By Samuel N. Giordano, MD, Gastroenterologist, Cooper Digestive Health Institute
March is Colorectal Cancer Awareness Month, which presents an ideal time to start the conversation about what colorectal cancer is and what we can do to prevent it. The first step is education, while the second step is encouraging our friends and family to take action and get checked.
In the United States, colorectal cancer is the second leading cause of cancer deaths among men and women. It is projected that 147,950 new cases of colorectal cancer will be diagnosed in 2020, and as many as 50,000 people will die of colon cancer. On average, you have a one in 24 chance of developing colorectal cancer in your lifetime. The risk of colorectal cancer increases with age as more than 90% of new cases occur after the age of 50. However, there has been an alarming recent trend of increased incidence in younger patients under the age of 50.
Colon cancer starts as a polyp, which is a small growth in your colon (large intestine) that over time can enlarge. Many patients with polyps are not even aware of them and have no symptoms at all. As polyps continue to grow, or if a patient has multiple polyps, the risk of one of those polyps turning into cancer increases. The purpose of a colonoscopy is to remove those polyps at an earlier stage before they have a chance to transform into colon cancer. This is why it is important to start screening early and stay ahead of the curve.
Unfortunately, at an early stage colon cancer may have no signs at all. When there are signs, some of the more common ones are unintentional weight loss, abdominal pain, blood in the stool, change in bowel habits, or narrow shaped stool. On blood testing, a patient may be found to have a low blood count or anemia, which could indicate microscopic blood loss in the stool. If you have any of these symptoms, you should alert your doctor and discuss any concerns.
The good news is that there are excellent ways to prevent and screen for colon cancer. Most men and women should start screening for colorectal cancer at age 50, and age 45 if you are African American. Screening may be recommended for younger patients with a family history of colorectal cancer or colon polyps, as they may be at higher risk for developing colon cancer. Only about two thirds of patients in the United States undergo colon screening, so this is something we as a nation need to work on.
A colonoscopy is the “gold standard” for colorectal cancer screening and prevention, and it is a safe and simple method to use. During colonoscopies, you are under anesthesia and typically wake up not even knowing the test was done. It involves adhering to a liquid diet the day before your test and taking a laxative prep.
Alternatives to colonoscopy, although not quite as effective, include CT colonography, which still involves a prep but is performed at a radiology suite. Another option involves stool-based testing such as a DNA-based stool test, a FIT test, or a fecal occult blood test. These stool tests look at possible signs of blood or colon cancer genetics.
Overall, you should know the signs and symptoms and listen to your body, as you know it best. Know your family history, or if you don’t, then ask. Get screened at the appropriate age, adopt an active lifestyle, and adhere to a healthy diet high in fruits, vegetables, and fiber, and limit consumption of red meat. Also, don’t smoke.