Main symptoms
- •Rectal bleeding (red blood)
- •Melaena (digested black blood)
- •Bowel habit change > 6 weeks
- •Abdominal pain
- •Unexplained weight loss
- •Chronic fatigue (occult anaemia)
- •Incomplete evacuation
- •Bloating, excessive gas
Risk factors
- ⚠️ Age over 50 (90%)
- ⚠️ First-degree family history (×2-4)
- ⚠️ Lynch syndrome, FAP
- ⚠️ Previous polyps
- ⚠️ IBD (Crohn's, ulcerative colitis)
- ⚠️ Red meat > 500 g/week
- ⚠️ Processed meats (IARC group 1)
- ⚠️ Obesity, sedentary lifestyle, smoking, alcohol
Management and treatments
**Localised**: surgery (colectomy, laparoscopic when possible) — CHUs + Moroccan clinics. **Rectum**: neoadjuvant radiotherapy + surgery. **Adjuvant**: FOLFOX/XELOX chemotherapy for high-risk stage II and stage III, for 6 months. **Stage IV**: palliative FOLFIRI + targeted therapies (bevacizumab/Avastin, cetuximab, panitumumab). **Immunotherapy** (pembrolizumab) for MSI. **ALD 100%**.
Prevention
FIT screening from age 50 (45 with risk factors), colonoscopy per guidelines. Fibre 25-35 g/day, Mediterranean diet, limit red meat < 500 g/week, avoid processed meats. Activity 150 min/week, smoking cessation, alcohol < 2 drinks/day.
Frequently asked questions
When to screen?+
Age 50 for all (FIT every 2 years). 45 if African origin or first-degree family history.
Is colonoscopy painful?+
No — under sedation/anaesthesia. Prep is the less pleasant part.
Processed meats = cancer?+
IARC group 1 (certain carcinogen). 50 g/day = +18% risk.
Cure odds?+
Stage I: 90%. II: 75%. III: 50-60%. IV: 15-20%. Early screening = vital.
📖 Detailed article
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