March is Colorectal Cancer Awareness Month, a time to shine a spotlight on a disease that for far too many people is deadly – but in most cases, it doesn’t have to be. By raising awareness of early detection through colorectal cancer screenings, we can save a lot of lives.
Colorectal cancer, often called colon cancer, is the fourth-most diagnosed non-skin cancer in the country. When considering cancers that affect both men and women, it is the second deadliest.
In 2019, the most recent year the U.S. Centers for Disease Control and Prevention has data available, there were more than 142,000 new cases of colorectal cancer and nearly 52,000 people died from the disease nationwide. The same year in Texas, there was a slightly higher incidence of new colon cancer cases than the national average.
“The sheer number of new colon cancer cases and the high number of colon cancer deaths each year is sobering,” says Dr. Bethany Malone, a colon and rectal surgeon based in Fort Worth. “But here is the good news: 90% of colon cancers discovered in early stages can be cured! That’s why we want to make sure everyone knows about the life-saving potential of colon cancer screenings.”
What is Colorectal Cancer?
As the name suggests, colorectal cancer is cancer that develops in the colon or the rectum.
If you need a refresher on your high school anatomy, check out this image:
Source: CDC
The colon and rectum form the large intestine. The large intestine is towards the end of the digestive process: the food we eat starts its journey in the mouth and travels through the esophagus. After a layover in the stomach, it continues to travel through the small intestine. Both the stomach and the small intestine are responsible for breaking down the food we eat.
When food exits the small intestine, it passes into the colon, where it is ultimately processed into a solid form and then passed through to the rectum. The rectum holds the stool until the body is ready to evacuate it through a bowel movement.
Colorectal cancer begins with the development of polyps – mushroom-shaped growths – in the colon or rectum. Polyps are initially non-cancerous; however, if they go undetected and are allowed to continue growing, they may turn into cancer. Benign polys, as well as some polyps that have become malignant, often do not produce any symptoms. That’s why proactive colorectal cancer screening is so important.
Who Needs Colorectal Cancer Screenings and When?
Most people should get their first colon cancer screening at age 45. Depending on the type of screening you have and your specific risk factors, you may not need another screening for several years if your results are normal.
All adults should continue to be screened periodically for colon cancer in accordance with their health care provider’s guidance until age 75. Adults older than 75 should discuss with their provider if additional screenings are warranted.
People who are at higher-than-normal risk of developing colon cancer may need to have their first screening before age 45. This includes people who have:
- Been diagnosed with Crohn’s disease or ulcerative colitis
- A family history of colorectal cancer or colorectal polyps
- Certain genetic conditions
The Colonoscopy
The most common screening for colorectal cancer is the colonoscopy. The colonoscopy has a lot of benefits:
- It allows the physician to get a detailed view inside the almost 7-foot length of your colon and rectum.
- The procedure itself is painless, as the patient is under anesthesia.
- It’s fast: the actual procedure usually only takes 20 minutes to an hour.
- It usually doesn’t cost anything: colonoscopies are covered by Medicare and most health insurance plans.
- If polyps are discovered during the screening, they can often be removed right then and there.
- If no abnormalities are detected, you may not need another colonoscopy for 10 years.
“Despite the many benefits of getting a colonoscopy, some people are reluctant to do so because of the preparation required for the procedure,” explains Dr. Jason Allen, a Fort Worth-based colon and rectal surgeon. “Keep in mind that the numerous benefits you get out of the colonoscopy far outweigh the relatively minor inconvenience of getting ready for it.”
Preparing for Your Colonoscopy
Once your primary care provider has referred you to a specialist – usually a colon/rectal surgeon or general surgeon – for your colonoscopy, he or she will give you detailed instructions on how to prepare for your procedure. For a colonoscopy to be effective, the patient must have empty bowels so the doctor can get an unobstructed view of the colon and rectum.
The first part of the preparation is to avoid certain foods in the days leading up to your colonoscopy. High-fiber foods that take longer to digest, such as raw fruits and vegetables, whole grains, nuts, seeds and beans are to be avoided for a few days.
The day before your procedure, you’ll transition to an all-liquid diet: certain juices and broths are OK, but no solid foods.
The night before your procedure, you’ll begin taking a special laxative your doctor prescribed for you. It may be a liquid that you drink, or it may be a series of tablets you take with plenty of water.
This medication will clear out your bowels. Yes, that means some frequent trips to the bathroom and you probably won’t get the best night’s sleep you ever had – but by the morning, the hardest part is over with!
What to Expect the Day of Your Colonoscopy
You’ll need someone to drive you to your appointment – since you will be under anesthesia, you can’t drive yourself home.
Once you’re at the hospital or surgical center, you’ll be checked in. The nurse will take you back and have you change into a gown. He or she will check your vital signs and insert an IV port into your arm for the anesthesia. The anesthesiologist will come by to do an evaluation and answer any questions you may have. The specialist will come in and tell you about the procedure and ask if you have any questions.
Once you are taken back to the procedure room, they’ll start the anesthesia IV, and you will soon be asleep. While you are dozing, the physician inserts a colonoscope, a long tube with a light on the end of it, through the anus and then into the rectum and colon. The colonoscope is long enough to travel the entire length of the colon, allowing for a comprehensive view.
If polyps are detected, the physician can remove them during the colonoscopy. When polyps are removed, they are sent to a lab for testing to determine if they are benign or cancerous.
The next thing you know, you’ll be waking up in a recovery area. The physician will come back in to tell you the results of your procedure. After the nursing staff confirms your vitals look good, you will get dressed and be on your way.
At this point, you’ll probably be hungry! Good news – you can now eat whatever you like. You may feel like taking a nap when you get home while the aftereffects of the anesthesia wear off.
“All in all, the time from when you start fasting to when you are completely back to normal is about 24 hours,” says Dr. Annie Lin, a colon and rectal surgeon in Fort Worth. “That’s not a bad tradeoff for a simple procedure that can potentially add years to your life, not to mention provide you with valuable peace of mind.”
Colorectal Cancer Risk Factors & Causes
As with many other diseases, some risk factors for colorectal cancer are outside of our control while others are influenced by the lifestyle choices we make. Risk factors we cannot control include:
- Age: Age is one of the primary risk factors for colorectal cancer. More than 90% of cases occur in people 50 or older.
- Race: African Americans are at higher risk.
- Inflammatory bowel disease (IBD), including Chron’s disease and ulcerative colitis.
- Heredity: Family history of colorectal cancer or colorectal polyps.
Lifestyle decisions that can affect colon cancer risk include:
- Smoking
- Excessive alcohol consumption
- Diets that are high in fat and/or low in fiber
- Lack of physical activity
People who are obese or overweight are also at an elevated risk of colon cancer. While genetic factors sometimes play a role in a person’s weight, a good diet and exercise plan will often help with weight loss.
Symptoms
Colorectal cancer often does not produce symptoms, which is why screening is so important. When this cancer does produce symptoms, those can include:
- Bloody stool
- Change in bowel behavior, such as prolonged constipation, diarrhea or discomfort
- General fatigue
- Unexplained weight loss.
Anyone experiencing these symptoms should make an appointment to see their physician. If the symptoms cannot be attributed to another cause, the physician will likely order a colonoscopy or other screening test to determine if there are abnormalities in the colon.
Treating Colorectal Cancer
If colon cancer is detected at an early stage, a colon/rectal surgeon is often able to remove the cancerous cells through surgery, if this was not done during the colonoscopy. Laparoscopic surgery is commonly used to remove colon cancers, and physicians are also able to collect cells from the lymph nodes at this time in order to determine if the cancer has spread.
In later-stage colon cancers, in which the cancer has spread to the lymph nodes or to other organs, chemotherapy is used after surgery to destroy remaining cancerous cells. In the event a large cancerous tumor must be removed, radiation therapy may be used to first shrink the tumor, increasing the likelihood that surgery will remove all of the cancerous tissue. Additionally, targeted drug therapies may be used to treat colon cancer, though this is usually done only in cases that are very advanced.
Get Checked
If you are 45 years old or older and you’ve never had a colonoscopy, now’s the time to get it done. You can add years to your life by catching cancer – or pre-cancerous polyps – early. And if your screening doesn’t reveal anything concerning, you will have gained some valuable peace of mind!
Start by making an appointment with your primary care provider today. And if you need to consult directly with a specialist, Privia Medical Group North Texas has several highly respected colon/rectal surgeons serving patients across the Dallas/Fort Worth Metroplex.
This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
This article contains information sourced from:
The U.S. Centers for Disease Control and Prevention
