By Anish Sheth, M.D., Princeton HealthCare System
When it comes to understanding colorectal cancer one of the first things you should know is that it can often be stopped before it starts.
Early detection is key to fighting colon cancer, and screening with a colonoscopy can detect pre-cancerous polyps so they can be removed and cancer can be prevented.
Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, according to the American Cancer Society, and is responsible for an estimated 49,700 deaths annually.
Overall, the lifetime risk of developing colorectal cancer is 1 in 20. However, the death rate from colorectal cancer has been going down for more than 20 years, in large part because of early detection through colonoscopy.
How it starts
In most cases, colorectal cancer begins as a polyp or abnormal growth in the colon, a 5-foot long tube that absorbs water and nutrients from food and functions as storage place for waste before it moves into the rectum and passes out the body.
Most polyps — or adenomas — are not cancer, but over time they may turn into cancer.
Polyps are common in adults, especially as they grow older. In fact according to the American Society for Gastrointestinal Endoscopy, it is estimated that the average 60-year-old without special risk factors for polyps has a 25 percent chance of having a polyp.
Risk factors
Age is the primary risk factor for colorectal cancer. Federal health statistics show that 90 percent of colorectal cancers occur in people who are 50 years old or older. Other uncontrollable risk factors include:
A personal or family history of colorectal cancer or polyps.
Inflammatory bowel disease, Crohn’s disease or ulcerative colitis.
Certain genetic conditions .
Race or ethnic background, such as being African American or Ashkenazi .
Risk factors that are in your control include:
Smoking .
Being overweight or obese.
Lack of exercise .
Diets that are high in red meats and processed meats .
Heavy alcohol use.
Symptoms
Normally, pre-cancerous polyps don’t cause any symptoms, which is why screening is important. If cancer develops and grows, symptoms may include:
A change in bowel habits.
Blood in your stool .
Stomach pain, aches or cramps that don’t go away.
Unexplained weight loss.
An ongoing feeling that you need to have a bowel movement.
If you develop any of these symptoms, talk with your doctor about your risk for colorectal cancer.
Screening saves lives
Screening with a colonoscopy is recommended starting at age 50, or earlier if you have a family history of colon cancer or pre-existing conditions such as ulcerative colitis.
A colonoscopy uses a flexible thin tube to view the colon and detect polyps. Often the polyps can be removed during the colonoscopy.
Except in rare cases, doctors no longer recommend other forms of colon cancer screening, such as fecal blood tests, because colonoscopy would still be necessary for a diagnosis.
It is important to note the link between withdrawal time — how much time the physician spends looking through the colonoscope for polyps — and the effectiveness of a colonoscopy. The American Gastroenterological Association has suggested guidelines recommending a minimum of six minutes before the colonoscope is withdrawn. Further, the use of a high-definition colonoscope increases a doctor’s ability to detect adenomas.
In addition to screening, you can take other steps to help prevent your risk for colorectal cancer such as eating a healthy diet, exercising, and maintaining a healthy weight. If you smoke, consider quitting.
Treatment
If cancer is detected, surgery is typically the main treatment. For many patients, the cancerous section of the colon can be removed using minimally invasive laparoscopy, which involves smaller incisions — leading to shorter recovery times — compared with traditional surgery. During the procedure, the two ends of the colon are reconnected to restore normal bowel function.
If the two ends of the colon cannot be reconnected, a colostomy may be needed. A colostomy involves creating an opening on the outside of the body and attaching a bag to collect waste that flows through. A colostomy may only be needed temporarily until the colon heals enough to be reattached.
Depending on the type and stage of the cancer, some patients may require additional treatment like chemotherapy or radiation.
Learn more
To learn more about colorectal cancer, join me for a live Internet chat hosted by Princeton HealthCare System from 7 p.m. to 7:30 p.m. on Thursday, March 19. I will take your questions and discuss steps you can take for the prevention and early detection of colon cancer as well as risk factors for colon cancer, screening methods and treatment options.
To participate, simply go to the USTREAM Channel at www.ustream.tv/channel/princetonhealth on your computer, tablet or smartphone on the day of the seminar.
If you’d like to ask a question during the web chat you can log in using your Facebook or USTREAM account or you can create a new account. Alternatively, you can also submit questions in advance by sending them to PrincetonHealth@gmail.com.
To pre-register visit www.princetonhcs.org. All those who pre-register will be entered to win one of several gift cards that will be awarded immediately following the web-chat. Must be present to win.
To find a physician with Princeton HealthCare System call (888) 742-7496 or visit www.princetonhcs.org.
Anish Sheth, M.D., is board certified in gastroenterology and is a member of the medical staff at University Medical Center of Princeton.
