Not because I work for a division of gastroenterology and hepatology, but……March is ‘Colorectal Cancer Awareness Month.’ I am sharing my interview talking points that will broadcast live on a local radio station Thursday morning. The DJ is actually going to undergo a live colonoscopy to promote colorectal cancer screening. In order to share a wealth of information with my readers that could possibly save a life, I am posting my interview. I hope that you find the following informative and useful. The information may not pertain to you at this time in your life, but please share with friends and family as early detection of colorectal cancer and routine screening DOES save lives!

1. With March being recognized as colorectal cancer awareness month, can you tell the listeners what colorectal cancer is?

Colorectal cancer is a common and can be a lethal disease. It is a cancer that occurs in the large intestine, that is otherwise known as the colon and rectum which is the last few inches at the end of the colon. Cells that line the colon become abnormal and grow into an uncontrolled mass of cells. Colorectal cancer usually begins as a polyp or polyps, which usually start out as benign or noncancerous tissue, but if left in place, overtime can become cancerous.

2. What is the incidence of colorectal cancer in the United States?

Globally, colorectal cancer is the third most commonly diagnosed cancer in males and the second in females. In the United States, of cancers that affect both men and women, colorectal cancer is the second leading cause of cancer-related deaths. According to the CDC, in 2009, 51,848 people in the United States died of colorectal cancer; that was 26,806 men and 25,042 women. It is, also, one of the most commonly diagnosed cancers in the United States. Annually, approximately 142,820 new cases of colorectal cancers are diagnosed, of which 102,480 are colon and the remainder are rectal cancers. This turns out to be approximately 1 in 19 people who will develop colorectal cancer.

3. Are there any risk factors for getting colorectal cancer?

The risk of developing colorectal cancer is influenced by both environmental and genetic factors. Low socioeconomic status is associated with an increased risk for the development of colorectal cancer thought to be at least partially due to the lack of adequate screening for the disease. Unhealthy lifestyle behaviors such as physical inactivity, unhealthy diet that is high in fat especially animal fat, low in calcium, folic acid or folate, and fiber, cigarette smoking, excessive alcohol intake, and obesity are thought to play a role in the development, as well. Age, however, is the most common risk factor for the development of colorectal cancer. It is most common in people 50 years of age or older encompassing 9 out of 10 people of this age group, and as noted, both men and women can be affected. Individuals with a family history of colorectal cancer in parents, brothers, sisters, or children are somewhat more likely to develop colorectal cancer themselves, especially if the relative had the cancer at a young age. If several close relatives have a history of colorectal cancer, the risk is even greater. Other risk factors include a personal history of colon or rectal polyps or if the individual has a disorder known as inflammatory bowel disease; with Crohn’s or ulcerative colitis being the two most prevalent of the inflammatory bowel diseases.

4. How is colorectal cancer detected?

There may be no warning symptoms early in the disease. This means that an individual may have polyps and even colorectal cancer without knowing it. However, some individuals do have symptoms that include a change in bathroom or bowel habits such as diarrhea or constipation, bright red stools or dark stools, feeling that their bowels do not empty out completely, stools that become narrower than usual, unexplained weight loss or fatigue, unexplained stomach pain, bloating or fullness, cramping, or increased gas, and nausea and/or vomiting. However, these symptoms may be caused by other health conditions, so it is important to see your healthcare provider for further evaluation. Given that symptoms may not occur until the disease is more advanced is why colorectal cancer screening is very important and can save lives.

5. What types of screening options are available?

Gastroenterologists, such as SIU HealthCare, Division of GI, conduct screenings to help detect, as well as, prevent colorectal cancer by finding and removing polyps before they become cancerous. Several tests are available for colorectal screening. These include annual fecal occult blood test, which is testing a sample of stool for blood on three consecutive specimens. If this test is positive for blood, then other tests are needed to find the source of the blood, such as a colonoscopy. Not all cancers or polyps bleed, however. Other screening methods include flexible sigmoidoscopy every five years, which is performed with direct visualization using a lighted flexible colonoscope, but only on the lower portion of the colon and rectum; both fecal occult blood test and flexible sigmoidoscopy together to increase the chance of finding polyps and/or cancer; a double-contrast barium enema every five years where barium is instilled into the large intestine to outline the colon and rectum and x-rays are taken; and, colonoscopy, which is the gold standard of colon cancer screening and the preferred method because of its thoroughness and advantages of examination. A colonoscopy entails using a lighted flexible scope as with a flexible sigmoidoscoy, but the entire length of the colon and rectum is inspected and if any polyps are detected during examination, they can be removed at that time. This is the most comprehensive and complete method of colorectal cancer screening. It is recommended every 10 years unless polyps or suspicious or cancerous tissue is found and then the timing of repeat examination is altered.

6. Who should be screened for colorectal cancer?

Anyone, male or female, 50 years of age or older should be screened for colorectal cancer and should discuss screening options with their healthcare provider. If an individual is under the age of 50, but believe that they could be at increased risk for developing colorectal cancer, they should talk with their healthcare provider, as well, to discuss possible earlier screening recommendations.

7. Why are these screening tests important?

Although colorectal screening, especially with colonoscopy examination, is effective at preventing and detecting colorectal cancer, fewer than half of Americans 50 years of age or older have been screened. According to the CDC, 2010 statistics showed that Illinois ranked among one of the lowest states in being up-to-date with colorectal screening by any method, ranking in the mid to upper 50th percentile range. The most important strategy to prevent colorectal cancer from occurring, is to remove polyps before they become cancerous. If detected early, the 5-year survival rate is over 90%. The longer cancer is allowed to progress undetected, the harder it is to treat and the greater the risk for poor outcome.

8. Most individuals are apprehensive or reluctant to perform the bowel cleansing or preparation required for a colonoscopy. Can you address this process for the listeners?

Again, colonoscopy, because of its obvious thoroughness and benefits of the exam with polyp detection and removal, is the preferred method for early detection of colorectal cancer. It does require colon cleansing prior to the procedure. If the colon is not properly emptied or cleaned out, the gastroenterologist may miss polyps or abnormal tissue during the exam. A poorly prepared colon may lead to an incomplete exam, a missed cancer diagnosis, or the need to repeat the colonoscopy screening sooner than usual recommendation. Therefore, it is of extreme importance to consume all of the bowel preparation and follow all of the instructions provided by the healthcare provider. However, there have been new developments in bowel cleansing with lower volume preparations. The bowel preparation prescribed by your healthcare provider would be based on your individual circumstances. I always tell my patients, that if you can forgo a few challenging hours of bowel preparation, the benefits of having a thorough and complete colonoscopy are well worth the challenge and may even save your life.

9. What can an individual do to reduce their risk of colorectal cancer?

Get screened for colorectal cancer routinely starting at age 50 and earlier is there are special risks or concerns, be physically active for at least 30 minutes daily, maintain a healthy weight, eat a healthy diet low in fat and containing fruits and vegetables, take a daily multivitamin containing folic acid or folate and selenium, limit daily alcohol consumption, and do not smoke or stop smoking if you do smoke.

Take away……….
Again, get screened for colorectal cancer routinely starting at age 50 and earlier is there are special risks or concerns. Three out of four cases of colorectal cancer occur in people with no known medical risk factors. Many people do not have early warning signs or symptoms; therefore, screening is critical. Less than 50% of all Americans 50 years of age and older are screened within recommended timeframes. Early detection can save lives.

Blessings until next time…………………………………….