Colorectal Cancer by Gillian Friedman, M.D.

Colorectal Cancer (which includes cancers of the colon, rectum and appendix, as well as some anal cancers) is the second leading cancer killer in the United States annually, trailing only lung cancer. It is the third most diagnosed cancer in the U.S. and Canada (after lung and breast in women, and lung and prostate in men). The American Cancer Society estimates that 146,940 cases of colorectal cancer (CRC) will be diagnosed in the U.S. this year, and 56,730 deaths will occur.

Despite its high incidence, colorectal cancer is one of the most detectable cancers, and if found early enough one of the most treatable. More than 90 percent of those diagnosed while the cancer is still localized survive more than five years. Currently, however, only 37 percent of colorectal cancers are detected in this early stage. The Harvard Center for Cancer Prevention recently reported that regular screening, combined with a healthy lifestyle, could prevent more than half of all U.S. colon cancer deaths. Primary prevention through polypectomy, or the removal of polyps, substantially reduces the risk of developing colorectal cancer.

The most common symptom of colorectal cancer is to have no symptoms at all. Nonetheless, people should pay attention to possible signs such as changes in bowel habits; diarrhea or constipation; narrower than normal stools; unexplained weight loss or anemia; constant tiredness; blood in the stool; a feeling that the bowel does not empty completely; or abdominal discomfort such as gas, bloating, fullness, cramps or vomiting. If you experience any of these symptoms for more than a few days, talk to your doctor to determine the cause. Understand that at this point you are diagnosing an active condition and no longer screening. If symptoms persist, insist on getting a colonoscopy.

Colorectal cancer is a slow-growing cancer that can take up to ten years to develop, leaving a generous window of opportunity for screening. Screening for colorectal cancer works in two ways—first, it identifies asymptomatic cancers early when treatment is most effective, and second, it locates growths (polyps) inside the colon that can be removed before they become cancer. Experts differ about which screening tests should be used and how often adults without known risk factors for colorectal cancer should be tested. However, all professional guidelines emphasize the importance of a regular screening program for all adults over age 50 and others at risk that includes annual fecal occult blood tests (FOBT), periodic partial- or full-colon exams, or both. Leaders in the field have estimated that widespread adoption of these screening practices could save as many as 30,000 lives each year. That’s more than 50 percent of the colorectal cancer deaths expected this year.

Unfortunately, screening rates are low. In a recent survey of Americans over age 50 conducted by the Centers for Disease Control (CDC), only 40 percent of respondents had ever had an FOBT (the take-home stool-card test) and only 42 percent had undergone a flexible sigmoidoscopy (a visual examination of the last part of the colon, where the majority of cancers occur). By contrast, 85 percent of women had been screened for breast cancer.

If screening works, why aren’t more people doing it? Screening rates are influenced by many factors, not least of which are lack of public awareness about colorectal cancer and the benefits of regular screening; inconsistent promotion of screening by medical providers; widespread limitations on insurance coverage for preventive health practices; negative attitudes about the screening procedures; and absence of social support for openly discussing and doing something about the disease down there.

If none of your relatives had CRC, the recommended age to start screening is 50. If you don’t know if your relatives had CRC, ask. Find out, and take the answer to your doctor to develop a screening plan that’s right for you. Knowing your family history and getting the appropriate screening could save your life. If CRC occurred in one first degree relative (a parent, sibling or child), or in two or more second degree relatives (aunts, uncles or grandparents), screening should start at age 40, or ten years before the age when your relative was diagnosed. If you have a history of inflammatory bowel conditions like ulcerative colitis or Crohn’s disease, or have abdominal or intestinal polyps, you may be at higher risk for CRC and should talk with your doctor about an appropriate screening strategy. Women have a higher incidence of cancers of the right side of the colon, which a flexible sigmoidoscopy won’t visualize. Thus, some authorities recommend that women in particular should have full-colon examinations.

The Colon Cancer Alliance offers patient support, education, research and advocacy.

www.ccalliance.org

Read the rest of the interview with your order of ABILITY Magazine. Other articles in the Kevin Richardson issue include— Volunteerism and Sean Astin, Awards/Galas—New Ability Awards & Western Law Center, Picture Perfect Kids, Marilyn Bartlett and the ADA, Seeing in the Dark, Headlines, Customized Employment, Events/Conferences, Humor Therapy...subscribe!