No one likes the thought of cancer – especially colon cancer. The truth is that many otherwise health-conscious adults are just too embarrassed or afraid to talk about it. Unfortunately, this silence has allowed colon cancer to become quite common in our society. Did you know that colon cancer is now the leading cause of cancer deaths in nonsmokers? Only lung cancer is more deadly. This year we can expect about 134,000 new cases of colon cancer – 55,000 deaths. We find about two or three new cases of colon cancer a week in our practice alone. That’s the bad news. The good news is that it is surprisingly easy to lower your risk of this common deadly disease. Read this pamphlet and discuss it with your doctor. Knowing these simple facts could save your life. Don’t be embarrassed to death.
Your digestive system
Your intestinal tract is about a thirty foot long hollow “pipe” that travels from top to bottom. Most of the digestive process occurs in the small intestine where food molecules are chemically broken down into smaller components that your body can use for strength, energy and tissue repair. After the digestive process is completed, the resulting waste travels downstream to the large intestine, or colon. Averaging about five feet in length, the colon has little to do with the actual digestive process. Rather, it functions much like a “water treatment plant” receiving about two gallons of liquid waste daily, purifying the water, and recycling it back into your blood stream for reuse. The remaining solid waste is stored in the last 6 inches of the colon – the rectum – until it is convenient to have a bowel movement.
First polyps, then cancer
Colon cancer is a malignant growth that occurs on the inner wall of the colon or the rectum. It is now known that colon cancer usually begins many years earlier as a small noncancerous growth called a polyp, which grows on the inner wall of the colon. Nobody knows what causes polyps to grow and why some people get them and others do not – but genetics probably plays some role. We do know that over time some polyps will grow larger until they develop into colon cancer. Although there are always exceptions, current data suggests that this malignant transformation is slow and may take as long as five years or longer.
Who is at risk?
You are. We all are. While there are certain risk factors, such as family history of colon cancer, that may increase your personal risk, the truth is that over 75% of cases have no unusual risk factors to warn them. In fact, about 1 in 17 adult Americans now develop cancer of the colon in their lifetime. As an example, if you went to a Pittsburgh Penguin’s hockey game and saw about 16,000 other cheering fans there, realize that almost 1000 of them would have colon cancer in their future. Standing together, they would cover the ice. This disease is very common. Despite a popular misconception, colon cancer is also an equal opportunity disease – men and women are equally affected. It can affect young adults, but most cases occur after the age of 50 and the risk increases with age.
What are the warning symptoms?
The most common symptom of colon cancer is no symptom at all. That is the problem. You could have a polyp, or even an early cancer, growing in your colon right now as you read this and feel perfectly fine. There are no symptoms such as pain, bleeding, or change in bowel habits to warn you – until it is too late. By the time that a colon cancer is large enough to change your bowel habits, it may already be too late. Left undetected, colon cancer eventually penetrates through the outer colon wall and spreads to other organs, most often lymph nodes and the liver. Then you have symptoms and real trouble. That is why, despite the development of modern surgical techniques and new medical treatments, the death rate of colon cancer has not improved in decades – less than half are cured. The key concept is – Don’t wait for warning symptoms.
Where’s the good news?
It has been well demonstrated that if colon cancer is caught in the earliest stages, the cure rate could be increased to 90%. Even better, it has been repeatedly shown that by detecting and removing colon polyps before they develop into cancer, colon cancer can be prevented. Most polyps can now be painlessly removed during a simple 20 minute outpatient “scope” procedure called colonoscopy. To decrease your risk of colon cancer, you need to have any colon polyps found and removed before they become cancerous. Early detection and destruction of any colon polyps must be your goal.
Screening exams
The problem is how do you know whether you have a polyp? Good question! You don’t. Since colon polyps, and even early colon cancer, are usually silent, you cannot rely on symptoms. To reduce your personal risk, you must undergo an active program of periodic colon checkups, before you have symptoms – just as you would for routine mammograms and prostate exams. You must go see your doctor when you feel well. Here are three different situations that might arise:
If you have symptoms:
Get tested now! Screening programs for colon polyps and cancer are designed for patients who have no symptoms. If you have symptoms such as rectal bleeding, altered bowel habit, or have been found to have unexplained iron deficiency anemia or a positive test for hidden blood in your stool (Hemoccult), you need to see your doctor for a full investigation, not a screening exam.
Average risk individuals with no symptoms:
Most people fit into this category. For those with no symptoms and no high risk factors, it is recommended that screening begin at age 50. At a minimum, this should include a 3-day Hemoccult card test for hidden blood in the stool every year and a flexible sigmoidoscopy, “short scope test,” every 5 years. Recently, it has been shown that this regimen still misses up to 30% of colon cancer and even more polyps. This is why most professional health organizations – like the American Cancer Society – now endorse Colonoscopy as a primary screening method. There are three advantages to colonoscopy. First is higher accuracy since the entire colon is visualized. Second, with colonoscopy most polyps can be removed when found – “one stop shopping.” Even better, if normal, screening colonoscopy need not be repeated as often.
High risk individual:
While we are all at risk, some of us have a higher risk than others because of certain factors in our medical history. Those who fall into a high risk category should also be screened, but at age 40. If there is a family history of colon cancer, start at age 40 or 10 years younger than the index case whichever is earlier. The appropriate test should be chosen by your physician depending on the circumstances. Most often, a colonoscopy “full scope” exam is done.
High risk factors include:
- Personal past history of colon polyps
- Personal past history of colon cancer
- Ulcerative or Crohn’s colitis
- Personal history of breast or uterine cancer
- Family history of colon cancer
- Family history of precancerous polyps
If you fall into one of these high risk categories, it is even more important that you begin a regular screening program.
Other ways to reduce risk
This polyp “search and destroy” approach is the cornerstone of colon cancer prevention. In addition, you may be able to further reduce your risk by eating a high fiber diet that contains more fruits, vegetables, whole grains and less fat. Trim the fat from your diet. Eat more fish and chicken and less beef, pork, and lamb. Supplementing your daily diet with 400 mcg. folic acid and 1000 mg. of calcium may also help. Recent studies have clearly shown the benefit of taking an 81 mg. baby aspirin daily.
Colon cancer is one of the most curable and preventable forms of cancer. When detected early, more than 90% of patients can be cured. Sadly, recent studies show that only about 12% of adults ever bother to have a colon examination. As an individual, you can dramatically reduce your risk of getting colon cancer by having regular examinations before symptoms develop. Following the simple guidelines can keep you healthy to enjoy the good life you have worked so hard to create. Take charge of your health.
