The Ins and Outs of Colon Cancer: The Who, What, When about Screening

picture of colon

Colorectal cancer remains the third most common (non-skin) cancer diagnosed in America, and it is one of the cancers that is gender indiscriminate, which means men and women are equally likely to be diagnosed with colon or rectal cancer (4.7% of men and 4.4% of women). While the curve is trending down in terms of prevalence and mortality rates are declining slightly, most likely due to improved screening, colon cancer remains the second leading cause of cancer deaths among men and women combined.

The good news is that when colon cancer is caught early, the survival rate is close to 90 percent. This means that the importance of paying attention to possible symptoms and getting screened according to the approved screening guidelines is critical—it can mean the difference between life and death.

Signs You Might Have Colon Cancer
And if you have rectal bleeding of any type or amount, or any change in the shape of bowel movements, see your doctor. Remember, blood in your stool or rectal bleeding could mean something as simple as hemorrhoids and does not necessarily signal colon cancer, but it is never normal and should always be checked by a physician.The most common early symptom that patients report is vague abdominal pain. If you have abdominal pain, including pain that comes and goes, don’t discount it or chalk it up to indigestion. Get it evaluated.

In addition, unexplained weight loss is another symptom that could signal colorectal cancer, or another type of cancer, and should be evaluated.

Current Screening Guidelines

A colonoscopy is the recommended technique for colon cancer screening. While painless, the procedure typically requires anesthesia but is done on an outpatient basis and offers the benefit of not only assessing colon health but being able to treat and/or biopsy suspicious growths or polyps at the same time.

The main updates in screening protocols is that we now recommend that all African Americans get their initial screening at age 45, while for Caucasians the recommendation is for a baseline colonoscopy at age 50. For everyone, follow up screenings are recommended at 10 year intervals as long as you are asymptomatic. If you have strong family history (a first degree relative) who was diagnosed with colorectal cancer before age 60, then your interval should be every five years.

What’s New

There is now a new stool test that can detect cancer by looking for certain DNA markers, however if the test indicates possible cancer, then a colonoscopy would still need to be done to verify. For this reason, a colonoscopy remains the preferred first course of screening because it’s not only diagnostic but therapeutic as well. If polyps are found they can be treated then and there.

We’re also finding more of a hereditary basis for colorectal cancer. If you’re 50 years old or younger and you have a first degree relative who has or has had colon cancer, you should be genetically tested, or if you have had 10 or more adenomatous polyps, you are a candidate for genetic testing. This helps us look for specific cell mutations. If none are found then we can decrease screening intervals. If mutations are found then consideration can be given toward elective colectomy. How is someone tested? Is it a blood test and is it available in most doc offices?

lady exercisingPrevention
The best way to reduce likelihood of colorectal cancer is to get regular exercise and eat a healthy balanced diet with plenty of whole fruits, vegetables and fiber. People who are sedentary and eat high fat diets and high amounts of processed foods and red meat have a higher incidence of colorectal cancer.

By Dr. Anthony Firilas, a colorectal surgeon with Roper St. Francis Physician Partners