Let’s Talk About Colon Cancer Prevention
Beginning at age 40, you should have an annual digital rectal exam (DRE) in which the doctor checks the portion of the colon that can be reached manually through the rectum. Starting at age 50, you should undergo two tests on a regular basis: a fecal occult blood test and sigmoidoscopy. A fecal occult blood test screens for traces of blood in the stool, a possible sign of polyps or tumors in the colon. This exam should be done once a year and can reduce the risk of dying from colon cancer by 33 percent. Every three to five years, you should also have a flexible sigmoidoscopy, which involves insertion of a lighted scope to view the lower colon. This procedure allows suspicious growths to be removed and biopsied, and may cut the incidence of colon cancer by 42 percent and the risk of death by half. Depending on your risk factors, a colonoscopy, which allows an examination of the entire colon, may be indicated.
In the June 15, 2000 issue of the New England Journal of Medicine, the results of one of the most rigorous studies comparing the accuracy of barium enemas with colonoscopy reported that people with risk factors for colon cancer can get more reliable results through colonoscopy than barium enemas. Researchers found that the barium enema detected only a third of the polyps detected through colonoscopy, and only half of the larger polyps (which are more likely to be cancerous). (Colonoscopy missed 20 percent of the smaller polyps.)
Cancer Myths & Facts
Myth: Colon cancer affects mostly men.
Fact: Colon cancer is an equal opportunity disease, affecting both men and women alike. Among women, only lung and breast cancers take more lives.
Myth: If I don’t have symptoms, I don’t need to be screened.
Fact: The early symptoms of colon cancer can be easily dismissed or overlooked. Digital rectal exams should begin at age 40, and routine screening, including sigmoidoscopy, should begin at age 50. Screening tests should begin earlier and occur more often if you have certain risk factors. See below for more information about risk factors.
Myth: Most people require a permanent colostomy, an opening in the abdominal wall through which waste from the colon passes, after surgery.
Fact: Some people may require a temporary colostomy after surgery, but newer surgical techniques have reduced the number of permanent colostomies to a minimum.
What risk factors increase my chance of developing colon cancer?
The presence of any of these factors increase your risk:
Familial adenomatous polyposis (FAP): in this condition, hundreds or even thousands of polyps develop in the colon and rectum, usually appearing during the teenage years, with cancer nearly always developing between the ages of 30 and 50.
Hereditary nonpolyposis colon cancer (HNPCC): an inherited condition where cancer may develop at a young age without first having many polyps.
Familial colorectal cancer in Ashkenazi Jews: some Jews of Eastern
European descent have an inherited change in their DNA that causes a slightly increased risk of developing colon cancer.
A personal history of colon cancer: cancer may recur in other areas of the colon and rectum.
A personal history of intestinal polyps: certain types of polyps increase the risk of colon cancer, especially if they are large or if there are many of them.
A personal history of chronic inflammatory bowel disease: also called ulcerative colitis or Crohn’s disease.
A family history of colon cancer: those with one or two immediate family members (father, mother, brother, sister) have two-to-three times greater than normal risk. If you have three immediate family members with the disease, your risk is 10 times greater than normal.
Aging: about nine out of 10 people with colon cancer are older than 50.
Diet: a diet high in animal fat may increase the risk of colon cancer.
Physical inactivity: people who exercise have a lower incidence of colon cancer.
How is colon cancer treated?
Much depends on the stage of the disease and your overall health at the time of diagnosis. Treatment may include surgery, chemotherapy, radiation therapy or a combination of these. Surgery is typically used to remove the cancer and all lymph nodes in the surrounding area.Your physician may recommend radiation therapy before and after surgery. This may be in the form of external radiation or internal radiation, which involves putting radioactive materials into the area where the cancer cells were found. Chemotherapy may be used as well. Biological therapy, which includes substances such as interleukin-2 and interferon, helps boost the body’s immune system and may be added to the treatment mix.You may also be a candidate for a clinical trial that is evaluating the latest drug treatment options.
What are some newer treatments for the disease?
Some people may be treated with minimally invasive surgical techniques, an alternative to traditional, open surgical procedures. Known as laparoscopic surgery, the procedure is performed through several tiny incisions, resulting in a shorter hospital stay and a quicker return to normal activities. Alternatively, in some people with small, low rectal cancers, internal radiation is used instead of surgery.
How important is family history in colon cancer?
It is of critical importance. Ten percent of all colon cancers are hereditary. Many people don’t know they have a family history of the disease, since talking openly about cancer is difficult. If you want to compile a family tree, you can obtain the cause of death of a family member by contacting the Bureau of Vital Statistics in the city where the family member died.
Blood in stool
Thinner stools than usual
Cramp-like pain in stomach region
Diarrhea followed by constipation
Unusual and continuing
lack of energy
Persistent, unexplained weight loss
Personal history of colorectal polyps
Family history of colorectal polyps or cancer (mother, father, sisters, brothers)
Family history of hereditary colorectal cancer syndromes (hereditary familial
Inflammatory bowel disease
High animal fat/low fiber diet
Fecal occult blood test
Digital rectal exam
CEA assay, blood test
Maintain healthy weight
A multivitamin including folic acid
Reduce animal fat in diet
Increase intake of fruits, vegetables and whole grains
Low-dose aspirin, if doctor permits
Calcium supplements, if doctor permits