An image of colorectal cancer (left) and colitis (right), which can raise your risk of developing colorectal cancer
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5 Things We Now Know About Colorectal Cancer

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Surprising new research suggests that people younger than 50 are getting diagnosed with the disease at record rates. For National Colorectal Cancer Awareness month, find out how to protect yourself—no matter what your age.

hen someone says the word “cancer,” what pops into your head? For many people, it’s a well-publicized form of the disease, like skin cancer or breast cancer.

But colorectal cancer, which can develop either in your colon or rectum, should be on that list, too. A did-you-know fact: It’s actually the third most common cancer in both men and women, and the second leading cause of cancer-related deaths, according to the American Cancer Society.

What’s more, it’s not just an “old person's" problem: Recent research suggests that colorectal cancer is now being diagnosed in adults under the age of 50 at record rates.

But the good news is that most cases of colorectal cancer are highly preventable, says Kurtis Bachman Kurtis Bachman, Ph.D.,Vice President, Colorectal Cancer Interception for the Janssen Pharmaceutical Companies of Johnson & Johnson, Ph.D., Vice President, Colorectal Cancer Interception for the Janssen Pharmaceutical Companies of Johnson & Johnson. What's more, Janssen is innovating new ways to not only treat the cancer, but also potentially stop the disease before it develops.

For National Colorectal Cancer Awareness month, we rounded up the latest science-backed information on who’s most at risk, how best to prevent the disease and why there’s growing hope for people who receive a diagnosis.

1.

It’s never too early to watch out for symptoms.

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Colorectal cancer is generally first spotted in the form of polyps, or growths, on the inner lining of the colon or rectum.

The American Cancer Society recommends that all adults begin screening for colon cancer at age 45. The gold standard test is a colonoscopy, during which your doctor uses a flexible, lighted tube to check for polyps in your rectum and colon while you’re under sedation. This should be repeated at least once every 10 years if no abnormal findings are discovered; if you have polyps, you'll need to go in for colonoscopies at shorter intervals.

According to one study published in the Journal of the National Cancer Institute, adults born around 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer, compared to those born around 1950.

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If you’re younger than that, it’s still important to be watchful for symptoms that a growing body of studies suggest could indicate colon cancer, such as rectal bleeding, or diarrhea or constipation that lasts more than a few days. In fact, according to one study published in the Journal of the National Cancer Institute (NCI), adults born around 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer, compared to those born around 1950.

“We don’t really have a good sense as to why; we suspect rising obesity rates may play a role, as well as diet, but those don’t seem enough to explain it entirely,” says Eduardo Vilar-Sanchez, M.D., Ph.D., associate professor of Cancer Prevention and Population Sciences at The University of Texas MD Anderson Cancer Center in Houston.

In any case, the NCI study found that people younger than 55 are nearly 60% more likely to be diagnosed with late-stage disease than older adults, often because they aren't aware of the symptoms. So if you have any concerning signs of illness, like the ones mentioned, don’t delay in getting them checked out.

2.

Certain diseases can raise your risk—as can your family tree.

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Almost one-third of all people with colorectal cancer have a family history of the disease. And about 5% have inherited gene syndromes that can lead them to develop the disease, with the most common ones being Lynch syndrome, historically known as hereditary non-polyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP). If colorectal cancer runs in your family, talk to your doctor about whether genetic testing might make sense for you.

You also have an increased risk of developing colorectal cancer if you’re overweight or have type 2 diabetes; high levels of insulin in your body may, over time, speed up the production of precancerous colon cancer cells, according to one theory.

Inflammatory diseases of the colon, such as ulcerative colitis and Crohn's disease, can raise your risk, too, says Dr. Bachman, since chronic inflammation causes DNA damage and the cells in the intestinal lining to continuously turn over, increasing the chances you’ll develop a mutation that could potentially morph into cancer.

Doctors recommend that anyone who has had an inflammatory bowel disease for more than eight years gets a colonoscopy every year or two so any suspicious polyps that have developed can be removed before they could potentially turn cancerous.

3.

Lifestyle changes have great potential to protect you.

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There are specific things you can do to help lower your odds of developing colorectal cancer, which isn’t true of all types of cancer, says Dr. Vilar-Sanchez. A few tips:

Try to maintain a healthy weight. Women who are overweight or obese have up to twice the risk of developing colorectal cancer before age 50 compared to women who are at a normal BMI, according to a Washington University study published in 2018.

Women who are overweight or obese have up to twice the risk of developing colorectal cancer before age 50 compared to women who are at a normal BMI.

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Eat a fiber-rich diet. The more the better—for each 10 grams you consume daily (the equivalent of around a cup of beans), you can help reduce your risk of colon cancer by 10%, according to a 2011 study. For extra credit, sub out deli meat sandwiches for hummus or peanut butter between bread instead. Processed meat has been linked to an increased risk of colon cancer, while fish and plant-based proteins appear to be protective.

Break a sweat. And the more active you are, the greater the benefits: One analysis of over 50 studies found that the most physically active folks had a 24% lower risk of colon cancer than the least active.

Cut back on cigarettes and alcohol. Women who have smoked (even if they’ve since quit) have an almost 20% increased risk for colon cancer, compared to those who’ve never taken a puff, according to a 2013 study. And skip that nightcap: People who have more than three drinks a day have a 50% increased risk of developing colon cancer, while a drink or two daily carries a 20% increased risk, according to a French study published in the Annals of Oncology.

4.

There are better treatments now than ever before.

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Despite the news about younger demographics being diagnosed with the disease in increasing numbers, rates of colorectal cancer deaths overall have been dropping for decades, thanks to an uptick in screening. But innovations in treatment have helped, too.

Product innovations like the ones Ethicon, a Johnson & Johnson Medical Devices Company, is pioneering are crucial in helping to ensure that patients who receive colon resection—a surgical procedure that's used to treat colon cancer—have a reduced risk for potential complications, like surgical site infection, bowel content leaks or post-operative bowel obstruction.

"Surgical resection is a curative modality for localized colon cancer"—that is, a way to treat it, explains Raymond S. Fryrear II, M.D. Raymond S. Fryrear II, M.D.,Vice President and Integrated Leader, Preclinical, Clinical & Medical Affairs, Ethicon, a Johnson & Johnson Medical Devices Company, Vice President and Integrated Leader, Preclinical, Clinical & Medical Affairs, Ethicon. "Our goal is to optimize outcomes and help reduce the risk of complications at every critical moment during surgery through tools like the Echelon CircularTM Powered Stapler" (shown above).

When it comes to drug treatments, probably the most exciting advance is immunotherapy—the use of medicines to help a patient’s own immune system better recognize and destroy cancer cells—in advanced stage colon cancer, says Dr. Vilar-Sanchez. Researchers are also in the very early stages of exploring vaccines that could have the potential to someday mobilize your immune system to attack specific cancer molecules, he adds.

5.

New ways to treat, and even catch, the disease before it progresses are also on the horizon.

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Imagine if your doctor could detect cancer before it began growing in your body, then give you medicine to prevent it from taking hold. That scenario is one that scientists are researching to help make a reality someday.

The gut microbiome—the mix of good and bad bacteria that lives in your digestive tract—has been linked to a bevy of diseases and conditions, including bowel disorders, obesity and even depression. Colorectal cancer could eventually be added to that list.

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Take, for instance, the gut microbiome (seen above)—the mix of good and bad bacteria that lives in your digestive tract that has been linked to a bevy of diseases and conditions, including bowel disorders, obesity and even depression. Colorectal cancer could eventually be added to that list.

“There’s been an explosion of studies suggesting a link between the two,” says Dr. Vilar-Sanchez. A 2018 study published in Science, for example, found that two types of bacteria commonly found in the gut—Bacteroides fragilis and E. coli—release toxins that can damage cell DNA, making them more likely to turn precancerous. These bacteria are often found in the guts of people with FAP, a condition that causes people to develop polyps in their colon—often as many as 100-plus—that can lead to cancer.

“Eventually, we hope to be able to use some of these gut bacteria as biomarkers," or physical signs of a person's medical state, "either to help predict who may be at higher risk to go on to develop colorectal cancer or to determine who may respond better to certain types of treatment,” adds Dr. Vilar-Sanchez.

That's not the only current research that revolves around helping address FAP, which, adds Dr. Bachman, is “a devastating disease that usually requires someone to eventually get their entire colon surgically removed.”

Now, Janssen is progressing an early-stage trial to study a medication for these patients that’s currently approved to treat another inflammatory disease.

“We are hoping we can address the elevated inflammation within the GI tract that has been shown to cause the disease to progress,” says Dr. Bachman. “We are also focused on bringing forward new therapeutic approaches to eliminate the majority of colorectal cancers by intercepting the disease before it starts.”

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Learn how Janssen Oncology is working to be able to detect the early signs of colorectal cancer—and other forms of cancer—to help stop these diseases before they progress.

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