Colon Cancer: What you need to know.

BY: MICHAEL LEWIS, MD

Colon cancer is a scary topic. I am sure most of you know someone who has been affected by this horrible cancer. If screened early, it is preventable, treatable and essentially curable.

Get this, Colon cancer is the Third leading cause of cancer related deaths in the United States – following Lung and breast/prostate (women/men).  Here are some scary stats:

* 40% of colon cancers are found while the cancer is found at a local stage (confined to colon or rectum

* 36% of colon cancers are found after the cancer is diagnosed at a regional stage (spread to surrounding tissue)

* 20% of colon cancers are found after the disease has spread to distant organs

* 90% or more colon cancers are found in patients over 50 years old.

* 90% of those diagnosed when the cancer is found at a local stage (confined to colon or rectum) survive more than five years.

* When the cancer has also spread to distant sites, only 13% of those diagnosed will reach the five-year survival milestone.

Ok – Do I have your attention now? I know what you must be thinking? “I don’t have colon cancer – I have no symptoms” and “there is NO WAY anyone is putting that 6 foot long camera in my ass!” I have two things to say in response to that. First, people that put off early screening and delay diagnosis is the reason why colon cancer is found late, yield a poor prognosis and lead to premature deaths. Secondly, get over it! I’ll tell you what, it’s much more uncomfortable to have radiation, chemotherapy and surgery, than it will be to have a camera go in your rectum.

WHO GETS SCREENED?                                                             Recommendations are for all human beings ages 50 years or older. There are some exceptions. If you have a first degree relative (mom, dad, brother, sister) who had colon cancer, you should get screening earlier -especially if one of these relatives either had colon cancer before they were 50, or there was a genetic condition leading to this such as Familial Adenomatous Polyposis. Also, if you have a history of inflammatory bowel disease (Ulcerative colitis or Crohn’s disease) you should get screened as well.

If you have two or more second degree relatives, aunts, uncles, grandparents etc., with colon cancer the same recommendations are made as above – early screening – to be determined by your physician.

Before we go on to prevention:

COLON CANCER MAY NOT HAVE ANY SYMPTOMS!

PREVENTION.                                                                                                                       Part I: There is no real prevention for colon cancer, besides EARLY DETECTION of pre-cancerous polyps (extra growths of tissue) which can be treated during the colonoscopy. The sample will be sent to pathology to see what kind of polyp it is – some are riskier (more likely to progress to cancer) than others. At this point, the gastroenterologist will determine if you need 1 year, 3-5 year or 10 year follow up for colonoscopy.

Part II: Good colon health can help reduce risk of colon cancer. Mainly the ingestion of fiber, around 25-35 grams per day – which you can find in leafy greens, grains, and soluble sources such as brand name Benefiber® or Metamucil®

Part III: Stop smoking! Smoking increases the risk of all cancers. If you need help quitting, you can contact your physician.

THE PREP                                                                                                                               It seems everyone is scared of “The Prep.” Basically you are given a diet of reasonably clear liquids and low residue foods for a couple of days prior to the procedure. The day/evening before, you are given a gallon of fluid made up of electrolytes and PEG (polyethylene glycol) aka: Miralax. A whole bottle’s worth of Miralax to be precise. You then drink it little by little until there is no more left. By that time – IT BEGINS!!!

It seems everyone is scared of “The Prep.” Basically you are given a diet of reasonably clear liquids and low residue foods for a couple of days prior to the procedure. The day/evening before, you are given a gallon of fluid made up of electrolytes and PEG (polyethylene glycol) aka: Miralax. A whole bottle’s worth of Miralax to be precise. You then drink it little by little until there is no more left. By that time – IT BEGINS!!!

One word of wisdom and caution:

If you think it’s a fart, it’s not a fart!

You can now guess what happens for the next 4 hours or so.

SCREENING TESTS
Colonoscopy – See “the procedure” below
Flexible Sigmoidoscopy – rarely used anymore – This tests uses a shorter camera and classically only sees the first 1/3 of the colon (just past the sigmoid). This is because 90% of colon cancers are in the first 1/3 of the bowel. I know what you’re thinking, what about the other 10% or the other 2/3 of the colon? You are right and that’s why we have moved away from this screening modality almost completely.

FOBT (fecal occult blood testing): Tests for microscopic blood in the stool (not visible to the naked eye). This is done yearly if people
aren’t getting (avoid) a colonoscopy.

THE PROCEDURE
Once you arrive and are taken in, you will be given an IV in most cases with a medicine to consciously sedate you. You are awake but sedated heavily. The medicine is also an amnestic, meaning you will forget everything (in most cases) from the time they initially gave it to you until to the time you have completed the procedure. A long, THIN! Camera is placed in your rectum and the gastroenterologist inspects your entire colon (hopefully the prep was good). If they see something odd or out of
the ordinary (redness, polyps) they will biopsy and/or remove it and send it to pathology. In most cases the entire procedure is less than 10
minutes, and usually under 8. You are then taken to the recovery room, where mostly everyone says: “is it done yet?”

WHEN TO FOLLOWUP
A Normal colonoscopy follow up is 10 years. If there is a polyp, then it can be 3-5 year follow-up depending on the type of polyp (beyond the scope of this article). If you have multiple polyps, or other issues such as diverticulosis (small out-pouchings in the colon which can lead to infection) you may be asked to be seen more frequently. If it is a “bad prep,” (all the stool wasn’t cleared) you may be asked to come back in a year.

If you want to do your best to prevent colon cancer, talk to your doctor about early screening. It may save your life!

PAY ATTENTION
If you notice: a change in your bowel habits, unexplainable weight loss, thin stool caliber (pencil-thin stools), blood in your stool or abdominal pain not typical for you, please contact your doctor ASAP. The presence
of these symptoms does not necessarily mean you have colon cancer, but it does deserve some attention.

Pay attention, you deserve it!

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