Colorectal Cancer: A Treatable Disease

Colorectal Cancer: A Treatable Disease
By Salim Amrani, MD
Los Alamos

Colorectal cancer is the third most common cancer in the United States. It is estimated that 140,000 persons will be diagnosed this year alone and over 50,000 die annually from it.

Unfortunately only 50 ercent of people over 50 years of age underwent a screening.

It is well established that genetic predisposition and environmental factors play a great role in the development of the cancer.

It is important to have a healthy balanced diet and lifestyle as it is known that excess in dietary fat, red meat and calories contribute in the genesis of the cancer. Tobacco and alcohol consumption are not only detrimental to your health but directly add to your risk of developing the disease.

Maintaining a healthy weight in addition to regular exercise with a fiber rich diet such as fruits and vegetables are believed to be protective. Although having a family member affected with colon and rectal cancer might increase your risk of developing colorectal cancer, 75 percent of new diagnosed cancers have no identifiable risk factor.

Participating regularly in colorectal cancer screening will decrease your chances of developing the cancer or being diagnosed late as most cancers are discovered in asymptomatic otherwise healthy persons. For the majority of the population the screening starts at age 50. However, if you have a family member affected by the disease or you have been diagnosed with inflammatory bowel disease you might need to be screened sooner.

The simplest screening test for colon and rectal cancer is testing of the stool to detect tiny amounts of invisible blood; this is called fecal occult blood testing. This test has been available for many years, is inexpensive and very simple. Unfortunately, it only detects cancer or polyps which are bleeding at the time of the test. Only about 50 percent of cancers and 10 percent of polyps bleed enough to be detected by this test. Therefore, further screening is necessary for accurate detection of cancers and polyps.

Flexible sigmoidoscopy is a test, which allows the physician to look directly at the lining of the colon and rectum. Only the lower one-third of the colon and rectum can usually be seen. This is the portion of the lower intestine which accounts for most polyps and cancers. When flexible sigmoidoscopy is combined with testing the stool for hidden blood, many cancers and polyps can be detected.

Colonoscopy provides a safe, effective means of visually examining the full lining of the colon and rectum. The colonoscopy procedure is not painful. Patients are sedated during the procedure to minimize any discomfort, which is mostly from the gas inserted to visualize the inside of the colon. The preparation itself (or “cleaning out”) the day before is a feared part of the procedure. While you will spend extra time in the bathroom eliminating all the stool, this preparation is extremely important as it allows for better visualization of the lining of the intestine. An inadequate preparation can lead to missed lesions or a need to repeat the procedure.

Imaging techniques such as a barium enema or a CT colonography are almost as good as colonoscopy in detecting large tumors, but it is not as accurate for small tumors or polyps. The combination of barium enema and sigmoidoscopy is better than either test alone, but not as good as colonoscopy.

A polyp is a precancerous lesion that if detected early and removed prevents progression to colon cancer. This is how colonoscopy and sigmoidoscopy prevent deaths from colon cancer – a fact that has been well demonstrated over time. Even large polyps can be removed endoscopically if benign. You may need a colorectal surgeon or specialist to perform these procedures.

While it is true that if cancer is found within the polyp, you may need surgery to remove that part of the colon, if the polyp is benign it can often be treated by the scope procedure alone. Even if you need surgery, many procedures today can be performed using laparoscopic or minimally invasive approaches, which minimize recovery time, pain, and have many other benefits.

Colorectal cancer is curable when detected early. Ninety-one percent of patients  with localized colorectal cancer (confined to the colon or rectum) are alive five  years after diagnosis. But only 37 percent of all colorectal cancers are diagnosed  at this stage. The remaining 63 percent of patients come to the doctor when the disease has spread regionally or to distant parts of the body.

Don’t wait – ask your doctor to get screened.

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