March 15, 2008 04:00 am March is National Colorectal Cancer Awareness Month. We should use this opportunity to focus on prevention and treatment of the disease, as well as getting up-to-date on new treatments. Colon cancer is a very common disease in Americans. There are about 150,000 cases diagnosed each year, and unfortunately more than 50,000 people die from the disease annually. The good news is that awareness of symptoms, along with screening for cancer in the early stages, before symptoms occur, could drastically lower the death rate. What are my risk factors for developing colorectal cancer? Risk factors include being older than 50, a history of colon polyps, a history of family members with colorectal cancer, and inflammatory bowel diseases, such as ulcerative colitis. Eating a diet rich in fruit and vegetables and maintaining an active lifestyle may protect against the development of this cancer. The role of high-fiber diets and calcium intake in colorectal cancer prevention is also being studied. The ideal time to diagnose this cancer is in its earliest stages. Colorectal cancer is usually curable if caught early, but cure rates fall with more advanced stages of disease. Can you describe the screening examination, and when I should have this done? Most cancers start as polyps in the colon and rectum, and since they typically cause no symptoms they are best identified on a screening examination. Most people with no personal or family history of colorectal cancer should start screening at age 50. Others need to speak with their physicians about when to begin screening. Patients take a colon cleansing preparation and are lightly sedated for the screening colonoscopy. A colonoscopy is a procedure where a specially trained endoscopist (usually a surgeon or gastroenterologist) inserts a small lighted flexible scope and inspects the inside of the colon. The patient typically has minimal discomfort with the examination. Polyps, if present, may be removed or biopsied through the scope. Imagine "" a colon polyp quickly and easily removed during a simple screening examination, could have been an advanced cancer if left undetected! Other less-common screening tests are sigmoidoscopy and barium enema. In the not-so-distant future, patients may undergo "virtual colonoscopy" inside a CT scanner. What are some symptoms I should be aware of? Colorectal cancer may also present with symptoms if not detected on routine screening. Symptoms may include belly pain, change in bowel habits including constipation, or blood in the stool. These are common symptoms that can be caused by a variety of illnesses, and should be discussed with your physician. How are colon and rectal cancers treated? Colon and rectal cancers are usually treated with surgery. Only a small percentage of colorectal cancer patients need to have a colostomy as part of their treatment. A colostomy is an opening in the abdominal wall that is made during surgery, with the end of the colon brought through this opening to form an opening or stoma. Most patients can have the cancer removed, and return home with normal bowel function and a regular diet. Will I need chemotherapy or radiation therapy? Following surgery, a pathologist reviews the cancer tissue and determines if it has invaded through the intestinal wall or spread to nearby lymph nodes. Some patients are given chemotherapy after surgery to reduce the risk of their cancer coming back, particularly if the cancer involves the lymph nodes. Patients with rectal cancer also usually have radiation as part of their treatment. We have seen major advances in the treatment of colorectal cancer in just the past few years. Many effective new drugs have been introduced, and others are under study in clinical trials. Bassett's Cancer Center has clinical trials open in the treatment of both early- and late-stage colon and rectal cancer. I hope those of you who have not had colon cancer screening will take the opportunity to speak with your doctor about it. It's a minor inconvenience that could turn out to be a lifesaver. Dr. Eric Bravin is a board-certified medical oncologist at Bassett Healthcare who sees patients in Cooperstown and Norwich.
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