Colorectal cancer

Risk factors

The following factors have been shown to increase the risk of developing colorectal cancer:

• Increasing age, with most cases occurring after 50
• A personal or family history of colorectal cancer or colorectal polyps
• Inherited genetic conditions such as Lynch syndrome
• Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis
• Overweight, obesity and type 2 diabetes
• Lifestyle factors, including smoking and high alcohol consumption
• Diet factors: such as high consumption of red and processed meat and low intake of fruits, vegetables and whole grains

Colorectal cancer in women

Although colorectal cancer affects women and men in similar numbers, there are some important differences:

• Women are often diagnosed at slightly older ages than men
• Tumors are more likely to develop in the right side of the colon in women, where
• symptoms can be less obvious
• Some symptoms, such as fatigue caused by iron deficiency anemia, may be
• overlooked or attributed to other causes
• Hormonal, reproductive, and genetic factors may influence risk, although
• research is ongoing

Understanding these differences may help improve awareness, diagnosis, and outcomes for women.

Screening and early detection

Colorectal cancer can often be detected early or prevented through screening.

In Sweden:

• A national screening program offers people aged 60–74 a fecal occult blood test (FIT)
• every two years.
• If blood is detected in the stool, a colonoscopy is offered
• Screening can detect early-stage cancer or precancerous polyps, improving outcomes.
• Possible symptoms include:
• Changes in bowel habits, such as persistent diarrhea or constipation
• Blood in the stool
• Anemia
• Abdominal pain
• Unexplained weight loss
• Fatigue

Diagnosis and treatment

If colorectal cancer is suspected, several tests may be used to confirm the diagnosis and determine how far the disease has spread.

Diagnosis is based on:

• Colonoscopy, to examine the colon and take tissue samples
• Biopsy to confirm the diagnosis
• Blood tests
• Imaging tests, such as CT or MRI scans
• In Sweden, patients with suspected colorectal cancer are managed through standardized
• care pathways (SVF) to support timely diagnosis and treatment.
• Treatment depends on the stage and location of the cancer and may include:
• Surgery
• Chemotherapy
• Radiotherapy, particularly for rectal cancer
• Targeted therapies or immunotherapy in selected cases

Living with and beyond colorectal cancer

Many people live long lives after colorectal cancer, especially when it is detected early.

Recovery can take time and may involve both physical and emotional adjustments.

Recovery is a continuous process, and patients may experience:

• Physical effects, such as fatigue, changes in bowel function, or treatment-related side effects
• Emotional challenges, including anxiety and fear of recurrence
• Changes in daily life, including diet, work, relationships, and social activities

Some people may also need to adjust to longer-term changes after treatment, for example related to digestion or, in some cases, a temporary or permanent stoma.

In Sweden, support is available throughout the cancer journey:

• Follow-up care through specialist healthcare teams
• Access to a contact nurse (kontaktsjuksköterska)
• Cancer rehabilitation services, supporting physical, emotional, and social recovery
• Patient organizations, offering peer support and practical advice

Fertility and family planning

Colorectal cancer mainly affects older adults, but it can also occur in younger people, where fertility may be a concern.

Treatment can affect fertility in several ways:

• Surgery involving the pelvis may affect reproductive organs
• Radiotherapy can damage the ovaries, uterus, or testes
• Chemotherapy may reduce fertility

Some treatments may also affect sexual function, hormone levels, or the ability to carry a pregnancy. In some cases, fertility preservation options (such as freezing eggs, sperm, or embryos) may be available. Fertility and reproductive health are part of cancer care, and patients can receive individual counselling to support informed decisions.

Reducing inequalities in colorectal cancer care

Although outcomes for colorectal cancer have improved substantially, differences in awareness, screening participation, and access to healthcare can contribute to unequal outcomes.

Key factors include:

• Participation in screening programs, which supports early diagnosis and improves survival
• Socioeconomic factors, as lower income or education are linked to later-stage diagnosis and poorer outcomes
• Access to healthcare, including timely assessment, diagnosis, and treatment
• Health literacy and awareness, influencing recognition of symptoms and participation in screening

Because colorectal cancer can often be detected early through screening, unequal participation may increase health inequalities. In Sweden, efforts to address this include a national screening program, standardized care pathways, and ongoing work to improve participation across all population groups.