March is Colorectal Cancer Awareness Month, a time to focus on the importance of proactive screening and early detection of cancers of the colon and rectum.
Colorectal cancer is one of the more common cancers: among non-skin cancers, it is the fourth most common cancer in men and women and is the fourth leading cause of cancer deaths in the United States. Of cancers that impact both women and men, it is the second-deadliest form of cancer and the second most common.
In 2022, there were 147,931 new cases of colorectal cancer reported in the United States. In 2023, more than 53,000 Americans died from the disease.
The five-year survival rate for colorectal cancer stands at 65%. The sooner cancer is detected, the greater the odds of successfully treating the disease and defeating it. That’s why screening is so important.
“Screening and early detection are the keys to successfully treating and overcoming colorectal cancer,” explains Dr. Annie Lin, a colon and rectal surgeon in Fort Worth. “All adults should get their first screening no later than age 45. We can cure up to 90% of colorectal cancers when they are caught early enough!”
Overview of Colorectal Cancer
The colon and rectum form the large intestine. The large intestine is one of the last stops in the digestive process: the food we eat starts its journey in the mouth and travels through the esophagus. After a layover in the stomach, it continues to travel through the small intestine. The stomach and small intestine help break down food.
When food exits the small intestine, it passes into the colon, where it is ultimately processed into a solid form and then passed through to the rectum. The rectum holds the stool until the body is ready to get rid of it through a bowel movement.
Colorectal cancer begins with the development of polyps – mushroom-shaped growths – in the colon or rectum. Polyps are initially non-cancerous; however, if they go undetected and are allowed to continue growing, they may turn into cancer. Polyps often do not produce any symptoms. That’s why proactive colorectal cancer screening is so important.
Colorectal Cancer Screening is a Lifesaver
Most people should get their first colon cancer screening at age 45. Depending on the type of screening you have and your specific risk factors, you may not need another screening for several years if your results are normal.
All adults should continue to be screened periodically for colon cancer in accordance with their doctor’s guidance until age 75. Adults older than 75 should discuss with their physician if additional screenings are warranted.
People who are at higher-than-normal risk of developing colon cancer may need to have their first screening before age 45. This includes people who have:
- Been diagnosed with Crohn’s disease or ulcerative colitis
- A family history of colorectal cancer or colorectal polyps
- Certain genetic conditions
The Colonoscopy
The most common screening for colorectal cancer is a colonoscopy. The colonoscopy has a lot of benefits:
- It allows the physician to get a detailed view inside the almost 7-foot length of your colon and rectum.
- The procedure itself is painless, as the patient is under anesthesia.
- It’s fast: the actual procedure usually only takes 20 minutes to an hour.
- It’s affordable: colonoscopies are covered by Medicare and most health insurance plans.
- If polyps are discovered during the screening, they can often be removed right then and there.
- If no abnormalities are detected, you may not need another colonoscopy for 10 years.
“The benefits of a colonoscopy are undeniable, yet some patients are reluctant to get one because of the preparation process,” notes Dr. Lin. “The numerous long-term benefits you get out of the colonoscopy far outweigh the short-term inconvenience of getting ready for one.”
Preparing for Your Colonoscopy
Once your primary care physician has referred you to a specialist – a colon/rectal surgeon, gastroenterologist or general surgeon – for your colonoscopy, he or she will give you detailed instructions on how to prepare for your procedure. For a colonoscopy to be effective, the patient must have empty bowels so the doctor can get an unobstructed view of the colon and rectum.
The first part of the preparation is to avoid certain foods in the days leading up to your colonoscopy. High-fiber foods that take longer to digest, such as raw fruits and vegetables, whole grains, nuts, seeds and beans are to be avoided.
The day before your procedure, you’ll transition to an all-liquid diet: certain juices and broths are OK, but no solid foods.
The night before your procedure, you’ll begin taking a special laxative your doctor prescribed for you. It may be a liquid that you drink, or it may be a series of tablets you take with plenty of water.
This medication will clear out your bowels. Yes, that means frequent trips to the bathroom and you may not get the best sleep, but by the morning, the hardest part is over with!
What to Expect the Day of Your Colonoscopy
You’ll need someone to drive you to your appointment – since you will be under anesthesia, you can’t drive yourself home.
Once you’re at the hospital or surgical center, you’ll be checked in. The nurse will take you back and have you change into a gown. He or she will check your vital signs and insert an IV port into your arm for the anesthesia. The anesthesiologist will come by to do an evaluation. The specialist will come in and tell you about the procedure and ask if you have any questions.
Once you are taken back to the procedure room, they’ll start the anesthesia IV, and you will soon be asleep. While you are dozing, the physician inserts a colonoscope, a long tube with a light on the end of it, through the anus and then through the rectum and colon. The colonoscope is long enough to travel the entire length of the colon, allowing for a comprehensive view.
If polyps are detected, the physician can remove them during the colonoscopy. When polyps are removed, they are sent to a lab for testing to determine if they are benign or cancerous.
The next thing you know, you’ll be waking up in a recovery area. The physician will come back to tell you the results of your procedure. After the nursing staff confirms your vitals look good, you will get dressed and be on your way.
At this point, you’ll probably be hungry! Good news – you can now eat whatever you like. You may feel like taking a nap when you get home while the aftereffects of the anesthesia wear off.
“All in all, the time from when you start fasting to when you are completely back to normal is about 24 hours,” explains Dr. Lori Gordon, a Fort Worth colon and rectal surgeon. “That’s not a bad tradeoff for a simple procedure that can potentially add years to your life, not to mention provide you with valuable peace of mind.”
Other Screening Tests
There are additional colorectal screening tests approved by the U.S. Food & Drug Administration (FDA).
Stool sample tests have been around for several years and have shown accuracy in detecting the presence of cancer. More recently, the FDA has approved a blood-based test for people with an average risk of colon cancer.
“These tests have a use in some circumstances, but the drawback is that they will not detect a pre-cancerous polyp,” explains Dr. Gordon. “Only a colonoscopy will detect polyps. If you have any, you want to have them removed as soon as possible.”
Colorectal Cancer Risk Factors & Causes
As with many other diseases, some risk factors for colorectal cancer are outside of our control while others are influenced by the lifestyle choices we make. Risk factors we cannot control include:
- Age: More than 90% of cases occur in people 50 or older. That’s why we should start screening at age 45.
- Race: African Americans are at higher risk.
- Inflammatory bowel disease (IBD), including Chron’s disease and ulcerative colitis.
- Heredity: The average person has a 5% chance of getting colon cancer. Those odds increase to 10-15% for someone who has a family history of the disease.
Lifestyle decisions that can increase colon cancer risk include:
- Smoking
- Excessive alcohol consumption
- Diets that are high in fat and/or low in fiber
- Lack of physical activity
People who are obese or overweight are also at an elevated risk of colon cancer. While genetic factors sometimes play a role in a person’s weight, a good diet and exercise plan will often help with weight loss. Medications, such as GLP-1s, may be an option for some patients to aid in weight loss.
Colorectal Cancer Symptoms
Colorectal cancer often does not produce symptoms, which is why screening is so important. When this cancer does produce symptoms, those can include:
- Bloody stool
- Change in bowel behavior, such as prolonged constipation, diarrhea or discomfort
- General fatigue
- Unexplained weight loss.
Anyone experiencing these symptoms should make an appointment to see their physician. If the symptoms cannot be attributed to another cause, the physician will likely order a colonoscopy or other screening test to determine if there are abnormalities in the colon.
Treating Colorectal Cancer
If colon cancer is detected at an early stage, a colon/rectal surgeon is often able to remove the cancerous cells through surgery, if this was not done during the colonoscopy. Laparoscopic surgery is commonly used to remove colon cancers, and physicians are also able to collect cells from the lymph nodes at this time to determine if the cancer has spread.
In later-stage colon cancers, in which cancer has spread to the lymph nodes or to other organs, chemotherapy is used after surgery to destroy remaining cancerous cells. In the event a large cancerous tumor must be removed, radiation therapy may be used to first shrink the tumor, increasing the likelihood that surgery will remove all the cancerous tissue. Additionally, targeted drug therapies may be used to treat colon cancer, though this is usually done only in cases that are very advanced.
Treatment for colorectal cancers continues to advance. Recent breakthroughs include new drugs that target specific gene mutations, as well as new immunotherapy treatments.
Get Checked
If you are 45 years old or older and you’ve never had a colonoscopy, now’s the time to get it done. You can add years to your life by catching cancer – or pre-cancerous polyps – early. And if your screening doesn’t reveal anything concerning, you will have gained some valuable peace of mind!
Start by making an appointment with your primary care provider today. And if you need to consult directly with a specialist, Privia Medical Group North Texas has several highly-respected colon/rectal surgeons serving patients across the Dallas/Fort Worth Metroplex.
This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
This article contains information sourced from:
The U.S. Centers for Disease Control and Prevention
