The Risk of Colon Cancer in Women

Key Takeaways

• Colon cancer develops when cells in the lining of the colon experience mutations and begin growing uncontrollably. It can be caused by genetics, lifestyle factors, diet factors, or inflammatory bowel disease (IBD), and often arises from a combination of these factors.
• Women often mistake the early symptoms of colon cancer for menstrual pain, iron-deficiency anemia, hemorrhoids, and other conditions that are common in women.
• Early symptoms of colon cancer include bowel changes, bloody stool, abdominal pain, fullness, bloating, unexplained fatigue, unexplained weight loss, narrow stools, and pelvic pain.
• Colon cancer screenings can detect asymptomatic cancer. Women should begin regular screenings at age 45, or earlier if they have a higher-than-average risk of colon cancer.

What Is Colon Cancer?

Colon cancer affects the colon, the portion of the large intestine that breaks down waste and helps to digest foods and absorb nutrients. It often develops from polyps inside the colon, which are usually found in the innermost colon lining, called the mucosa. Polyps are made of cells that excrete mucus, among other fluids. When the cells inside these polyps change or mutate, cancer can develop. At that point, the mutated cells begin to multiply rapidly. This is how tumors form.

If polyps are detected during a colonoscopy, the physician typically will remove them during the procedure. Although most polyps are non-cancerous, some can slowly become cancerous over time. Without treatment, cancer arising from polyps can spread first to other areas of the colon and eventually invade nearby structures, such as the lymph nodes and blood vessels. This is why early detection and colon cancer treatment are so important.

What Causes Colon Cancer?

Several factors have been found to increase the risk of developing colon cancer. ­These risk factors  include:

• Genetics:Individuals with a family history of polyps or cancer are more susceptible to developing colon cancer.
• Lifestyle choices:Smoking, excessive alcohol consumption, and not getting enough exercise can all contribute to colon cancer development.
• Poor diet:A diet low in fruits, vegetables, and whole grains can increase colon cancer risk, as can eating processed meats.
• Inflammatory bowel disease (IBD):Patients with chronic inflammatory conditions affecting the colon, such as Crohn’s disease or ulcerative colitis, can be at increased risk of colon cancer.

While colon cancer most often affects individuals who are age 50 or older, the number of younger adults being diagnosed with colorectal cancer is increasing. While colon cancer occurs slightly more frequently in men, women are nearly as susceptible and should know the warning signs of the disease. According to the American Cancer Society, the lifetime risk for developing colon cancer is one in 23 for men and one in 25 for women.

Colon Cancer Risk Factors Specific to Women

While most risk factors are the same across genders, some risk factors behave differently depending on whether the person is a man or a woman. Examples of gender-specific risk factors include:

• Menopause: The drop in estrogen levels following menopause can accelerate the development of colon polyps, potentially leading to colon cancer.
• Previous cancer: Women with a personal or family history of breast cancer, ovarian cancer, or uterine cancer are also at a higher risk of developing colon cancer.

Conversely, certain health and lifestyle factors can reduce a woman’s colon cancer risk. Some studies have shown that postmenopausal use of hormone replacement therapy (HRT) can significantly reduce colon cancer risk. Women who have had multiple full-term pregnancies may have a lower cancer risk, as well. Finally, Lynch syndrome, a genetic condition, is typically less closely tied to colon cancer in women than it is in men, although it is more likely to increase risk of endometrial cancers.

Why Does Colon Cancer Present Differently in Women?

Although women get colon cancer nearly as often as men, it is frequently detected much later. This difference is partially because women are more likely to develop right-sided (upper) colon cancer, which causes less obvious bleeding. Right-sided tumors can also be difficult to detect with a standard colonoscopy and may be more aggressive than left-sided cancers.

Further, many early signs of colon cancer can be mistaken for other health concerns that are common in women. Menstrual cycles, iron-deficiency anemia (IDA), and hemorrhoids may all cause symptoms that resemble those of colon cancer, leading patients to dismiss what they are experiencing as not concerning. Increasing awareness of colon cancer symptoms is crucial to improving detection rates and improving treatment outcomes for women with colon cancer.

What Are the Early Warning Signs of Colon Cancer in Women?

Many patients do not experience any symptoms of colon cancer early on. When early signs are present, they often resemble the signs of less-serious gastrointestinal conditions. The following is an overview of which symptoms to look for, when they probably should not be cause for concern, and when to call a doctor:

Changes in Bowel Habits

Diarrhea is defined as unusually loose or watery stools. Constipation is defined as having fewer than three bowel movements in a week, which may not pass without straining. Both conditions are common and can be triggered by stress, diet, lifestyle changes, bacterial infections, and other factors. Less often, bowel changes can signify a serious health issue, such as cancer.

What Changes Are Notable?

Most people have mild diarrhea or constipation a few times each year. These cases typically resolve within a few days (for diarrhea) or a few weeks (for constipation). Patients should contact their doctor if the change persists longer than usual.

What to Tell the Doctor

Patients should track when the changes began and whether they correspond to any lifestyle or dietary changes. This information will help the doctor narrow down the cause of diarrhea or constipation.

Blood in Stool

Tumors and polyps are more fragile than healthy colorectal tissue, and they frequently bleed when stool passes by. Bright red blood in the toilet or on toilet paper indicates bleeding in the rectum, or the lower part of the colon. Maroon-colored or black stools indicate bleeding higher in the digestive tract, with the blood having been partially digested as it passed through the digestive tract, turning it dark and tarry.

Colon Cancer vs. Hemorrhoids

Hemorrhoids can also cause bleeding – and also merit medical attention. Any amount of blood in the stool should be evaluated by a medical practitioner. Heavy bleeding after a bowel movement may warrant an emergency visit.

Persistent Abdominal Cramping

Abdominal cramping can cause pain in the stomach, but it may also be felt as lower back pain. Like diarrhea or constipation, it can result from food intolerances, a poor diet, stress, and other lifestyle factors. This type of cramping should go away within a few days or when the trigger is resolved. If the cramps do not go away, the patient should speak with a physician about possible colon issues.

Colon Cancer vs. Period Cramps

Cramping caused by colorectal cancer can feel very similar to menstrual cramping. If cramps occur outside of a woman’s period, or if the pain is more severe than typical period pain, the woman should speak with a physician about getting her pain evaluated.

Persistent Urges to Have a Bowel Movement

If a person experiences persistent urges to have a bowel movement, or if the bowels still feel full after having a bowel movement, this may signify changes in the colon. Cancerous growths can partially or fully block the colon, preventing complete evacuation of stool. Other types of blockages can have a similar effect. People should speak with a physician to have the cause of this sensation identified and, if necessary, treated.

Bloating

Bloating is a common complaint that is often associated with dietary changes, menstrual periods, or a low level of physical activity. A colon blockage may also cause feelings of bloating. The blockage prevents a complete bowel evacuation, resulting in a full, bloated, or gassy feeling. Patients should contact a physician if the feeling does not go away or gets worse over time.

Unexplained Fatigue

Persistent bleeding from a polyp or tumor may lead to iron-deficiency anemia (IDA). Anemia causes fatigue, which is defined as tiredness, weakness, or a severe lack of energy that persists even after resting. It may also cause irritability, difficulty concentrating, reduced motivation, or feelings of being overwhelmed.

Colon Cancer and Iron-Deficiency Anemia

Iron-deficiency anemia is far more common in women than in men, largely due to blood loss from menstruation. Patients should contact a physician whenever they experience severe fatigue that interferes with everyday activities, especially if the fatigue is new.

Unintentional Weight Loss

Colon cancer interferes with the body’s ability to absorb nutrients effectively. Over time, this inability may result in unintentional or unexplained weight loss. Any sudden weight loss, especially without exercise or dieting, is a reason for concern. Patients should take note of when the change began and speak with a physician about its most likely causes.

Narrow or Ribbon-Like Stools

Healthy stools should be medium-brown, smooth, and round in diameter. If stools are thin or ribbon-like in shape, they indicate issues inside the colon. A partial blockage may force stools to deform to pass, resulting in the narrow or flattened shape seen in the toilet. Reduced nutrient absorption may also cause changes in the appearance of stool.

Nausea or Vomiting

Nausea and vomiting are less common symptoms of colon cancer. These complaints occur when a severe blockage disrupts the digestive system, trapping food inside the body. The body attempts to get rid of the food by vomiting. Patients should seek immediate medical help if they experience sudden and severe abdominal pain or are vomiting fecal matter.

Pelvic Pain

Another less common symptom of colon cancer is pelvic pain. As the tumor grows, it creates discomfort by pressing on nearby organs and nerve clusters. The pressure is felt as pain in and around the pelvis. Because this symptom is typically caused by a well-developed tumor, it is more common in later stages of colon cancer.

Early-Stage vs. Late-Stage Symptoms: A Comparison

Colon cancer is a progressive condition. As the cancer advances to later stages, its initial symptoms become more severe while new ones rise to the forefront.

What Symptoms Appear at Stages I and II?

Stage I and II colon cancer tumors are relatively small. The tumor is found only in the colon or rectum wall and has not spread to any other tissues, including lymph nodes. Because the tumor has not spread, its symptoms typically are still mild. Many patients do not experience any changes at this time. Others notice minor to severe gastrointestinal changes, such as:

• Diarrhea or constipation
• Blood in or on the stools
• Persistent abdominal cramping
• Feeling like the bowels do not empty completely
• Persistent bloating
• Unexplained fatigue and weakness
• Unexplained weight loss
• Rarely, nausea and vomiting

Although difficult to detect, stage I and II colon cancer is the most easily treated form of the disease. Because it has not spread, the cancer can be targeted with radiation therapy or removed with surgery.

What Changes at Stages III and IV?

At stages III and IV, the cancer has spread outside the colon. Stage III colon cancer has spread into the nearby lymph nodes. Stage IV cancer has spread through the lymphatic and circulatory systems to distant parts of the body, such as the liver and lungs. New symptoms develop. Depending on where the cancer has spread, these may include:

• Swollen lymph nodes
• Severe fatigue and weakness
• Severe belly pain
• Loss of appetite
• Pelvic pain
• Enlarged liver
• Jaundice (yellowed skin and eyes)
• Difficulty breathing
• Ongoing cough
• Chest pain
• Bone pain

Late-stage colon cancer is more difficult to treat. Surgery cannot completely remove a cancer that has spread throughout the body, so oncologists must use systemic treatments such as chemotherapy. While Stage IV cancer treatments have poorer outcomes than early-stage disease, advances in targeted therapies and immunotherapy have led to improved patient outcomes.

Symptoms	Early-Stage	Late-Stage
Diarrhea/Constipation	Yes	Yes
Abdominal cramping	Yes	Yes
Blood in stools	Yes	Yes
Bowel changes	Yes	Yes
Persistent bloating	Yes	Yes
Unexplained fatigue	Yes	Yes
Unexplained weight loss	Yes	Yes
Pain in other body parts (chest, bones, pelvis, stomach, etc.)	No	Yes
Swollen lymph nodes	No	Yes
Jaundice	No	Yes
Loss of appetite	No	Yes
Enlarged liver	No	Yes
Difficulty breathing	No	Yes
Ongoing cough	No	Yes

What Are the Colon Cancer Screening Recommendations for Women?

While symptom identification can assist with early cancer detection, many patients do not experience any changes until later in the disease’s progression. Routine colon cancer screenings are the most effective way of detecting asymptomatic cancer as well as pre-cancerous polyps.

Typical recommendations state that patients should begin routine screenings at age 45. High-risk patients, such as those with Lynch syndrome or a personal history of cancer, may begin screenings at age 40 or earlier depending on the individual case. The recommended frequency depends on the type of screening used.

Colonoscopy

During a colonoscopy, the physician inserts a thin probe called a colonoscope into the colon via the anus. The colonoscope is made with flexible tubing, allowing easy and convenient insertion and mobility. It is equipped with a small video camera and a light to provide the physician with a clear view of the colon. If polyps are found, they may be removed during the colonoscopy. Normal-risk patients should get colonoscopies every 10 years.

Other Screening Methods

Colon cancer screening does not always require invasive testing. Noninvasive types of preventative colon cancer testing include:

• Virtual colonoscopy (X-ray)
• Fecal immunochemical test (FIT)
• Fecal DNA test

These tests should be repeated every year or every few years. While these less-invasive screening methods can rule out colon cancer for many people at normal risk of the disease, a colonoscopy may still be necessary if noninvasive test results suggest a problem. People at elevated risk for colon cancer are not candidates for these screening methods and should have a colonoscopy instead.

Get Colon Cancer Care Near You in NJ, CT, MA, and the Washington, D.C., Area

Patients who have been diagnosed with colon cancer can receive high-quality care at Regional Cancer Care Associates. We offer cutting-edge treatments at more than 20 locations near you across New Jersey, Connecticut, Massachusetts, and the Washington, D.C., area, helping patients obtain care close to home. Contact RCCA today to schedule an appointment.

Frequently Asked Questions About Colon Cancer Symptoms

What are the very first signs of colon cancer in women?

The very first signs of colon cancer include changes in bowel movements, bloody stool, bloating, abdominal cramps, and persistent fatigue or weakness.

Can colon cancer symptoms be mistaken for period pain or IBS?

Yes, colon cancer symptoms are frequently mistaken for period pain or irritable bowel syndrome (IBS). Patients should speak with their physician if they experience period pain outside of their normal cycle, or if their IBS symptoms get worse without warning.

At what age should women start colon cancer screening?

Most women should start colon cancer screening at age 45. Women with a higher-than-average risk of colon cancer should start screening at age 40 or even earlier.

Is blood in stool always a sign of colon cancer?

No, blood in stool is not always a sign of colon cancer. More commonly, this symptom indicates hemorrhoids or a pre-cancerous polyp.

What does stool look like when a person has colon cancer?  

The stool is often thin or ribbon-like. Its appearance depends on where the cancer is located. Left-sided (lower) cancers cause normal-colored stools that may have streaks of blood. Right-sided (upper) cancers, meanwhile, cause dark, tarry stools.

Can colon cancer cause weight gain in women?

Colon cancer is frequently associated with weight gain because poor diet and exercise habits increase cancer risk. However, the cancer does not actually cause weight gain. In fact, colon cancer is more likely to cause unexplained weight loss.

How quickly does colon cancer progress if untreated?

Untreated colon cancer can progress very quickly. While pre-cancerous polyps may take 10 to 15 years to become cancerous, malignant tumor growth rates can vary significantly from person to person and depend on the biology of the cancer. Certain types of colon cancer grow faster than others.

What should I do if I have multiple colon cancer symptoms?

One or two symptoms of potential colon cancer, such as diarrhea or cramping, may indicate a benign condition, especially if they are mild, go away on their own after a short period of time, or have another highly likely cause. However, if you have multiple, severe, previously unexperienced, or persistent symptoms, you should consult a physician without delay.