Colon cancer: from symptoms to surgery and life after recovery

The U.S. Preventive Services Task Force lowered the screening colonoscopy age to 45 from 50 for those at average risk of colon cancer because of the increase in diagnoses in younger people. For those younger than 45, it’s important to understand your risk for colon cancer and the signs and symptoms.

For instance, if you have a family history, your doctor may recommend screenings before you’re 45. If you recognize symptoms, you’ll know when to see your primary care provider for an exam. Keep reading to find out what can influence your risk and notable symptoms to know.

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Should I worry about colon cancer?

Colon cancer is one of the most common cancers. The risk increases with age, but recent trends show a rise in cases among younger adults. While lifestyle factors like diet, weight and sedentary habits may contribute, there is no single known cause for this shift.

How is colon cancer detected?

Most polyps don’t cause symptoms, which is why colonoscopy screenings are essential. If polyps aren’t detected and removed, colon cancer can develop. A colonoscopy can also detect early cancer before it causes symptoms. While prevention is possible through screenings, early detection is also key. Late-stage colon cancer can spread to nearby tissues or other parts of the body, making treatment more difficult.

Here are more details about how colon cancer can be detected:

• Colonoscopy: A gastroenterologist inserts a flexible tube with a camera into the colon to look for polyps or abnormal growths. They can remove polyps and take biopsies of growths to send for testing. A pathologist will examine the tissue under a microscope to confirm whether it contains cancerous cells.

Watch a video to learn more about colonoscopies.

• Imaging tests: CT scans, MRIs and PET scans help determine if cancer has spread beyond the colon to other organs.

• Blood tests: In July 2024, the U.S. Food and Drug Administration approved the first blood test to use as primary screening for people at average risk for colon cancer.

• Fecal sample tests: At-home fecal sample tests can detect colon cancer.

Once diagnosed, doctors will determine the stage of cancer, which influences treatment options.

What are the signs of colon cancer?

• Changes in bowel habits, including persistent diarrhea, constipation or stools that are thinner than usual. If these changes last longer than a few weeks, see your primary care provider.

• Blood in the stool that looks bright red, dark or tar-like may indicate bleeding in the digestive tract. This could be caused by hemorrhoids, but it should always be checked by a doctor.

• Persistent abdominal discomfort, including frequent cramps, bloating, gas or pain that doesn’t go away may be a symptom of colon cancer.

• Unexplained weight loss: Losing weight without changes in diet or exercise can be a sign that something is wrong in the body.

• Fatigue and weakness: Colon cancer can cause slow internal bleeding, leading to anemia and resulting in persistent tiredness.

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Colostomy and ileostomy from colon cancer surgery

For some people undergoing colon cancer surgery, a colostomy or ileostomy may be necessary. These procedures create an opening (stoma) in the abdominal wall to allow waste to exit the body when normal passage through the intestines is not possible.

What is a colostomy?

A colostomy is a surgical procedure where a colorectal surgeon brings a section of the colon to the surface of the abdomen, creating a stoma. Waste from the digestive tract collects in a colostomy bag attached to the stoma. Colostomies may be temporary or permanent, depending on the extent of the colon surgery and the ability of the remaining colon to heal and function properly.

What is an ileostomy?

An ileostomy is like a colostomy but involves bringing the small intestine (ileum) to the surface of the abdomen instead of the colon. Waste collects in a pouch because it bypasses the large intestine, resulting in a liquid stool consistency.

Why would someone need a colostomy or ileostomy?

You may need a colostomy or ileostomy if:

• The section of the colon removed during a colectomy prevents normal bowel function.

• The colon needs time to heal after surgery before being reconnected.

• The tumor is blocking the colon, preventing waste from passing normally.

• Your entire colon is removed. In these cases, most people need a permanent ileostomy.

Ostomy nurses provide support and guidance on how to manage an ostomy bag and maintain a good quality of life. Many people adjust well to life with a stoma. In some cases, a second surgery may be performed later to reverse a temporary colostomy or ileostomy.

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What is recovery like after colon cancer surgery?

How long it takes you to recover from colon cancer surgery depends on several factors, including:

• How much of your colon was removed and how your digestive system is adjusting to the changes.

• Whether you require additional treatments.

Generally, your recovery may take longer after an open colectomy versus a minimally invasive operation.

What happens when colon cancer is too large to remove surgically?

In some cases, colon cancer may be too large to be safely removed through surgery. When this happens, your care team will focus on other treatment strategies to shrink the tumor, relieve symptoms and improve quality of life.

Surgery may not be an option when:

• The tumor has grown into nearby organs, making complete removal too complicated.

• The cancer has spread too extensively for surgery to be effective.

• Your overall health may not allow for a major operation.

What are treatment alternatives if colon cancer surgery is not an option?

Stent placement for blockages: If the tumor is blocking the colon and making it difficult for waste to pass, your colorectal surgeon or an advanced gastroenterologist may place a colonic stent to keep the bowel open. This is a minimally invasive procedure that helps relieve symptoms like severe constipation, bloating and pain.

Chemotherapy and radiation therapy: These treatments can help shrink the tumor to make surgery possible later or to slow the cancer’s growth and manage symptoms.

Targeted therapy and immunotherapy: This type of personalized medical oncology works by attacking the cancer cells of your specific tumor, helping slow progression and sometimes reducing tumor size.

For some people, a combination of these treatments may be used to control the cancer and improve comfort, even if surgery is not an immediate option.

What happens if colon cancer has spread to other parts of the body?

When colon cancer spreads to other parts of the body (metastatic colon cancer), treatment options and goals may change. The most common areas colon cancer spreads to include the liver, lungs, peritoneum (the lining of the abdomen) and lymph nodes.

In some cases, surgery may still be recommended if the cancer has spread but remains localized to a few areas, such as the liver or lungs. If tumors can be surgically removed, this may improve survival outcomes.

Even if surgery is not possible, other treatment options can help manage the disease so you can maintain a good quality of life for as long as possible. Your colon cancer care team may focus on treatments to slow the cancer’s growth and improve quality of life. These treatments may include chemotherapy, immunotherapy or radiation therapy to help alleviate symptoms. Keep reading to learn more about these treatment options.

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What questions should I ask my colorectal surgeon?

Before surgery, it’s important to be fully informed. Here are some key questions to ask your surgeon:

• What type of surgery do I need? Are there different ways to perform this surgery?

• What are the benefits and risks of the different surgery options? Understanding expected outcomes and potential complications can help you prepare mentally and physically.

• Will I need a colostomy bag? In some cases, a temporary or permanent colostomy is required to allow the colon to heal.

• How will you help me manage any pain after surgery?

• When can I resume things like eating, showering and using the bathroom after surgery?

• Is there anything I should do or avoid after surgery and for how long? Your surgeon may encourage walking around the hospital room and at home to help with healing. You may also need to limit how much weight you lift for several weeks after surgery.

• How will the surgery affect my bowel function and digestion? Some people experience changes in bowel habits and digestion after surgery.

• What is the expected recovery time? Knowing the timeline can help with planning for daily life and work.

• When will I need to follow up with you after surgery? How many follow-up visits will I need?

• What dietary changes should I make post-surgery? Following a certain diet can improve digestion and prevent complications. At Nuance Health, registered dietitians and certified oncology nutritionists are part of the care team.

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How is life after colon cancer surgery?

Many people return to a normal life after recovery. The body usually adjusts to the changes in the colon. However, some may experience short-or long-term changes in bowel habits, digestion or energy levels.

Dietary adjustments:

• Eat smaller, more frequent meals to improve digestion.

• Gradually reintroduce fiber to prevent constipation. Although fiber usually helps with digestion, too much fiber, especially without enough water, may cause constipation after colon surgery.

• Stay hydrated to aid bowel function.

• Avoid foods that cause excessive gas or bloating.

Physical activity:

• Start with light exercises like walking to regain strength.

• Avoid lifting anything heavy for several months.

• Engage in low-impact workouts once cleared by your surgeon.

Appearance:

• After the incisions heal fully, you can gently massage the scars to improve blood flow.

• There are many creams available for scars. Ask your surgeon for a recommendation.

Chemotherapy for colon cancer

Chemotherapy or other types of medical oncology may be used before, during or after surgery to shrink tumors or eliminate remaining cancer cells. Some individuals may require multiple cycles of chemotherapy depending on the stage of cancer.

Neoadjuvant chemotherapy may be used before surgery to help shrink the tumor.

HIPEC (Hyperthermic Intraperitoneal Chemotherapy) is a specialized procedure where heated chemotherapy is delivered directly into the abdominal area during surgery to destroy remaining cancer cells. HIPEC is often used for advanced or metastatic colon cancer cases. 

Watch a video to learn more about HIPEC at Nuvance Health.

Post-surgery medical oncology including chemotherapy and immunotherapy is systemic (total body) treatment to eliminate potential cancer cells and lower the risk of a recurrence. You may need chemotherapy after surgery if the cancer has spread from the colon to other parts of the body or your care team determines through testing that you would benefit from it.

Radiation therapy for colon cancer

Radiation is less commonly used for colon cancer but may be recommended if the cancer is located in the rectum. Radiation helps shrink tumors before surgery or reduce the risk of recurrence.