Last Updated: April 22, 2015
Ninety percent of the time, colon cancer occurs in those who are
over age 50. Also called colorectal cancer, this disease is the
second leading cause of cancer death in the United States, claiming
the lives of almost 50,000 men and women annually.
Colorectal Cancer & Age-Related Myths
Colon cancer in seniors remains one of the most preventable
cancers if detected early enough. However, most doctors believe
that, because of the perceived invasive and uncomfortable nature of
the screenings, people delay screening and colon cancer is often
far along by the time it's diagnosed. Another factor in delayed
diagnosis is age.
"We make the mistake of bypassing the detection screenings in
the elderly," Dr. Samuel Whiting, of the Seattle Cancer Care
Alliance and the University of Washington Medical Center, explains.
"Yet there is not necessarily an appropriate time to stop screening
for colon cancer. In fact, the odds are just as good for someone
over seventy to survive this disease as it is for someone half that
Whiting states that there is no reason to make decisions
concerning treatment based on someone's age. "Age is also not a
deciding factor because all of the drugs that we use for younger
patients are available for older patients. Though of course,
doctors will look carefully at the vulnerability of aging areas
like the kidneys, etc."
While some patients may not be property screened due to old age,
others may receive a delayed diagnosis due to young age.
"I went to my primary care doctor after discovering blood in my
stool," recalls Anita Mitchell, a 44-year-old Seattle resident and
outspoken advocate for preventive screening. "My doctor told me not
to worry, it was probably hemorrhoids. I went in again after a
noticeable change in my bowel movements, another significant
symptom of colon cancer. Again, my doctor said it was nothing,
blaming the change on the coffee I drank."
Anita Mitchell was only 40 at the time of her first symptoms.
Her doctor didn't consider an oncologist referral because only 10%
of people under fifty contract the disease. She returned to her
doctor after the blood level in her stool increased dramatically.
She had also just learned that her father had died of colon cancer.
In fact, she should have received her first screening at age 30, 10
years before her father's initial diagnosis.
When Mitchell finally saw a gastroenterologist, he found so many
polyps in her colon that he bypassed a biopsy and sent her straight
to the oncologist. Her CAT Scan revealed seven additional tumors in
her liver. Immediate surgery removed eighteen inches of colon,
sixteen lymph nodes, and an ovary. Four years later, Mitchell is
finally feeling healthy again.
"It's easy for doctors to blow you off when you are young and
showing signs of an older person's disease," she says. "It's
important to have hope, and not let anyone tell you you're a
Colorectal Cancer Risk Factors
According to the Mayo Clinic, one in 17 Americans contracts
colon cancer at some point in their lives. Because of this, it's
recommended that people begin screening for the disease no later
than age 50. Of course, screening should begin earlier if one has
familial history with the disease. A history of inflammatory bowel
disease (IBD) such as Crohn's disease or ulcerative colitis may
also lead to higher rates for the cancer. Though the disease
strikes men and women equally, African Americans appear much more
vulnerable. People who smoke are twice as likely to get colon
cancer. Those who are obese, drink heavily, maintain a sedentary
lifestyle, or suffer from diabetes
are also considered more susceptible.
Conversely, a healthy, active lifestyle that includes consistent
exercise and a high fiber diet rich in vegetables and fruits with
limited red meat intake improves the chances of preventing colon
cancer in seniors.
Colorectal Cancer Screening
Because colon cancer is usually slow growing, timely screening
for small precancerous growths (called adenomatous polyps) is by
far the most successful preventative of the disease. Awaiting
symptoms, including a change in bowel habits, narrow stools, rectal
bleeding, cramps, or unexplained weight loss, increases the chances
of discovering a stage III or IV cancer.
"Colon cancer is almost completely preventable," says Dr.
William Grady, medical director of the Gastrointestinal Cancer
Prevention Program at the Seattle Cancer Care Alliance.
"Unfortunately, only 20 to 40 percent of people receive screenings
when they turn 50, which also explains why roughly a third of the
cases we see are too far advanced for realistic survival."
There are several effective methods of screening for colon cancer,
This remains the most comprehensive of tests. Long thought to be
as painful as it was invasive, Whiting explains that there is
plenty of myth in this assumption: "People tend to fear what the
colonoscopy entails, but this is just an issue of education because
the more people learn how the study is done, the more they realize
it is not unbearably invasive. Just based on probabilities, I would
never discourage someone from having one."
- Flexible Sigmoidoscopy
A less invasive procedure, the sigmoidoscopy surveys just the
lower portion of the colon. Worrisome polyps and tissue can also be
removed surgically through the sigmoidoscope. Rarely conducted with
anesthesia, the procedure costs less than the colonoscopy, but
should be conducted every five years. Both Whiting and Grady
recommend that people over 50 with low risk undergo the procedure
in tandem with an annual fecal occult blood test.
- Fecal Occult Blood Test (FOBT)
Completely noninvasive, the FOBT is designed to identify traces of
blood in your stool, blood that is invisible to the naked eye.
Though quite inexpensive and as convenient as collecting a stool
sample, the FOBT doesn't distinguish the source of blood, which can
result in a false-positive test. Additionally, cancers and (most
polyps) don't always bleed, which may then result in a
- Barium Enema
Recommended every four to five years, this analysis involves
coating the entire colon with barium, then viewing it via X-ray for
abnormalities. Though this procedure carries less physical
discomfort then the scopes, the doctor doesn't enjoy the potential
of removing suspicious polyps and tissue. This test should also be
issued together with an annual FOBT.
Recent research developments may offer new standards in colon
cancer screening. These tests include:
- Capsule Endoscopy
This involves ingesting a pill-sized camera that records the
middle portion of your colon. The endoscopy even contains its own
light source. The apparatus detects intestinal bleeding and polyps,
as well as inflammatory bowel disease, ulcers and tumors.
Unfortunately, the pill-camera cannot remove troublesome
- DNA Stool Testing
This looks for DNA changes in your stool that are caused by
existing cancerous cells. Precancerous polyps are also revealed by
DNA changes, as detected by genetic markers. According to the Mayo
Clinic, this test ranges from 71 to 91 percent for detecting
cancers, and from 51 to 82 percent for detecting large polyps.
- Virtual Colonoscopy (VC)
A three-dimensional X-ray of the colon, hundreds of instant
photographs are taken to capture the entire landscape of the colon
wall. Though equally noninvasive and much more accurate than the
barium enema, VC shares the same limitations on real time surgery
as the barium enema. There is also the potential for missing the
smallest polyps with this screening method.
These numerous screening tests, combined with an early-detection
survival rate of nearly 95 percent, means there are few excuses for
people to avoid a preventive procedure. Even Stage II detection
leads to an 85 percent recovery rate. To add perspective, Stage IV
recovery is but 5 percent. Most insurance companies, including
Medicare, cover the standard cycles of tests as well.
"There are even new colonoscopes that are more flexible and less
invasive," Grady explains. "So if there is anything that can be
done to prevent colon cancer it may come from more discussion about
the importance of [timely] screenings."
Colorectal Cancer Treatment
Treatment after early detection is often straightforward, and
positive. "Surgical treatment results in a very high rate of
success if the cancer is detected early," Grady says. Treatment may
involve the following:
For Stage I and Stage II colon cancers, surgery is often so
effective that no other form of treatment is needed. Several
surgical procedures exist, ranging from a "local excision," when
surgeons remove the cancer and surrounding tissue during the
colonoscopy, to the "extended resection," when the cancer has
spread beyond the colon wall and the removal of most of the colon
This may include oral or injected drugs designed to kill remaining
cancers. Chemotherapy may also be injected in the specific area of
the body to focus on a specific organ or set of organs.
Fluorouracil (5-FU) has been the drug most often used in colorectal
cancer treatments. Newer drugs include Camptosar®,
Eloxatin®, and Xeloda®.
- Radiation Therapy
High dose X-rays can be used to kill cancer cells. External
radiation uses an outside x-ray machine and internal radiation
employs a radioactive substance that is sealed in a variety of
time-released apparatuses placed within the body near the
While most of these therapies are considered experimental, the FDA
has recently approved two new drugs in this class,
Erbitux® and Avastin®, to treat colorectal
cancers. These medications, called monoclonal antibodies, are
usually used in conjunction with chemotherapy and encourage the
body's own immune system to fight cancer.