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Healthy living after treatment of childhood, adolescent, and young adult cancer

Colorectal Cancer: Are You at Risk?
The risk of cancer increases for everyone as they age. Depending on the specific treatment you received for childhood
cancer, you may be at increased risk for developing colorectal cancer (cancer of the colon or rectum). It is important tounderstand that risk, so that you can take steps to protect your health.
What is colorectal cancer?
Colorectal cancer is a type of cancer that occurs in the colon (large intestine) or the rectum (the last several inches ofthe large intestine). Colorectal cancer is the second leading cause of cancer deaths in the United States. Many of these
deaths happen because the cancers are found too late to be cured. If colorectal cancer is found early enough, it canusually be cured.
What are the risk factors?
Several studies have shown those who were treated with radiation to the abdomen, pelvis, spine, or total body
irradiation (TBI) during childhood, adolescence, or young adulthood have an increased risk of developing colorectal
cancer. It is therefore important for you to obtain your radiation treatment records so that you know what radiation you
received.
Other known risk factors for developing colorectal cancer include:• Having had colorectal cancer or large intestinal polyps in the past
• Having a close relative (sibling, parent or child) who has had colorectal cancer before age 50• Having ulcerative colitis or Crohn’s disease•

Having a hereditary colon cancer syndrome (such as familial adenomatous polyposis)

What are the signs of colorectal cancer?
Most colorectal cancers begin as a polyp. A polyp starts as a small, harmless growth in the wall of the colon orrectum. However, as a polyp gets larger, it can develop into a cancer that grows and spreads. During the early stage ofcolorectal cancer, there are rarely any outward signs or symptoms to alert you or your healthcare provider that cancer
is present. This is why screening is so important. Once the cancer has become more advanced, the following signs
may be evident. If you have any of these signs, you should see your healthcare provider immediately:• Bleeding from your rectum• Blood in your stool or in the toilet after you have a bowel movement• A change in the shape of your stool• Cramping pain in your lower stomach• A feeling of discomfort or an urge to have a bowel movement when there is no need to have one•

A change in the normal frequency of your bowel movements

Other conditions can cause these same symptoms. You should be evaluated by your healthcare provider to find out thereason for your symptoms.
When is colorectal cancer likely to occur?
In the general population, colorectal cancer is most likely to occur between the ages of 45 and 65. In cancer survivors
who were treated with abdominal, pelvic, spinal, or TBI radiation, it may occur earlier. The risk begins to increasearound 10 years after the radiation.
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Healthy living after treatment of childhood, adolescent, and young adult cancer

What can I do to protect my health?
Most people who received radiation therapy to the abdomen, pelvis, spine, or TBI will not develop colorectal cancer.
However, if you received this type of radiation, it is important to understand that the risk is higher for you than it is forother people your age who never received radiation. So, the best way for you to protect your health is by taking steps
to closely monitor your colon. That way, if a cancer develops, it can be detected in its earliest stages, when treatment
is most effective.
What monitoring is recommended?
If you were treated with radiation therapy to the abdomen, pelvis, spine, or TBI during childhood, adolescence, or young
adulthood, you should be screened for colorectal cancer beginning 5 years after radiation or at age 30, whicheveroccurs last. You should talk with your healthcare provider about which screening option is best for you. These options
include stool-based testing every three years or colonoscopy every five years.
What is stool-based testing?
If you choose stool-based testing, you will need to provide a stool sample, which will be sent to a laboratory to checkfor signs of colorectal cancer.
What is a colonoscopy?
A colonoscopy is a procedure where a thin, flexible tube connected to a video camera is inserted into your rectum andslowly guided into your colon. The doctor is able to look at the colon on a monitor, and any polyps or growths can beremoved through the tube during the exam.
A colonoscopy requires a “bowel prep” the day or night before the procedure to empty the intestines. Your healthcare
provider should give you instructions on how to do this.
The procedure may be uncomfortable, but it is usually not painful. Before you have this test, you will be given a
medicine to make you feel relaxed and sleepy.
Is there anything else that I can do to minimize the risk?
The following lifestyle changes may help to reduce the risk of colorectal cancer and will help you stay as healthy as
possible:• Eat a variety of healthy foods, with an emphasis on grains, fruits and vegetables.
– Eat five or more servings of a variety of vegetables and fruits each day.
– Choose whole grains in preference to processed (refined) grains and sugars.
– Limit consumption of red meats, especially processed meats (such as hot dogs or bologna) and those high infat.
–•Choose foods that help you maintain a healthy weight.

Adopt a physically active lifestyle.
– Engage in at least moderate physical activity (such as brisk walking) for 30 minutes or more on five or moredays of the week.
– Engaging in 45 minutes or more of moderate to vigorous activity (activities such as running, in which you are
not able to carry on a conversation without needing to catch your breath) on five or more days per week may
further reduce your risk of colorectal cancer.

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Healthy living after treatment of childhood, adolescent, and young adult cancer

Written by Kevin C. Oeffinger, MD, Duke University Medical Center, Durham, NC.
Reviewed by Amelia DeRosa, RN, BSN, CPON; Kayla L. Foster, MD, MPH; Christine Yun, MSN, PNP, CPON.

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or young
adulthood.
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Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying Health
Links were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’s
Oncology Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
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