ADVANCED GASTROENTEROLOGY OF NAPLES, PA

Colonoscopy Reduces Colorectal Cancer Risk 

Shardul A. Nanavati, MD

Colorectal cancer is the second-leading cause of cancer death in the United States. In 2009, approximately 146,000 individuals were diagnosed with colorectal cancer in the United States, and more than 49,000 individuals died of this disease. Colorectal cancer is a disease in which malignant (cancer) cells form in the inner lining of the colon or rectum. Most colon and rectal cancers originate from benign wart-like growths on the inner lining of the colon or rectum called polyps. Not all polyps have the potential to transform into cancer. Those that do have the potential are called adenomas. It takes more than 10 years, in most cases, for an adenoma to develop into cancer. This is why some colon cancer prevention tests are effective even if done at 10-year intervals. For patients with high risk factors, the 10-year interval is too long and more frequent tests are required.

Screening is VITAL to Prevention & Early Detection. Screening means looking for cancer or polyps when patients have no symptoms. Finding colorectal cancer before symptoms develop dramatically improves the chance of survival. Identifying and removing polyps before they become cancerous actually prevents the development of colorectal cancer. Refinements in screening, staging, and treatment strategies have improved survival from this disease, with over 65% of patients diagnosed with colorectal cancer surviving over 5 years after diagnosis. The number of colorectal cancer survivors continues to increase. This trend is accelerated by the increasing compliance to screening and the availability of more effective colorectal cancer treatment regimens.

Are YOU at risk for colorectoral cancer?

1. Everyone age 50 and older - 93% of those diagnosed are 50 years old and over. Current recommendations are to begin screening at age 50 if there are no risk factors other than age for colorectal cancers. A person whose only risk factor is their age is said to be at average risk.
2. Both men and women - Men tend to get colorectal cancer at an earlier age than women, but women live longer so they 'catch up' with men and thus the total number of cases in men and women is equal.
3. Anyone with a family history of colorectal cancer - If a person has a history of two or more first-degree relatives (parent, sibling, or child) with colorectal cancer, or any first-degree relatives diagnosed under age 60, the overall colorectal cancer risk is three to six times higher than that of the general population. For those with one first-degree relative diagnosed with colorectal cancer at age 60 or older, there is an approximate two times greater risk of colon cancer than that observed in the general population. Special screening programs are used for those with a family history of colorectal cancer. A well-documented family history of adenomas is also an important risk factor.
4. Anyone with a personal history of colorectal cancer or adenomas at any age, or cancer of endometrium (uterus) or ovary diagnosed before age 50 - Persons who have had colorectal cancer or adenomas removed are at increased risk of developing additional adenomas or cancers. Women diagnosed with uterine or ovarian cancer before age 50 are at increased risk of colorectal cancer. These groups should be checked by colonoscopy at regular intervals, usually every 3 to 5 years. Woman with a personal history of breast cancer have only a very slight increase in risk of colorectal cancer.

Symptoms of colorectal cancer vary depending on the location of the cancer within the colon or rectum, though there may be no symptoms at all. The prognosis tends to be worse in symptomatic as compared to asymptomatic individuals. The most common presenting symptom of colorectal cancer is rectal bleeding. Cancers arising from the left side of the colon generally cause bleeding, or in their late stages may cause constipation, abdominal pain, and obstructive symptoms. On the other hand, right-sided colon lesions may produce vague abdominal aching, but are unlikely to present with obstruction or altered bowel habit. Other symptoms such as weakness, weight loss, or anemia resulting from chronic blood loss may accompany cancer of the right side of the colon. You should promptly see your doctor when you experience any of these symptoms.

Even if no symptoms are present it is strongly recommended to be screened every five to ten years. Adenomas can grow for years and transform into cancer without producing any symptoms. By the time symptoms develop; it is often too late to cure the cancer, because it may have spread. Screening identifies cancers earlier and actually results in cancer prevention when it leads to removal of adenomas (pre-cancerous polyps).

The preferred screening test is a colonoscopy. The entire colon and rectum can be examined during a colonoscopy to detect early signs of cancer. The procedure entails taking a very flexible, thin, lighted instrument, and very gently passing it around the entire colon. During the examination doctors look for any abnormalities, redness, irritation, or polyps, and appropriate measures are taken to determine why the irritation exists, or in fact to remove the polyps. The colon is both examined, biopsies may be taken if necessary, and the removal of polyps, or small groups within the colon, can be performed. Sedation is usually used for comfort during a colonoscopy but it is not a requirement.

The strategy for reducing colorectal cancer deaths is simple. For normal risk individuals, begin colonoscopy screening at age 50 and repeat the screening every five to ten years. More frequent screenings should be performed on patients with a high risk of developing colorectal cancer. For both average and high risk individuals, all potential pre-cancerous polyps must be removed.

Recent observations suggest regular use of non-steroidal anti-inflammatory drugs or aspirin, reduce the chances of colorectal cancer death by 30-50%. These drugs also have risks, particularly intestinal bleeding, and patients should consult their physician as to whether regular use of these agents is appropriate. Folate, calcium, and post-menopausal estrogens each have a modest protective benefit against colon cancer. A high fiber (vegetables) and low fat diet, regular exercise, maintenance of normal body weight and cessation of smoking are also beneficial. None of the measures is as effective as or should replace colorectal cancer screening.

For more information on Colorectal Cancer and/or Colonoscopy Screening please contact Dr. Nanavati of Advanced Gastroenterology at 239-593-9599.