Screening is the key to prevention.
By Jill Case
You probably didn’t wake up this morning thinking about colorectal cancer. In fact, it’s probably something that never crosses your mind until someone you know is diagnosed. March is National Colorectal Cancer Awareness Month, and it’s designed to get you thinking, talking and learning more about this largely preventable cancer. According to the Centers for Disease Control, “Among cancers that affect both men and women, colorectal cancer (cancer of the colon or rectum) is the second leading cause of cancer deaths in the United States. Every year, about 140,000 Americans are diagnosed with colorectal cancer and more than 50,000 people die from it.
What is Your Risk?
Dr. Subhakar Mutyala, radiation oncologist with Scott & White Healthcare Temple, says, “nine out of every 10 people [who get colorectal cancer]are age 50 or over.” This has led to the recommendation that everyone should be screened at age 50, unless they have other risk factors.
“If you have a first-degree relative (a parent or sibling) who was diagnosed with colon cancer, but was over the age of 60, that doesn’t actually change your risk,” Mutyala adds. “If you have one first-degree relative who was diagnosed with colorectal cancer under the age of 60, or if you have multiple first-degree relatives with colorectal cancer, regardless of age, that changes you to a high-risk patient. You should start screening at the age of 40 or 10 years younger than the earliest diagnosed relative. So if you had a parent who was diagnosed with colorectal cancer at age 45, you should start your screening at 35.”
Other things that place a patient at risk are having certain conditions such as inflammatory bowel disease (IBS), Crohn’s disease or genetic syndromes like familial adenomatous polyposis or Lynch syndrome.
“African Americans should start at age 45 because they have a higher risk factor for colon cancer,” Mutyala also notes. People of Ashkanazi Jewish descent are also at higher risk. These risk factors are not something that you can control, but there are things that you can do to reduce your risk. “Diet seems to be a risk factor,” Mutyala explains. “Heavy red meat, processed meats like hot dogs. A lot of vegetables in your diet actually seem to protect you from colorectal cancer. That being said, the fiber supplements have not been shown to be equivalent to eating a leafy diet.”
In addition, there are four risk factors—smoking, heavy alcohol use, obesity and lack of physical activity—that people can affect by changing their behavior and habits.
What are the Symptoms?
Colorectal cancer and precancerous polyps do not always cause symptoms, making the screenings that much more important for detection. If you do notice any of the following symptoms, seek a doctor’s advice: blood in or on the stool, stomach pain or persistent cramps that do not go away, pencil-thin stools or unexplained weight loss. You can be asymptomatic and still have polyps or cancer. This is exactly why everyone, whether you feel sick, should have a screening.
“Ideally, the benefit of this screening, and it ’s been proven to be effective, is you are finding a cancer before it’s even a cancer, like a polyp, and then removing it, so you actually have less chance of developing a cancer,” Mutyala says. “Or, if you do find cancer, you find it at an earlier stage where it’s much easier to get treated. Those are the main goals of it: that you are preventing cancer if you are removing the precancerous polyps or finding the earlier stage cancer.”
The first step is awareness. The second and most important step is your call; schedule a screening today if you are older than 50 or in the at-risk category.
Dr. Subhakar Mutyala is a radiation oncologist with Scott & White Healthcare, sw.org. He also serves as the associate director of the Baylor Scott & White Cancer Institute.
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Colonoscopies: Everything You Wanted (or Didn’t Want) to Know!
Let’s face it, nobody ever looks forward to having a colonoscopy, but once you know how truly important and valuable this test is to your life and your health, you will realize there is no reason to avoid it. ATX Man spoke to Dr. Melvin Lau to find out what you need to know.
AM: Why is it necessary to do the prep, which is the part of the procedure many people dislike, before having a colonoscopy?
Dr. Melvin Lau: The bottom line is we expect to find at least one polyp in about 25 percent of men during a routine colonoscopy. For us to do a colonoscopy and find these polyps, the colon has to be clean. The wall has to be clean enough so we can look for these polyps, whether big or small. The cleaner the colon, the better the physician can detect the polyp. We also know that colorectal cancer is the second leading cause of cancer death in America. Often times, patients who present with colon cancer have avoided a colonoscopy early on. One thing that people don’t realize is that you don’t develop colon cancer overnight. It takes many years, beginning with a growth on the wall of the colon, called a polyp. That polyp basically stays there and grows over time. What we really want is to find and remove polyps so as to prevent colon cancer.
AM: What can you tell me about the anesthesia used for the procedure?
ML: There are two types of sedation involved with colonoscopies. The first one, commonly known as “twilight sleep,” is also known as “moderate sedation.” That’s where the gastroenterologist gives intravenous medicine during the procedure to keep patients comfortable. The patient is often sleeping but may wake up. The medicine has a slight amnesiac affect, so they often do not remember much. Throughout the whole procedure, we are monitoring the patient’s heart rate, blood pressure and oxygen saturation. The other sedation is called “deep sedation.” This is where an anesthesiologist or a nurse anesthetist would give propofol. Patients are still sleeping on their own, but they are in a much deeper sleep, so they definitely don’t remember anything.
AM: What happens if the doctor finds polyps during the procedure?
ML: The goal of every colonoscopy is to find every polyp and remove them. We have many tools to remove polyps of different shapes and sizes because we know that if we fail to remove a polyp, there is an inherent risk that the colon polyp can transform in to colorectal cancer in the future.
AM: What are the possible complications of the procedure?
ML: Serious complications are rare. If you go to the literature, and even in our institution, it’s about three per 1,000 cases performed. Those are for serious complications, which include bleeding, perforation, infection and a cardio-pulmonary event, which can occur during the procedure. I would say that like any other procedure, these are inherent risks. However, by completely avoiding the procedure, one will lose the benefit of polyp detection and may develop colorectal cancer in the future. It’s all a matter of risk and benefit. I would say that in our experience, of those serious complications, bleeding is probably the most common.
AM: Is there any way to reduce the risks of complications during the procedure?
ML: I think everybody does have individual risk, so someone with heart or lung diseases may be more susceptible to a cardio-pulmonary event. In any case, we do recommend that patients who do have serious medical history speak with the person doing the colonoscopy prior [to having the procedure].
AM: What is your best advice for someone who is avoiding having a colonoscopy?
ML: Colon cancer is the second leading cause of cancer death in the U.S., and it need not be that way. I want people to know that colon cancer is very preventable. Unlike any other cancers, we have a way to detect and even remove colon polyps, and by removing colon polyps, we can essentially prevent colorectal cancer. Dr. Melvin Lau is a gastroenterologist with Scott & White Healthcare in Round Rock, sw.org, and an assistant professor at Texas A&M University Health Science Center.