By Ravi Kondapalli, M.D.
Of cancers affecting both men and women, colorectal cancer (cancer of the colon and rectum) is the second leading cancer killer in the United States, but it doesn’t have to be. Colon cancer is one of the most preventable cancers. Proper screening can literally mean the difference between life and death.
Screening can find precancerous polyps – abnormal growths in the colon or rectum – so they can be removed before turning into cancer. Screening also helps find colorectal cancer at an early stage, when treatment often leads to a cure.
According to the Centers for Disease Control and Prevention, in 2013, 136,119 people in the United States were diagnosed with colorectal cancer, and 51,813 died from the disease.
Everyone is at risk for colon cancer as we age. Our immune system becomes less robust and isn’t as effective at killing cancer cells. Risk is higher for people with a family history of colon cancer or a personal history of ulcerative colitis or Crohn’s disease. African Americans are at higher risk, and multiple factors may contribute to their increased risk.
Risk for colon cancer also may be increased by lifestyle, including obesity, smoking, a high-fat diet, and lack of exercise.
For most people, screening should begin at age 50, although the American Cancer Society is now recommending that screening begin at age 45. This guidance is supported by major gastroenterology professional associations, but Medicare and other health insurers have not yet adopted it.
For African Americans, screening should begin at age 45 as they may get colon cancer at an earlier age and are more likely to have an aggressive form of the disease. Screening may start at an even younger age for some individuals, depending on the patient’s risk factors. A gastroenterologist can advise on the appropriate screening schedule.
People who have symptoms should see a doctor and may be evaluated right away. Symptoms include rectal bleeding, weight loss, loss of appetite, change in bowel habits, or anemia.
Usually, there is no abdominal pain with colon cancer. If a patient has pain, it’s either rectal cancer or a complication from colon cancer, such as a bowel perforation.
The “Gold Standard” of Screening
While there are tests that look for blood or altered DNA in stool samples, they are not as reliable as the “gold standard” of colorectal screening: the colonoscopy.
In 2016, the Food & Drug Administration approved a blood test to detect a gene for colon cancer screening. The efficacy of this test is comparable to stool testing for colon cancer screening. At present it is not recommended for routine colon cancer screening. If a patient does not want to do any of the available colon cancer screening tests, then the blood test is an option, but it is not covered by most insurers.
The colonoscopy is a very low risk procedure and is highly effective in finding polyps and early colon cancer. With advances in technology and patient care there is no reason to avoid the procedure because of fear of complications.
The day before a colonoscopy, the patient is restricted to a clear liquid diet. At 5 p.m. the day before the procedure, the patient drinks the first of two doses of a doctor-prescribed fluid to clear the bowel. The patient drinks the second dose within eight hours of the procedure. This timing is important for the colonoscopy to reveal the bowel wall more clearly, and decrease the chance of missing polyps.
The patient receives conscious sedation for the out-patient procedure, and resumes a normal diet and activities the same day, except for driving, which can be resumed the following morning.
If polyps are found, they are removed during the procedure and sent to pathology for analysis. Most polyps found early are benign. If pathology shows cancer, the patient is referred to a surgeon and cancer specialist.
The Good News: Survival Rates Improving
Even if somebody has colon cancer, survival is improving because of advances in technology and treatments. The technologies for surgery and chemotherapy have advanced a great deal. Surgery can be performed robotically and laparoscopically. Chemotherapies are better and less taxing on the patient. Radiation protocols (for rectal cancer) are much more focused.
A small percentage of the population can’t undergo a colonoscopy because of overall medical condition. For those patients, the stool tests may be used, but again, they are not as reliable as a colonoscopy.
The good news is that rates of colorectal cancer – both incidences and deaths – are going down in the United States. Improved patient education and screening is saving lives.
For more information about colon cancer, visit www.cdc.gov or contact Florida Digestive Health Specialists in Venice at 941-483-5730.
Screening Guidelines for
• For most people, have your first colonoscopy at age 50, although the American Cancer Society is now recommending that screening begin at age 45.
• Screening for African Americans starts at age 45.
• For high-risk individuals, get screened as recommended by your gastroenterologist. High-risk includes family history of colon cancer or polyposis syndromes, or personal history of ulcerative colitis or Crohn’s disease.
• See a doctor right away if you have symptoms including rectal bleeding, weight loss, loss of appetite, change in bowel habits, or anemia.
Venice Regional Bayfront Health
Call 941-483-5730 or visit VeniceRegional.com