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more articles by Brennan, Peter , MD  |  author's bio

March is Colon Cancer Awareness Month

March is Colon Cancer Awareness Month

By Peter Brennan, MD

Colorectal cancer is the second leading cause of cancer death, following lung cancer. Unlike lung cancer, however, colorectal cancer is largely preventable through regular screening and early detection and treatment. And because the vast majority of colorectal cancers develop slowly over a period of years, screening need only occur every eight to ten years for the average adult with no identified risk factors.

At what age should colorectal cancer screening begin?

For an adult with average risk factors, screening for colorectal cancer should begin at age 50. For those with an early family history of colorectal cancer (parent or sibling before age 70) screening should begin at age 40. A history of colon cancer in a grandparent, aunt, uncle, or cousin conveys an intermediate risk and should be discussed with your physicians. However, if you have symptoms of colorectal cancer at any age, you should talk with your physician about being screened.

What are the risk factors for colorectal cancer?

Age is the most important and the lifetime risk is 5-6 percent for those at average risk and 10-15 percent for those with a family history of colon cancer. People with longstanding ulcerative colitis or Crohn's disease are at elevated risk. Eating red meat and smoking convey slightly elevated risk.

What symptoms should I watch for?

The two most suggestive symptoms or signs of colorectal cancer are blood in the stool and the particular type of anemia that signals blood loss, called iron deficiency anemia. While changes in bowel habits may indicate the presence of advanced colorectal cancer, such changes usually can be attributed to other causes. Having blood counts and stool checks as part of physical exams may identify colorectal cancer because polyps and tumors often bleed while sloughing off their surface tissue. However, it is the large polyps that tend to bleed and it is best to find and remove polyps while they are small and not bleeding. This is why we recommend regular screening even when there are no discernable symptoms.

What are the screening methods for colorectal cancer?

Fecal occult blood testing via slides collected at home can help with early detection. Some polyps and even tumors do not bleed, however, so this screening method alone cannot provide a full evaluation.

Endoscopic screening procedures include sigmoidoscopy, which examines the lower 25 to 33 percent of the colon, and colonoscopy, which views the entire colon with the assistance of sedation. Because colonoscopy is much more comprehensive-and colon polyps can be removed with electrosurgery during its performance-it has become the preferred screening strategy. Capsule endoscopy, which is also available at Cayuga Medical Center, successfully examines the small intestine (tumors here are fortunately relatively rare) but does not capture good views of the colon (large intestine).

What happens during a colonoscopy?

Prior to undergoing a colonoscopy, which is performed as an outpatient procedure at both Cayuga Medical Center and Surgicare, you must drink a liquid preparation that serves to cleanse your colon. Once at the medical center, you will be given a light sedative to ease any anxiety you may have. Then, using a thin, flexible tube, the gastroenterologist will examine the entire length of your colon and remove precancerous polyps seen. Serious complications are rare; with an average of one patient every ten years requiring follow-up surgery.

What about x-ray tests?

In special circumstances, where colon anatomy is difficult and a colonoscope can't be passed into the colon, a barium enema may be recommended for viewing the colon. An evolving imaging technology called virtual colonoscopy uses CT scanning to view the colon. This approach still requires bowel cleansing (prep) and air inflation of the colon, and it cannot detect smaller polyps. If a polyp is found, a colonoscopy is still needed. Advances in virtual colonoscopy are occurring, though currently it is not approved for general screening.

If you have troubling symptoms, see your doctor and get them checked out. If you have no symptoms or elevated risk factors, have a screening colonoscopy at age 50. Colon cancer typically begins with polyps, and when these are removed in their earliest stages, your risk for colon cancer is drastically reduced.

Dr. Brennan is board certified in gastroenterology and internal medicine, serves on the medical staff of Cayuga Medical Center, and practices with Gastroenterology Associates of Ithaca. He earned his MD at SUNY Upstate Medical University in Syracuse, did his internship and residency at the University of Virginia Medical Center, and completed a fellowship in gastroenterology at the Medical College of Virginia. Dr. Brennan can be reached at (607) 272-5011.

If you are a Tompkins County resident with no health insurance, or if your health insurance policy does not cover the cost of screening tests for colorectal cancer, you may be eligible for assistance from The Cancer Services Program of Cortland and Tompkins Counties. You may also be eligible for help if your policy requires you to pay a high co-payment or deductible that you can't afford. Call Cayuga Medical Center for more information about The Cancer Services Program of Cortland and Tompkins Counties at 277-0960.

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