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Blood in stool

Abdominal pain

Constipation symptoms

Constant fatigue

Stomach ache

Lower abdominal pain

Sensation of not emptying bowel

Gastric pain in chest

Irregular bowel movements

Thin stools

Feeling tired all the time

Unexplained weight loss

Not seeing your symptoms? No worries!

What is Colon Cancer?

Cancer of the large intestine which is the final part of the digestive tumors. It often grows from non-cancerous polyps in the intestine. Both polyps and colon cancers can be found during colonoscopy (camera test of colon). Symptoms can include blood in stool, diarrhea or constipation or both, or abdominal pain but many times there are no symptoms and the cancer is found on colonoscopy. It can be easily treated in early stages, so the general population is encouraged to get screened with colonoscopy and sometimes stool tests. Risk factors include a family history of colon cancer or polyps, or a personal history of abnormal polyps, low-fiber high-fat diets, some inflammatory bowel diseases, diabetes, obesity, and lack of exercise.

Typical Symptoms of Colon Cancer

Diagnostic Questions for Colon Cancer

Your doctor may ask these questions to check for this disease:

  • Is your stool thin and narrow like a pencil?
  • Have you noticed any blood in your stool?
  • Have you ever had any issues with a colonoscopy?
  • Have you been diagnosed with Ulcerative Colitis?
  • Have you had black, shiny stools?

Treatment of Colon Cancer

In most cases a gastroenterologist will diagnose the tumor with a biopsy during colonoscopy or sigmoidoscopy. They will then order CT scans and MRIs and will refer the patient to a colorectal surgeon. A medical oncologist may be consulted to discuss recommendations for chemotherapy before or after surgery and sometimes a radiation oncologist will give radiotherapy to the area. Since the types of treatment can include surgery, radiation, chemotherapy, or a combination of these, it is often important to be treated by a multidisciplinary team, particularly in the case of rectal cancers.

Reviewed By:

Robin Schoenthaler, MD

Robin Schoenthaler, MD (Oncology)

Board certified radiation oncologist with over 30 years experience treating cancer patients. Senior physician advisor for expert medical options in adult oncology. Published award-winning essayist on medical and health issues and more.

Aiko Yoshioka, MD

Aiko Yoshioka, MD (Gastroenterology)

Dr. Yoshioka graduated from the Niigata University School of Medicine. He worked as a gastroenterologist at Saiseikai Niigata Hospital and Niigata University Medical & Dental Hospital before serving as the Deputy Chief of Gastroenterology at Tsubame Rosai Hospital and Nagaoka Red Cross Hospital. Dr. Yoshioka joined Saitama Saiseikai Kawaguchi General Hospital as Chief of Gastroenterology in April 2018.

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Content updated on Jan 14, 2025

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  • History - considers past illnesses, surgeries, family history, and lifestyle choices.

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Symptoms Related to Colon Cancer

Diseases Related to Colon Cancer

FAQs

Q.

Is Cancer Genetic? The Reality of Lynch Syndrome and Medical Next Steps

A.

Cancer is sometimes genetic, and Lynch syndrome is a key example that significantly increases the risk of colon and endometrial cancers; overall, about 5 to 10 percent of cancers are inherited. There are several factors to consider; see below to understand red flags in family history, how Lynch is inherited, and the next steps like genetic counseling, testing, and earlier, more frequent colonoscopy and related screenings that can save lives.

References:

* Boland CR. Lynch Syndrome: An Update. N Engl J Med. 2023 Jul 27;389(4):346-357. doi: 10.1056/NEJMra2215424. PMID: 37490795.

* Stigliano V, Cencioni C, D'Angelo C, Stigliano V, Bischetti S, Borro M, De Luca M, Balducci S, Balducci E, Di Franco G, Capuano S, Fragnoli D, Martini M, Ciolli P, Del Bene G, Stigliano M, Cini C. Detection and Management of Lynch Syndrome: A Review. Front Oncol. 2021 Jan 12;10:600720. doi: 10.3389/fonc.2020.600720. PMID: 33505872; PMCID: PMC7833895.

* Seifert J, Vilar E, Stello K, Burke CA, Burt RW, Liska D, Provenzale D, Reiffenberg E, Rossi M, Syngal S, Weiss JM, You YN, Yurgelun MB, Mutch MG. Surveillance and Management of Patients With Lynch Syndrome: An International Consensus Statement From the Collaborative Group of the Americas on Inherited Colorectal Cancer. Gastroenterology. 2022 Dec;163(6):1481-1493.e4. doi: 10.1053/j.gastro.2022.08.019. Epub 2022 Aug 23. PMID: 36007604.

* Hampel H, Pearlman R, Haraldsdottir S, Cohen S, Seifert J, Goldberg Y, Seidenfeld J, Liska D, Mutch MG, Monahan P, Yurgelun MB, Syngal S, Weiss JM, Burt RW. Genetic Testing for Lynch Syndrome: Current Practices and Challenges. Clin Cancer Res. 2021 Mar 15;27(6):1591-1601. doi: 10.1158/1078-0432.CCR-20-3770. Epub 2020 Dec 28. PMID: 33371900; PMCID: PMC7961136.

* Palomba G, Palomba E, Falchero L, Ivaldi F, Loffredo C, Bottino C, Balestrazzi A, Gismondi P. Lynch syndrome: from genetics to clinical practice. ESMO Open. 2023 Oct;8(5):101869. doi: 10.1016/j.esmoop.2023.101869. Epub 2023 Sep 13. PMID: 37717468; PMCID: PMC10547748.

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Q.

Is it Just Bloating? Signs of Colon Cancer & Medically Approved Next Steps

A.

There are several factors to consider. Bloating alone is common and usually harmless, but if it lasts more than 2 to 3 weeks or comes with blood in the stool, persistent bowel changes, abdominal pain, unexplained weight loss, or fatigue, it could signal colon cancer and should be checked. Recommended next steps include tracking symptoms, using a reputable symptom checker, contacting a clinician promptly for red flags, and following screening guidance that starts at age 45 or earlier if you are higher risk; go to urgent care for severe pain, heavy bleeding, persistent vomiting, or signs of blockage. See the complete guidance, risk factors, and what to do in different scenarios below.

References:

* Hosseinpour M, Khazaei Z, Gholami M, Moradi Y, Salimi Y. Symptoms of Colorectal Cancer and Associated Factors: A Systematic Review. Front Oncol. 2022 Jan 28;11:794217. doi: 10.3389/fonc.2021.794217. PMID: 35149363; PMCID: PMC8835263.

* Vasileiadis I, Zafiriou N, Kalampas A, Koutsikos S, Goulielmos NP, Giannousis I. Early Detection of Colorectal Cancer: A Narrative Review. Int J Environ Res Public Health. 2022 Dec 22;20(1):162. doi: 10.3390/ijerph20010162. PMID: 36585149; PMCID: PMC9818815.

* Sheng J, Zhai Z, Yan B, Deng S, Zhang Y, Yu C. Colorectal Cancer Screening: An Updated Overview. Cancer Res Treat. 2023 Oct 12. doi: 10.4143/crt.2023.708. Epub ahead of print. PMID: 37775534.

* Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2021 Jul 3;398(10294):91-104. doi: 10.1016/S0140-6736(21)00075-0. PMID: 34208491.

* Seifert L, Kussin A, von Wyl T, Spalinger M, Reiner CS, Sulz MC, Misselwitz B. Alarming Symptoms for Colorectal Cancer and Referral Pathways: A Systematic Review. Digestion. 2020;101(6):710-721. doi: 10.1159/000508544. Epub 2020 Jul 17. PMID: 32675276.

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Q.

Is it Colorectal Cancer? Why Your Gut is Changing & Medical Next Steps

A.

Gut changes are common and often not cancer, but red flags like blood in the stool, bowel habit changes lasting more than 2 to 3 weeks, unexplained weight loss or fatigue, and persistent abdominal pain warrant prompt medical evaluation, and screening from age 45 can prevent cancer by finding and removing polyps. There are several factors to consider, including benign causes, personal and family risk, and which tests to do next such as stool tests and colonoscopy; see below for the complete guidance and actionable next steps that may affect your care.

References:

* Maida, C. M., Sferrazzo, S., Alaimo, B., Scalia, G., Alaimo, I., Bellanca, L., Cannova, S., Alaimo, G., & D'Alessandro, R. (2021). Change in bowel habit and rectal bleeding as red flags for colorectal cancer: a systematic review. *Journal of Clinical Medicine*, *10*(14), 3097.

* Dekker, E., Tanis, P. J., Vleugels, J. L. A., Kasi, P. M., & Wallace, M. B. (2023). Diagnosis and Management of Colorectal Cancer: An Updated Review. *JAMA*, *329*(3), 251–263.

* US Preventive Services Task Force, Davidson, K. W., Barry, M. J., Mangione, C. M., Cabana, L. S., Caughey, A. B., ... & Wong, J. B. (2021). Colorectal Cancer Screening: Updated Recommendations From the U.S. Preventive Services Task Force. *JAMA*, *325*(19), 1965–1975.

* Rawla, P., Sunkara, T., & Barsouk, A. (2022). Colorectal Cancer: Epidemiology, Risk Factors, and Clinical Presentation. *Medical Sciences (Basel, Switzerland)*, *10*(4), 184.

* Zhang, M., Ye, Y., Ma, K., Wang, Y., Zhang, W., Chen, S., Sun, Y., & Chen, G. (2023). New advances in the diagnosis of colorectal cancer. *Frontiers in Oncology*, *12*, 1074092.

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Q.

Is it colon cancer? Why your gut is changing and medically approved next steps

A.

There are several factors to consider: most gut changes are benign, but persistent bowel habit changes, blood in stool, unexplained weight loss, fatigue, or anemia, especially after 45 or with a family history, can signal colon cancer. Medically approved next steps include seeing a clinician promptly and getting guideline-based screening starting at 45, with colonoscopy as the gold standard and stool tests or imaging as alternatives. See below for red flags, risk factors, and which tests to choose and when, since those details can change your next steps.

References:

* Sung H, Siegel RL, Laversanne J, Soerjomataram A, Jemal A, Bray F. Global Patterns in Colorectal Cancer Incidence and Mortality in 2020. Gut. 2022 Sep;71(9):1761-1770. PMID: 35031575.

* Kahi CJ, Imperiale TF, Juliar BE, et al. Current and Future Directions for Colorectal Cancer Screening. Clin Transl Gastroenterol. 2021 Jan;12(1):e00293. PMID: 33417387.

* Mouchli A, Fakhoury M, Al Bitar S, Al Akl N, Khalifeh H. Colorectal Cancer: Diagnosis, Screening, and Treatment. Dis Mon. 2022 Nov;68(11):101429. PMID: 35914902.

* Bjerregaard B, Nørgaard M, Thomsen R. Symptomatic presentation of colorectal cancer and associated factors: a systematic review. Scand J Gastroenterol. 2023 Feb;58(2):137-147. PMID: 36005747.

* Lieu CH, Renfro LA, Dasari A, et al. Multidisciplinary management of colorectal cancer. World J Gastroenterol. 2022 Jan 14;28(2):162-177. PMID: 35087383.

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Q.

Is it just gas? Colon cancer symptoms and the medical steps you need.

A.

There are several factors to consider: gas-like bloating that persists or worsens beyond two weeks, especially with changes in bowel habits, rectal bleeding, ongoing abdominal pain, unexplained weight loss, or fatigue, may signal colon cancer rather than simple gas. See below for the full checklist of symptoms, risk factors, and step-by-step medical actions your doctor may use, from stool tests and bloodwork to a colonoscopy, plus urgent red flags and screening timelines that could change your next steps.

References:

* Douaiher J, Tazkarji R. Colorectal Cancer: Symptoms, Risk Factors, and Screening. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. PMID: 32644485.

* Stoffel EM, McKinnon WC. Colorectal Cancer. Med Clin North Am. 2019 Nov;103(6):1005-1020. doi: 10.1016/j.mcna.2019.07.001. PMID: 31587652.

* Ejaz A, Khan MJ, Khan Z, Zafar MJ. Symptom Awareness and Screening for Colorectal Cancer. Cureus. 2020 Mar 27;12(3):e7445. doi: 10.7759/cureus.7445. PMID: 32346513; PMCID: PMC7188151.

* Zafar MJ, Khan MJ, Ejaz A, Asghar MS, Khan Z. Early detection of colorectal cancer: A review. World J Gastrointest Oncol. 2021 Jan 15;13(1):1-14. doi: 10.4251/wjgo.v13.i1.1. PMID: 33494443; PMCID: PMC7808389.

* Rex DK, Boland CR, Dominitz JA, et al. Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017 Jul;112(7):1016-1031. doi: 10.1038/ajg.2017.171. Epub 2017 Jun 27. PMID: 28657685.

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Q.

Silent Internal Struggle? Why a Colonoscopy is Your Shield + Medical Next Steps

A.

Colonoscopy is your best shield against silent colon cancer, which often causes no symptoms even when you feel fine, because it not only finds early disease but can remove precancerous polyps during the same visit; most people should start at 45, earlier if higher risk. There are several factors to consider that can change your next steps, including symptoms that need prompt care, how stool tests differ and when an abnormal result means colonoscopy, safety and prep, and what happens if something is found; see complete details below.

References:

* Davidson KW, Barry MJ, Mangione CM, et al. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 May 18;325(19):1965-1977. doi: 10.1001/jama.2021.5754. PMID: 34008130.

* Bretthauer M, Grosse A, Haug U, et al. Efficacy of Colonoscopy in Reducing Colorectal Cancer Incidence and Mortality: A Systematic Review and Meta-analysis. Gastroenterology. 2021 Nov;161(5):1699-1719.e16. doi: 10.1053/j.gastro.2021.07.034. Epub 2021 Aug 17. PMID: 34418465.

* Rex DK, Kahi CJ. Postpolypectomy Surveillance Recommendations. Curr Treat Options Gastroenterol. 2021 Mar;19(1):16-24. doi: 10.1007/s11938-021-00329-z. PMID: 33763776.

* Shaukat A, Kahi CJ. Current challenges and future directions in colorectal cancer screening. World J Gastroenterol. 2023 Feb 14;29(6):960-975. doi: 10.3748/wjg.v29.i6.960. PMID: 36814917; PMCID: PMC9939525.

* Crosbie AB, Corley DA, Phalen JA, et al. Colorectal Cancer Screening with Fecal Immunochemical Test, Colonoscopy, or Both: A Scoping Review. Ann Intern Med. 2023 Jan;176(1):77-87. doi: 10.7326/M22-1323. Epub 2022 Nov 29. PMID: 36442111.

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Q.

Colonoscopy for Women 30-45: Red Flags & Your Action Plan

A.

Routine screening usually begins at 45, but women 30 to 45 should ask about colonoscopy sooner if they have red flags like recurrent rectal bleeding, persistent bowel changes for more than 2 to 3 weeks, unexplained iron deficiency anemia, concerning abdominal pain or weight loss, or a strong family history or inflammatory bowel disease. Your action plan includes knowing your family history, tracking symptoms, improving lifestyle habits, using a symptom checker, and speaking to a clinician early since colonoscopy can both find and remove polyps. There are several factors to consider and important timing details that can change next steps, so see below for the complete guidance.

References:

* Vuik FE, Nieuwenburg S, Westerink LM, Leenders M, Ponsioen CY, van der Meulen MP, Dekker E, Cats A, Fockens P, van Eeden S, van der Post RS, van Gorp J, van Engeland M, van Hees K, Dekker J, Lacle M, Stolk R, van Geest G, Oldenburg B. Rising incidence of early-onset colorectal cancer: a systematic review and meta-analysis. Gut. 2019 Jun;68(6):1002-1011. doi: 10.1136/gutjnl-2018-316712. Epub 2018 Oct 17. PMID: 30333256.

* Ma C, Zhao Y, Luo X, Zheng Y, Xie J, Song M, Wang S, Li J. Symptoms of early-onset colorectal cancer: a case-control study. Cancer. 2021 Jul 15;127(14):2510-2521. doi: 10.1002/cncr.33532. Epub 2021 Apr 19. PMID: 33871071.

* Syngal S, Brand RE, Church JM, Giardiello FE, Horton IJ, Lynch HT, Offit K, Peters JA, Rubenstein J, Shannon KM, St John DJ, Stoffel EM, Burt RW. Clinical Practice Guidelines for Hereditary Colorectal Cancer Syndromes: Recommendations From the American College of Gastroenterology. Am J Gastroenterol. 2015 Oct;110(10):1497-511. doi: 10.1038/ajg.2015.324. Epub 2015 Sep 22. PMID: 26391452.

* Singh S, Feuerstein JD, Kvasnovsky CL, Cheifetz AS. Colorectal Cancer Surveillance in Inflammatory Bowel Disease: A Review of Current Guidelines and Future Directions. Clin Transl Gastroenterol. 2018 Nov 1;9(11):205. doi: 10.1038/s41424-018-0056-1. PMID: 30385750; PMCID: PMC6376510.

* Gupta S, Ma D, Halverson AL, Ross JS, Chung DC. Colorectal Cancer Screening in Younger Adults: New Guidelines and Clinical Implications. J Clin Oncol. 2021 May 20;39(15):1621-1631. doi: 10.1200/JCO.20.03058. Epub 2021 Apr 22. PMID: 33886524.

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Q.

Colon Cancer Poop: 5 Signs Women 65+ Should Never Ignore

A.

Women 65 and older should not ignore five colon cancer stool signs: any blood in the stool, persistent thin or pencil like stools, ongoing diarrhea or constipation, frequent mucus or a constant urge to go, and unexplained anemia or fatigue that may reflect hidden bleeding. These are about patterns that last more than 2 to 3 weeks and should prompt a call to your doctor and up to date screening, since colon cancer is highly treatable when found early. There are several factors and next steps to consider, including when to seek care, what tests to ask about, and how to describe symptoms, so see the complete guidance below.

References:

* Nielsen, H. N., Murchie, P., & Campbell, N. C. (2018). Colorectal Cancer Symptoms in Older Adults: A Systematic Review. *Journal of Geriatric Oncology*, *9*(4), 387–395. https://pubmed.ncbi.nlm.nih.gov/29961688/

* Brenner, H., & Hoffmeister, M. (2016). Symptomatology of Colorectal Cancer in Older Adults: A Population-Based Study. *Journal of the American Geriatrics Society*, *64*(1), 164–169. https://pubmed.ncbi.nlm.nih.gov/26687483/

* Siegel, R. L., Miller, K. D., Wagle, N., & Jemal, A. (2023). Cancer statistics, 2023. *CA: A Cancer Journal for Clinicians*, *73*(1), 17-48. https://pubmed.ncbi.nlm.nih.gov/36633252/

* Douaiher, J., Dhuli, K., & Kordahi, M. (2021). Colorectal Cancer: Current Perspectives on Risk Factors, Pathogenesis, Diagnosis, and Management. *Current Oncology Reports*, *23*(11), 127. https://pubmed.ncbi.nlm.nih.gov/34687000/

* Barth, H., von Wirth, K., & Steigleder, T. (2016). The incidence of colorectal cancer symptoms in a general practice population aged 50-79 years. *Zeitschrift für Gastroenterologie*, *54*(7), 659–665. https://pubmed.ncbi.nlm.nih.gov/27448347/

See more on Doctor's Note

Q.

Pencil-Thin Stools and Blood: Identifying Colon Cancer Stool Changes

A.

Pencil-thin stools and blood in stool can be warning signs of colon cancer, especially if they last more than 2 to 3 weeks, worsen, or occur with other issues like black tarry stools, a feeling of incomplete emptying, weight loss, or fatigue, though common causes like hemorrhoids or IBS are also possible. There are several factors to consider. See complete details below for specific red flags, noncancer causes, who is at higher risk, how screening and stool tests fit in, and clear guidance on when to contact a doctor or seek urgent care.

References:

* Sunkara, A., & Tepper, J. E. (2020). Colorectal Cancer: Symptoms. *Seminars in Oncology Nursing*, *36*(3), 151020.

* Rawla, P., & Sunkara, T. (2020). Colorectal Cancer: An Update on Epidemiology, Risk Factors, Screening, and Prevention. *Gastroenterology Research*, *13*(2), 65-71.

* Weinberg, B. A., & Goldberg, J. E. (2023). Early-Onset Colorectal Cancer: Clinical and Molecular Characteristics. *Journal of Clinical Oncology*, *41*(16), 2884-2895.

* El-Sharkawy, H., & El-Sharkawy, J. (2023). Rectal bleeding: an often ignored red flag. *Journal of Gastroenterology and Hepatology*, *38*(3), 395-397.

* O'Connell, J. B., & Magnuson, A. (2021). The clinical spectrum of colorectal cancer in young patients: a systematic review. *Journal of Surgical Research*, *262*, 1-10.

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