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Colon + Rectal Cancer

Colon and rectal cancer (also known as colorectal cancer) accounts for cancers that begin in the colon and rectum. These cancers are often grouped together because they share many symptoms, testing methods and treatments. Colorectal cancer is preventable with the proper screenings, so it's important to stay on top of your colon health with your doctor.

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Colorectal cancer screening age lowered to 45

Colorectal cancer is the fourth most common type of cancer. On a positive note, colorectal cancer is preventable with proactive health screenings. The rise of routine colon screening has significantly dropped cancer rates for aged 50 and over since the early 2000s.

However, colorectal cancer rates among young adults are on the rise for reasons that aren’t fully understood yet. Because of this, the United States Preventive Services Task Force (USPSTF) lowered the recommended age from 50 to 45 to begin routine colon screenings.

So wherever you are in life’s journey, you can trust our team to over-deliver on your colorectal cancer care.

Dr. Jason Hall, Surgeon-in-Chief and Chair of the Department of Surgery at Tufts Medical Center, talking to patient before surgery.
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Colorectal cancer starts from tiny growths called polyps. Some polyps can be cancerous, while others are harmless (noncancerous). To lower your chances of developing colorectal cancer, it's a good idea to remove any detected polyps on the spot. When polyps are left alone, they could turn into the beginnings of colorectal cancer. That's why taking care of them early is a smart, preventative move.

If you’re experiencing the following symptoms, speak with your doctor or gastroenterologist to learn if you’re living with colorectal cancer:

Abdominal cramping
Abdominal pain
Bloody or dark stools
Change in stool consistency (diarrhea or constipation)
Loss of appetite
Weight loss
Colon cancer risk factors

It’s especially important to look out for colon cancer symptoms if you’re at high risk for the disease. Several factors can increase the risk of developing colon cancer, including:

  • Alcohol use: Consuming 2+ drinks per day for men and 1+ for women.
  • Diet: Eating a lot of red or processed meat, especially if you don't often eat vegetables, fruits or whole-grain fibers.
  • Family history: People with an immediate family member who has had colon cancer or polyps are up to 3x more likely to develop it themselves.
  • Inflammatory bowel disease: People living with inflammatory bowel diseases like ulcerative colitis or Crohn’s disease should be on the lookout for polyps.
  • Obesity: People who qualify as obese are about 30% more likely to develop colon cancer than those who don't.
  • Tobacco: People who smoke tobacco are generally at higher risk for cancer, including colon cancer.
Rectal cancer risk factors

Rectal cancer is linked to certain risk factors, including:

  • Age: People over the age of 40 
  • Pre-existing cancer: Living with pre-existing ovarian cancer, endometrial cancer or breast cancer 
  • Diet: Eating a lot of red or processed meat, especially if you don't often eat vegetables, fruits or whole-grain fibers
  • Family history: People who have a family history of colorectal cancer or polyps
  • Hereditary conditions: Having certain hereditary conditions, such as familial adenomatous polyposis (FAP) and hereditary nonpolyposis colon cancer (HNPCC or Lynch syndrome) 
  • Inflammatory bowel disease: People living with inflammatory bowel diseases like ulcerative colitis or Crohn’s disease should keep a close eye out for polyps.
  • Medical history: Having a previous history of colorectal cancer or advanced polyps as well as living with a confirmed presence of polyps in the colon or rectum


We’re here to help you navigate your colorectal health and wellness journey. Our first stop on this path is a series of tests and health screenings.

Most colorectal cancers can be traced back to pre-cancerous polyps, known as adenomas. This is a common condition where pre-cancerous polyps form along the colon’s lining. Early detection and removal of adenomas help significantly drop your risk of developing colon cancer. That’s why it’s so important for people with an average risk of developing colorectal cancer to stay on top of their health with routine screenings starting at age 45.

Early onset colon cancer may also be linked to genetic factors. If you have an immediate family member who has a history of colorectal cancer, you may benefit from a genetic consultation. During your consultation, you’ll learn about what your family history can say about your future health and how you can get ahead of it.

A majority of colorectal cancers are detected and diagnosed with the aid of tests like a colonoscopy, Cologuard® and InSure® FIT.


A colonoscopy is the gold standard for preventing colon cancer. We use a long scope to view the colon in real-time and identify anything concerning. Your doctor may remove or sample suspicious lesions on the spot to check for colorectal cancer.


Cologuard® is a colorectal cancer screening test that analyzes a stool sample for changes in DNA that could signal cancer is present.

InSure® FIT

InSure® FIT is an easy-to-use fecal immunochemical test (FIT) that looks for hidden blood in a stool sample. This hidden blood (also known as occult blood) can point to possible conditions affecting your lower gastrointestinal tract.

Additional colorectal cancer tests

Double contrast barium enema

A double contrast barium enema is a special type of X-ray test we use to look for anything unusual or suspicious. A care team member injects air and barium into the rectum and colon to enhance the X-ray images.

While larger lesions are easier to see with a barium enema, smaller lesions may go undetected. Your health deserves more than a wait-and-see approach, so we’ll perform a follow-up colonoscopy to sample any suspicious lesions.

Colonography (“virtual colonoscopy”)

A colonography is a combination of a barium enema and a CT scan that we use to examine your large intestine. This test is much more accurate than a simple barium enema. However, smaller lesions may go undetected. We’ll leave nothing to chance and perform a follow-up colonoscopy to sample any suspicious lesions.

Fecal occult blood tests

We use fecal occult blood tests to evaluate your stool for small amounts of blood that may not be visible to the naked eye. Bloody stool can point to a number of different conditions, like hemorrhoids. That’s why we follow up on positive tests with a full colon evaluation to search for colorectal cancer.

Flexible sigmoidoscopy

A flexible sigmoidoscopy involves inserting a short scope through the anus to examine your colon and rectum. Your doctor may remove or sample suspicious lesions on the spot to test for colorectal cancer.

Tests to stage colorectal cancer

Once we’ve located a tumor, it’s important to understand if the disease is spreading and, if so, how far. This process is called staging, and it helps us design the most effective care plan for you. We stage colon and rectal cancers based on:

  • How far the cancer has moved into the colon wall
  • Whether cancer has spread to the lymph nodes around the rectum
  • Whether the cancer has spread to other parts of the body (metastasis)

Staging starts with your doctor taking a small sample of the tumor to then examine under the microscope. Your doctor may recommend one or a combination of tests to further understand your condition:

Your doctor will use the information from these tests to determine what your next best treatment move is, like surgery, radiation or chemotherapy.



Your doctor will consider the stage of your colon cancer to map your unique treatment path. Early-stage colon cancer may only require surgery to remove the cancer. More advanced stages may bring chemotherapy into your treatment mix to reduce the chance of cancer returning.

Advanced colorectal cancer

Living with advanced colorectal cancer is complex, but understanding your treatment plan doesn’t have to be. We consider colorectal cancer to be advanced when:

  • It has spread locally (cancer has grown beyond where it started, but not to other locations)
  • It has spread to other parts of the body (metastatic cancer)

We turn to a variety of medical and surgical approaches that can improve your quality of life and offer you more time to experience what matters most to you. Your treatment may include these proven medical approaches:

  • Chemotherapy
  • Clinical trials
  • Medication therapy
  • Radiation therapy
  • Y-90 (SIR-Spheres)

We can also explore the following surgical approaches as part of your treatment plan:

  • Enterostomal therapy
  • Hyperthermic intraperitoneal chemotherapy (HIPEC) for widespread intra-abdominal disease
  • Intra-operative brachytherapy (radiation)
  • Minimally invasive surgery
  • Pelvic exenteration
  • Wide visceral excision and reconstruction

Combined endoscopic-laparoscopic surgery (CELS)

During a colonoscopy, doctors may spot a harmless-looking polyp that they can’t remove because it’s in a hard-to-reach place. Even if this polyp doesn't appear concerning, it's a good idea to remove it so it doesn't develop into cancer over time. The traditional approach for treating these polyps is with a colectomy, which involves removing a part of or the entire colon.

However, about 80% of these people ultimately don’t have cancer, so moving forward with a major surgery to remove the polyp is a large undertaking.

At Tufts Medicine, we’re bringing the latest breakthroughs to your colorectal care with a technique called combined endoscopic-laparoscopic surgery (CELS).

CELS combines techniques used during a colonoscopy with laparoscopy to cover your colon from all angles. This approach gives your doctor a clear view of the polyp to remove with precision. CELS is a smart alternative to a colectomy because of these important benefits:

  • Fewer long-term side effects
  • Lower rate of complications
  • More affordable medical costs
  • Shorter recovery time

Sometimes, despite everyone’s best efforts, we can’t remove the polyp with CELS. In that case, your doctor may recommend moving forward with a  colectomy.

Transanal endoscopic microsurgery (TEM) 

Transanal endoscopic microsurgery (TEM) is a minimally invasive surgical technique that allows surgeons to operate on concerning lesions in the middle and upper rectum without having to make an incision through the abdomen.

Instead, doctors use a special microscope with an attached video camera that allows them to evaluate your organs in real-time. This microscope gets inserted through the anus and into the rectum, where your doctor will then use long instruments to grasp, cut and suture the lesion.

The major advantages of TEM include:

  • Little pain
  • No external scars 
  • No hospital stay
  • Normal anorectal function
  • Rapid recovery at home

Nutrition + colorectal cancer

Nutrition plays an important role in managing colorectal cancer. You can find your colorectal cancer care and nutritional needs all under one roof at Tufts Medicine.

We offer our nutrition services like counseling and dietary planning to all patients living with colorectal cancer. Registered dietitians are ready to talk through any nutrition challenges or concerns related to cancer and ostomy procedures.

Young adults living with colorectal cancer

There's a noticeable change in the landscape of colorectal cancer, as it moves away from predominately affecting people age 50 and older to now becoming more common among young adults instead.

Being a young adult with a cancer diagnosis can bring on a wave of emotions. We’re here to help you navigate these new waters with our Reid R. Sacco Adolescent and Young Adult (AYA) Program for Cancer and Blood Diseases.

We invite young people (between ages 18–39) who are living with cancer to find hope, comfort and camaraderie in our AYA Program.



How many people are diagnosed with colorectal cancer in the United States each year?

Colorectal cancer is the fourth most common cancer found in all people, with more than 200,000 cases diagnosed in the United States each year. It’s the third-leading cause of cancer death in the United States.

How long does it take for colon polyps to turn cancerous?

To put things in perspective, it takes about 7–10 years for a small polyp to turn into cancer. But once it’s cancerous, it develops at a much faster rate. That's why yearly screenings are so important.


Awards + accreditations

The Commission on Cancer (CoC) of the American College of Surgeons (ACoS) has granted a 3-year Approval with Commendation as a Comprehensive Community Cancer Program to the Cancer Center at Lowell General Hospital, as well as its Outstanding Achievement Award (OAA), designed to recognize cancer programs that strive for excellence in providing quality care to cancer patients.

Nurse comforting patient before a colon and rectal surgery.
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Amber Gross, SRNA (nurse assistant), Heidi MacFarlane, RN, Jason Hall, MD and Sharma Joseph, MD preparing patient for colon and rectal surgery
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