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Colon Cancer Awareness

Colon Cancer Awareness

March is colon cancer awareness month. Unfortunately colon cancer if not found early can be a particularly deadly disease. We have three major goals regarding colon cancer:

  1. Prevent it
  2. If not prevented, at least find it early
  3. If found to be advanced, treat it with the most modern chemotherapeutic and surgical advances

75% of people who get colon cancer have no family history. Of the 25% of people who get colon cancer AND have a family history, only 20% of these people carry one of the known genes that predispose to colon cancer. Those genes include the Lynch genes and the APC genes. Over our lifetimes, women get as many colon cancers as men. More and more Americans are presenting with colon cancer earlier than expected. Breast cancer does not increase the risk of colon cancer.

The vast majority of colon cancer starts out as a benign polyp called a benign tubular adenoma. The adenoma may grow larger and mutate into a villous adenoma, which is the precursor to colon cancer. The progression from an adenoma to colon cancer is called the chromosomal instability pathway. A minority of colon cancer starts out from benign sessile serrated polyps, which are commonly found in the right side of the colon, and tend to be very flat and more common in women. The sessile serrated pathway to colon cancer is called the hypermethylation pathway.

Unfortunately polyps rarely have any symptoms. The best way to prevent colon cancer is to have routine colonoscopies, which detect and remove polyps before they grow into cancer. Colonoscopies save thousands of lives each year by removing precancerous polyps. Early colon cancer also has no symptoms. Finding an early cancer on colonoscopy results in surgery, which is often curative without chemotherapy needed. An ostomy (bag) is only needed when the cancer is in the rectum. Chemotherapy is needed when a colon cancer is found that involves surrounding lymph nodes or has spread to other organs such as the liver. A colonoscopy is inadequate to remove a colon cancer. The downsides of colonoscopy are the risks of the procedure, the cost, and the inconvenience of the preparation and the inconvenience for the friends or family members that must accompany the patient. The upside is simply the thousands of lives saved each year.

A take home stool test for occult blood (called FIT) is also a routine “preventative” screening procedure. As most polyps do not bleed, the stool test for occult blood is considered a screening test for cancer, not polyps. So the goal of the FIT is to initiate the search for a colon cancer before the cancer is advanced. FIT does not require any dietary adjustment before performing the test. A new stool test called Cologuard was just approved by the FDA. Cologuard tests the stool for not only occult blood but also for abnormal DNA shed by advanced polyps and colon cancer. People with blood in the stool and/or an abnormal Cologuard should have a colonoscopy. Another option for screening people for polyps and cancer is a “virtual” colonoscopy. This is a special CAT scan that detects most large polyps and colon cancers. The CAT scan requires a similar preparation to a colonoscopy, and the procedure is not as accurate as a colonoscopy.

The symptoms of aggressive colon cancer at the rectum and last half of the colon are usually red blood in the stool (often mistaken for hemorrhoids), and cramping lower abdominal pains. The symptoms of aggressive colon cancer in the top half of the colon are usually related to anemia from chronic bleeding.

The medical community is dedicated to preventing this potentially deadly disease by colon cancer screening. Please discuss this information with your health care professional.