Colon Cancer Awareness & Prevention
March 8, 2010
Dr. Susan Briley and Dr. Bill Harb

News notes provided by webmd.com

March is COLON CANCER AWARENESS MONTH

What Is Colorectal Cancer?

In order to understand colon and rectal cancer, collectively known as colorectal cancer, it might first help to understand what parts of the body are affected and how they work.

The Colon

The colon is a 6-foot long muscular tube connecting the small intestine to the rectum. The colon, which along with the rectum is called the large intestine, is a highly specialized organ that is responsible for processing waste so that emptying the bowels is easy and convenient. The colon removes water from the stool, and stores the solid stool. Once or twice a day it empties its contents into the rectum to begin the process of elimination.

The Rectum

The rectum is an 8-inch chamber that connects the colon to the anus. It is the rectum’s job to receive stool from the colon, to let you know that there is stool to be evacuated, and to hold the stool until evacuation happens.

What Is Colorectal Cancer?

Cancer that begins in the colon is called colon cancer, and cancer that begins in the rectum is called rectal cancer. Cancers affecting either of these organs also may be called colorectal cancer.

Colorectal cancer occurs when some of the cells that line the colon or the rectum become abnormal and grow out of control. The abnormal growing cells create a tumor, which is the cancer.

Digestive Diseases: Colorectal Polyps and Cancer

Colorectal cancer is the third most common cancer and the second leading cause of cancer deaths among American men and women. These cancers arise from the lining of the large intestine, also known as the colon. Tumors may also arise from the lining of the very last part of the colon, called the rectum.

Unfortunately, most colorectal cancers are “silent” tumors. They grow slowly and often do not produce symptoms until they reach a large size. Fortunately, colorectal cancer is preventable, and curable, if detected early.

How Does Colorectal Cancer Develop?

Cancer of the colon and rectum usually begins as a polyp. The word “polyp” is a nonspecific term to describe a bump on the surface of the colon. Polyps can also be bumps of normal colorectal lining which do not increase the risk of colorectal cancer.

The two most common types of polyps found in the large intestine include:

• Hyperplastic polyps. Usually small, left-sided polyps that do not carry a risk of developing into cancer. However, large hyperplastic polyps, especially on the right side of the colon, are of concern and should be completely removed.
• Adenomas or adenomatous polyps. Benign polyps, which, if left alone, could turn into colon cancer.

Although most polyps never become cancerous, virtually all colon and rectal cancers start from these benign growths.

Polyps and colon cancer develop when there are mutations or errors in the genetic code that controls the growth and repair of the cells lining the colon. People may inherit diseases in which the risk of colon polyps and cancer is very high.

Who Is at Risk for Colorectal Cancer?

While anyone can get colorectal cancer, it is most common among people over the age of 50. Risk factors for colorectal cancer include:

• A personal or family history of colorectal cancer or polyps.
• A diet high in fat and low in fiber.
• Inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
• Obesity.
• Smoking.

What Are the Symptoms of Colorectal Cancer?

Unfortunately, colorectal cancer may strike without symptoms. For this reason, it is very important to be screened regularly by your doctor for colorectal cancer, even if you have no symptoms.

There are a number of tests your doctor can perform to diagnose colorectal cancer. These tests include:

• Sigmoidoscopy. This is a procedure used to examine the very last part of the colon (sigmoid colon and rectum). This test can detect polyps, tumors and other changes in the sigmoid colon and rectum. During this exam, a biopsy (tissue sample) can also be taken for testing.
• Colonoscopy. A colonoscopy examines the entire colon and rectum. During this procedure, a biopsy may be taken.
• Colon X-rays. Also known as a barium enema or lower GI, this test provides an outline of the colon lining as well as detects polyps, tumors and changes in the colon and rectum.

The earliest sign of colon cancer may be bleeding. Often tumors bleed only small amounts intermittently, and evidence of the blood is found only during chemical testing of the stool. This is called occult bleeding, meaning it is not always visible to the naked eye. When tumors have grown to a large size they may cause a change in the frequency or the diameter of the stool.

Common symptoms of colorectal cancer include:

• A change in bowel habits (constipation or diarrhea).
• Blood on or in the stool that is either bright or dark.
• Unusual abdominal or gas pains.
• Unexplained weight loss.
• Anemia.

What Happens If a Polyp Is Found?

If polyps are found, they should be removed and sent to a laboratory for microscopic analysis. Once the microscopic type of polyp is determined, the follow-up interval for the next colonoscopy can be made.

How Is Colorectal Cancer Treated?

The majority of polyps can be removed during a routine colonoscopy and looked at and examined under a microscope. Very large adenomas and cancers are removed with surgery. If the cancer is found in the early stages, surgery is curative. Advanced colorectal cancers may be treated in a variety of ways, depending on their location. Treatments include surgery and radiation therapy or chemotherapy.

How Can I Prevent Colorectal Cancer?

Living a healthy lifestyle that includes regular exercise, maintenance of a healthy weight, and a diet that is low in fat and high in fiber, vegetables and fruit is probably your best start at general cancer prevention. Checking the colon for polyps and cancer is another important step.

General Screening Recommendations:

These recommendations are for people without symptoms or a personal or family history of colorectal polyps or cancer or inflammatory bowel disease. Screening should begin at the age of 50.

• Fecal occult blood test performed once a year. This is a simple at-home test that checks for blood in the stool that you may not be able to see. This is usually performed in conjunction with flexible sigmoidoscopy every five years. OR
• Flexible sigmoidoscopy performed every 5 years. This is an outpatient procedure for examining the inside of the lower portion of the large intestine, called the sigmoid colon, and also the rectum. This is usually done in conjunction with the annual fecal occult blood testing. OR
• Colonoscopy, performed once every 10 years. This is the preferred test. OR
• Air contrast barium enema performed once every 5-10 years. During this procedure, a barium enema is given and then air is blown in to make the barium spread over the lining of the colon, producing an outline of the colon on X-ray. This test is not preferred because it can miss large polyps or cancer.

The recommendations for those at a higher risk of developing colon cancer are listed below.

Family history of colorectal cancer (this includes parents, siblings or children):

Begin screening (colonoscopy preferred) at the age of 40 or 10 years earlier than the youngest person in the family who was diagnosed with colon cancer. For example, if your parents or siblings were diagnosed with colon cancer at age 55, you should start screenings at age 45.

People with precancerous polyps (adenomas) of the colon (1-2, less than 1 cm, tubular adenomas):

• Colonoscopy at the time of initial polyp diagnosis.
• Colonoscopy at 3 to 5 years after polyp removal; if normal, colonoscopy in 10 years if no other risk factors.

People with large (1 cm or larger), more than 2 adenomas or adenomas with villous components or severe dysplasia:

• Colonoscopy at the time of initial polyp diagnosis.
• Colonoscopy at 3 years after polyp removal; if normal, repeat every 5 years.

People who have undergone surgery for colon cancer and have no remaining colorectal polyps:

• Colonoscopy at one year after surgery; if normal, repeat in 3 years; if still normal, repeat in 5 years.

People with a family history of familial adenomatous polyposis:

• In puberty, begin surveillance with endoscopy every 1-2 years; counseling to consider genetic testing; and referral to a specialty center.
• If genetic testing is positive and/or polyposis is confirmed, a colectomy is recommended.

People with a family history of hereditary non-polyposis colon cancer:

• At age 21, colonoscopy and counseling to consider genetic testing; referral to a specialty center.
• If genetic test is positive or if you have not had genetic testing, colonoscopy every 2 years until age 40, then every year.

People with inflammatory bowel disease:

• Colonoscopy with biopsy starting 8 years after the start of pancolitis, or colitis occurring throughout the colon, or 12-15 years after the start of left-sided colitis; repeat every 1-2 years.

My grandfather was diagnosed with colon cancer when I was 12.  I remember going over to my grandparents’ house daily as he dealt with his illness.  Unfortunately, when his cancer was discovered it had already spread to his liver, thus making it incurable.  He helped me daily with my homework.  I struggled in school.   I watched him loose weight and his appetite.  He got worse.  It was killing him; and me. I cried every night. Why me?  Why my grandfather? Here was a man who was the rock of our family, and he was brought to his knees. He finally died from colon cancer.

It didn’t have to happen to him.  It didn’t have to happen to my grandmother, either. Fortunately, her colon cancer was diagnosed at an early stage and she was cured with surgery and didn’t even need chemotherapy.  My mother’s father and brother were not as lucky.  Both died from colon cancer.

Common myths prevent many from having their colonoscopy.  The truth is colon cancer can be prevented.  And it can be prevented with an exam that takes less than an hour.  Colorectal cancer that is diagnosed early can be cured.  And most patients with colorectal cancer won’t ever need a colostomy.  Colonoscopy for the prevention of colon and rectal cancer (screening colonoscopy) is now covered by many insurance plans, including Medicare.

As a colon and rectal surgeon, I daily care for and operate on patients with colon and rectal cancer.  Almost without fail, the ones on whom I operate for colorectal cancer have never had a colonoscopy.  I see people suffer daily with a disease they don’t have to have.  I see them suffer from a disease that can be prevented.  I see the look in their eyes when they realize they could have prevented it, but didn’t because they didn’t want to have a colonoscopy. I think of their children and grandchildren who have to go through what I did with my family.  And I wonder why.

This year, 150,000 Americans will be diagnosed with colorectal cancer. And 54,000 will die from colorectal cancer.  Will you be one of them?  Or will you take the time out of your day to have an exam that can save your life.  Ask your physician to schedule yours today and help me put an end to this awful disease.

Copyright The Tennessean March, 2008

Are you like Tony Snow? Or me?  Have you had someone in your family with colon cancer?

Snow was diagnosed with colon cancer at age 49.  His mother died from colon cancer at age 38, when he was 17.  We know things now about colon cancer that we didn’t know when Snow’s mother died 36 years ago.  And, he is not alone in having a family history of colon cancer.  This year, approximately 150,000 Americans will be diagnosed with colon or rectal cancer and ¼ of them will have had someone in their family with colorectal cancer

You may be aware of the recommendations for screening colonoscopy for the prevention of colon and rectal cancer.  Colon cancer can be prevented through the removal (by colonoscopy) of pre-cancerous growth, called polyps.  In people without a family history, colonoscopy should begin at age 50.

However, this is not the same for people with a family member who has had colon or rectal cancer. People with a family history of colorectal cancer are at higher risk for colorectal cancer and should have colonoscopy done at an earlier age. In most people, this is age 40 or 10 years before the age of diagnosis of their family member.  For Snow, this would have been age 28, since his mother was diagnosed at age 38.

Common myths prevent many from having their colonoscopy.  The truth is colon cancer can be prevented.  And it can be prevented with an exam that takes less than an hour.  Colorectal cancer that is diagnosed early can be cured.  But one of the main reasons people are not checked for colorectal cancer is lack of awareness.  That’s why I’m writing this today.

If you have a family history of colorectal cancer, like both Tony Snow and me, please get your colonoscopy.  As a colon and rectal surgeon, I treat patients daily with colorectal cancer.  I also have a family history of colon cancer.  My grandfather and uncle died from it and my grandmother was diagnosed with it.  If my uncle, who knew his father had colon cancer, had his colonoscopy at the appropriate age, maybe he wouldn’t have died from colon cancer at age 52.

Know your family history and talk with your primary care physician about it.  Ask your physician to schedule a screening colonoscopy.  Please help me put an end to this terrible disease.

Dr. William J. Harb is a colorectal surgeon at Baptist Hospital and practices with Cumberland Surgical Associates.

Copyright The Tennessean July, 2008

All content © Copyright 2000 – 2009 WorldNow and WTVF. All Rights Reserved.
For more information on this site, please read our

TOPIC: Colon Cancer Awareness
Monday, March 5, 2006

News notes via www.webmd.com

Q: What is colorectal cancer?

A: Cancer is an abnormal and uncontrolled growth of cells in the body. “Colorectal” refers to the colon and rectum, which together make up the large intestine. Colorectal cancer can originate anywhere in the large intestines. The majority of colorectal cancers develop first as polyps, abnormal growths inside the colon or rectum that may become cancerous.

Q: What is screening?

A: Screening is when a test is used to look for a disease before there are any symptoms. Cancer screening tests are effective when they can detect diseases early and lead to more effective treatment or when they can detect disease before it has become cancer and prevent the development of cancer.

Q: What causes colorectal cancer?

A: The exact cause of most colorectal cancers is not yet known, however research has established that approximately 75% of colorectal cancers occur in people with no known risk factors. Risk factors that may increase a person’s risk of developing colorectal cancer include

• A personal or family history of colorectal polyps or colorectal cancer, or
• Inflammatory bowel disease (Ulcerative colitis or Crohn’s disease), or
• Genetic syndromes such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon cancer (HNPCC). (Just 5% of colorectal cancers are linked to these genetic syndromes.)

Q: How does colorectal cancer affect the U.S. population?

A: Colorectal cancer is the 2nd leading cancer killer in the United States. In 2004, the American Cancer Society estimates that 146,940 people in the U.S. will be diagnosed with colorectal cancer and 56,730 people will die of the disease.¹

¹Source: Cancer Facts and Figures 2004, American Cancer Society, 2004.

Q: Who is at risk to develop colorectal cancer?

A: Colorectal cancer occurs in men and women of all racial and ethnic groups. Approximately 75% of colorectal cancers occur in people with no known risk factors. Here are other important facts about who is at risk for developing colorectal cancer

• Most colorectal cancers – more than 90% – are diagnosed in people aged 50 years or older. The risk for developing colorectal cancer increases with age.
• A family history of colorectal cancer or colorectal polyps increases a person’s risk of developing colorectal cancer.
• Certain diseases of the intestines, including inflammatory bowel disease (Ulcerative colitis or Crohn’s disease), can increase the risk for colorectal cancer.

Q: Is there anything I can do to reduce my risk for colorectal cancer?

A: There is strong scientific evidence that having regular screening tests for colorectal cancer beginning at age 50 reduces deaths from colorectal cancer. Screening tests can find precancerous polyps (abnormal growths) in the colon and rectum, and polyps can be removed before they turn into cancer. In this way, colorectal cancer is prevented.

Studies have also shown that increased physical activity and maintaining a healthy weight can decrease the risk for colorectal cancer. Evidence is less clear about other ways to prevent colorectal cancer. Research is underway to determine whether dietary changes may decrease the risk for colorectal cancer. Currently there is no consensus on the role of diet in preventing colorectal cancer; however, medical experts recommend a diet low in animal fats and high in vegetables, fruits, and whole grain products to reduce the risk of other chronic diseases, such as coronary artery disease and diabetes. It may also reduce the risk of colorectal cancer. In addition to studying dietary changes, researchers are examining the role of certain medications and supplements, including aspirin, calcium, vitamin D and selenium, in preventing colorectal cancer. However, the most effective way to reduce your risk of colorectal cancer is by having colorectal cancer screening tests beginning at age 50.

Q: Who should be tested for colorectal cancer?

A: All men and women aged 50 years or older should be tested routinely for colorectal cancer. Others who are at increased risk should speak to their doctors about earlier or more frequent testing. Those at increased risk are people with

• A family history of colorectal cancer or colorectal polyps.
• Certain diseases of the intestines, including inflammatory bowel disease (Ulcerative colitis or Crohn’s disease).
• Genetic syndromes such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon cancer (HNPCC). (Just 5% of colorectal cancers are linked to these genetic syndromes).

Q: Why should I get screened?

A: Screening saves lives. Having regular screening tests beginning at age 50 could save your life. Colorectal cancers almost always develop from precancerous polyps (abnormal growths) in the colon or rectum. Screening tests can find polyps, so they can be removed before they turn into cancer. Screening tests also can find colorectal cancer early, when treatment works best and the chance for a full recovery is very high.

Q: What are the symptoms of colorectal cancer?

A: Colorectal cancer develops with few, if any, symptoms at first. However, if symptoms are present, they may include

• blood in or on the stool
• a change in bowel habits
• stools that are narrower than usual
• general, unexplained stomach discomfort
• frequent gas, pains, or indigestion
• unexplained weight loss
• chronic fatigue

These symptoms can also be associated with other health conditions. If you have any of these symptoms, discuss them with your doctor. Only your doctor, through testing, can determine why you’re having these symptoms.

Q: What are the screening tests for colorectal cancer?

A: Several tests can be used to screen for colorectal cancer. These tests are used alone or in combination with each other

• Fecal Occult Blood Test (FOBT) – A test that checks for occult (hidden) blood in the stool. At home, using a small stick from a test kit, you place a small amount of your stool, from three bowel movements in a row, on test cards. You return the cards to your doctor’s office or a lab, where they’re checked for blood. This test is recommended yearly. (If blood is found, you likely will need a follow-up colonoscopy.)
• Flexible Sigmoidoscopy – Before this test, you use a strong laxative and/or enema to cleanse the colon. Flexible sigmoidoscopy is conducted at the doctor’s office, a clinic or a hospital. The doctor (or other specially trained health professional) uses a narrow, flexible, lighted tube to look at the inside of the rectum and the lower portion of the colon. During the exam, the doctor may remove some polyps (abnormal growths) and collect samples of tissue or cells for closer examination. This test is recommended every 5 years. (If polyps are found, you will need a follow-up colonoscopy.)
• Combination of Fecal Occult Blood Test (FOBT) and Flexible Sigmoidoscopy – Some doctors recommend having both tests to increase the chance of finding polyps (abnormal growths) and cancers. When used in combination with each other, FOBT is recommended yearly and flexible sigmoidoscopy is recommended every 5 years.
• Colonoscopy – Before this test, you will take a strong laxative to cleanse the colon. Colonoscopy is conducted in a doctor’s office, clinic, or hospital. You are given a sedative to make you more comfortable, while the doctor uses a narrow, flexible, lighted tube to look at the inside of the rectum and the entire colon. (This test is similar to flexible sigmoidoscopy, except the tube used is longer and allows the doctor to see the entire colon.) During the exam, the doctor may remove some polyps (abnormal growths) and collect samples of tissue or cells for closer examination. This test is recommended every 10 years. (Colonoscopy is also used as a follow-up test if anything unusual is found during one of the other screening tests.)
• Double Contrast Barium Enema – This test is conducted in a radiology center or hospital. Before the test, you use a strong laxative and/or enema to cleanse the colon. This procedure involves taking X-rays of the rectum and colon after you are given an enema with a barium solution, followed by an injection of air. The barium coats the lining of the intestines so that polyps and other abnormalities are visible on the X-ray. (If polyps are found, you will need a follow-up colonoscopy.)

Q: What about testing for colorectal cancer using new technology, such as virtual colonoscopy and stool DNA testing?

A: Although virtual colonoscopy and stool DNA testing are in use in some settings, data are not yet sufficient to support these tests for colorectal cancer screening. Research studies are being conducted to evaluate their effectiveness as screening tests, especially compared to those screening tests already recommended for colorectal cancer.

Computed tomographic (CT) colonography, commonly referred to as virtual colonoscopy, and uses multiple CT images to create a 3-dimensional view of the colon. As is the case with traditional colonoscopy, a patient must prepare for virtual colonoscopy by drinking a strong laxative to thoroughly cleanse the colon. Air is pumped into the rectum to expand the rectum and colon. If a polyp or abnormality is found, it cannot be removed during this procedure. A follow-up colonoscopy, using a lighted tube inserted into the rectum and the colon, will be necessary to remove polyps or take tissue samples for further analysis. Because virtual colonoscopy is still considered experimental, most insurance plans do not cover the procedure.

Molecular testing of genetic material (DNA) in stool is a promising technology that may become an option for screening in the future. This technique has not yet been shown to detect pre-cancerous polyps and is still experimental.

Q: How do I know which screening test is right for me?

A: Scientific data do not currently suggest that there is one “best test.” Each test has advantages and disadvantages. Patients and their doctors are encouraged to discuss the benefits and potential risks associated with each screening option as they decide which test to use and how often the patient should be tested. The Centers for Disease Control and Prevention (CDC) recommends that patients speak with their doctors about getting screened. Which test to use will depend on a patient’s preferences, his or her medical condition, the likelihood the patient will follow up and have the test, and resources available for testing and follow-up.

Q: Is colorectal cancer screening covered by insurance?

A: Most insurance plans help pay for screening tests for people aged 50 years or older. Many plans also help pay for screening tests for people under age 50 who are at increased risk for colorectal cancer. Check with your health insurance provider to determine your colorectal cancer screening benefits.

Q: What are the Medicare Preventive Service Benefits for colorectal cancer screening?

A: People with Medicare Part B coverage who are age 50 or older are eligible for colorectal cancer screening. However, in the case of colonoscopy, there is no age limit. For more information about Medicare, call the Centers for Medicare & Medicaid Services at 1-800-MEDICARE (1-800-633-4227) or visit the Medicare Web site. For TTY for the hearing impaired, call 1-877-486-2048.

Q:  What is the treatment for colorectal cancer?

The first step in treating colorectal cancer is usually an operation to remove the tumor. A fairly simple operation can be done during a colonoscopy or sigmoidoscopy to remove small polyps and a small amount of tissue surrounding them. Sometimes a major operation, in which the cancer and part of the colon or rectum around it are removed, is needed. If cancer has spread to another part of your body, such as the liver, you may need more far-reaching surgery.

Once the cancer has been examined under a microscope, it will be staged. Staging is a way for your doctor to tell how far, if at all, your cancer has spread. It also helps your doctor decide what your treatment should be.

There are several different types of staging systems, so it’s important to ask your doctor to explain carefully what stage your cancer is in and what that means.

In general, the most common staging system describes colorectal cancer this way:

• Stage I: Your cancer has not spread beyond the inside of your colon or rectum.
• Stage II: Your cancer has spread into the muscle layer of your colon or rectum.
• Stage III: Your cancer has spread to one or more lymph nodes in the area.
• Stage IV: Your cancer has spread to other parts of your body, such as the liver, lung, or bones.

Q:  What is the initial treatment?

You and your doctor will work together to decide what your treatment should be. You will consider your own preferences and your general health, but the stage of your cancer is the most important tool for choosing your treatment.

Surgery is almost always used to remove colon cancer. If the cancer is found early, you may need only a simple procedure, called a polypectomy, in which a doctor removes small polyps found in the colon or rectum during a colonoscopy or sigmoidoscopy.

For a larger cancer, more extensive surgery may be needed to remove the cancer and part of the colon or rectum around it. This is called a bowel resection. During this operation, your doctor will also remove some of your lymph nodes for testing. The healthy ends of the colon or rectum are then sewn back together.

Sometimes it isn’t possible to rejoin the ends, and a colostomy is needed. This creates an opening on the outside of your abdomen where waste can pass through into a colostomy bag. The colostomy may be temporary until your colon heals, or it may be permanent if the entire lower colon or rectum was removed. Very few people who have colorectal cancer need a permanent colostomy.

Q:  What are the types of treatment?

Radiation therapy, which uses X-rays to destroy cancer cells, is standard treatment for some types of colorectal cancer. Radiation therapy is often combined with surgery or chemotherapy. Radiation therapy may be used as palliative care to reduce obstructions, bleeding, or pain.

Compared to surgery alone, radiation therapy given before surgery for rectal cancer reduces the risk that the cancer will return and can improve your chances of survival.¹¹

Chemotherapy uses medications to destroy cancer cells throughout the body. Chemotherapy may be indicated for many stages of colorectal cancer and may be used to prolong survival, improve quality of life, and relieve pain from cancer that has spread to other areas of the body.

If your cancer has recently been diagnosed, you may experience a wide variety of emotions. Most people experience some denial, anger, and grief. Others may have few emotions. There is no “normal” or “right” way to react to a diagnosis of cancer. There are many things you can do to help with your emotional reaction to colorectal cancer. You may find that talking with family and friends helps you manage your emotions. Some people find that spending time alone is what they need.

If your reaction interferes with your ability to make decisions about your health, it is important to talk with your health professional. Your cancer treatment center may offer psychological services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other people who have had similar feelings can be very helpful.