Content derived from DocTalk with Greta Bernier, MD, Colorectal Surgeon
Why is it important to talk about colorectal cancer now?
March is colorectal cancer awareness month. During the COVID-19 pandemic, fewer people have been getting their preventive screenings for colorectal cancer, with as much as a 70% decrease in colonoscopies. We want to make sure you know what your options are for colorectal cancer screening and why it’s an important part of caring for ourselves.
How does colorectal cancer screening save lives?
Colorectal cancer is the third most common cancer in both men and women and the third most common cause of cancer-related deaths. Prevention is crucial. Through colorectal cancer screening, we can find polyps and remove them before they ever become cancers. We can find cancers early, sometimes even before someone notices symptoms. Because of preventive screenings, there are fewer instances of colorectal cancer and deaths.
What are the new screening guidelines and age recommendations?
While the incidence and death rate of colon cancers are going down, we are seeing an increase in the rate of finding colon cancers in younger people (under the age of 50). It has been noted that cancers found in younger people tend to be more aggressive and advanced when they are found. In the past, guidelines recommended colorectal cancer screenings begin at age 50. In 2018, the American Cancer Society and some of our surgical societies recommended that screening begin earlier, at the age 45. If you are 45-49 years old, ask your primary care provider if screening is right for you. If you have a personal history of colorectal cancer, family history or history of gastrointestinal disorders, your doctor may suggest screening before age 45. Checking your screening benefits with your insurance provider is also suggested.
What are the options for screening including the stool card and colonoscopy and how do they work?
A stool card is something you take home to collect a stool sample to send in for evaluation. A colonoscopy is a procedure where a small, flexible camera is used to look at the colon to directly see if the colon and lining look healthy. Because this procedure can be uncomfortable to complete while we are awake, sedation, not a general anesthetic, is offered during this procedure.
What are some considerations and limitations with each of the tests?
There are some important differences between a colonoscopy and a stool card test. A stool card is a test used to look for blood, or remnants of blood, in the stool as well as any other factors that may show further evaluation for colon cancer or polyps is needed. A stool card test should be done every year, if a person is not also having a colonoscopy. The stool card test is not as accurate as a colonoscopy—it can result in false negatives and false positives. A colonoscopy is considered the gold standard test. Colonoscopies have the benefit of both finding any problems and being therapeutic, meaning that if polyps or a mass is found, they can be taken out and biopsied. If everything looks great during a colonoscopy, you don’t have to have one again for 10 years. If you are healthy and don’t have major health issues preventing you from having one, then a colonoscopy is the recommended test.
What’s the big deal about the bowel prep for a colonoscopy?
Since the colonoscopy uses a small, flexible camera to look at the colon, the colon needs to be clear to look at the actual lining. The bowel prep clears stool out of the colon by causing diarrhea. Most patients say it is pretty well-tolerated and find that the benefit of not having to complete it for another ten years is great. There are different bowel prep options that you can talk about with your provider.
What are polyps and why would they be removed during a colonoscopy?
Polyps are a visible overgrowth of cells in the lining of the colon. There are three main types of polyps: ademonas, inflammatory polyps and serrated polyps. We are most concerned with ademonas, which are a precursor to colorectal cancer. If left alone for years, ademonas will turn into a cancer. If we can find them early in this pre-cancerous stage, then that cancer can be prevented. Inflammatory polyps are an overgrowth of normal cells which show no increased risk of cancer. Serrated polyps have a risk of cancer associated with them as do ademonas. If we find these types of polyps, we would potentially do a follow-up colonoscopy sooner than the ten years recommended in the general guidelines.
What lifestyle changes can we make to reduce our risk of colorectal cancer?
Maintain a healthy weight, stay active, quit smoking, and cut down on alcohol. The World Health Organization classified red meats as a carcinogen, meaning it can promote cancer growth in our bodies. Though it’s not a big enough risk that adopting a vegetarian diet is necessary, be mindful of how much red or processed meat you are eating. You may not be able to change your family history, but try to learn your family’s history of colon and rectal cancer and what age they were diagnosed. If diagnosed when they were younger, it may change when providers suggest getting your first screening.
What are the signs and symptoms of colorectal cancer?
The most common things we see when cancers are causing symptoms are blockages created by the tumor making it hard for the stool to get through. Other symptoms may include:
- constipation or less frequent bowel movements
- feeling nauseated, bloated and distended
- blood in stool
- change in color and size of bowel movements
- night sweats
- weight loss
With many types of cancer, you may not show any symptoms for a very long time depending on where they are located and that’s why it’s important to get screenings done on time.
How can a patient get referred for screening at Valley?
Your primary care provider can send in a referral for a colonoscopy or you can reach out directly to schedule one. Our schedulers will go through a series of questions with you to decide if you may need to be seen by a provider before scheduling. For more details about whether you may be a candidate for a Direct Access Colonoscopy, and for contact information to schedule, see this page.