ways to prevent cancer.

Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer. Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer. Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer. Other trials are done with healthy volunteers who are not known to have any risk factors for cancer.

The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include exercising more or quitting smoking or taking certain medicines, vitamins, minerals, or food supplements.

New ways to prevent colorectal cancer are being studied in clinical trials.

Clinical trials are taking place in many parts of the country. Information about clinical trials can be found in the Clinical Trials 2 section of the NCI Web site. Check NCI's PDQ Cancer Clinical Trials Registry for colon cancer prevention trials 3 or rectal cancer prevention trials 4 that are now accepting patients.



Glossary Terms

adenoma (A-deh-NOH-muh)
A tumor that is not cancer. It starts in gland-like cells of the epithelial tissue (thin layer of tissue that covers organs, glands, and other structures within the body).
alcohol (AL-kuh-hol)
A chemical substance found in beer, wine, and liquor, and some medicines, mouthwashes, household products, and essential oils (scented liquid taken from plants). Alcohol contains a carbon atom attached to a hydroxyl group (a molecule made of an oxygen atom and a hydrogen atom).
aspirin (AS-pih-rin)
A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention.
blood (blud)
A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
breast cancer (brest KAN-ser)
Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
calcium (KAL-see-um)
A mineral needed for healthy teeth, bones, and other body tissues. It is the most common mineral in the body. A deposit of calcium in body tissues, such as breast tissue, may be a sign of disease.
calorie (KA-luh-ree)
A measurement of the energy content of food. The body needs calories as to perform its functions, such as breathing, circulating the blood, and physical activity. When a person is sick, their body may need extra calories to fight fever or other problems.
cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
celecoxib (SEH-luh-KOK-sib)
A drug that reduces pain. Celecoxib belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is being studied in the prevention of cancer.
centimeter (SEN-tih-MEE-ter)
A measure of length in the metric system. There are 100 centimeters in a meter and 2½ centimeters in an inch.
cholesterol (koh-LES-teh-rol)
A waxy, fat-like substance made in the liver, and found in the blood and in all cells of the body. Cholesterol is important for good health and is needed for making cell walls, tissues, hormones, vitamin D, and bile acid. Cholesterol also comes from eating foods taken from animals such as egg yolks, meat, and whole-milk dairy products. Too much cholesterol in the blood may build up in blood vessel walls, block blood flow to tissues and organs, and increase the risk of developing heart disease and stroke.
clinical trial (KLIH-nih-kul TRY-ul)
A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.
colon (KOH-lun)
The longest part of the large intestine, which is a tube-like organ connected to the small intestine at one end and the anus at the other. The colon removes water and some nutrients and electrolytes from partially digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus.
colon cancer (KOH-lun KAN-ser)
Cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).
colonoscopy (KOH-luh-NOS-koh-pee)
Examination of the inside of the colon using a colonoscope, inserted into the rectum. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
colorectal cancer (KOH-loh-REK-tul KAN-ser)
Cancer that develops in the colon (the longest part of the large intestine) and/or the rectum (the last several inches of the large intestine before the anus).
congestive heart failure (kun-JES-tiv hart FAYL-yer)
Weakness of the heart muscle that leads to a buildup of fluid in body tissues.
diagnosis (DY-ug-NOH-sis)
The process of identifying a disease, such as cancer, from its signs and symptoms.
diet (DY-et)
The things a person eats and drinks.
dose (dose)
The amount of medicine taken, or radiation given, at one time.
drug (drug)
Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
estrogen (ES-truh-jin)
A type of hormone made by the body that helps develop and maintain female sex characteristics and the growth of long bones. Estrogens can also be made in the laboratory. They may be used as a type of birth control and to treat symptoms of menopause, menstrual disorders, osteoporosis, and other conditions.
familial adenomatous polyposis (fuh-MIH-lee-ul A-deh-NOH-muh-tus PAH-lee-POH-sis)
An inherited condition in which numerous polyps (growths that protrude from mucous membranes) form on the inside walls of the colon and rectum. It increases the risk of colorectal cancer. Also called familial polyposis and FAP.
fiber (FY-ber)
In food, fiber is the part of fruits, vegetables, legumes, and whole grains that cannot be digested. The fiber in food may help prevent cancer. In the body, fiber refers to tissue made of long threadlike cells, such as muscle fiber or nerve fiber.
folic acid (FOH-lik A-sid)
A nutrient in the vitamin B complex that the body needs in small amounts to function and stay healthy. Folic acid helps to make red blood cells. It is found in whole-grain breads and cereals, liver, green vegetables, orange juice, lentils, beans, and yeast. Folic acid is water-soluble (can dissolve in water) and must be taken in every day. Not enough folic acid can cause anemia (a condition in which the number of red blood cells is below normal), diseases of the heart and blood vessels, and defects in the brain and spinal cord in a fetus. Folic acid is being studied with vitamin B12 in the prevention and treatment of cancer. Also called folate.
gene (jeen)
The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein.
hereditary nonpolyposis colon cancer (heh-REH-dih-TAYR-ee NON-PAH-lee-POH-sis KOH-lun KAN-ser)
An inherited disorder in which affected individuals have a higher-than-normal chance of developing colorectal cancer and certain other types of cancer, often before the age of 50. Also called HNPCC and Lynch syndrome.
hormone (HOR-mone)
One of many chemicals made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in the laboratory.
hormone replacement therapy (HOR-mone reh-PLAYS-ment THAYR-uh-pee)
Hormones (estrogen, progesterone, or both) given to women after menopause to replace the hormones no longer produced by the ovaries. Also called HRT and menopausal hormone therapy.
ibuprofen (I-byoo-PROH-fen)
A drug used to treat fever, swelling, pain, and redness by preventing the body from making a substance that causes inflammation. It is a type of nonsteroidal anti-inflammatory drug (NSAID). Also called Advil and Motrin.
inflammatory bowel disease (in-FLA-muh-TOR-ee BOW-ul dih-ZEEZ)
A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn disease.
inherited (in-HAYR-ih-ted)
Transmitted through genes that have been passed from parents to their offspring (children).
intestine (in-TES-tin)
The long, tube-shaped organ in the abdomen that completes the process of digestion. The intestine has two parts, the small intestine and the large intestine. Also called bowel.
kidney (KID-nee)
One of a pair of organs in the abdomen. Kidneys remove waste from the blood (as urine), produce erythropoietin (a substance that stimulates red blood cell production), and play a role in blood pressure regulation.
mineral (MIH-neh-rul)
In medicine, a mineral is a nutrient that is needed in small amounts to keep the body healthy. Mineral nutrients include the elements calcium, magnesium, and iron.
naproxen (nuh-PROK-sen)
A drug used to treat mild pain and the symptoms of arthritis and several other conditions. It is also being studied in the treatment of bone pain in patients with cancer. Naproxen stops the body from making substances that cause pain and inflammation. It is a type of nonsteroidal anti-inflammatory drug (NSAID) and a type of cyclooxygenase inhibitor. Also called Naprosyn.
nonsteroidal anti-inflammatory drug (NON-steh-ROY-dul AN-tee-in-FLA-muh-TOR-ee ...)
A drug that decreases fever, swelling, pain, and redness. Also called NSAID.
obesity (oh-BEE-sih-tee)
A condition marked by an abnormally high, unhealthy amount of body fat.
overweight (OH-ver-WAYT)
Being too heavy for one’s height. Excess body weight can come from fat, muscle, bone, and/or water retention. Being overweight does not always mean being obese.
PDQ
PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.
personal history (PER-suh-nul HIH-stuh-ree)
A collection of information about a person’s health. It may include information about allergies, illnesses and surgeries, and dates and results of physical exams, tests, screenings, and immunizations. It may also include information about medicines taken and about diet and exercise. Also called personal health record and personal medical history.
polyp (PAH-lip)
A growth that protrudes from a mucous membrane.
postmenopausal (post-MEH-nuh-PAW-zul)
Having to do with the time after menopause. Menopause (“change of life”) is the time in a woman's life when menstrual periods stop permanently.
prevention (pree-VEN-shun)
In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).
progesterone (proh-JES-teh-RONE)
A type of hormone made by the body that plays a role in the menstrual cycle and pregnancy. Progesterone can also be made in the laboratory. It may be used as a type of birth control and to treat menstrual disorders, infertility, symptoms of menopause, and other conditions.
protective factor (proh-TEK-tiv FAK-ter)
Something that may decrease the chance of getting a certain disease. Some examples of protective factors for cancer are getting regular physical activity, staying at a healthy weight, and having a healthy diet.
protein (PROH-teen)
A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.
rectal cancer (REK-tul KAN-ser)
Cancer that forms in the tissues of the rectum (the last several inches of the large intestine closest to the anus).
rectum (REK-tum)
The last several inches of the large intestine closest to the anus.
recur (ree-KER)
To come back or to return.
risk factor (... FAK-ter)
Something that increases the chance of developing a disease. Some examples of risk factors for cancer are age, a family history of certain cancers, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic changes.
sigmoidoscopy (sig-MOY-DOS-koh-pee)
Examination of the lower colon using a sigmoidoscope, inserted into the rectum. A sigmoidoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Also called proctosigmoidoscopy.
statin (STA-tin)
Any of a group of drugs that lower the amount of cholesterol and certain fats in the blood. Statins inhibit a key enzyme that helps make cholesterol. Statin drugs are being studied in the prevention and treatment of cancer.
stomach (STUH-muk)
An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.
supplemental nutrition (SUH-pleh-MEN-tul noo-TRIH-shun)
A substance or product that is added to a person’s diet to make sure they get all the nutrients they need. It may include vitamins, minerals, protein, or fat, and may be given by mouth, by tube feeding, or into a vein.
supplementation (SUH-pleh-MEN-TAY-shun)
Adding nutrients to the diet.
surgery (SER-juh-ree)
A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.
vitamin D (VY-tuh-min ...)
A nutrient that the body needs in small amounts to function and stay healthy. Vitamin D helps the body use calcium and phosphorus to make strong bones and teeth. It is fat-soluble (can dissolve in fats and oils) and is found in fatty fish, egg yolks, and dairy products. Skin exposed to sunshine can also make vitamin D. Not enough vitamin D can cause a bone disease called rickets. It is being studied in the prevention and treatment of some types of cancer. Also called cholecalciferol.

Table of Links

1http://www.fruitsandveggiesmatter.gov
2http://www.cancer.gov/clinicaltrials
3http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?diagnosis=43419&tt=4&a
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4http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?diagnosis=43157&tt=4&a
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