colon or rectum where it may invade blood or lymph vessels that carry away cellular waste and fluid (Figure 2). Cancer cells typically spread first into nearby lymph nodes, which are bean-shaped structures that help fight infections. They can also be carried via blood vessels to other organs and tissues, such as the liver or lungs,13 or be shed directly into the peritoneum (membrane lining the abdomen).14 The spread of cancer cells to parts of the body distant from where the tumor started is called metastasis. The extent to which cancer has spread at the time of diagnosis is described as its stage. Staging is essential for determining treatment choices and assessing prognosis (prediction of disease outcome). The two most common cancer staging systems are the American Joint Committee on Cancer (AJCC) tumor, node, and metastasis (TNM) system, typically used in clinical settings, and the Surveillance, Epidemiology, and End Results (SEER) summary staging system, used for descriptive and statistical analysis of tumor registry data. In this document, we will describe CRC stages using the SEER summary staging system: • In situ: Cancers that have not yet begun to invade the wall of the colon or rectum; these preinvasive lesions are not included in the cancer statistics provided in this report • Local: Cancers that have grown into the wall of the colon or rectum, but have not extended through the wall into nearby tissues • Regional: Cancers that have spread through the wall of the colon or rectum and have invaded nearby tissue, or that have spread to nearby lymph nodes • Distant: Cancers that have spread to other parts of the body, such as the liver or lung What are the symptoms of colorectal cancer? Early CRC often has no symptoms, which is one of the reasons screening is so important. As a tumor grows, it may bleed or block the intestine. The most common symptoms are: • Bleeding from the rectum • Blood in the stool or in the toilet after having a bowel movement • Dark or black stools Figure 2. Stages of Colorectal Cancer Growth ©2005, Terese Winslow U.S. Govt. has certain rights Colorectal Cancer Facts & Figures 2020-2022 3 • A change in bowel habits or the shape of the stool (e.g., more narrow than usual) • Cramping, pain, or discomfort in the lower abdomen • An urge to have a bowel movement when the bowel is empty • Constipation or diarrhea that lasts for more than a few days • Decreased appetite • Unintentional weight loss In some cases, blood loss from the cancer leads to anemia (low number of red blood cells), causing symptoms such as weakness, excessive fatigue, and sometimes shortness of breath. Timely evaluation of symptoms consistent with CRC is essential for all individuals, regardless of age, given the increasing incidence in young adults (see page 6). Colorectal Cancer Occurrence How many new cases and deaths are estimated to occur in 2020? In 2020, there will be an estimated 104,610 new cases of colon cancer and 43,340 cases of rectal cancer diagnosed in the US (Table 1). Although the majority of CRCs are in adults ages 50 and older, 17,930 (12%) will be diagnosed in individuals younger than age 50, the equivalent of 49 new cases per day. An estimated 53,200 people will die from CRC in 2020, including 3,640 men and women younger than age 50. Unfortunately, reliable statistics on deaths from colon and rectal cancers separately are not available because almost 40% of deaths from rectal cancer are misclassified as colon cancer on death certificates.15 The high level of misclassification is partly attributed to the misconception among some that the terms colon cancer and colorectal cancer are synonymous because of the widespread use of “colon cancer” to refer to both colon and rectal cancers in educational messaging. To help mitigate the issue and be more explicitly inclusive of rectal cancer patients, several organizations have publicly ended this practice.16 The ability to study these deaths separately is increasingly important given the steep rise in rectal cancer incidence among younger adults.17 How many people who have been diagnosed with colorectal cancer are alive today? As of January 1, 2019, there were 776,120 men and 768,650 women alive in the US with a history