Prevention Is Key to Surviving Colorectal Cancer

As with almost every other cancer, early detection increases your odds of survival and cure. March is National Colorectal Cancer Awareness Month, and doctors are warning that once you have symptoms, colorectal cancer might be beyond the early detection stage.

“If we’re looking at symptoms, we’ve already lost the (early detection) game,” said Julian Armstrong, M.D., a physician and gastroenterologist on the medical staff at Texas Health Harris Methodist Hospital Fort Worth. “You want to find it when there aren’t any symptoms — we want to be looking for something in its precancerous stage.”

Symptoms can include:

  • Changes in bowel habits, including diarrhea or constipation, or a change in the consistency of your stool that lasts longer than four weeks;
  • Rectal bleeding or blood in the stool;
  • Ongoing abdominal pain, including gas or cramps;
  • A feeling like your bowels never empty;
  • Fatigue;
  • Unexplained weight loss.

“Rectal bleeding can often bring people in,” Armstrong explained. “A change in bowel habits can be a difficult thing to quantify, but come in if you’re concerned.”

“And an iron deficiency — you really have to pay attention to that, particularly if it’s a man,” he continued. “In a woman, it depends — women can be anemic for a variety of reasons, especially during the fertile years.”

Armstrong said even if none of those symptoms mean you have cancer, you’re uncomfortable, and that can be treated. “There could be something else going on, and we can treat that and help you be more comfortable,” he said. “Any change from your baseline in bowel habits should be checked.”

Screenings, Armstrong said, are usually advised beginning at age 50 (the Centers for Disease Control says 90 percent of all colorectal cancers occur in the over 50 age group), but “the fastest growing group of colorectal cancer diagnoses is the age 40 to 50 group.”

“Men are more likely to die of colon cancer than women,” he said. “And African Americans are at a higher risk as well.”

Some of the leading physicians’ groups recommend screenings for African American men should start at age 45. “The national guidelines say 50 is fine,” Armstrong said. “I personally believe that African Americans should begin having screenings after 45, not 50.”

Screening options include:

  • Colonoscopy
  • High-sensitivity fecal occult blood test (FOBT), stool test or fecal immunochemical test (FIT)
  • Sigmoidoscopy

So, are there ways to avoid colon cancer?

Yes and no. The CDC recommends that in addition to screenings, a person should be physically active, maintain a healthy weight, not drink too much alcohol, and not smoke.

But there are risk factors — and not all of them are necessarily things within a person’s control.

“There’s a myriad of them [risk factors],” Armstrong said. “But the things that make it more of a risk are diet, genes, and environment. And of those two, diet is really the only one you can control.”

According to Armstrong, diet can have a bigger impact on your risk than you might think.

“Red meat — that’s actually a real thing,” he said. “Fiber will decrease your risk. Being obese will increase your risk. And being sedentary — that’s also not so good.”

“If you have a first-degree family member — that’s a mother, father, sister or brother — with colon cancer, that is an independent risk factor, which absolutely doubles your risk of having colon cancer,” he added. “And if it was before the age of 50, that’s also a huge red flag.”

Armstrong said that inflammatory bowel diseases — including Crohn’s disease and ulcerative colitis — can also increase a risk of colon cancer, especially the longer a person has them.

We know that with breast cancer, for instance, knowing that you have certain genetic mutations early can provide you with an array of prevention opportunities. Doctors have found that’s true with colon cancers as well.

Lynch Syndrome, or hereditary nonpolyposis colon cancer (HNPCC), is the most common type of inherited colon cancer, according to the Colon Cancer Alliance (CCA).

“It accounts for about two percent of all colon cancer cases. It is caused by changes in an HNPCC gene,” the CCA said. “Most people with an altered HNPCC gene will develop colon cancer, and the average age at diagnosis is 44.”

“And it’s not just colon cancer,” Armstrong added. “Several organs can be affected, including the brain.”

The second type is rarer. Familial adenomatous polyposis (FAP) is an inherited condition that results in hundreds of polyps forming in the colon and rectum. It accounts for less than one percent of all colon cancer cases, the CCA said.

“FAP is a genetic predisposition,” Armstrong explained. “By age 45 there is an almost 100 percent guarantee that the person will have colon cancer.”

“We will do an early colectomy (a surgical procedure to remove all or part of your colon) in those cases,” he continued. “A 100 percent chance of colon cancer is hard to argue with.”

And people with BRAC mutations are often also referred to a gastroenterologist for a colonoscopy, Armstrong said, “because the BRAC mutation can also increase the risk for colon cancer.”

Knowing all your risk factors, watching your weight and activity level, and having regular screenings as recommended by your primary care physician can improve your odds if you are diagnosed with colon cancer.

Colon cancer is survivable — if caught early.

“The most obvious way to survive colon cancer is to have a colonoscopy before you have symptoms,” Armstrong said. “The polyps can be removed early.”

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

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