Gastrointestinal medical oncologist Dr. Luis Diaz talks with a colleague in an MSK hallway.
MSK's Guide To

Colon Cancer

Overview

No one should face colon cancer alone. At MSK, our team of colon cancer experts is here for you.

You may be reading this because you or someone you care about has learned they have colon cancer. Or maybe you’re curious about your risk of getting colon cancer.  

It’s important to get to know the signs of colon cancer. It’s best if we can catch it early, when it may be easier to treat. But at MSK, we have treatment options for colon cancer at every stage.   

This guide is a good place to learn about what causes colon cancer and how to prevent colon cancer. You can learn about the signs and symptoms of colon cancer. 

This information can help you get ready to talk with your healthcare provider and understand your next steps. 

Meet MSK’s colon cancer experts

What is colon cancer?

Colon cancer happens when healthy cells in your colon grow out of control and form a mass called a tumor. 

Colon and rectal cancers are often grouped together because the colon and rectum are part of the same organ. The colon is the first 5 feet of the large intestine. The rectum makes up the last 6 inches of the large intestine.  

Cancer that starts in the colon is called colon cancer. When cancer starts in the rectum, it’s called rectal cancer. Cancer in the colon or rectum is also known as colorectal cancer.

Radiologist Dr. Viktoriya Paroder and MSK colleagues review radiology scans on a computer.
What are the signs of colon cancer?

Early-stage colon cancer often does not cause symptoms. That’s why we recommend you get regular screenings, based on your risk factors for colon cancer. 

Anatomy of the colon and the digestive system

After you swallow food, it moves into your esophagus (ee-SAH-fuh-gus). This long tube carries food from your mouth into your stomach. In your stomach, the food starts to digest (break down). 

From your stomach, the food moves into your small intestine. Digestion also takes place here. The intestines absorb many nutrients. Anything that isn’t absorbed is called waste. 

The waste moves to your colon. Some water is reabsorbed (taken back) into your body. The rest of the waste enters the end of your colon, which is called your rectum. Your rectum is a holding area for the waste (poop) until it leaves your body through your anus. 

The colon has a few parts:

  • Cecum (SEE-kum): This part gets waste from the small intestine and moves it to the ascending colon. The cecum is a pouch about 3 inches (8 cm) long.
  • Ascending colon: This part goes from the cecum to the transverse colon. It’s where water and nutrition get absorbed. Food waste then moves sideways to the transverse colon. The ascending colon is about 8 inches (20 cm) long.
  • Transverse colon: This part carries the waste to the descending colon. It’s about 18 inches (46 cm) long.
  • Descending colon: This part helps turn food waste into poop. It’s on your left side, and is about 6 inches (15 cm) long.
  • Sigmoid colon: This part connects to the rectum. It’s about 14 to 16 inches (35 to 40 cm) long, and also helps turn food waste into poop. 
Diagram of the digestive system, including the esophagus, stomach, colon, large intestine, ileum, rectum, and anus.
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Diagram of the digestive system, including the esophagus, stomach, colon, large intestine, ileum, rectum, and anus.

The digestive system, including the colon. 

The digestive system, including the colon. 

Diagram of the parts of the colon, including the transverse, descending, ascending, and sigmoid colon.
MSK Dialog Window
Diagram of the parts of the colon, including the transverse, descending, ascending, and sigmoid colon.

Parts of the colon.

Parts of the colon.

How does colon cancer start?

Colon cancer can grow slowly over a few years. It often starts as a small abnormal (not normal) growth on the inside lining of the colon. This is called a colon polyp.  

Colon polyps are common, and they are not cancer. Most types will not harm you.  

Still, most colorectal cancers start from a polyp. The polyp grows slowly, and it can take as long as 10 years for a polyp to become cancer. For example, most colorectal cancer start in adenomatous (ad-uh-NO-muh-tus) polyps. That’s why it’s so important to remove any polyps that show up during a routine screening. That way we can prevent colon cancer. 

Colon cancer starts because of genetic changes (mutations or variants). These genetic causes sometimes may be inherited (passed from parents to children). 

Risk factors and prevention

What causes colon cancer?

A risk factor is anything that raises your chance of getting a disease, such as cancer.   

There are some risk factors you cannot control. These include your age, race, or the genes you were born with. 

There are other risk factors that you may be able to change. Research shows that having healthy habits can lower your risk for cancer.  

A few risk factors can raise your risk for getting colon cancer. Examples are:

Most colon cancers start after age 50. But in recent years, more young people in their 20s, 30s, and 40s are getting colon cancer. Most people under age 50 with colorectal cancer do not have a family history of the disease. 

Your risk may be higher if you have had: 

  • Colon cancer before.
  • Precancer polyps on a screening test.
  • Inflammatory bowel diseases, such as ulcerative colitis or Crohn’s colitis. 

Your risk for colon cancer is higher if: 

  • People closely related to you by blood (such as your parents, sister, or brother) have had colon cancer.
  • Your close blood relatives have had colon cancer before age 50.
  • A few of your blood relatives have had colon cancer.
  • A few of your blood relatives have had certain other cancers. These include endometrial, ovarian, gastric, urinary tract, brain, and pancreatic cancers. 

Your risk may be higher because of genetic changes (mutations or variants) you were born with. These mutations may be hereditary (they run in your family).  

But only a small number of colorectal cancers are caused by gene mutations that are inherited (passed down from parents). 

These are some genes that can mutate and cause colon cancer: 

  • APC
  • MUTYH
  • POLD1  and  POLE 
  • GREM1
  • MLH1
  • MSH2
  • PMS2
  • MSH6 

There are inherited conditions that raise your chances of getting colon cancer. They include Lynch syndrome and familial adenomatous polyposis (A-deh-NOH-muh-tus PAH-lee-POH-sis).  

You can lower your colon cancer risk by living a healthy lifestyle. This includes eating a balanced diet and exercising regularly. You should also avoid or limit tobacco (smoking, vaping, and chewing tobacco) and alcohol.  

These risk factors can raise your risk for colon cancer: 

  • A diet high in red, processed, or burned or blackened meats.
  • Not enough exercise.
  • Being obese, with extra fat around the waist.
  • Smoking or using tobacco products.
  • Drinking too much alcohol. 
MSK Recommends

Fiber may lower your risk for some common cancers. Our nutrition experts recommend most people aim for 25 grams of fiber a day. Try to get most of your fiber from whole foods, such as whole grains, vegetables, and fruit. Add fiber slowly with simple changes, like swapping white bread or pasta for whole grains.  

Who is at higher risk for colon cancer?

You may be at high risk for colorectal cancer if you: 

  • Are age 45 or older. 
  • Had polyps that can turn into cancer. A polyp is a small growth inside your colon.  A colonoscopy can find polyps and remove them. 
  • Have inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease.  
  • Have a close blood relative diagnosed with colorectal cancer before age 50. 
  • Have a family history of colon or other cancers, such as stomach, urinary tract, pancreatic, uterine, or brain.  
  • Have certain familial genomic conditions, such as Lynch syndrome or familial adenomatous polyposis (A-deh-NOH-muh-tus PAH-lee-POH-sis). These conditions are rare causes of colon cancer that are hereditary (they run in your family). 
  • Are overweight or obese.  

Your race can also play a role in your risk for getting colorectal cancer. For example, colorectal cancers affect the Black community in the U.S. at a higher rate than other races. 

Can genetic testing tell me if I have mutations?

The genes you were born with (inherited) can raise your chances of getting colorectal cancer. 

MSK is one of the few hospitals that can test for changes in many genes at the same time. Our multi-gene panel test can find a hereditary cause of cancer faster. This genetic testing can help us find the best treatment for the type of colon cancer you have. 

MSK’s test checks DNA for mutations linked to hereditary colorectal cancer and polyposis. It also can check for gene mutations linked to Lynch syndrome, which can cause colorectal cancer. 

The MSK Difference

Having Lynch syndrome raises your risk for colon and rectal cancers. MSK has a special program to help families with Lynch syndrome. Our experts will monitor you and schedule regular cancer screenings. MSK CATCH can help prevent or catch colon cancer at an earlier stage, when it’s easier to treat. 

Can I lower my risk for colon cancer?

There are some steps you can take to lower your risk for colon cancer. There also are some risk factors that you cannot control.  

Research shows that some healthy habits can lower your risk. Making healthier choices in your everyday life can help. 

You can also lower your risk by taking care of your health in these ways:

Eat more fruits, vegetables, and fiber, and less animal products and fat. To learn more, we have information about following a healthy diet. By making healthy food choices, you can lower your cancer risk by:

  • Staying at or reaching a healthy weight for you.
  • Having less extra body fat.
  • Supporting a healthy microbiome (the good bacteria living in your digestive tract).
  • Helping your immune system work better.
  • Helping your body work better and repair itself. 

Exercise regularly. Even some regular physical activity can lower your risk for colon cancer. Try taking the stairs instead of the elevator, and walk whenever you can. 

Keep a healthy weight. Obesity is a big risk factor for colon cancer. 

MSK Recommends Bring these questions to your next appointment

Talking about cancer screening and risks with your doctor can help you feel confident when making decisions about your care. 

  • Am I at risk for colorectal cancer?
  • When should I start colorectal cancer screening?
  • What screening test is right for me and why?
  • How do I get ready for my screening test?
  • Will insurance cover the cost of the test?

Screening for colon cancer

What is colon cancer screening?

Colon cancer screening means getting routine tests to find colon cancer, even before you have any signs or symptoms. The goal of regular screening is to find cancer early, when it’s easier to treat. 

Colon cancer screening aims to find tumors or lesions that are precancerous (can become cancer). This lets us remove precancerous lesions before they can form a tumor. 

The most common screening test for colon cancer is a colonoscopy

Gastroenterologist Dr. Mark A. Schattner is in scrubs and doing a colon cancer screening test.

Gastroenterologist Dr. Mark A. Schattner is a colon cancer screening expert at MSK in New York City.

What are the screening tests for colon cancer?

There are a few kinds of colorectal cancer screening tests and guidelines.   

A colonoscopy is the most common way to screen for colorectal cancer. It’s the only screening test that can both find and remove small growths on the colon’s inner lining.  

These growths in the colon or rectum are called polyps. They’re not cancer, but can become cancer. This means that a colonoscopy can both find and prevent colon cancer. 

Your doctor will put a flexible tube with a camera through your anus. They’ll look at your rectum and colon. Watch our video to see what happens during a colonoscopy.

There are other types of colorectal cancer screening tests.

A flexible sigmoidoscopy uses a shorter tube than a colonoscopy. Like a colonoscopy, your doctor can remove polyps. But they can only check the lower part of the colon.   

A virtual colonoscopy, also called a CT colonography, is an imaging test. CT scan technology makes 2D and 3D images of the colon and rectum. You may still need a regular colonoscopy if we must get a sample or remove a polyp or other lesion.    

Other tests are based on stool (poop) to indirectly look for signs of cancer or polyps. One example of a stool DNA test is known by its brand name, Cologuard. You’ll still need a colonoscopy if the test result suggests you may have polyps.    

Learn more about screening tests for colon cancer

When should you be screened for colon cancer?

These are MSK’s latest screening guidelines for colon cancer. They may be different from those of other groups of experts. We base your type of screening, and your screening schedule, on your personal risk for colon cancer.   

It’s important to talk with your doctor about your level of risk for getting colon cancer. You can decide on the best schedule to start colon cancer screening. 

MSK recommends people at average risk for colon cancer start getting screened at age 45.  

We also recommend people at higher risk for colorectal cancer talk with their healthcare provider about when to start screening. 

If you’re 75 or older, talk with your healthcare provider about whether screening is right for you. In general, we do not recommend routine screening after age 85. 

You’re at average risk for colorectal cancer if you’re 45 or older and have:

  • No symptoms.
  • Never had colorectal cancer, and neither have your close family members related to you by blood. These include your parents, siblings, or children.
  • Never had polyps in your colon or rectum. Polyps are growths that are not cancer but can become cancer.
  • Never had inflammatory bowel disease, such as ulcerative colitis or Crohn’s colitis. 

You’re at higher risk for colorectal cancer if you:  

  • Have close family members related to you by blood (parents, siblings, or children) who had colorectal cancer.
  • Have had a colonoscopy that found polyps in your colon or rectum. Polyps are growths that are not cancer but can become cancer.
  • Have certain changes (mutations or variants) in your genes, such as Lynch syndrome or familial adenomatous polyposis (FAP). These conditions are rare causes of colon cancer that are hereditary (it runs in your family). 

Signs and symptoms

What are the signs and symptoms of colon cancer?

Colon cancer often does not cause symptoms in the early stages. That’s why we recommend you get regular screenings for colon cancer, such as a colonoscopy, even if you feel well. Screening needs are based on your age, health history, and other risk factors. 

There are some things that may be signs of colon cancer. If you have any rectal bleeding or blood in the stool, tell your doctor right away. 

Video | 1:33 When Should You Get Screened for Colorectal Cancer?

This video has information about the guidelines for when to get colorectal cancer screening, what the test is like, and why it's important to get screened.

Visit your healthcare provider if you notice these possible symptoms of colon cancer, and they last for 2 weeks: 

  • You have bleeding from your rectum.
  • There’s blood in your stool (poop).
  • You have diarrhea (often have loose stool), constipation (not being able to poop), or narrow stool (thin like a pencil or flat like a belt). 
  • You feel an urge to poop that does not go away after pooping. 
  • You have pain or cramping in your abdomen (belly) that lasts a long time, but you don’t know why. 
  • You’re losing weight fast, without trying. 
  • You often feel tired, but don’t know why. 
  • You have anemia, but don’t know why.

Most often, these symptoms do not mean you have colon cancer. Tell your healthcare provider if a symptom is very bad or lasts longer than 2 weeks.

When you turn age 45, it’s time to schedule a colonoscopy. If you’re younger than 45, it’s very important to watch for these symptoms. Talk with your healthcare provider right away.

More young people are getting colon cancer. MSK cares for about 500 people with young-onset colorectal cancer each year. 

MSK RECOMMENDS

MSK's Ralph Lauren Center offers free or lower cost cancer care, including referrals for colorectal cancer screenings. Some people do not get screened because they’re worried about the cost, say MSK researchers. New York residents who are uninsured or underinsured may be able to get screened with no out-of-pocket costs.  

Innovations at MSK

Our experts always are discovering new information about colon cancer. We’re learning ways to diagnose the exact type and stage of colon cancer. We’re finding out how to find it early when it’s easier to treat. Explore the latest colon cancer news from MSK.