Colorectal Cancer

Cancer of the colon and rectum (colorectal cancer) is the third most common cancer. It is also the third leading cause of cancer-related death in the United States. More than 140,000 new cases are diagnosed each year. 

Fortunately, colorectal cancer incidence and mortality rate have been decreasing. This is likely a result of early diagnosis through screening, prevention and improved treatment. Advances in treatment and surgeries that preserve the pelvic floor muscles have improved the length and quality of life for patients with colorectal cancer.

The Gastrointestinal Oncology Disease Team at Penn State Cancer Institute  is committed to the screening, early detection, staging and multidisciplinary management of colorectal cancer.

Treatment

Surgery is usually required for any stage of colorectal cancer. Depending on your stage, surgery may be used to cure the cancer or to relieve symptoms and prolong your life. Here are treatment options, depending on the tumor’s stage: 

  • Stage I colon cancer: If your tumor has not spread outside the colon wall, your primary treatment may include surgical removal of the colon (colectomy) with the removal of regional lymph nodes. 
  • Stage I rectal cancer: For a tumor that has not spread beyond the rectum, the tumor may be surgically removed or treated with chemotherapy prior to surgery. Or, you may require radiation therapy followed by surgical removal of tumor. Alternatively, chemotherapy combined with radiation therapy can be performed with the intention to cure the disease.
  • Stage II or III colorectal cancer: If the tumor has invaded the deep layer of colon wall (stage II with high-risk features) or involves the regional lymph nodes (stage III), you may need chemotherapy after surgery.
  • Stage IV colorectal cancer: This means the tumor has spread to distant organs. In addition to surgery, you may require systemic treatment such as chemotherapy, targeted therapy, immunotherapy or a clinical trial. Depending on the extent of tumors and their response to chemotherapy, surgery to remove the tumors may be considered with curative intent.

Palliative Care

Patients with advanced colorectal cancer may benefit from palliative care to help control cancer-related symptoms and maintain quality of life. 

Genetic Counseling 

If you have colon cancer or a family history of the disease, talk to your doctor about genetic counseling for you and your family.

Treatment for Complex Colorectal Cancer Cases

If you have a chronic gastrointestinal condition, heart disease or lung disease, you and your care team will need to carefully manage your condition. These diseases can complicate or delay cancer treatment, so proper treatment is crucial. 

Managing complex cases is our strength. Our specialists from many disciplines work as a team to provide personalized treatment for you. In addition to your cancer specialists, other providers involved in your care may include:

  • Cardiologists
  • Gastroenterologists 
  • Infectious disease physicians 
  • Internal medicine physicians 
  • Pulmonary critical care physicians

Care Team

You may see one or more of the following specialists for your cancer treatment.
Michael Deutsch, MD Michael Deutsch, MD Surgeon View Researcher Profile
Niraj J. Gusani, MD Niraj J. Gusani, MD Surgeon View Researcher Profile
Nimalan Jeganathan, MD Nimalan Jeganathan, MD Surgeon View Researcher Profile
Heath Mackley, MD Heath Mackley, MD Radiation Oncologist View Researcher Profile
Abraham Mathew, MD Abraham Mathew, MD Gastroenterologist View Researcher Profile
Thomas McGarrity, MD Thomas McGarrity, MD Gastroenterologist View Researcher Profile
Kevin McKenna, MD Kevin McKenna, MD Surgeon View Researcher Profile
Ali Mohamed, MD Ali Mohamed, MD Medical Oncologist View Researcher Profile
Matthew Moyer, MS, MD Matthew Moyer, MS, MD Gastroenterologist View Researcher Profile
Frances Puleo, MD Frances Puleo, MD Surgeon View Researcher Profile
Nabeel Sarwani, MD Nabeel Sarwani, MD Radiologist View Researcher Profile
Ian Schreibman, MD Ian Schreibman, MD Gastroenterologist View Researcher Profile
Jeffrey Scow, MD Jeffrey Scow, MD Surgeon View Researcher Profile
Leila Tchelebi, MD Leila Tchelebi, MD Radiation Oncologist View Researcher Profile
Leonard Tuanquin, MD Leonard Tuanquin, MD Radiation Oncologist View Researcher Profile
Nelson Shu-Sang Yee, MD, PhD, RPh Nelson Shu-Sang Yee, MD, PhD, RPh Medical Oncologist View Researcher Profile
Amanda Cooper, MD Amanda Cooper, MD View Researcher Profile
Walter Koltun, MD Walter Koltun, MD View Researcher Profile

Locations

Penn State Cancer Institute

Penn State Cancer Institute

400 University Dr
Hershey, PA 17033

Phone: 717-531-6585
Penn State Health Medical Group - Colonnade

Penn State Health Medical Group - Colonnade

32 Colonnade Way
State College, PA 16803

Phone: 814-272-4445
Penn State Health Medical Group - Elizabethtown

Penn State Health Medical Group - Elizabethtown

1 Continental Dr
Elizabethtown, PA 17022

Phone: 717-361-0666
Penn State Health Medical Group - Nyes Road Specialties

Penn State Health Medical Group - Nyes Road Specialties

121 N Nyes Rd
Suite C
Harrisburg, PA 17112

Phone: 717-657-4045
Penn State Health Medical Group - Palmyra

Penn State Health Medical Group - Palmyra

941 Park Dr
Palmyra, PA 17078

Phone: 717-838-6305
Penn State Health Medical Group Camp Hill - Specialties

Penn State Health Medical Group Camp Hill - Specialties

3025 Market St
Entrance A
Camp Hill, PA 17011

Phone: 717-761-8900
Penn State Health Surgery Specialties

Penn State Health Surgery Specialties

200 Campus
Suite 3100
Hershey, PA 17033

Phone: 717-531-8887

Clinical Trials

An investigation of the daily experiences of colorectal cancer survivors preparing for follow-up appointments: An ecological momentary assessment study
Communication preferences related to over screening for cancer among older adults
GLNE 007 Evaluation of Stool Based Markers for the Early Detection of Colorectal Cancers and Adenomas
GLNE 010: Validation and Comparison of Biomarkers for the Early Detection of Colorectal Adenocarcinoma

Groups, Classes and Support

Support groups offer an opportunity to connect with other patients, caregivers and families. Learn more about support groups offered at Penn State Cancer Institute.

Prevention and Screening

" src="/documents/11750805/11931853/Colorectal+Cancer+One+and+Three/d7e1a251-6334-bf65-e73d-c6fc7174ecb1?t=1551097303211" />Colorectal Cancer Prevention

You can reduce your risk of colorectal cancer with the following lifestyle changes:

  • Avoid or limit red meat in your diet.
  • Eat fish and legumes. 
  • Maintain a healthy weight and body mass index (BMI).
  • Don’t smoke.
  • Take aspirin. (Talk to your doctor before taking any new medication.)

Colorectal Cancer Screening Options

These guidelines are only for those with average risk of colorectal cancer, which does not include those with a family or personal history of colon cancer or polyps. Be sure talk to your doctor about your family history and other risk factors for colorectal cancer to make sure the correct test is recommended. Those with family history may benefit from screening at an earlier age and be sent directly for a colonoscopy. All the screening tests listed below are effective at finding colorectal cancer. Most health insurance plans, including Medicare, cover most of these tests. No matter which screening test you use, the most important thing is to get tested.

Fecal Tests

Fecal Immunochemical Test (FIT)

How often:

  • Once a year

How it works:

  • You take a stool sample at home using a kit your provider gives you
  • It checks for blood in samples from one bowel movement
  • Mail your sample to a lab

High-Sensitivity Guaiac-Based Fecal Occult Blood Test (HSgFOBT)

How often:

  • Once a year

How it works:

  • You take stool samples at home using a kit your provider gives you
  • Mail your samples to a lab
  • It checks for blood in samples from three bowel movements

Multi-target Stool DNA (MT-sDNA)

How often:

  • Every three years

How it works:

  • You collect a bowel movement and stool sample at home using a kit your provider has shipped to you
  • It checks stool for blood and abnormal DNA from polyps or cancer
  • You mail a whole bowel movement and stool sample to a lab

Visual Tests

Colonoscopy

How often:

  • Every 10 years

How it works:

  • Your provider uses a tube with a tiny camera to look for and remove polyps and cancer your colon and rectum
  • You take a prep (tablets and something to drink) before the test to empty the colon
  • It causes diarrhea (watery stool)
  • You will be sedated and need a day off work
  • You will need someone to drive you to and from the appointment

CT Colonography (CTC)

How often:

  • Every five years

How it works:

  • The test is also called a virtual colonoscopy
  • Your provider uses an X-ray machine to look for polyps and cancer in your colon and rectum
  • You take a prep (tablets and something to drink) before the test to empty the colon.
  • It causes diarrhea (watery stool)

Flexible Sigmoidoscopy (FS)

How often:

  • Every five years

How it works:

  • Your provider uses a tube with a tiny camera to look for and remove polyps and cancer in the lower part of your colon and rectum
  • You give yourself one or two pre-filled enemas before the test to empty and clean the colon
  • This test is not available in most places

Symptoms and Diagnosis

Cancer of the colon and rectum (colorectal cancer) is the third most common cancer.

Symptoms

Common signs and symptoms of colorectal cancer include:

  • Abdominal pain or cramping
  • Bloody or dark stool
  • Changes in bowel habits that last longer than a few days, such as constipation, diarrhea or narrow stool
  • Fatigue
  • Rectal bleeding (bright red blood), which can lead to iron-deficient anemia 
  • Unintentional weight loss 
  • Urge to have a bowel movement that doesn't go away after you have one 
  • Weakness

Diagnosis

Colorectal cancer is diagnosed using one or more of the following methods:

If you have a colorectal tumor, your doctor may use the following to determine the stage of the tumor:

Colorectal Cancer

Cancer of the colon and rectum (colorectal cancer) is the third most common cancer. It is also the third leading cause of cancer-related death in the United States. More than 140,000 new cases are diagnosed each year. 

Fortunately, colorectal cancer incidence and mortality rate have been decreasing. This is likely a result of early diagnosis through screening, prevention and improved treatment. Advances in treatment and surgeries that preserve the pelvic floor muscles have improved the length and quality of life for patients with colorectal cancer.

The Gastrointestinal Oncology Disease Team at Penn State Cancer Institute  is committed to the screening, early detection, staging and multidisciplinary management of colorectal cancer.

Surgery is usually required for any stage of colorectal cancer. Depending on your stage, surgery may be used to cure the cancer or to relieve symptoms and prolong your life. Here are treatment options, depending on the tumor’s stage: 

  • Stage I colon cancer: If your tumor has not spread outside the colon wall, your primary treatment may include surgical removal of the colon (colectomy) with the removal of regional lymph nodes. 
  • Stage I rectal cancer: For a tumor that has not spread beyond the rectum, the tumor may be surgically removed or treated with chemotherapy prior to surgery. Or, you may require radiation therapy followed by surgical removal of tumor. Alternatively, chemotherapy combined with radiation therapy can be performed with the intention to cure the disease.
  • Stage II or III colorectal cancer: If the tumor has invaded the deep layer of colon wall (stage II with high-risk features) or involves the regional lymph nodes (stage III), you may need chemotherapy after surgery.
  • Stage IV colorectal cancer: This means the tumor has spread to distant organs. In addition to surgery, you may require systemic treatment such as chemotherapy, targeted therapy, immunotherapy or a clinical trial. Depending on the extent of tumors and their response to chemotherapy, surgery to remove the tumors may be considered with curative intent.

Palliative Care

Patients with advanced colorectal cancer may benefit from palliative care to help control cancer-related symptoms and maintain quality of life. 

Genetic Counseling 

If you have colon cancer or a family history of the disease, talk to your doctor about genetic counseling for you and your family.

Treatment for Complex Colorectal Cancer Cases

If you have a chronic gastrointestinal condition, heart disease or lung disease, you and your care team will need to carefully manage your condition. These diseases can complicate or delay cancer treatment, so proper treatment is crucial. 

Managing complex cases is our strength. Our specialists from many disciplines work as a team to provide personalized treatment for you. In addition to your cancer specialists, other providers involved in your care may include:

  • Cardiologists
  • Gastroenterologists 
  • Infectious disease physicians 
  • Internal medicine physicians 
  • Pulmonary critical care physicians
You may see one or more of the following specialists for your cancer treatment.
Michael Deutsch, MD Michael Deutsch, MD Surgeon View Researcher Profile
Niraj J. Gusani, MD Niraj J. Gusani, MD Surgeon View Researcher Profile
Nimalan Jeganathan, MD Nimalan Jeganathan, MD Surgeon View Researcher Profile
Heath Mackley, MD Heath Mackley, MD Radiation Oncologist View Researcher Profile
Abraham Mathew, MD Abraham Mathew, MD Gastroenterologist View Researcher Profile
Thomas McGarrity, MD Thomas McGarrity, MD Gastroenterologist View Researcher Profile
Kevin McKenna, MD Kevin McKenna, MD Surgeon View Researcher Profile
Ali Mohamed, MD Ali Mohamed, MD Medical Oncologist View Researcher Profile
Matthew Moyer, MS, MD Matthew Moyer, MS, MD Gastroenterologist View Researcher Profile
Frances Puleo, MD Frances Puleo, MD Surgeon View Researcher Profile
Nabeel Sarwani, MD Nabeel Sarwani, MD Radiologist View Researcher Profile
Ian Schreibman, MD Ian Schreibman, MD Gastroenterologist View Researcher Profile
Jeffrey Scow, MD Jeffrey Scow, MD Surgeon View Researcher Profile
Leila Tchelebi, MD Leila Tchelebi, MD Radiation Oncologist View Researcher Profile
Leonard Tuanquin, MD Leonard Tuanquin, MD Radiation Oncologist View Researcher Profile
Nelson Shu-Sang Yee, MD, PhD, RPh Nelson Shu-Sang Yee, MD, PhD, RPh Medical Oncologist View Researcher Profile
Amanda Cooper, MD Amanda Cooper, MD View Researcher Profile
Walter Koltun, MD Walter Koltun, MD View Researcher Profile
Penn State Cancer Institute

Penn State Cancer Institute

400 University Dr
Hershey, PA 17033

Phone: 717-531-6585
Penn State Health Medical Group - Colonnade

Penn State Health Medical Group - Colonnade

32 Colonnade Way
State College, PA 16803

Phone: 814-272-4445
Penn State Health Medical Group - Elizabethtown

Penn State Health Medical Group - Elizabethtown

1 Continental Dr
Elizabethtown, PA 17022

Phone: 717-361-0666
Penn State Health Medical Group - Nyes Road Specialties

Penn State Health Medical Group - Nyes Road Specialties

121 N Nyes Rd
Suite C
Harrisburg, PA 17112

Phone: 717-657-4045
Penn State Health Medical Group - Palmyra

Penn State Health Medical Group - Palmyra

941 Park Dr
Palmyra, PA 17078

Phone: 717-838-6305
Penn State Health Medical Group Camp Hill - Specialties

Penn State Health Medical Group Camp Hill - Specialties

3025 Market St
Entrance A
Camp Hill, PA 17011

Phone: 717-761-8900
Penn State Health Surgery Specialties

Penn State Health Surgery Specialties

200 Campus
Suite 3100
Hershey, PA 17033

Phone: 717-531-8887
An investigation of the daily experiences of colorectal cancer survivors preparing for follow-up appointments: An ecological momentary assessment study
Communication preferences related to over screening for cancer among older adults
GLNE 007 Evaluation of Stool Based Markers for the Early Detection of Colorectal Cancers and Adenomas
GLNE 010: Validation and Comparison of Biomarkers for the Early Detection of Colorectal Adenocarcinoma
Support groups offer an opportunity to connect with other patients, caregivers and families. Learn more about support groups offered at Penn State Cancer Institute.

" src="/documents/11750805/11931853/Colorectal+Cancer+One+and+Three/d7e1a251-6334-bf65-e73d-c6fc7174ecb1?t=1551097303211" />Colorectal Cancer Prevention

You can reduce your risk of colorectal cancer with the following lifestyle changes:

  • Avoid or limit red meat in your diet.
  • Eat fish and legumes. 
  • Maintain a healthy weight and body mass index (BMI).
  • Don’t smoke.
  • Take aspirin. (Talk to your doctor before taking any new medication.)

Colorectal Cancer Screening Options

These guidelines are only for those with average risk of colorectal cancer, which does not include those with a family or personal history of colon cancer or polyps. Be sure talk to your doctor about your family history and other risk factors for colorectal cancer to make sure the correct test is recommended. Those with family history may benefit from screening at an earlier age and be sent directly for a colonoscopy. All the screening tests listed below are effective at finding colorectal cancer. Most health insurance plans, including Medicare, cover most of these tests. No matter which screening test you use, the most important thing is to get tested.

Fecal Tests

Fecal Immunochemical Test (FIT)

How often:

  • Once a year

How it works:

  • You take a stool sample at home using a kit your provider gives you
  • It checks for blood in samples from one bowel movement
  • Mail your sample to a lab

High-Sensitivity Guaiac-Based Fecal Occult Blood Test (HSgFOBT)

How often:

  • Once a year

How it works:

  • You take stool samples at home using a kit your provider gives you
  • Mail your samples to a lab
  • It checks for blood in samples from three bowel movements

Multi-target Stool DNA (MT-sDNA)

How often:

  • Every three years

How it works:

  • You collect a bowel movement and stool sample at home using a kit your provider has shipped to you
  • It checks stool for blood and abnormal DNA from polyps or cancer
  • You mail a whole bowel movement and stool sample to a lab

Visual Tests

Colonoscopy

How often:

  • Every 10 years

How it works:

  • Your provider uses a tube with a tiny camera to look for and remove polyps and cancer your colon and rectum
  • You take a prep (tablets and something to drink) before the test to empty the colon
  • It causes diarrhea (watery stool)
  • You will be sedated and need a day off work
  • You will need someone to drive you to and from the appointment

CT Colonography (CTC)

How often:

  • Every five years

How it works:

  • The test is also called a virtual colonoscopy
  • Your provider uses an X-ray machine to look for polyps and cancer in your colon and rectum
  • You take a prep (tablets and something to drink) before the test to empty the colon.
  • It causes diarrhea (watery stool)

Flexible Sigmoidoscopy (FS)

How often:

  • Every five years

How it works:

  • Your provider uses a tube with a tiny camera to look for and remove polyps and cancer in the lower part of your colon and rectum
  • You give yourself one or two pre-filled enemas before the test to empty and clean the colon
  • This test is not available in most places
Cancer of the colon and rectum (colorectal cancer) is the third most common cancer.

Symptoms

Common signs and symptoms of colorectal cancer include:

  • Abdominal pain or cramping
  • Bloody or dark stool
  • Changes in bowel habits that last longer than a few days, such as constipation, diarrhea or narrow stool
  • Fatigue
  • Rectal bleeding (bright red blood), which can lead to iron-deficient anemia 
  • Unintentional weight loss 
  • Urge to have a bowel movement that doesn't go away after you have one 
  • Weakness

Diagnosis

Colorectal cancer is diagnosed using one or more of the following methods:

If you have a colorectal tumor, your doctor may use the following to determine the stage of the tumor: