Colorectal cancer occurs as a growth in the lining of the colon or rectum that becomes cancerous. Most colorectal cancers start as polyps that are precancerous. A polyp is a flat, strawberry or mushroom-like growth that grows on the inside lining of the colon or rectum. Not all polyps will turn into cancer; however precancerous polyps can become cancer over time. The average estimated time for a precancerous polyp to become cancer is 5 to 10 years, but some can occur sooner.
What are symptoms of colorectal cancer?
Symptoms do not have to occur at first but as time progresses, warning signs will develop. These include rectal bleeding, crampy, abdominal pain, especially in the lower abdomen, or pain during a bowel movement. Sometimes there will be an urge to move your bowels without having a bowel movement. Most importantly, if there is a change in a person’s bowel movement, especially in the shape of the stool, one should see their doctor about this.
Who is at risk for colorectal cancer?
Colorectal cancer is the third most common cause of cancer in both men and women. Anyone age 50 or older should get screened. Some people have a greater risk for colorectal cancer, especially if they have a parent, sibling, or child that has had colorectal cancer or colon polyps. If family members have had cancer of the uterus, ovary or other organs, these make someone a higher risk for colorectal cancer. Of course having colon cancer or precancerous polyps in the past makes one a continued risk for colorectal cancer. Also, if a patient has Crohn’s disease or ulcerative colitis they are a higher risk. A syndrome such as familial adenomatous polyposis leads to many polyps in the colon or rectum and makes this person a much higher risk for colorectal cancer. Also, someone who has a genetic abnormality called Lynch syndrome can develop colon cancer without the cancer being preceded by the growth of a polyp.
In a recently published article in the Journal Cancer a retrospective study in the under-50 population between the years 2004 and 2015 found that the rate of colorectal cancer rose and that these younger patients were more likely to have advanced disease at the time that they were diagnosed. The implications of this new information suggests perhaps lowering the age for screening colonoscopy to age 45. Before doing that on a broad scale however, large prospective screening studies of patients younger than 50 years are needed to determine the risks, benefits and costs of screening this younger patient population.
Colorectal screening is safe and effective. Routine screenings can find cancerous growths and remove them. There are many choices of screening tests and you should talk to your doctor about which test is best for you. Colonoscopy is the only way that you can both test for colon cancer and prevent colon cancer at the same time. If your gastroenterologist sees polyps he or she will remove them right away, during the procedure. There are other tests that can be used such as a fecal immunochemical test, a fecal occult blood test, and a Cologuard test. These three tests may call for further testing such as a colonoscopy if abnormalities are found.
I am often asked about prevention of colon cancer. Besides getting tested regularly, there are many lifestyle healthy choices that can lower your risk of colorectal cancer. These include avoiding smoking, limiting alcohol intake, and eating foods that are high in fiber such as fruits and vegetables. Try to eat cruciferous vegetables, which would include broccoli, cauliflower, and cabbage. Limit the amounts of fat, butter, red meat, oils, charcoal broiled and salt-cured foods that you eat. Exercise regularly and keep a healthy weight and try to increase your calcium intake.
Colonoscopy is the main way doctors check for colon diseases and remove colon polyps, which can cause cancer. It is the gold standard for colorectal disease detection and prevention.
By Dr. Louis Saco MD, FACP, MBA
Address: Watson Clinic Main, 1600 Lakeland Hills Blvd., Lakeland, FL 33805
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