Key takeaways

  • Colorectal lymphoma is a rare colon cancer. It that begins in lymph nodes, is potentially life threatening, and is often found in advanced stages.
  • Symptoms of colorectal lymphoma, such as abdominal pain and bloody bowel movements, typically appear after a tumor has formed. Diagnosis may involve colonoscopies, CT scans, and biopsies.
  • Treatment for colorectal lymphoma may involve surgery, chemotherapy, and radiation; early detection and combined therapies improve survival rates.

The American Cancer Society (ACS) reports that 108,860 new cases of colon cancer are expected in 2026. One type of cancer that can affect the colon is lymphoma.

Colorectal lymphoma, or lymphoma in the colon or rectum, is a potentially fatal condition that is often detected only after it has already reached more advanced stages.

Whether you’ve been diagnosed with colorectal lymphoma or you’re worried that you may get it, it’s important to discuss recommendations for the next steps with your healthcare team. We’ve gathered information to help you feel prepared for these discussions.

Lymphoma in the colon is extremely serious and potentially life threatening. Diffuse large B-cell lymphoma (DLBCL) is the most frequently seen lymphoma subgroup in the colon. It’s made of cells that rapidly multiply and are more aggressive than other B-cell lymphomas.

In the United States, colorectal cancer is the third leading cause of cancer deaths in both men and women, per the ACS. The rate of people dying from colon cancers has been decreasing due to improved detection methods and treatment options. However, these types of cancers are still very serious.

Colorectal lymphoma is a type of colon cancer that begins in the lymph nodes.

Lymphoma is a general term for cancer that begins in the lymphatic system. While many types of cancers can spread to the lymph nodes, only those that begin in lymphoid tissue are considered lymphoma.

Lymphoid tissue can be found throughout the body, allowing lymphoma to form in many locations. Approximately 40% of all extranodal lymphomas are found in the GI tract. However, lymphoma originating in the colon is still very rare, representing only 1% or less of colon cancer diagnoses.

Is colorectal lymphoma the same as colorectal cancer?

Colorectal lymphoma is a form of colorectal cancer. However, there are differences between the two. For instance, colorectal lymphomas and colorectal cancer have certain overlapping and certain distinct symptoms. Fevers and night sweats can occur in colorectal lymphoma, but they’re very uncommon in colorectal cancer.

Also, the chemotherapy drugs used for colorectal lymphomas are different than those for colorectal cancers, as each type of cancer is sensitive to different treatments.

In addition, subtypes of colorectal lymphomas can vary. For example, diffuse large B-cell lymphomas are more aggressive than slower-growing types of colorectal lymphomas, such as follicular lymphoma or colorectal cancers.

Symptoms of colorectal lymphoma typically develop after a tumor has already formed.

After a tumor has developed, you may experience:

  • abdominal pain
  • unexplained weight loss
  • gastrointestinal bleeding or bloody stools

If there’s obstruction, you may also experience nausea and vomiting. However, one way that colorectal lymphoma differs from other types of colon cancers is that bowel obstruction and perforations are rare since the tumors are pliable and soft.

Colorectal lymphoma occurs more often in people between 50 and 70 years old. Researchers haven’t yet discovered the specific reason why people develop primary lymphoma in the colon. However, risk factors for colorectal lymphoma may include:

  • previous radiation therapy or chemotherapy
  • a family history of lymphoma
  • viral infections, such as HIV or hepatitis
  • exposure to toxic chemicals, like pesticides and Agent Orange

Immunodeficiency and other systemic conditions, like the development of non-Hodgkin’s lymphoma, may also increase the risk of developing colorectal lymphoma.

Systemic lymphoma

In some cases, cancerous B cells and T cells that have settled in your colon can cause colorectal lymphoma. These cells start growing and reproducing without control.

Diagnosing colorectal lymphoma is challenging because this type of colon cancer can appear without symptoms.

Therefore, it’s important to consider cancer screening even before you have symptoms. This is particularly true between ages 50 and 70 years, when you may be most likely affected by colorectal lymphoma.

If you’re experiencing symptoms like abdominal pain and bloody bowel movements, your doctor may perform a physical exam, looking for abdominal masses and enlarged organs. Your doctor may also perform a digital rectal exam to feel for any abnormal areas in the rectum.

In addition to a physical exam, your doctor will likely order additional tests, such as a colonoscopy or ultrasound. Computerized tomography (CT) scans or a double-contrast barium enema with X-ray are frequently used to identify colorectal lymphomas.

If they discover a mass, your doctor will typically order a biopsy and gene and protein tests on the tissue sample. If the biopsy confirms cancer, they may order MRI scans, X-rays, and blood tests to see how much of the body the cancer affects.

Does colorectal lymphoma show up on a routine colonoscopy?

Your doctor may spot colorectal lymphoma during a routine colonoscopy. However, a CT scan is often used to find any changes in your GI tract and understand the extent of the disease.

There’s no one standard treatment for primary colonic lymphoma because many different factors, such as your symptoms and how far the cancer has spread, need to be considered.

Treatment for lymphoma in the colon can include:

  • chemotherapy
  • radiation
  • surgery

Surgery is the primary treatment in cases involving an obstruction, perforation, or bleeding. In some cases, doctors are able to make a diagnosis before surgery and treat the lymphoma with chemotherapy combined with immunotherapy.

If there’s a tumor that needs to be removed, doctors will often remove the portion of the colon with the tumor and then reconnect the ends of the colon.

In most cases, people undergo surgery to remove the tumor, followed by chemotherapy. In some cases, radiation may be advised to help prevent new tumors from forming.

Because symptoms often appear so late, half of colorectal lymphomas are not identified until they’re already in stage 4. By this point, it’s likely that the cancer will have already metastasized or spread to other organs. This makes it harder to successfully treat.

However, early detection and treatment can help prevent cancer from spreading and improve survival.

A 2019 review of studies showed that when both surgery and chemotherapy were used, median survival times increased from 36 to 53 months. Without chemotherapy, relapse rates after surgery were higher, too.

One study in the review found that 83% of colorectal lymphoma patients lived for 10 or more years if the lymphoma had not spread or metastasized and surgery was followed by chemotherapy.

More recent research indicates that, depending on cancer stage and histological subtype, the 5-year survival rate is between 60% and 80%.

    Early detection of lymphoma in your colon can improve your chance of survival. Although symptoms often do not appear until after a tumor has formed, screening tools like colonoscopies can help identify colon cancer sooner.

    If you have a family history of colon cancer, it’s important to talk with your doctor about whether you would benefit from screening and how you can reduce your chances of developing cancer.