Colon Cancer: Prevention

Colon Cancer: Prevention 

Here in the USA colorectal cancer is the fourth leading cause of death in both men and women.

Statistics vary from country to country. Nevertheless it is important to pay heed. The good news is that largely it is a preventable cause of death.

In my previous post I talked about genetics of cancer. Just like breast cancer, there are certain genes identified that are linked to colon cancer. The two common ones are Familial Adenomatous Polyposis( FAP) and Hereditary Non Polyposis Colon Cancer( HNPCC). You need not remember these names. But what you should be aware of is that if you have two or more first or second degree relatives who were diagnosed with colon cancer you may have one if these genes in the family and talking to your family physician about it may be a good idea. 

Individuals with such histories in their families are screened much earlier than the general population.

What is screening ? 

Screening is a test for detection of cancer( or any condition for that matter) BEFORE one has any presenting symptoms. It is an effective way of prevention.

A screening test is recommended for certain age groups if the initial studies show a benefit of saving lives or reducing harm when applied to a large population. 

Since the risks for some subsets may be higher than the general population, the screening recommendations are sometimes adjusted to suit this subset.

For colon cancer until recently the recommendation was to start screening for the general population at age 50. In the past year this was lowered to start at age 45 probably because more and more younger people were noted to get this cancer.

For the subset of people who had a strong family history of colon cancer, whether or not they were tested or identified for a high risk gene, the age recommended to start screening is 10 years earlier than the age of the youngest family member who was diagnosed with this cancer. 

For example, if a woman had 3 members in her family who had colon cancer:  maternal grandmother who had the cancer at age 60, an uncle who was diagnosed at age 50 and another uncle at age 45, she should start screening at age 35. 

There are different types of screening tests. The conventional method is a colonoscopy.

For low risk patients ( no family history) with normal findings on the first colonoscopy it may be repeated after 10 years. 

For low risk patients with findings of polyps it may be repeated in 3-5 years depending on size and number of polyps, type of polyp etc.

These recommendations are often amended so don’t be surprised if in a year or two you are informed of something different.

High risk patients are recommended colonoscopy every year.

Someone recently asked me if colonoscopy is painful ?

No, it is not normally painful. You are sedated for the actual procedure so you don’t feel a thing. There may be mild discomfort afterwards but not always. I had my first colonoscopy when I turned 50 and had absolutely no discomfort when I recovered from the sedation.

The thing most uncomfortable about a colonoscopy is the preparation procedure before the test. Your colon needs to be clean and empty to get a good look at when they enter with the colonoscope which is a tube with a camera at the end. To make it clean you need to be on a liquid diet 2 days prior and additionally take some medicines to purge out everything on the day before the actual test. Obviously you are weak and somewhat dehydrated due to all this. 

Someone needs to drive you to the place on the day of the test and pick you up later. 

There are advantages to getting the colonoscopy over other methods of screening. Since the device is directly inside the colon doing surveillance for any polyps or other suspicious areas, the specialist can take a biopsy of that area or remove the polyp then and there. Secondly in low risk patients if everything looks normal you can sit back and relax for 10 years! Like me. Now I don’t have to worry until I turn 60. My physician is not after me until then 😃

If you are terrified to go through the preparation or the colonoscopy itself, there is a simpler, easier test. It is called the fecal globin test. All you have have to do is get a small amount of stool on a card given to you and give it back to your doctor’s office or lab. The test is designed to detect microscopic quantities of blood in your stool( poop) that would not be visible with the naked eye. 

If the test is negative ( no blood detected) it is a relatively good indicator that all is good and you can rest for 1 year , then repeat the test.

If the test is positive ( blood is detected) then you need to get a colonoscopy to see where it is coming from. It may be a less scary source like a hemorrhoid but it needs to be seen to be sure you are not missing a cancer.

A third test available for screening is a CT scan ( called CT colonography). The disadvantage of this is that one cannot get a biopsy the same time if any abnormalities are seen.

Most tests that are for screening are free here in the USA. I’m not sure about the systems in other places.

In any case, always good to talk to your doctor during your routine visits. Ask questions. Be informed about the diagnoses in your family members. A lot of times when I see a new patient they tell me “ my mother had cancer or my grandfather had cancer “. But they don’t know what kind of cancer each family member had . Not all cancers are same or equal in their risks and testing methods. Always equip yourself with details. What age the person got it? What specific type of cancer it was ? Etc.

Besides being informed about your family history and staying up to date with your personal screenings it is also important to know what you can do to minimize the risks for getting cancer.

Where colon cancer is concerned smoking, alcohol consumption, a diet rich in meats and fats and low in fiber, lack of exercise,being obese increase the risk. Reverse of these lowers your risk.

What are the symptoms that people with colon cancer present with ?

Unexplained weight loss 

Loss of appetite 

Blood in the stool

Abdominal pains, cramps

Change in bowel habits( alternating constipation or diarrhea, thinning of stools)

Anemia

Fatigue 

Don’t become a hypochondriac imagining every single thing happening to you and believing you have cancer or something serious. But don’t ignore your symptoms when you are truly having them. Both extremes are not good.

Stay informed. Stay vigilant. Stay healthy.

Saree is a paat silk from Assam in deep purple ( baingani) color with buttis, borders and pallu in a gold color thread. Not jari.