WVU Medicine Uniontown Hospital presents “Understanding your risk and how to best protect yourself against colorectal cancer.”
WVU Medicine Uniontown Hospital presents “Understanding your risk and how to best protect yourself against colorectal cancer.”
March is colorectal cancer awareness month. It is usually a good time to check if you need to be screened for colorectal cancer.
What is colorectal cancer?
Colorectal cancer is a cancer that arises from the large intestine. The large intestine has two parts, the colon and the rectum.
Any cancer that starts to grow from the inner lining of the colon or rectum is called a colorectal cancer.
What are the warning signs that I might have colorectal cancer?
Colorectal cancer can present with many different symptoms or signs. Some people may not have any symptoms. This is why it is so important to follow the guidelines for prevention with regular screening.
The following are some of the symptoms to watch for:
• A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
• A feeling that you need to have a bowel movement that’s not relieved by having one
• Rectal bleeding with bright red blood
• Blood in the stool, which might make the stool look dark brown or black
• Cramping or abdominal (belly) pain
• Weakness and fatigue
• Unintended weight loss
If I have symptoms, what should I do?
Any of the above symptoms should definitely be discussed with your doctor. When a person has symptoms testing should be offered to determine the cause, even when screening has not detected any abnormality in the past.
Are there specific things that increase my risk of colorectal cancer?
There are many risk factors for colorectal cancer. Some can be modified by changes in habits and some are not affected by any changes.
Factors or habits that can be modified:
• Age
• Being overweight or obese
• Not being physically active
• Diet
• High in red meat or processed meat
• Cooking meat at high temperatures
• Low vitamin D level
• Smoking
Factors that cannot be modified, but do increase the risk:
• Age
• History of adenomatous polyps
• History of inflammatory bowel disease like ulcerative colitis or Crohns’ disease
• Family history of colorectal cancer or adenomatous polyps. A first degree relative especially if they were younger than 50 when they were diagnosed.
• An inheritied disorder like Lynch syndrome or famililial adenomatous polyposis
Screening
American Cancer Society guidelines are as follows:
Screening tests that can be done include virtual exams or stool based tests.
Virtual exams are as follows and they have the advantage of being able to see the colon. Except for the CT colonography the other modalities can potentially remove a polyp or determine if something is actually cancer.
• Colonoscopy every 10 years
• CT colonography (virtual colonoscopy) every 5 years
• Flexible sigmoidoscopy (FSIG) every 5 years
Stool based tests are as follows and they are not invasive and do not involve preparation. As such, there is a possibility that cancers or polyps can be missed. In addition if they give an abnormal result, a colonoscopy would be recommended anyway.
• Fecal immunochemical test (FIT)
• Guaiac-based fecal occult blood test (gFOBT)
• Stool DNA test
Patients without any family history of colorectal cancer or adenomatous polyps should start screening at the age of 45.
And this screening should continue every 10 years to the age of 75. Between the ages of 76 and 85 it will depend on the underlying health of the individual person.
Patients who are high risk need to be screened more frequently.
High risk:
• A strong family history of colorectal cancer or certain types of polyps
• A personal history of colorectal cancer or certain types of polyps
• A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
• A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome (also known as hereditary non- polyposis colon cancer or HNPCC)
• A personal history of radiation to the abdomen (belly) or pelvic area to treat a prior cancer
If I am diagnosed with colorectal cancer, what happens next?
A colorectal cancer diagnosis is usually made at the time of a colonoscopy with biopsy. Once a diagnosis of cancer is made, your doctor will usually order more tests and refer you to several specialists. Cancer care is complex and involves many different doctors.
Some of the specialists that could be involved are gastroenterologists, surgeons, medical oncologists, doctors that administer medications or radiation oncologists, doctors who administer radiation.
The first step after diagnosis, involves doing imaging with CT scans, MRI scans or PET scans to determine if the cancer has spread.
If the cancer has not spread a plan of care is made that usually involves surgery as well as chemotherapy. If it is a rectal cancer, the plan of care also includes radiation.
If the cancer has spread to distant organs then the plan of care usually involves treatment with chemotherapy, immunotherapy or targeted therapies or a combination.
Some information in this feature is shared courtesy of the American Cancer Society.
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