March is National Colorectal Cancer Awareness Month and a reminder to be screened for colorectal cancer and a time to refresh your healthy lifestyle habits to help reduce your risk of developing cancer of the colon, rectum or anus. Worldwide, colorectal cancer is the third most common type of cancer. Colorectal cancer is the fourth leading cause of cancer-related death in the United States.
So here’s a fun pop quiz. Did you know your stomach and digestive system can move food along even while you’re standing on your head? Muscles, not gravity, send food and drink through your body. You may not have taken anatomy in school, but knowing the basics of your digestive system can go a long way in you enjoying your favorite foods and staying healthy throughout your lifetime.
What is colorectal cancer?
The lower part of your digestive system is made up of the large intestine also called the large bowel. The colon is a muscular tube about five feet long that comprises the majority of your large intestine. As food travels through your colon, waste matter collects in your rectum, the final six inches of your digestive system, before it passes from your body.
Colon cancer and rectal cancer are generally grouped together because they share common features. Most colorectal cancers start at the inner lining of the colon or rectum as a growth known as a polyp. Some types of polyps can turn into cancer, but this typically takes several years. The life-saving role of routine colorectal cancer screenings is to find and remove any polyps early.
In most cases, colorectal cancers start in cells that lubricate the interior of your colon and rectum. These adenocarcinomas are the most common. The American Cancer Society lists the other less common types of colorectal tumors.
What increases the risk for colorectal cancer?
Much of the risk comes from the American diet and lifestyle of eating lower fiber and higher fat. The actual rate of colorectal cancer related to genetic predisposition is approximately 5% of the total cases. The majority of colorectal cancers are in people who have no known family history. The lifetime percentage of having colorectal cancer as an American is roughly 4%. So colorectal cancer appears in a majority of people who are just average Americans that need to be screened.
What are the warning signs of colorectal cancer?
The Centers for Disease Control and Prevention (CDC) reports that, “Colorectal polyps and colorectal cancer don’t always cause symptoms, especially at first. That is why getting screened regularly for colorectal cancer is so important.”
If a person has any of the following symptoms, they need to consult with their doctor as soon as possible for a thorough medical workup.
- Changes in bowel habits
- Abdominal pain
- Blood in stools
- Unexplained weight loss
- Anemia
What is the best screening for colorectal cancer?
For asymptomatic people, we routinely use a colonoscopy to screen for disease. A colonoscopy is a procedure that uses a colonscope or special medical scope to look side your rectum and colon. A colonoscopy is the preferred method, the gold standard of screening for colorectal cancer. Period. A colonoscopy can visualize the entire colon and the procedure is both therapeutic and diagnostic.
The endoscopist can biopsy and remove any polyps, which are tissue growths in the lining of the colon or rectum. These polyps are then identified under a microscope to tell if the polyps are benign, pre-cancerous lesions or cancerous. From these colonoscopy results, the doctor can dictate a prognosis and recommend follow-up screenings. A colonoscopy is not 100% perfect, but with an adequately prepared patient and an experienced endoscopist, the testing sensitivity and specificity approaches 100%.
The Cologuard® home screening test has received attention in recent years, but Cologuard is only recommended for people with average risk of colorectal cancer. If we have a patient with a personal history of colonic polyps, we do not prescribe Cologuard. Cologuard looks for genetic mutations and blood in a person’s stool sample but cannot visually see inside your colon like a colonoscopy can. From research I’ve seen, with Cologuard you can miss cancers about 15% of the time, and there’s a higher risk of not catching cancer in the early stages.
Some people are hesitant to get colonoscopy screenings or they are worried about the cost, but the Affordable Care Act requires screening for colorectal cancer beginning at age 45 be provided at no extra cost. This screening is 100% covered under every private health insurance plan in the nation. Also, as a positive sidenote, there are options for drinking the colonoscopy prep. Some doctors allow for other prep arrangements that make the day-before preparation a little more tolerable.
How often should you get a colorectal screening?
A year ago, the United States Preventive Services Task Force lowered the age for an initial colorectal cancer screening to age 45 from age 50 because on increased incidents of colorectal cancers at a younger age. If you have a family history of colorectal cancer, then typically you would get a baseline screening earlier than age 45. Repeat screenings depend on the results of your latest colonoscopy. In addition, if you have certain underlying health conditions such as inflammatory bowel disease (ulcerative colitis or Crohn’s disease) or Lynch syndrome (hereditary non-polyposis colorectal cancer) you would be screening more frequently.
For people who choose the Cologuard route, they must be retested between one and three years. If a patient has a normal colonoscopy, they are typically given a clean bill of health and do not need a repeat colonoscopy for 10 years.
Why are routine colorectal cancer screenings so necessary?
Every week I see colonoscopy reports in which someone has a pre-cancerous polyp and it’s a good thing they had their colonoscopy. But some people do much better maintenance on their cars than do they for their bodies. Some individuals would never go without changing their vehicle’s oil every 3,000 miles, but when it comes to making sure they are healthy, they just overlook a colonoscopy.
We are adults and we do adult things. We are supposed to be self-responsible and self-reliant. That’s why we brush our teeth, floss, buckle our seatbelt and look both ways before we cross the street. Getting a colonoscopy is in the responsible self-care category. We take care of ourselves. We owe it to ourselves and those around us, including our family, to take care of ourselves. Some people refuse to be screened when colorectal cancers are so preventable.
We have a tremendously strong medical community in the city of Omaha, and at think we focus on prevention of all types of cancers and disease conditions. Proper screening is the key to you living a healthy life for the betterment of you and those you care about.
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