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March is colon cancer screening month! With that, I thought it valuable to go into this somewhat common preventable condition.
Colon cancer is the number 2 cause of cancer death in America and the number 3 or 4 most common types of cancer. 90% of people diagnosed are over the age of 50, which we will get into in a moment. The scariest fact is that the deaths from colon cancer in younger people is going up. This sparked a change in the guidelines in 2018 and my practice.
1. What is colon cancer?
Your colon or large intestine is an organ at the end of the GI tract. It is divided into sections called the cecum (hooks into the small bowel), ascending colon, transverse colon, descending colon and sigmoid colon. The sigmoid colon then hooks into the rectum, which exits your body. The colon is lined by cells whose main job is water balance.
Roughly every 3 days your colon lining turns around. Your body then gets rid of this lining and little factory workers in your colon rebuild a new colon. One day tone of these factory workers gets tired of building the same old colon lining and starts making something different. This odd lining is called a polyp. Almost all polyps are PRE-cancerous by definition.
Add 5-10 years on this factor workers lining (polyp) and you will get cancer.
2. How do I get colon cancer?
There are genetic syndromes that will make someone at risk for colon cancer. Exampled of this include:
- Lynch syndrome
- Familial adenomatous polyposis
- BRCA1 carriers (breast cancer risk too)
- Inflammatory bowel disease (Crohn’s and Ulcerative colitis)
..and more. Genetics do play a part, but without your parents, multiple relatives who are not your parents, or multiple generations, your family history plays only part of the picture. Also, to note, a family history of polyps does not change our age to screen you as doctors.
Other things that you cannot change like age (older > higher risk) and ethnicity (African American high versus not) are at play. There are modifiable risk factors as well.
Your use of substances like tobacco and alcohol also leads to higher risk. The more, the higher your risk goes. Being sedentary, obese, diabetic, and eating low vegetable intake, high processed meats can also increase your risk.
3. Bad news
The worst part of this condition is that it is silent. Yes, some people do experience bleeding, abdominal pain, weight loss, change in bowel habits, but the most common symptoms of IS…NO SYMPTOMS. That’s right, cancer usually causes no symptoms until it has gotten advanced or is large.
This is EXACTLY WHY we recommend ALL people get screened for colon cancer at age 45 because you could feel fine, but still have cancer.
4. Good News
There are MANY ways to find out if you have colon cancer and PREVENT IT. Also, if you get colon cancer it is VERY treatable and the chances for cure are HIGH.
Yes, I am a GI doc, so colonoscopy is the primary way to crack this code. Get it DONE! If you are 45 or over, go now. If you have symptoms, GO NOW! If you have a family history of colon cancer, GO NOW!
Many people are hesitant to go (guys), because, eww something is near my butt. Well, you will be asleep for the test, most likely, so you will have no idea. A colonoscope is about the diameter of an index finger. Almost everyone that gets it done for the first time says “that wasn’t too bad.” Just do it already it is a breeze.
5. Old Faithful – Screening
The hardest part of the procedure is the bowel preparation. You will need to take an electrolyte based laxative to clean out your bowels. This is vital for your doctor to be able to see polyps which can turn into cancer.
You can do you procedure sedated, but also you can do it without sedation. If using sedation you will need a ride the day of the test and plan to take the day off of work. Risks of colonoscopy include perforation (hole in the bowel, <1/1,000), bleeding (1/100 or less), infection, missed lesions and rare cautery induced inflammation and spleen damage. The risks of anesthesia will be detailed by your Anesthesiologist and if you have chronic health conditions that can place you at a higher risk (like heart attack), I recommend getting clearance by your heart, lung and/or family doctor first.
If you won’t get a colonoscopy done, then there are now stool tests called the FIT or Cologuard™ where you deliver a stool sample in a box, mail it to a lab and they test your stool for blood, DNA and tumor markers.
Though easy, this does miss several polyps as stated in the original paper published in the New England Journal of Medicine in 2014. That said, something is better than nothing.
6. When to Get Screened Early
Standard rules apply for most (again 45 years old), however, for those of you with a family history in your parents, siblings or multiple generations/relatives your age is 40 or the age of the youngest person with cancer minus 10, whichever is youngest.
Other ages for younger colonoscopy are above for people with Lynch and other hereditary colon cancer syndromes.
7. What happens after?
After the colonoscopy, you will either have a normal examination and get your next test in 10 years (2 if stool testing), or you will have polyps. The interval for colonoscopy is based upon the size, number, and character of polyps. Your doctor should guide you on the interval.
Plan to take the day of the test easy and stay hydrated. You cannot drive, operate heavy machinery or sign legal documents after anesthesia, but usually do not have any limitations from the procedure itself.
Despite successful colon cancer screening and the slow growth of colon cancer, the age of colon cancer diagnosis is getting younger. Colon cancer is multifactorial involving genetics, diet and other environmental factors.
With that in mind, get your examination done despite your gross-factor hang-ups TRUST me you will thank yourself.