What is Colorectal Cancer

Colorectal cancer is a cancer of the colon or rectum. It is the second leading cause of cancer death in the US, and the leading cause of cancer death under age 50. The good news is that colon cancer is highly preventable. It often begins as a precancerous polyp that gradually transforms into cancer over many years. Regular screening with colonoscopy allows physicians to detect and remove polyps before they become malignant, dramatically reducing cancer risk.

Risk Factors

• Some risk factors you cannot change:
  • Risk increases with age
  • Men are slightly higher risk than women
  • Prior colorectal cancer or precancerous polyps in self or first-degree relatives
  • Inherited syndromes such as familial adenomatous polyposis or Lynch syndrome
  • Inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
• Some risk factors you can change:
  • Diet high in red and processed meat
  • Obesity, physical inactivity
  • Smoking, and moderate to heavy alcohol use.

Screening Methods

• Colonoscopy: The gold standard for screening; it allows detection and removal of precancerous polyps to prevent colon cancer from even developing, and diagnosis of cancer that is already present in earlier, curable stages.
• Stool tests: Fecal immunochemical test (FIT), stool DNA tests (such as Cologuard), and fecal occult blood tests can identify hidden blood or DNA changes. Positive results require colonoscopy.
  • For average risk individuals, screening with stool tests is preferrable to no screening.
  • Stool tests can reliably detect colon cancer but are not good at detecting even large precancerous polyps. They reduce deaths from colon cancer but are not as good as colonoscopy screening at preventing colon cancer from developing.  By the time stool tests turn positive, a patient may already have cancer and need treatments such as surgery, chemotherapy, or radiation rather than a polyp that can be removed during colonoscopy
  • Increased risk individuals including those who have had precancerous polyps in the past should get colonoscopy rather than stool tests
• Shield blood test: weaker performance data and not recommended by major medical society guidelines

Who Should Be Screened

Most adults of average risk should begin colorectal cancer screening at age 45. Those with higher risk factors may need earlier or more frequent screening. Patients with first degree relatives who had colon cancer or “advanced” precancerous polyps need to be screened at the earlier of 40 or 10 years before that relative’s age of diagnosis.  If you have any questions about your personal colon cancer screening plan, we would be happy to discuss this with you here at Salem Gastro.

Symptoms

Colon cancer frequently has no symptoms early on, which is why screening is important.  When symptoms do appear, they can include:

• Rectal bleeding or blood in the stool.  Do not just assume bleeding is from hemorrhoids.
• Iron‑deficiency anemia.  The body does not lose significant amounts of iron naturally outside of menstruation, so iron deficiency anemia can be a sign of bleeding from colon cancer
• Persistent abdominal pain or cramping
• Changes in bowel habits (diarrhea, constipation, or narrowing of the stool)
• Unintentional weight loss

If you notice symptoms concerning for colon cancer, contact us at Salem Gastro for an evaluation.  Early detection saves lives.