David A. Greenwald, MD, Director of Clinical Gastroenterology and Endoscopy, The Mount Sinai Hospital
Colon Cancer: Preventable, Treatable, Beatable
Each year, more than 50,000 Americans die from colon cancer, the second leading cause of cancer deaths in the United States. And for reasons that are unclear, the rate of colon cancer has increased dramatically in younger adults. The vast majority of these deaths are preventable, simply by identifying and removing polyps, or small growths, that occur on the lining of the large intestine, also known as the colon. However, one-third of the eligible United States population has never had such screening, leaving many people in danger of developing a cancer that could easily be prevented.
Who Should Get Screened, and When?
The American Cancer Society recommends that people at average risk for colon cancer be screened regularly starting at age 50. The recommended interval for screening depends on the test. For example, colonoscopy should be done every 10 years, while stool tests are recommended at one- or three-year intervals. People at increased risk for colon cancer should be screened earlier than 50. This includes people with a family or personal history of colon cancer and those with inflammatory bowel conditions like ulcerative colitis or Crohn’s disease. The American College of Gastroenterology also recommends that African-Americans, who have a higher incidence of colon cancer, be screened starting at 45.
If any of these risk factors apply to you, talk to your doctor about a strategy for colon cancer screening.
Warning Signs of Colon Cancer
The goal of screening is to prevent colon cancer, but that is not always successful. If you have any of these warning signs, see your doctor right away:
· Rectal bleeding or blood in the stool;
· Unexplained change in bowel habits;
· Unexplained change in the caliber of one’s stool, like having much thinner stools than usual;
· Unexplained abdominal pain;
· Unintended weight loss;
· Unexplained low blood count or anemia.
Anybody younger than 50 who has one of these symptoms, especially rectal bleeding, should not assume it is “nothing” or “just hemorrhoids.” It needs to be evaluated and treated.
Early Detection Is Key
Small polyps can grow into big polyps, which sometimes develop into cancer. Since it is impossible to predict which polyps will turn into cancer, the goal is to find and remove all polyps. Fortunately, the transition from a small polyp to cancer generally takes many years, so there is ample time to identify polyps and remove them before they become cancerous.
During the screening for polyps, colon cancer may also be detected. The earlier this cancer is found, the better the prognosis. Early-stage colon cancer usually requires surgery, but if caught before it spreads outside the wall of the colon or to any other organ, the cure rate is more than 90 percent.
Screening With Colonoscopy
Colonoscopy is a test that uses an instrument called a colonoscope to look inside the colon for polyps and cancer. Inserted gently through the rectum, a colonoscope is a small tubular device with a light and a camera inside of it. The procedure is painless for most patients because they are typically sedated.
The day before the examination, the patient usually consumes a clear liquid diet, followed by a bowel preparation that acts as a strong laxative. Often, the solution is divided in half, with the patient drinking one quart of it the day before the procedure, and the other quart six hours beforehand. Most people find this to be the worst part of the experience, but cleaning out all fecal material from the colon is critical for the colonoscopist to clearly see the intestinal lining and detect any abnormalities.
A benefit of screening with colonoscopy is that polyps can be detected and then removed during the same procedure. The specimen is then sent to a pathology laboratory for analysis, and recommendations for follow-up are based on the results.
Other Screening Options
Colonoscopy is the gold standard for colon cancer screening, but numerous barriers—financial, logistical, or emotional—deter many people from having it. Thankfully, there are other effective screening tests for colon cancer—some can even be self-administered at home. In addition to colonoscopy, the American Cancer Society and other organizations have approved these screening options:
· Sigmoidoscopy, which examines only the lower part of the colon, and often does not require sedation;
· X-ray-based tests, including barium enema and a type of CT scan that provides a “virtual” colonoscopy;
· Self-administered stool-based tests that are sent to a lab for analysis to detect either hidden blood or abnormal cells in the stool, which can be signs of polyps or cancer.
Note that when these other tests are positive, they all lead to a colonoscopy to detect and remove polyps or early cancer. It is important to consult with a health care professional and pick an option that is right for you, as the best test for colon cancer screening is the one that actually gets done.
“80% by 2018”
Over the past decade, colorectal screening rates in this country have increased from just over 40 percent to more than 60 percent, helping significantly reduce the incidence and death rates of this type of cancer. Now a national campaign called “80% by 2018,” promoted by the American Cancer Society and the National Colorectal Cancer Roundtable, aims to boost screening rates in America to 80 percent by 2018. We have made a lot of progress, but still have a way to go. If you are eligible, why not be screened now? It could save your life.