March is Colon Cancer Awareness month so this is a great time to talk about colon cancer, the third most common cancer in men and women and the second leading cause of cancer deaths in the United States. When found early, colon cancer can be highly curable. Colon cancer occurs in the large intestine which makes up about five feet of your intestine, and the last portion of the intestine, the rectum. Together these cancers are referred to as colorectal cancers.
Colorectal cancers usually begin as polyps, benign growths which begin on the surface of the colon. The two most common types of polyps are adenomas and hyperplastic polyps. These form when the cells lining the colon grow abnormally. Most polyps remain benign, but some have the potential to turn into cancer so removing them early can prevent colorectal cancers.
Risk factors for colon cancer include:
Age-most common over the age of 50
History of polyps or inflammatory bowel diseases like Crohnâ€™s Disease
Family history of colon cancer
History of ovarian or breast cancer
Diet high in processed or red meats
Sedentary lifestyle with little exercise
Smoking and drinking excess alcohol
Common symptoms of colon cancer are:
a change in bowel habits such as diarrhea or constipation
feeling that your bowels do not empty completely
finding blood, either bright red or very dark, in your stool
finding your stools are more narrow like a pencil
frequently having gas pains, cramps or bloating
unexplained weight loss
feeling very tired all the time
significant change in appetite, nausea or vomiting
Colon cancers can be present for several years before symptoms develop so it is very important to get screenings for colon cancer. The most effective prevention is early detection and removal of precancerous polyps. Everyone over 40should have a yearly digital rectal exam where your doctor will feel for any abnormal growths. A test for occult blood will be performed. Tumors on the colon will bleed slowly and usually this is not visible. A small amount of stool is placed on a card and microscopic amounts of blood can be detected. A person who tests positive for occult blood can have a 30-45 percent chance of having a polyp and a 3-5 percent chance of having colon cancer. Many other conditions can cause blood in the stool so further testing is necessary.
Beginning at age 50 it is recommended that everyone has a screening colonoscopy. A flexible tube with a light and camera is inserted into the intestine. A colonoscopy can detect and remove polyps as well as diagnose other diseases like diverticulosis or colitis. Depending on your history a colonoscopy is recommended every 5-10 years for screening, every 2-3 years if you have polyps or other risk factors. Preparation for a colonoscopy requires cleaning the colon with a bowel prep. Several different methods are available, including pills. Usually this is done as an outpatient procedure and a light sedation is given. Most patients tolerate colonoscopy very well and experience little discomfort. Some people have a lot of anxiety about a colonoscopy so talk to your doctor. Do not let anxiety keep you from having what could be a life saving procedure.
If you have been diagnosed with colon cancer you will be referred to a surgeon and an oncologist. Together these doctors work to develop a treatment plan based on the size and stage of your cancer.
Stage 0: the cancer is only in the innermost lining of the colon.
Stage 1: the cancer is not beyond the inner lining. Stage 2: the cancer has spread into the muscle layer of the colon.
Stage 3: the cancer has spread to one or more lymph nodes in the area.
Stage 4: the cancer has spread to other parts of the body such as the liver, lung or bones.
Surgery is the most common treatment for colorectal cancers. If a cancer is found very early it may be removed entirely though the colonoscope. For most cancers a partial colectomy is performed by removing the portion of the colon and sewing the colon back together. Lymph nodes will also be removed around the colon to examine for any spread of the cancer outside the colon. Depending on the location of the cancer the colon may not be reconnected and a colostomy or bag, is required. This may be temporary or permanent.
Depending on the stage of the cancer, chemotherapy or radiation may be required in addition to surgery. Chemotherapy is the treatment of cancer using drugs, either given orally or intravenously. Radiation therapy uses high energy x-rays to kill cancer cells or keep them from growing. In the case of some rectal cancers this may actually be done prior to any surgery. Early Detection and treatment of colorectal cancers can lead to over 80% five survival rates.
There are steps you can take to dramatically reduce your chances of getting colorectal cancer. Appropriate screening over the age of 40, paired with, a low fat, high fiber diet with fruits and vegetables, plenty of exercise and reducing body fat could prevent 45 percent of colorectal cancers. Talk to your doctor, March is the perfect month to get started!
Dr. Margaret Aswad is a surgeon with Carolinas Medical Center-Lincoln.