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An estimated 93,090 cases of colon cancer and 39,610 cases of rectal cancer are expected to be diagnosed in 2015. Colorectal cancer is the third most common cancer in both men and women. Incidence rates have been decreasing for most of the past two decades, which has been attributed to both changes in risk factors and the uptake of colorectal cancer screening among adults 50 years and older. Colorectal cancer screening tests allow for the detection and removal of colorectal polyps before they progress to cancer. From 2007 to 2011, incidence rates declined by 4.3% per year among adults 50 years of age and older, but increased by 1.8% per year among adults younger than age 50.

Early detection: Beginning at the age of 50, men and women who are at average risk for developing colorectal cancer should begin screening. Screening can detect colorectal polyps, which can be removed before becoming cancerous, as well as cancer at an early stage, when treatment is usually less extensive and more successful. There are a number of recommended screening options, which differ with respect to the need for bowel prepara­tion, test performance and limitations, how often they should be performed, and cost. For the Society’s recommendations for colorectal cancer screening, see page 52.

Treatment: Surgery is the most common treatment for colorec­tal cancer. For cancers that have not spread, surgical removal of the tumor may be curative. A permanent colostomy (creation of an abdominal opening for elimination of body waste) is rarely needed for colon cancer and is infrequently required for rectal cancer. Chemotherapy alone, or in combination with radiation, is given before (neoadjuvant) or after (adjuvant) surgery to most patients whose cancer has penetrated the bowel wall deeply or spread to lymph nodes. For colon cancer in otherwise healthy patients age 70 or older, adjuvant chemotherapy is equally effec­tive as in younger patients; toxicity in older patients can be limited by avoiding certain drugs (e.g., oxaliplatin). Several tar­geted therapies have been approved by the FDA to treat colorectal cancer that has spread to other parts of the body (metastatic colorectal cancer).