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
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
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
What are the screening methods for
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
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
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
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