Understanding Colorectal Cancer

It may be socially taboo to discuss our colons, rectums and anything having to do with poop, but there’s nothing embarrassing about being open and honest about colorectal cancer. Cancer is dangerous, no matter where it starts or where it’s located.

The colon and rectum are part of the body’s digestive system and comprise the large intestine, which is where the last part of our food is processed before leaving the body. The term colorectal cancer includes cancers of both the colon and the rectum, which will affect more than 140,000 Americans this year alone, according to the American Cancer Society (ACS).

Colorectal cancer is the third-leading cause of cancer deaths, and will take the lives of more than 50,000 people in 2018. The good news is the death rate from colorectal cancer has been falling in recent years due to improved screening and treatment.

Winston Chan, M.D., colon and rectal surgeon and physician on the medical staff at Texas Health Arlington Memorial, says that while colorectal cancer has a high death rate, it can often be prevented.

“The most important thing people need to know about colon cancer is that it’s one of the top three cancers that lead to death, but is very preventable in terms of people having regular colonoscopies,” he explains. “A lot of patients know they need to be screened, but they also need to know it’s not something that is wise to delay. A colonoscopy not only screens for cancer but treats polyps as well, which can prevent cancer. Prevention and early treatment are both very important.”

The ACS reports that most colorectal cancers begin as polyps that grow on the lining of the colon and rectum, but not all polyps are cancerous. Hyperplastic and inflammatory polyps are more common but are not generally cancerous, while adenomatous polyps are more likely to become cancerous. Polyps also become cancerous more often when they are larger than 1cm or look abnormal, known as dysplasia. There are fives types of colorectal cancers, including adenocarcinomas (which comprise 95 percent of all cases), carcinoid tumors, gastrointestinal stromal tumors, lymphomas and sarcomas.

Our bodies may experience short-term gastrointestinal changes due to illness or a change in diet, but the following conditions may indicate colorectal cancer and require a visit to your physician:

  • Changes in your regular bowel habits
  • Blood in the stool
  • Diarrhea, constipation or the feeling that the bowel doesn’t completely empty
  • Stools that are narrower or a different shape than usual
  • Increased gas pains, bloating, a feeling of fullness or cramping
  • Unexplained weight loss, fatigue and/or vomiting

Risk factors for colorectal cancers fall into two categories: those we can do something about and those we can’t. The following risk factors can be lessened or eliminated based on lifestyle changes:

  • Excess weight (especially for men)
  • Lack of physical activity
  • Diets high in red meat (beef, pork, lamb and liver) and highly processed meats (hot dogs and some lunch meats)
  • Smoking
  • Heavy alcohol consumption

It’s important to try and control modifiable risk factors if at all possible, as the following factors cannot be changed:

  • Age (risk increases over the age of 50)
  • Personal or family history of polyps, colorectal cancer, inflammatory bowel disease or inherited syndromes
  • Race (African Americans have the highest incidence and mortality rates in the U.S., while Ashkenazi Jews have the highest risk worldwide)
  • Type 2 diabetes diagnosis

Colorectal cancer screening is the best way to stay ahead of danger, as tests can detect polyps before they become a problem or catch cancerous polyps in early stages. Polyps may take as many as 10 to 15 years before they become cancerous and the survival rate for early-stage cancer is 90 percent, meaning early detection is crucial.

The ACS recommends men and women over age 50 start regular screening for polyps and colorectal cancer, which means either a colonoscopy every 10 years or a CT colonography (virtual colonoscopy), flexible sigmoidoscopy or double-contrast barium enema every five years. Cancer may also be detected by annual tests including a fecal immunochemical test or guaiac-based fecal occult blood test, as well as a stool DNA test, which can be done every three years. The frequency and type of test should be determined by a person’s physician based on his or her level of risk. (Read more about the details of each test at the National Cancer Institute.)

Chan acknowledges that some patients dread having a colonoscopy so they avoid it altogether, but he says the process has improved and there are other options on the table.

“The bowel preparation has improved so it’s not as burdensome to your bowel function, and many colonoscopies are done under sedation so it’s a painless, 15- to 20-minute procedure a patient won’t even remember,” he says. “Assuming a patient’s results are normal, they won’t need another procedure for as many as 10 years. One day of inconvenience is well worth having that peace of mind.

“If a patient is adamant about not wanting a colonoscopy, there are other ways to screen for colorectal cancer. It’s not my first recommendation and I don’t think these other tests are as good, but doing some screening is better than doing nothing. It’s better to go with one of these other options and know there isn’t cancer growing without us knowing about it.”

Earlier or more frequent screening may be considered necessary if a person is considered high risk due to the following factors:

  • History of adenomatous polyps or previous colorectal cancer
  • History of inflammatory bowel disease such as ulcerative colitis or Crohn’s disease
  • Family history of polyps or colorectal cancer
  • Family history of hereditary colorectal cancer syndrome (familial adenomatous polyposis or Lynch syndrome)

Remember, don’t ignore any gastrointestinal changes, and let your doctor know if you are at high risk for colorectal cancer so you can discuss the appropriate time to begin screening. If you are 50 or older, it’s time to get on a regular screening schedule to check for polyps and cancer. While having a colonoscopy or other colorectal testing may not sound like the most fun way to spend a day, it could ultimately save your life … and that’s nothing to be embarrassed about.

“Colorectal cancer is becoming more prevalent in the younger population, so we tell people not to ignore it if they have bowel irregularities,” Chan says. “If it’s a symptom that persists, even if there’s no family history, we highly recommend they be evaluated by their primary care physician, gastroenterologist or colorectal surgeon, because it could be something serious.

“It’s very hard to reason with younger patients that these symptoms could indicate something like cancer, but it’s not as rare as they may think. Colorectal cancer is very common but it’s also very treatable. Similar to breast cancer, if we catch it early enough, a patient can have a very good prognosis and outcome.”

To find a physician to speak with about digestive health or colon cancer screenings, visit TexasHealth.org/FindAPhysician.

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