HEALTH MATTERS
By: Dr. Aloysius Rho
According to the American College of Gastroenterology, cancer of the colon or rectum (colorectal cancer) claims 55,000 lives each year, making it the second leading cancer in the United States. Each year, 138,000 new cases are documented and men and women between the ages of 65 to 74 have the highest incidence.
Because colorectal cancer often develops without symptoms, preventative care and early detection of precancerous growths are imperative in fighting the disease. It is not until the late stage of the disease that people can develop symptoms. With the use of a colonoscopy, colorectal cancer is nearly completely preventable.
Experts have identified several associations that may contribute to the development of colorectal cancer, including a diet that is low in fiber and high in fat; long-term exposure to environmental or occupational toxins, and a personal or family history of polyps.
In addition, other risk factors include age over 40, a history of breast or gynecologic cancer, and family history of colorectal cancer. A strong family history of colon cancer is defined as having more than one immediate family member (first-degree relative) with colorectal cancer, or a single first-degree relative who developed the cancer before age 60.
Those with a strong family history should have a colonoscopy at age 40 or 10 years before the age of diagnosis of the youngest relative affected with the cancer. Moderate family history is defined as having a first-degree relative who developed colorectal cancer after age 60. Those with a moderate family history should undergo a screening for polyps at age 40.
There are four investigative and/or screening methods available, including fecal occult blood test (FOBT), which checks stool for microscopic blood; flexible sigmoidoscopy, which looks at the lower one-third of the colon; double-contrast barium enema (DCBE), a less effective method that can miss more than 20 percent of large lesions, and colonoscopy, which is both diagnostic and therapeutic.
Colonoscopy is a simple procedure with amazing benefits. It should not be feared. Done at a hospital or surgical center in 15-30 minutes, a colonoscopy enables doctors to both detect and remove polyps. Polyps are growths on the wall of the colon and are fairly common as people age. Colorectal cancer can be avoided by detecting and removing these polyps when they are in their early stages. If the growths are small enough, they can be biopsied through the scope. If they are larger, a snare device placed through the scope can remove the growths.
Polyps typically come in two shapes stalked (also called pedunculated) or flat. While many polyps are benign, a fair number are precancerous. It usually takes five to 10 years for a polyp to develop into cancer, which is why yearly screenings are so important.
About a week prior to having a colonoscopy, it is important to avoid aspirin products or blood thinners. The day before, a liquid diet is required and the bowels must be cleansed. Immediately before the procedure, the patient is sedated, and most people sleep right through it. The average recovery time is about 45 minutes and there are no dietary restrictions after the colonoscopy is finished.
Some people may experience cramping due to air that has been puffed into the bowel during the procedure. Once the air is passed, the discomfort goes away.
Colorectal cancer is often silent until its late stages, making it important to be aware of these symptoms:
Blood in or on the stool;
Change in bowel habits;
General stomach discomfort;
Diarrhea, constipation, or feeling that the bowel does not empty completely;
Frequent gas pains;
Weight loss for no apparent reason;
Rectal bleeding, and/or
Constant tiredness or exhaustion.
Following a low-fat, high-fiber diet, maintaining a proper weight, minimizing your intake of salt-cured, pickled and smoked foods, and increasing your intake of vitamins C, A, and D are beneficial to maintaining overall good health.
March is Colorectal Cancer Awareness Month. See your doctor for a rectal exam every year beginning at age 40, have a baseline colonoscopy at age 50 (or earlier, depending on family history), have an annual stool blood test, and if you are at regular risk, get a colon checkup every five to 10 years. If you are experiencing any blood in your stool, see your doctor immediately.
Remember that early detection and removal of growths are key to preventing colorectal cancer.
Dr. Aloysius Rho is a board-certified gastroenterologist on staff at The Medical Center at Princeton. This article was prepared in collaboration with Lorraine Seabrook.