Colorectal Cancer Prevention
Can colorectal cancer be prevented?
Several medical approaches may be used alone or in combination to lower the risk for colorectal cancer in high-risk people. Each approach differs in their benefits, risks and effectiveness. None of these approaches completely eliminates the risk for cancer.
- Medications (sometimes called ). Medications can lower the risk for colorectal cancer, but enough risk remains that experts still recommend screening.
- Combination of colonoscopy and removal of before they become cancer. See our colorectal screening section for more information.
- Risk-reducing colectomy (sometimes called prophylactic surgery). This options is typically reserved for people with a very high risk for colorectal cancer and those people with too many to control with colonoscopy and polyp removal.
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SIGN UP FOR CONTENT UPDATESWhich medications can lower the risk for colorectal cancer?
Much of the research on medications to lower colorectal cancer risk have focused on pain medications known as NSAIDS. These drugs have been studied in both average-risk and high-risk people.
Aspirin
- In people at average risk for colorectal cancer, long term use of aspirin can reduce the risk of colorectal and colorectal cancer.
- For people at high risk for colorectal cancer, multiple studies have shown a benefit of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDS).
- In people with , daily aspirin may decrease the risk for colon cancer and other cancers. In one study, people who took 600 mg of aspirin daily for two years or more had a 60 percent decrease in their risk for colorectal cancer.
- More studies are needed to help experts understand the best dose and duration of aspirin to protect people with from colorectal cancer.
Other anti-inflammatory drugs
- In people with the rare syndrome Familial Adenomatous Polyposis (FAP), caused by a mutation in the gene, the drugs Sulindac and celexicob have been shown to lower the risk for .
Research on other drugs
- Vaccines are being studied in clinical trials to see if they can lower the risk for colorectal cancer in people with .
- New drugs are being studied in a clinical trial to learn how well it can lower the risk for cancer in people with FAP.
- Other medications and dietary supplements have been studied through clinical trials, some of which may be enrolling high-risk people.
- Currently, there is not enough evidence to support using of any of these other agents to lower the risk for colorectal cancer.
Who should consider medications to lower the risk for colorectal cancer?
The guidelines on for colorectal cancer vary based on a person's gene mutation and personal situation.
- For , (mutations in , , , or ), the NCCN guidelines recommend that people discuss the benefits, risks and limitations of aspirin to lower the risk for colorectal cancer with their doctor.
- For people with FAP and AFAP, (mutations in the gene) the guidelines mention that with Sulindac may be considered after surgery to lower the risk of in the remaining tissue. However, the guidelines point out that more research is needed to determine how effective it is for lowering cancer risk for cancer.
- For people with MAP, (mutations in both copies of the MUTYH gene) the guidelines mention that may be considered. However, the guidelines point out that none of the research on colorectal cancer has specifically studied people with MAP.
The guidelines do not specifically recommend for people with mutations in other genes that increase the risk for colorectal cancer.
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What is a risk-reducing colectomy?
Colectomy is surgery to remove some or all of the colon. Colectomy is typically used to treat colorectal cancer or other diseases of the colon. People at very high risk for colorectal cancer may have a risk-reducing colectomy in order to prevent colorectal cancer from developing.
Colectomy can have risks and long-term health effects, so it's usually only recommended for people with a very high risk for colorectal cancer. It's important for people considering a risk-reducing colectomy to speak with cancer genetics and surgical experts in order to learn as much as possible about their colorectal cancer risk and to make an informed decision about the best option for lowering their risk.
What are the different types of colectomy?
Colectomy surgeries vary by how much tissue is removed.
- Segmental colectomy removes just a portion of the colon to treat cancer or other abnormalities. It is not typically used for prevention of cancer.
- Total proctocolectomy with ileal pouch and anal anastomosis (TPC-IPAA) removes the colon and rectum but spares the anal sphincter (the muscle that controls bowel movement release). People who have this surgery may remain continent with bowel control. The surgeon will use a portion of the small intestine to create an internal pouch, which stores waste until a bowel movement.
- Total abdominal colectomy with ileorectal anastomosis () removes the entire colon but spares the rectum. Not all people are candidates for this surgery, as the intact rectum may still have elevated cancer risk.
- Total proctocolectomy with permanent end ileostomy (TPC-EI) removes the entire colon, rectum and anus and creates an ostomy opening at the end of the small intestine. The end ileostomy is positioned on the abdominal wall and requires the use of an ileostomy bag to manage stool output.
Colectomy may be performed in 2 ways:
- For open surgery (also known as a laparotomy), doctors make one long incision in the abdomen to access the colon.
- Colectomy may also be done by laparoscopy - where a small incision is made for a small flexible scope with a camera, which is used to see the colon. Additional small incisions are made to insert surgical instruments needed to perform the colectomy.
In general, people who have surgery by laparoscopy may heal quicker and spend a shorter time in the hospital than people who have open surgery. Not all colectomies can be performed by laparoscope, so it's important for people to speak with their doctor about which surgery is right for them.
Who should have a risk-reducing colectomy?
Undergoing risk-reducing surgery is a very personal decision that is not right for everyone. The NCCN guidelines recommend that people with the mutations in the genes listed below discuss the benefits, risk, and different options for risk-reducing colectomy with their doctor, in order to make a decision that is right for them.
Familial adenomatous polyposis (FAP or AFAP)
For people with FAP or AFAP, NCCN recommends discussion of colectomy when they first develop . The type of colectomy depends on a person's medical history and preference, but options include:
- Total proctocolectomy with Ileal Pouch and Anal Anastomosis (TPC-IPAA)
- Total abdominal colectomy with ileorectal anastomosis ()
- Total proctocolectomy with permanent end ileostomy (TPC-EI)
For people with , the guidelines recommend discussion about risk-reducing colectomy for people who have already been diagnosed with colorectal cancer or for people who are not able to undergo recommended high-risk screenings. For these individuals, total abdominal colectomy with ileorectal anastomosis () may be discussed as an option for preventing development of future colon cancers.
MUTYH associated polyposis (MAP)
For people with MUTYH associated polyposis (MAP), with mutations in both copies of their MUTYH gene, who have that cannot be managed with colonoscopy alone, surgery is often recommended.
Other genes
For people with a mutation in AXIN2, GREM1, MSH3 (two mutations/MSH3-associated polyposis), NTHL1 (two mutations), POLD1 and POLE whose cannot be managed with colonoscopy, experts may recommend surgery.
What are the surgical risks with colectomy?
Every surgery has potential risks; some are more serious than others. Some possible risks with colectomy include:
- infection
- delayed healing
- blood loss
- blood clots
- internal bleeding
- hernia
- intestine blockage
- intestine leakage
- damage to other organs
It is important for people to discuss possible surgical risks with a surgeon to understand the seriousness and likelihood of these risks before making the decision to have risk-reducing surgery.
Is colorectal cancer screening still required after risk-reducing colectomy?
Even after risk-reducing surgery, there may be risk for and cancer in the tissue that remains. Scoping of remaining tissue depends on type of surgery and how much tissue remains, but may include:
- sigmoidoscopy.
- pouchoscopy.
- limited scoping of terminal ileum.