By Dr. Jeffrey A. Gordon
Every day, someone is either given the diagnosis of, or is undergoing treatment for, colorectal cancer. You may know someone. It is the third most common cancer in the United States.
The American Cancer Society estimates approximately 135,430 people in the U.S. (approximately 1,600 people in Connecticut) will be diagnosed with colorectal cancer this year. One in 22 men and 1 in 24 women will get it in their lifetime.
Over the past 20 years, the number of people who have died from cancer overall, including colorectal cancer, has decreased by 50 percent. There are an estimated 1.2 million colorectal cancer survivors in the U.S. This is all wonderful news.
Here’s what has made it possible:
- Informing people about getting screened.
- People actually going to get screened.
- Colonoscopies that find polyps (small growths in the colon and rectum) so they can be removed before they turn into cancer.
- Finding cancer at early stages that are easily treated.
- New cancer treatments.
A colonoscopy looks directly inside the bowel. Unlike a sigmoidoscopy, which looks only at the rectum and the last part of the colon (called the sigmoid), a colonoscopy looks at the rectum and the entire colon. Medical studies show that if polyps are found, then removing them before cancer starts directly decreases the chance of dying of colorectal cancer. That is why colonoscopies are recommended — not just once, but on a scheduled basis.
If a polyp is not removed, over time it grows and can become cancerous. You may have one polyp. You may have more than one. You may have a polyp removed and then another one forms elsewhere in the bowel. It is when a cancer develops that it becomes dangerous. That is why finding and removing polyps is so important. A colonoscopy is easy and safe. You’re asleep during it. Some people are embarrassed to talk about a colonoscopy. But you don’t want to die of embarrassment because you did not get a colonoscopy!
Have you had your screening colonoscopy yet?
Most people think that having colorectal cancer is associated with symptoms. But when colon cancer starts small, especially when it is a polyp or when it is an early stage, it has no symptoms. You do not know you have it. That is why getting a screening colonoscopy is important. By the time symptoms develop — such as loss of appetite, weight loss, fatigue, abdominal pain, bloating, changes in bowel habits or blood in the stool — the cancer may be at an advanced stage.
Sometimes colorectal cancer is associated with blood in the stool. More often than not, such blood is associated with hemorrhoids. But sometimes it is not. You also may not see any blood in the stool, but it is there microscopically. This is a reason for testing the stool for blood. No matter how blood is detected – whether you see it or a test finds it – getting a colonoscopy can find if something is causing the bleeding.
If a colorectal cancer is found, surgery is often needed to remove it. For early stage colorectal cancer, surgery alone can cure it. Chemotherapy may be used after surgery to increase the potential of being cured. Chemotherapy eradicates any microscopic cancer remaining after surgery. Not everyone needs chemotherapy. It depends on the features and extent of the cancer. Molecular and genetic tests can also help a physician decide who may or may not benefit from chemotherapy.
In advanced-stage colorectal cancer, when the cancer has spread to sites of the body distant from the colon and rectum (such as to the lungs, liver, brain, and bones), an array of therapies can help people enjoy better of qualities of life for longer periods of time than ever before. Chemotherapy and biologic therapy, the latter targeting features of the cancer, are used as part of a continuum of care over time. The side effects of chemotherapy are less than they were many years ago and the drugs used are more effective than the older drugs. Supportive care maneuvers are able to decrease treatment side effects. These have allowed more people to get the doses of the treatments they need and to stay longer on the treatments that are working.
A family history of colorectal cancer may increase your risk of developing colorectal cancer. It is estimated that between 5 percent and 10 percent of colon cancers have a hereditary component. You cannot change your family history, but you can get genetic counseling and testing, if needed, to assess your risk even if you do not have colorectal cancer.
Other factors that increase colorectal cancer risk:
- Overweight or obese.
- Physically inactive.
- Eating a lot of red or processed meats.
- Overcooking meats when frying or grilling
- Smoking cigarettes.
- Too much alcohol (more than two drinks a day for men or one drink a day for women)
- Crohn’s disease.
- Ulcerative colitis.
Additional risk factors include age and ethnic background. Colorectal cancer can occur in people who are less than 50 years of age, but over the age of 50, as one ages, the risk increases. African-Americans and people of Jewish Ashkenazi (eastern European descent) have an increased risk of colorectal cancer.
Some factors that decrease colorectal cancer risk include eating a lot of vegetables, fruits and whole grains.
Knowing your risks helps you plan for the future. If you modify your lifestyle, you can improve your odds for a healthy future. But some factors — age, family history and ethnicity — you cannot change.
Unfortunately, approximately 33 percent of people in the U.S. who should be screened for colorectal cancer do not get it done. In Connecticut, the statistic is better: approximately 25 percent of people do not get a colonoscopy. This puts our state No. 5 in a national ranking of people getting screening colonoscopies. Talk with your doctor about what you can do for yourself, a family member or a friend.
I recommend the following starting at age 50 years for people at “average” risk, based upon information from the American Cancer Society and the U.S. Preventive Services Task Force:
- Checking for blood in the stool every year by fecal occult blood test (FOBT) or fecal immunochemical test (FIT).
- Considering the additional check of the stool by DNA testing every three years.
- Following a defined colonoscopy schedule, such as every 10 years.
If you have a family history of colorectal cancer or other risk factors, then you may be in a “high” risk category and thus need screening tests done earlier than age 50 years and/or frequently.
March may be the colorectal Cancer Awareness Month, but any day is a good day to do something for yourself so that you can live healthier and longer. Contact me at Hartford HealthCare Oncology Waterford (860.443.4455) or click here for directions.
Dr. Jeffrey A. Gordon is board-certified in Hematology and Medical Oncology. He works at Hartford HealthCare Oncology in Waterford. He is the president of the Connecticut State Medical Society. Dr. Gordon’s opinions do not reflect any official position or policies of the CSMS.