Colon cancer is the second leading cause of death in men and third leading cause of death in women in the United States. It is the fourth most commonly diagnosed cancer. There is estimated to be approximately 96,000 cases diagnosed this year with approximately 50,000 people dying from it in the same year. Between the years 2004 and 2013 the incidence of colon cancer decreased at a rate of approximately 3% per year for adults older than 50. However, colon cancer rates have increased during this same period by 2% per year in those younger than 50. This has been mostly due to an increase in the number of rectal cancer cases, however, colon cancer is certainly an important contributor. Currently, the mortality rate is down 50% from its peak. This is thought to be due to better cancer prevention, screening (meaning earlier detection) and better treatments.
Colon cancer typically starts out as a polyp which over time takes on dysplastic or cancerous changes eventually turning into cancer. It starts in the inner lining of the colon and can grow through the remaining linings over time. If a polyp is detected early enough and cut out the risk of cancer dramatically drops. The two most common types of polyps are hyperplastic polyps which usually are not associated with cancer and adenomatous polyps which are considered pre-cancerous polyps.
Early stage colon cancer which is when it is most curable rarely has signs/symptoms associated with it. That is why screening is so important. We will touch on this in a bit. Signs and symptoms of colon cancer can include: a change in bowel habits, narrower (pencil-like) stool, blood in the stool, pain during bowel movements (tenesmus,) and lower abdominal cramping. There are of course other things to look out for which include weight loss and loss of appetite, however, these are less specific and can be associated with many, many disease processes.
Risk factors associated with colon cancer are both modifiable and non-modifiable. The risk factors we have control over include: smoking, consumption of red meat, obesity, physical inactivity, heavy alcohol consumption and lack of fruits and vegetables. I often get asked about red meat consumption in my clinic due to the fact that it is often talked about on the internet. To be clear, the International Agency for Research on Cancer classified processed meat as a carcinogen in 2016 due to the fact that consumption was consistently linked to colon cancer. Non-modifiable risk factors would include hereditary genetic syndromes such as Lynch Syndrome and Familial Adenomatous Polyposis Syndrome . Also included in this is the inflammatory bowel disorders such as Crohn’s disease and ulcerative colitis.
The current recommendation is to have a screening test performed at the age of 50 for both men and women who are of average risk. There are different screening tests available, however, in my opinion the best one is a colonoscopy. This allows for complete visualization of the colon, as well as, affording the opportunity during the procedure to remove any precancerous polyps which may exist. Other potential screening tests include: fecal occult blood testing, fecal immunochemical testing, double-contrast barium enema, flexible sigmoidoscopy, stool DNA test or CT colonography. Which test is done determines how often it should be done and should something be found then a colonoscopy would need to be performed to further assess the potential abnormality.
Treatment of early colon cancer is surgery. If, during surgery positive lymph nodes are detected or the colon cancer has perforated the wall of the intestine chemotherapy is usually recommended. At this time, chemotherapy for 6 month’s (a dose every 2 weeks) is recommended. However, studies are ongoing to see if certain groups of people may be able to undergo a shorter course of therapy. Time will tell, however, the last study was promising. If the metastatic colon cancer is diagnosed then chemotherapy and/or targeted therapy is recommended.
I can’t stress enough the importance of screening for this cancer. I unfortunately see many people who have never had a screening test. The fear of having a colonoscopy is real and understood, however, those who have it done invariably tell me that it was “no big deal.” People tell me the worst part of a colonoscopy is the not the procedure itself but the prep or “clean-out” prior to the procedure. Having a good prep is very important because the better the prep, the better the physician performing the colonoscopy can see the inside of your intestines allowing to see all potential lesions present.
My advice to you is to not be afraid. We medical professionals do and see things everyday that can be embarrassing for people. We get it, we understand and although it may be embarrassing to you it still needs to be done. We as health care professionals also have to have these screening procedures done and although nobody really likes to do them there is no doubt that lives are saved when they are done. Don’t let fear or embarrassment cost you your life. Get screened!!