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Colorectal cancer starts in the colon or the rectum. These cancers can also be called colon cancer or rectal cancer, depending on where they start. Colon cancer and rectal cancer are often grouped together because they have many features in common.
Cancer starts when cells in the body start to grow out of control. To learn more about how cancers start and spread, see What Is Cancer?
To understand colorectal cancer, it helps to know about the normal structure and function of the colon and rectum.
The colon and rectum make up the large intestine (or large bowel), which is part of the digestive system, also called the gastrointestinal (GI) system (see illustration below).
Most of the large intestine is made up of the colon, a muscular tube about 5 feet (1.5 meters) long. The parts of the colon are named by which way the food is traveling through them.
The ascending and transverse sections together are called the proximal colon. The descending and sigmoid colon are called the distal colon.
The colon absorbs water and salt from the remaining food matter after it goes through the small intestine (small bowel). The waste matter that's left after going through the colon goes into the rectum, the final 6 inches (15cm) of the digestive system. It's stored there until it passes through the anus. Ring-shaped muscles (also called a sphincter) around the anus keep stool from coming out until they relax during a bowel movement.
Most colorectal cancers start as a growth on the inner lining of the colon or rectum. These growths are called polyps.
Some types of polyps can change into cancer over time (usually many years), but not all polyps become cancer. The chance of a polyp turning into cancer depends on the type of polyp it is. There are different types of polyps.
Other factors that can make a polyp more likely to contain cancer or increase someone’s risk of developing colorectal cancer include:
For more details on the types of polyps and conditions that can lead to colorectal cancer, see Understanding Your Pathology Report: Colon Polyps.
If cancer forms in a polyp, it can grow into the wall of the colon or rectum over time. The wall of the colon and rectum is made up of many layers. Colorectal cancer starts in the innermost layer (the mucosa) and can grow outward through some or all of the other layers (see picture below).
When cancer cells are in the wall, they can then grow into blood vessels or lymph vessels (tiny channels that carry away waste and fluid). From there, they can travel to nearby lymph nodes or to distant parts of the body.
The stage (extent of spread) of a colorectal cancer depends on how deeply it grows into the wall and if it has spread outside the colon or rectum. For more on staging, see Colorectal Cancer Stages.
Most colorectal cancers are adenocarcinomas. These cancers start in cells that make mucus to lubricate the inside of the colon and rectum. When doctors talk about colorectal cancer, they're almost always talking about this type. Some sub-types of adenocarcinoma, such as signet ring and mucinous, may have a worse prognosis (outlook) than other subtypes of adenocarcinoma.
Other, much less common types of tumors can also start in the colon and rectum. These include:
The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
American Cancer Society. Colorectal Cancer Facts & Figures 2020-2022. Atlanta, Ga: American Cancer Society; 2020.
Korphaisarn, K., Morris, V., Davis, J.S. et al. Signet ring cell colorectal cancer: genomic insights into a rare subpopulation of colorectal adenocarcinoma. Br J Cancer. 2019; 121: 505–510. https://doi.org/10.1038/s41416-019-0548-9.
Lawler M, Johnston B, Van Schaeybroeck S, Salto-Tellez M, Wilson R, Dunlop M, and Johnston PG. Chapter 74 – Colorectal Cancer. In: Niederhuber JE, Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa. Elsevier: 2020.
Libutti SK, Saltz LB, Willett CG, and Levine RA. Ch 62 - Cancer of the Colon. In: DeVita VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams & Wilkins; 2019.
Libutti SK, Willett CG, Saltz LB, and Levine RA. Ch 63 - Cancer of the Rectum. In: DeVita VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams & Wilkins; 2019.
Luo C, Cen S, Ding G, Wu W. Mucinous colorectal adenocarcinoma: clinical pathology and treatment options. Cancer Commun (Lond). 2019;39(1):13. Published 2019 Mar 29. doi:10.1186/s40880-019-0361-0
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Colorectal Cancer Screening. V.2.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf on Jan 23, 2020.
Steele SR, Johnson EK, Champagne B et al. Endoscopy and polyps-diagnostic and therapeutic advances in management. World J Gastroenterol 2013; 19(27): 4277-4288.
Thorlacius H, Takeuchi Y, Kanesaka T, Ljungberg O, Uedo N, and Toth E. Serrated polyps – a concealed but prevalent precursor of colorectal cancer. Scand J Gastroenterol. 2017; 52(6-7):654-667. DOI: 10.1080/00365521.2017.1298154.
Last Revised: June 29, 2020
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