Cancer of the colon (large intestine) and rectum is the kind that people are least willing to mention because of its embarrassing location and the unpleasantness of preparing for a colonoscopy to detect it. Yet, colorectal cancer is the third-most-common type of malignancy around the world that accounts for about 10% of all oncological cases and globally is the second-leading cause of cancer-related deaths.
The good news is that over the past 15 years there has been a decrease in the incidence of colorectal cancer in Israel, according to a Health Ministry report on the incidence that included mortality data from colorectal cancer (the last statistics are from 2021).
In 2021, 2,759 people were diagnosed with colorectal cancer and 1,209 people died of the disease. The proportion of patients diagnosed in 2021 in an early stage of the disease doubled compared to 2000.
Between the years 1996 and 2021, there was a decrease in mortality trends from colorectal cancer among Jews, while among Arabs, mortality trends remained stable. The ministry’s National Center for Disease Control on incidence and mortality data from colorectal cancer contains trends in contracting the disease and mortality between 1996 and 2021.
In 2021, 2,759 people in Israel were diagnosed with invasive colorectal cancer (53% men and 47% women); these figures are relatively similar to the year 2020, in which 2,787 people were diagnosed with this cancer.
Significant annual decrease
In the last decade and a half in Israel, there has been a significant annual decrease of 2-3% in the incidence of the cancer among women and men. In addition, between the years 2000 and 2021, there was a significant decrease in the incidence of the disease in the age groups included in the national program for the early detection of the disease in Israel (ages 50 to 74).
Compared to 2020 and according to age and per 100,000 people, there was a decrease in 2021 in the incidence rate of colon and rectal cancer in all population groups. Among Arab men and Arab women, there was a greater decrease in the incidence of this disease in those years, so that the incidence rate among Arab men decreased from 26.7 to 22.4, respectively, and among Arab women there was a decrease from 18.1 to 15.8. Among Jewish men, this rate decreased from 23.9 to 23.5, respectively, and among Jewish women there was a drop from 18.8 to 18.1, respectively. The proportion of patients diagnosed in the early stage of the disease in 2021 has doubled compared to this proportion in 2000 (39.6% and 19.9%, respectively).
In 2021, 1,209 Israelis died from invasive cancer of the colon and rectum, half of them men and the vast majority (about 91%) Jews; these data are similar to those in 2020.
Between 1996 and 2021, there was a clear downward trend of about 3% in death from the malignancy among Jews (men and women); among Arabs (men and women), the mortality trends have been stable during this period.
There has been an increase in the survival rate from the disease over the years in all population groups, with the most noticeable increase occurring in the age groups that are included in the screening tests for the early detection of the cancer (ages 50 to 74).
Prof. Lital Keinan Boker, director of the National Center for Disease Control, said that this type of malignancy “is the fourth-most-common malignant disease in Israel. The data show that compared to other countries, more people in Israel are diagnosed with the disease, yet the mortality figures are the same as those across the world, indicating that treatment in Israel and early diagnosis save lives.”
She concluded that the ministry recommends that people aged 50 to 74 perform a fecal occult blood test once a year, and if the test is positive, they undergo a colonoscopy. For those at high risk, a colonoscopy should be at a frequency determined by the type of risk, that is – after consulting with the family physician because such a test saves lives.
In an international comparison among 185 countries that report to the International Agency for Research on Cancer (IARC), the incidence rate of colorectal cancer in Israel is 24.8 per 100,000 people, a figure higher than the world average of 18.4 per 100,000 people. The death rate in Israel (8.8 per 100,000 people) is relatively similar to the world average (8.1 per 100,000).
Incidence rates have been dropping in high-income countries, mostly as a result of effective screening programs. The prognosis for colorectal cancer varies depending on the stage at diagnosis.
Early-stage cancers have higher survival rates than advanced-stage cancers.
Stool-based tests are non-invasive screening methods used to detect the presence of colorectal cancer or precancerous polyps in the stool. The most common type of stool-based tests is the fecal occult blood test (FOBT), that detects hidden blood in the stool – a possible indicator of colorectal cancer or polyps. It involves collecting a small sample of stool and sending it to a laboratory for analysis. If blood or abnormal findings are detected in the stool, further diagnostic procedures, such as a colonoscopy are usually recommended to confirm the presence of colorectal cancer or polyps.
Diagnostic methods for colorectal cancer include physical examination, imaging, examination of the inside of the colon using colonoscopy or sigmoidoscopy, taking a sample of tissue (biopsy) for histopathology examination, and molecular testing to identify specific genetic mutations or biomarkers to guide the best treatment option.
Treatments include radiation, surgery, chemotherapy, targeted therapy, and immunotherapy.
In some cases, surgery may be recommended for metastatic colorectal cancer to remove tumors that are causing symptoms or blocking the intestine.
Localized treatments, such as radiofrequency ablation, cryoablation, or radiation therapy, may be used to treat specific areas of metastasis, such as liver metastases. Radiation therapy may given to help control the disease and manage symptoms, such as pain or bleeding.