Preventing colon cancer has improved over the years with the advent of colonoscopies …
By Eric H. Shen, M.D. Princeton HealthCare System
March is Colorectal Cancer Awareness Month and an opportune time to talk with your doctor about your risk for colon cancer and how to prevent the disease through screening and a healthy lifestyle.
The American Cancer Society estimates that more than 140,000 cases of colorectal cancer are diagnosed annually, making it the third most common cancer found in men and women in the United States.
Thanks in large part to improved screening and treatment, however, the death rate from colorectal cancer has been declining for the past 15 years, according to the ACS.
While doctors remain uncertain about what causes colon cancer, it is clear that chances of developing the disease increase after age 50. Other common risk factors include a previous history of polyps or colon cancer, a history of inflammatory bowel disease and genetics.
Patients with early-stage colon cancer generally don’t exhibit any symptoms. Signs of more advanced disease may include:
• Blood in the stool.
• Unexplained weight loss.
• Changes in the caliber of the stool.
• Anemia.
If you experience any of these symptoms, make an appointment to see your doctor to determine the cause. Most often the problem is something that can be easily diagnosed and treated.
Preventing colon cancer has improved over the years with the advent of colonoscopies and an increased awareness about the disease.
Colonoscopy is the best and most common tool today for detecting and removing lesions and polyps (abnormal growths) before they become cancerous. Doctors recommend that healthy men and women age 50 and above have a colonoscopy every 10 years. High-risk patients should consult with their doctor about the need for screening earlier and more often.
During a colonoscopy, doctors use a colonoscope — equipped with a video camera and ports to insert medical instruments — to examine the length of the colon and remove any suspicious growths. The procedure, which is one of many services offered at University Medical Center at Princeton’s Endoscopy Suite, is performed while the patient is sedated and generally takes about 15 to 20 minutes.
Preparation for the procedure involves following a clear liquid diet a day before and ingesting a laxative solution that helps clean out the colon so doctors can get a clear view. While most first- time patients are apprehensive about the preparation, the majority later say that it is easier than they expected.
Important to the success of the procedure is how clean the colon is from the preparation, how well the physician can reach the cecum (the end of the colon) and how much time is spent withdrawing the endoscope, which is usually when doctors look for polyps.
A New England Journal of Medicine study identified the connection between colonoscopy withdrawal times and the effectiveness of the procedure. The research showed that some physicians were 10 times better at finding polyps than some of their colleagues — a rate that was greatly affected by withdrawal time. The American Gastroenterological Association recommends a minimum of six minutes for withdrawal of the colonoscope to look for polyps.
University Medical Center at Princeton has begun its own study emphasizing the importance of adequate withdrawal time.
Because colon cancer is a slow-growing disease, it is unusual to find in individuals who undergo routine screenings, since potential problems are typically spotted during those screenings and can be identified and resolved early. If cancer is detected, treatment typically involves a combination of surgery (usually laparoscopic) and chemotherapy or radiation. Moreover, new surgical techniques are now enabling doctors at University Medical Center at Princeton to also remove cancer that has spread from the colon to the liver at the same time.
In addition to screening and early detection, certain lifestyle behaviors may help lower the risk for colon cancer. These include:
• Eating a high-fiber diet, rich in fruits and vegetables. Though there is much debate about the role fiber plays in preventing colon cancer, doctors continue to recommend eating a diet high in fiber because of its overall nutritional value and because it promotes good bowel function.
• Limiting your consumption of red meat and animal fat. Studies have suggested that people who regularly eat red meat may have an increased risk of developing colon cancer in comparison to those whose diets are low in red meat and animal fat.
• Taking a daily multivitamin containing folic acid or folate. Doctors believe that folic acid, as well as calcium and Vitamin D, can lower colon cancer risk.
• Exercising. The American Cancer Society recommends getting at least 30 minutes of physical activity five days a week or more.
• Avoiding cigarette smoke and limiting alcohol intake to no more than one drink per day for women or two for men.
Aspirin and drugs such as ibuprofen have been found to prevent the growth of polyps. Yet these drugs can cause serious side effects and are not recommended for the general public for colon cancer prevention. If you are at high risk for the disease, however, talk to your doctor about whether a daily aspirin regimen is advisable.
For post-menopausal women, hormone replacement therapy has also been shown to reduce their risk for getting colon cancer. Yet those that do develop the disease may develop a faster growing cancer.
Princeton HealthCare System, through its Community Education and Outreach Program, will be hosting a discussion on “Links Between Colorectal Cancer and Nutrition” from 7 p.m. to 8:30 p.m. on Wednesday, March 24 at the Princeton Fitness & Wellness Center, Princeton North Shopping Center, 1225 State Road, Montgomery. To register for the free session or for more information, visit www.princetonhcs.org/ calendar or call (888) 897-8979.
Eric H. Shen, M.D., is a board-certified gastroenterologist and a member of the medical staff at University Medical Center at Princeton.