Wow. Eliminating death from cancer. Wouldn’t that be a story to read?

For some cancers this is not far from the truth.

Each year in the United States nearly 50,000 people die of a common and mostly preventable illness. Yet we still find people who won’t take the simple steps to prevent getting this disease.

I’m talking about colon and rectal cancers. A disease that previously was discussed only in quiet, hushed conversations has become one of the true medical success stories of our generation.

A disease that formerly resulted in death rates of greater than 50 percent has become a disease that is nearly 90 percent preventable.

Colorectal cancer has been known as a silent killer. It often is far advanced before it causes noticeable symptoms. The sad reality is that most cases of colon cancer could be prevented entirely. The good news is that screening exams to detect colon cancer are effective and are readily available.

As a gastroenterologist (a GI doc), I find it frustrating to find many patients with newly diagnosed colorectal cancer had the opportunity to undergo colon cancer screening in the past, but elected not to. In about one-third of my patients who come in for screening exams I find pre-cancerous polyps or growths that are easily removed at the time of their procedure. Polyp removal essentially eliminates the potential for colon cancer to develop.

So what is the problem?

The simple answer is that despite widespread availability of screening tools, only about a third of eligible patients actually have a screening test performed. The rest refuse, ignore their physician’s advice, or choose to take their chances.

Summarized below are the current recommendations for colorectal cancer screening as advocated by various national organizations on colon cancer prevention and detection. These guidelines apply to both men and women as both genders are equally susceptible to the consequences of this disease.

The simplest screening test is known as the fecal occult blood test (FOBT).

This is actually a quick test to determine if blood is present in your stool.

It is easy to do but has limited value. A better test for detecting blood in the stool is the fecal immunochemical test (FIT). It uses antibodies to test for hidden blood in the stool. It is more sensitive than the FOBT and doesn’t require a restricted diet before testing.

A second available test is a flexible sigmoidoscopy exam. This is where a thin, flexible lighted tube is advanced into the rectum and distal colon. This is usually done in an office setting and often without the need for a sedative. Its main drawback is that it typically views less than a third of the colon. As polyps located beyond the reach of this scope might be missed, this test has fallen out of favor.

The “gold standard” in colon cancer prevention is to perform a colonoscopy. This is an endoscopic procedure designed to look inside the entire colon with a long, flexible lighted tube. It is a very safe and relatively comfortable procedure (aided by sedation). With colonoscopy, most identified polyps can be safely removed during the procedure. By removing the polyps, this can significantly reduce the likelihood of cancer developing. This is the preferred screening test for detection and removal of colon polyps.

Colonoscopy should generally be performed initially at age 50, and then every 10 years if no polyps were seen. If there is a family history of colon cancer or polyps an earlier colonoscopy might be advised. African Americans are advised to start colon cancer screening around age 45.

Other testing options are available. These include:

• A CT scan image of the colon (not as sensitive at detecting polyps, it cannot remove polyps and has the disadvantage of x-ray exposure)
• A test to look for abnormal DNA in the stool (helps to find established cancers but not pre-cancerous polyps. Not as reliable as a colonoscopy) 

Obviously screening exams are designed to find disease at an early stage before symptoms arise. Although polyps and the early stages of colorectal cancer usually present with no symptoms, there are warning signs to watch for.

• A change in bowel habits
• Blood in the stool (even “fresh” blood)
• Narrowed stool
• Bloating and fullness or a feeling that the bowel cannot empty completely.
• Frequent gas pains
• Unexplained weight loss without dieting
• Continued fatigue
• Unexplained anemia

 

These are all potential warning signs for colon and rectal cancer. Don’t ignore these signs even if under age 50.

Don’t let yourself or loved ones become a cancer statistic. When you think about colon cancer know that it is a preventable disease. And prevention is only effective if you are willing to undergo the proper screening tests.

Talk to your physician to see what is appropriate for you. Colonoscopy screenings are covered by most insurance policies and can often be made without a referral.

Thomas Ruffolo, MD is a gastroenterologist with Vidant Gastroenterology–Washington and can be reached at 252-946-1573.