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Colon Cancer Screening

Gastroenterology Center in Cypress specializes in preventing, diagnosing, and treating gastrointestinal disorders. Board-certified in Internal Medicine and Gastroenterology, passionate about helping patients recover from various digestive ailments and conditions, including..

What is Colorectal Cancer?

Colorectal cancer, also known as large bowel cancer, is a condition where malignant (cancerous) cells form in the inner lining of the colon or rectum. The colon and rectum together make up the large intestine, which is the final segment of the digestive system. The primary function of the large intestine is to reabsorb water from intestinal contents, transforming it into solid waste for expulsion. The colon constitutes the first several feet of the large intestine, while the rectum makes up the last six inches.

Most colorectal cancers develop from benign, wart-like growths known as polyps, which form on the inner lining of the colon or rectum. Not all polyps have the potential to become cancerous; those that do are called adenomas. It typically takes over ten years for an adenoma to progress into cancer. This slow progression is why some colorectal cancer screening tests are effective even when conducted every ten years. However, this interval may be too long for individuals with certain conditions, such as ulcerative colitis or Crohn’s colitis, or those with a strong family history of colorectal cancer or adenomas.

How Common is Colorectal Cancer?

Colorectal cancer ranks as the second leading cause of cancer-related deaths overall and the third most common cause of cancer-related deaths among both men and women in the United States. In men, lung and prostate cancers are more prevalent, while in women, lung and breast cancers are more common. In 2007, it was estimated that there would be 153,000 new cases of colorectal cancer and 52,000 deaths resulting from the disease.

What is Screening for Colorectal Cancer?

Screening involves checking for cancer or polyps in patients who do not have any symptoms. Detecting colorectal cancer early, before symptoms appear, significantly improves the chances of survival. By identifying and removing polyps before they turn cancerous, colorectal cancer can actually be prevented.

Who is at Risk for Colorectal Cancer?

  • Everyone age 50 and older: The average age for developing colorectal cancer is 70 years, with 93% of cases occurring in individuals aged 50 and older. It is recommended to start screening at age 50 if there are no other risk factors besides age. Individuals with age as their only risk factor are considered to be at average risk.

  • Men and women: Men tend to develop colorectal cancer at a younger age than women, but women live longer, equalizing the total number of cases between genders.

  • Anyone with a family history of colorectal cancer: Individuals with two or more first-degree relatives (parent, sibling, or child) with colorectal cancer, or any first-degree relative diagnosed under age 60, have a three to six times higher risk than the general population. For those with one first-degree relative diagnosed at age 60 or older, the risk is approximately doubled. Special screening programs are recommended for those with a family history of colorectal cancer. A documented family history of adenomas is also an important risk factor.

  • Anyone with a personal history of colorectal cancer or adenomas at any age, or cancer of the endometrium (uterus) or ovary diagnosed before age 50: Individuals who have had colorectal cancer or adenomas removed are at increased risk of developing additional adenomas or cancers. Women diagnosed with uterine or ovarian cancer before age 50 are at increased risk of colorectal cancer. These groups should undergo regular colonoscopies, typically every 3 to 5 years. Women with a personal history of breast cancer have only a slight increase in risk for colorectal cancer.

What are the Symptoms of Colorectal Cancer?

The symptoms of colorectal cancer can vary depending on the location of the cancer within the colon or rectum, and sometimes there may be no symptoms at all. Generally, the prognosis is worse for symptomatic individuals compared to those without symptoms. The most common symptom of colorectal cancer is rectal bleeding.

Symptoms Based on Cancer Location

  • Left-Sided Colon Cancer: Cancers on the left side of the colon typically cause bleeding and, in advanced stages, may lead to constipation, abdominal pain, and obstructive symptoms.
  • Right-Sided Colon Cancer: Cancers on the right side of the colon may cause vague abdominal pain and are less likely to present with obstruction or changes in bowel habits. Other symptoms can include weakness, weight loss, or anemia due to chronic blood loss.

If you experience any of these symptoms, it is important to see your doctor promptly.

Why Should You Get Checked for Colorectal Cancer Even If You Have No Symptoms?

Adenomas can grow and transform into cancer over several years without causing any symptoms. By the time symptoms appear, the cancer may have already spread, making it more difficult to treat. Screening allows for the early detection of cancer and can prevent cancer from developing by enabling the removal of adenomas (pre-cancerous polyps) before they turn into cancer.

What Tests Are Available for Screening?

Several options are available for screening average-risk individuals for colorectal cancer:

Fecal Occult Blood Test

This test checks for hidden blood in the stool, which can be a sign of colon cancer. Your doctor will ask you to collect a stool sample to be tested in a lab. There are two types of tests: the guaiac test and the fecal immunochemical test (FIT). FIT is the preferred test. Both tests should be done annually. If the test is positive, a colonoscopy is recommended.

Double Contrast Barium Enema (DCBE)

This test involves using a white liquid called barium to show images of the colon and rectum on an X-ray. The barium is inserted into the colon using a rectal tube, and multiple X-rays are taken. Although DCBE is less expensive than a colonoscopy, it is also less effective. Studies have shown that DCBE detects only 50% of larger adenomas (greater than 1 cm) and is inferior to colonoscopy. Because of its limitations, DCBE is not widely used for screening and should be done every 5 years if used. If polyps are found, a colonoscopy should follow. Another X-ray test, the single contrast barium enema (SCBE), is considered inferior to DCBE and is not recommended for screening.

Sigmoidoscopy

This test uses a sigmoidoscope (a thin, lighted instrument) to view the lower colon and rectum for polyps and cancers, usually covering the lower 2 feet of the colon. If an adenoma is found, a colonoscopy should be performed. Sigmoidoscopy does not examine the entire colon and is less reliable than colonoscopy. Sedation is usually not required. Sigmoidoscopy should be done every 5 years, often in conjunction with an annual fecal occult blood test.

Colonoscopy

During a colonoscopy, your doctor can examine your entire colon and rectum for early signs of cancer. Polyps can be removed during the procedure. Sedation is typically used. Colonoscopy is the only test recommended for average-risk individuals at 10-year intervals.

Computerized Tomographic (CT) Colonography and Magnetic Resonance (MR) Colonography

Also known as “Virtual Colonoscopy,” these tests use CT or MR scanners along with computer-assisted software to look for polyps and cancers without inserting a colonoscope or using liquid barium. These tests are still in development, have not been established as reliable screening methods, and are not currently endorsed for colorectal cancer screening.

Fecal DNA Testing

This test checks for abnormal DNA from colorectal cancers shed into the stool. If abnormal DNA is found, a colonoscopy is performed. This test should be repeated every 5 years if the result is negative.

What Else Can I Do to Prevent the Development of Colorectal Cancer?

  • Screening and Surveillance

    • For Normal-Risk Individuals: Begin screening at age 50. The preferred approach is a colonoscopy every 10 years. Alternatively, an annual stool test for blood combined with a flexible sigmoidoscopy every 3 to 5 years can be used.
    • For High-Risk Individuals: More frequent colonoscopic surveillance is needed for those with a personal history of colorectal cancer or adenomatous polyps, a family history of colorectal cancer, non-hereditary polyposis, or conditions like inflammatory bowel disease. Medicare provides for surveillance colonoscopy every two years for high-risk individuals.
    • Polyp Removal: For both average and high-risk individuals, removing all potential pre-cancerous polyps is crucial.

    Lifestyle and Medication

    • Medications: Regular use of non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin can reduce the risk of colorectal cancer death by 30-50%. However, these drugs also carry risks, such as intestinal bleeding. Consult your physician to determine if regular use is appropriate for you.
    • Diet and Supplements: Folate, calcium, and post-menopausal estrogens have modest protective benefits against colon cancer.
    • Healthy Habits: Maintaining a high-fiber (vegetable-rich) and low-fat diet, regular exercise, normal body weight, and quitting smoking are beneficial.

    While these measures are helpful, none are as effective as regular colorectal cancer screening.

Comprehensive Care for a Wide Range of Digestive Conditions

We treat a broad spectrum of common and complex conditions, including hepatitis, gastroesophageal reflux disease (GERD), peptic ulcer disease, colitis, gallbladder and biliary tract diseases, nutritional disorders, irritable bowel syndrome (IBS), colon polyps, and cancers of the digestive system.

Diagnosis and Treatment of Digestive Disorders

GERD, IBS, Crohn's disease, ulcerative colitis, and celiac disease.

Endoscopic Procedures

endoscopic procedures such as colonoscopies and upper endoscopies

Management of Liver Diseases

treat liver-related conditions, such as hepatitis, fatty liver disease, cirrhosis, and liver cancer,

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