By Fay Kastrinos, MD, MPH Gastroenterologist NewYork-Presbyterian Hospital/Columbia University Medical Center Assistant Professor in Clinical Medicine Columbia University College of Physicians and Surgeons Felice Schnoll-Sussman, MD, FACG, AGAF Acting Director, The Jay Monahan Center for Gastrointestinal Health NewYork-Presbyterian Hospital/Weill Cornell Medical Center Assistant Professor of Clinical Medicine Weill Cornell Medical College
According to the Centers for Disease Control and Prevention, colorectal cancer screening saves lives. If everyone 50 years old or older were screened regularly, as many as 60% of deaths from this cancer could be avoided.
It’s Time to Make That Call
March is National Colon Cancer Awareness Month and, as gastroenterologists, we are too keenly aware of the toll of colon and rectal cancers on individuals and families. This month, we join with our colleagues at NewYork-Presbyterian Hospital and around the country in the Make That Call campaign to get the message out – colon cancer is preventable. If you are 50 or older, male or female, we urge you to schedule your screening colonoscopy.
So, what are you waiting for? Make that call today – it could save your life.
Learn more at makethatcall.org.
If you’re thinking about getting a colonoscopy, but just haven’t gotten around to making that call, consider this:
- Colorectal cancer is very preventable.
- Colorectal cancer is the leading cause of cancer deaths in non-smokers.
- Colorectal cancer is the third most common cancer in the United States.
- After the age of 50, the risk for colon cancer increases.
- Colorectal cancer strikes men and women equally, though women may be less inclined to get screened. This may be related to being busy caring for their family and loved ones, at times ignoring their own preventive care.
- You could have colon cancer and not even know it. This is why screening – before symptoms occur – is essential.
- Colonoscopies save lives by finding early cancer at a more treatable stage or abnormal growths that can be removed before they turn into cancer.
As the population ages – beginning about the age of 50 – the risk of colon cancer increases. This is why we recommend that men and women who are without symptoms and have no family history of colon cancer have their first screening at this age.
The risk increases if there is a family history of colon cancer and/or colon polyps, or inherited polyposis syndromes, such as Lynch syndrome – also known as Hereditary Non-Polyposis Colorectal Cancer (HNPCC), or Familial Adenomatous Polyposis (FAP). In these situations, screening should begin much earlier and is performed much more frequently. Inflammatory bowel disease, such as Ulcerative Colitis (UC) and Crohn’s colitis, can also increase the risk.
Lifestyle factors may contribute to some degree of risk, as colorectal polyps and cancer can be associated with smoking, and a diet high in fat and calories and low in fiber.
The Colonoscopy: What’s All the Fuss About?
There are many misconceptions about colonoscopies relating to the preparation, the process, discomfort, and embarrassment. As we’ve learned from so many of our patients, before they had their first colonoscopy screening, they weren’t thinking that they might have cancer; they were more concerned about the procedure itself. However, we’ve also seen that those who have undergone a colonoscopy often become its best advocates.
While preparation for the colonoscopy is often considered the least pleasant part of the process, it is one of the most important. A clean colon enables the physician to gain a clear view of the intestinal wall during the procedure. Your doctor will give you specific instructions for this preparation. It typically includes a diet of clear liquids and no solid foods the day before, and drinking a special cleansing solution to enable you to thoroughly evacuate your bowel. Over time, these preparations have become easier to tolerate. There are now different formularies and various ways of splitting the dosing so that the cleansing process is easier on your system, yet still effective.
Colonoscopies are generally performed with light sedation, and sedation levels can be tailored to the individual. Most of our patients do not remember anything of the procedure after sedation has been administered.
During the colonoscopy, the physician uses a thin, flexible tube with a fiber optic camera to visualize the inner lining of the entire colon and the lower part of the small intestine to detect polyps, tumors, ulcers, and any inflammation or bleeding. Today’s high-definition endoscopic technology enables the identification of the smallest lesions. If abnormal growths or polyps are found, tissue samples can be obtained and abnormal growths or polyps can be removed during the same procedure. In general, you should be able to return to work and resume normal activities the day after the procedure.
A colonoscopy is considered the gold standard for screening to prevent colon cancer. Other tests include a sigmoidoscopy, which is used to examine the rectum and the left side of the colon. If a polyp is discovered during this procedure, the patient will then be advised to have a full colonoscopy. A stool card, also known as a fecal occult blood test, evaluates the stool for hidden blood and, while it can indicate a diagnosis of cancer, it is not as valuable in detecting a precursor or premalignant condition such as polyps. Cancers that are picked up on stool cards are likely to be more advanced.
Most colorectal polyps are benign. However, if left undetected, precancerous polyps may undergo changes that make the cells grow out of control, and that is what leads to cancer. If a colon polyp is removed, the cancer can be prevented.
Treating Colon Cancer: It Takes a Team
Symptoms of colon cancer generally do not appear until the disease is more advanced. Symptoms may include changes in bowel habits lasting more than a few days, feeling the need for a bowel movement even after having had one, rectal bleeding, cramping or abdominal pain, weakness and fatigue, and unexpected weight loss.
Successful treatment for colon cancer requires a team. Members of this multidisciplinary group may include your gastroenterologist; radiologists who will perform the imaging tests that will help confirm the diagnosis and the stage of the cancer; and the medical, surgical and radiation oncologists who work together to develop the optimal treatment plan for each individual patient. This team, which should be in place soon after a diagnosis of colon or rectal cancer is made, is extremely important – helping the patient and family through a stressful time, ensuring continuity of care from diagnosis to recovery, and making a good outcome possible.
The treatment plan for colorectal cancer usually involves surgery. Whenever possible, colorectal surgeons will use minimally invasive approaches to remove colorectal cancer while preserving bowel function. The medical oncologist may suggest chemotherapy for certain types of colon cancers, and radiation and chemotherapy for locally advanced rectal cancers.
Chemotherapy and radiation may be recommended prior to surgery to shrink the size of a tumor and reduce the risk associated with removing the tumor. Following surgery, these treatments may be used to destroy any remaining cancer cells. Nurses, social workers, nutritionists and other health professionals will provide ongoing care and guidance throughout the patient’s treatment and recovery.
New therapies for colon and rectal cancers are continually under development. These include targeted chemotherapy agents that destroy cancerous cells and leave healthy cells unharmed, and minimally invasive surgical devices and techniques that improve safety, hasten recovery time and achieve higher cure rates.
Major academic medical centers will offer these latest therapies and advanced treatment approaches. In addition, these centers have the capacity to evaluate patients for an inherited predisposition to the development of colorectal cancer and provide genetic testing and counseling to patients and at-risk family members when appropriate.