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Colon cancer is the second leading
cause of cancer-related deaths in the United States, accounting for
about 20 percent of all cancer deaths. This year alone, more than 131,000
Americans will be diagnosed with colon cancer, and 56,000 will die from
it.
Colon cancer is also one of the most curable types of
cancer if it is diagnosed early. When detected at its earliest stages,
chances for a cure are as high as 90 percent. There are several excellent
screening and diagnostic methods to detect colon cancer early, before
it has spread to vital organs. There are also a variety of simple steps
you can take to help prevent it. Learning about the risk factors, knowing
the signs and symptoms, and having regular screenings for colon cancer
are your best defenses against this all-too-common cancer.
Reducing Your Risk
You can help reduce your risk by keeping in mind several factors that
may put you at a moderate to high risk of developing colon cancer. These
risk factors are:
Your age:
About 90% of colon cancer cases occur in people older than age 50
About 6% of people age 75 to 80 have had colon cancer
Your race and ethnicity:
African-American women are more likely to develop colon cancer than
are women of other racial and ethnic groups. African-American men have
the highest incidence rates of several cancers, including colon cancer.
African-American men and women are more likely to die of colon cancer
than are men and women of other racial and ethnic groups.
Your lifestyle:
Eating a low-fiber, high-fat diet, being overweight, smoking, and having
an inactive lifestyle can increase your risk of developing colon cancer.
Personal or family history:
Polyps are small benign (non-cancerous) growths that occur in the colon
and rectum. Although most remain unchanged, some develop into cancerous
growths.
Diseases of the colon:
These include Crohn’s disease and ulcerative colitis.
Some hereditary conditions:
Certain hereditary conditions, such as the tendency to have many colon
polyps, can result in colon cancer at a young age.
Early Detection Saves Lives
The key to successful colon cancer treatment is finding the
cancer at an early stage, before it has spread to surrounding tissues
and organs. Most colon cancers develop from polyps, small growths found
inside the intestine. Keep in mind, though, that most polyps are not
cancerous.
The goal of screening for colon cancer is twofold: to
detect early-stage cancerous tumors; and to detect and remove benign
polyps, which may develop into colon cancer. There are several excellent
screening methods available at The Colon Cancer Prevention Center at
Hackensack University Medical Center to help your physician determine
if there is anything abnormal in your colon or rectum and whether it
is benign or cancerous. These screening methods include:
Colonoscopy:
This procedure offers the best chance to detect and prevent colon cancer,
according to leading research studies. The gold standard, colonoscopy
is similar to a flexible sigmoidoscopy except the instrument is longer
because your doctor will be viewing your entire colon. You will be given
a mild sedative to make you comfortable. Attachments on the end of the
tube enable your doctor to remove a small tissue sample if one is needed
for a biopsy and polypectomy.
Digital rectal exam:
Using a gloved finger, your doctor examines the first few inches of
your rectum to check for polyps or other irregularities. This exam can
be performed right in the doctor’s office during a routine checkup.
It is usually utilized in combination with another screening method.
Fecal occult blood test of the stool:
This test, which can be completed at home or in the doctor’s office,
is used to detect the presence of blood in your stool, which may come
from colon cancer or a large polyp. However, blood in the stool may
not necessarily be caused by cancer; it may result from hemorrhoids,
constipation, or diet. Because not all cancers and small polyps bleed,
or they may do so intermittently, the fecal occult blood test is often
used in conjunction with other screening methods.
Flexible sigmoidoscopy:
During a flexible sigmoidoscopy, your doctor uses a slender tube (called
an endoscope) with a light to visualize the inside of your rectum and
the last two feet of your colon (the sigmoid colon). Nearly half of
all cancers are found in this area. Attachments on the end of the endoscope
enable your doctor to remove a small tissue sample if one is needed
for a biopsy.
Flexible sigmoidoscopy takes only several minutes to complete
and is usually performed as an outpatient procedure with no anesthesia.
An enema may be given before the procedure to clear your bowel of stool.
During the sigmoidoscopy, you will be asked to lie on your left side
with your knees drawn up. You may feel a slight discomfort when the
lubricated end of the tube enters your anus and rectum.
Virtual colonoscopy:
You should discuss with your physician if you are a candidate for virtual
colonoscopy. Performed in the Radiology Department, the procedure, which
takes only about 10 minutes to complete, combines a CAT scan, sophisticated
image processing computers, with skilled radiologists to actually recreate
and evaluate the inner surface of the colon. You will lie on the CAT
scan table and a thin tube, about the diameter of a rectal thermometer,
is placed into your rectum, through which air is introduced into your
colon. The air is necessary to distend the colon to allow polyps or
any abnormalities in the colon to stand out from the normal colon surface.
X-ray studies:
Your doctor may recommend a radiographic test called a barium enema
– which uses a liquid called barium or a combination of barium
and air – to view your entire large intestine. Liquid barium (and
air) is placed in your colon in a slender tube. X-rays are then taken
of the area, which help the physician detect any abnormal polyps. This
test can be somewhat uncomfortable, but it takes only about 30 minutes
to complete.
Colon Screening Guidelines
The American Cancer Society recommends that persons undergo colon cancer
screenings beginning at age 50. General recommendations include: a fecal
occult blood test every year; flexible sigmoidoscopy every three to
five years after the initial screening; a barium enema every five to
10 years; and colonoscopy every 10 years. However, your physician will
recommend to you a personalized screening schedule based on your age,
your risk factors, and your personal medical history.
Preparing for a Colonoscopy
A routine colonoscopy, performed every 10 years after age 50 –
or more frequently if you have a personal or family history of colon
cancer – may be one of your best defenses against colon cancer.
It enables your physician to view your entire large intestine, take
tissue samples for a biopsy if needed, and remove any polyps that may
be found.
One or two days before the test, you will be asked to
take several laxatives to empty your colon of stool. On the day of the
test, you will be given a mild sedative to make you feel more comfortable.
A colonoscopy can cause mild discomfort, but it takes only about 30
minutes to complete. Your physician will use a long, slender instrument
with a light on one end to view your colon and rectum. You will be asked
to lie on your left side with your knees drawn up. You may feel a slight
discomfort when the lubricated end of the instrument enters your anus
and rectum. Your physician will then view your colon and remove any
polyps that are found. You will be ready to leave the office within
one to two hours.
Preparing for a Virtual Colonoscopy
Instructions for a colon cleansing preparation will be prescribed upon
scheduling the virtual colonoscopy. The cleansing preparation is done
the day before the scheduled day of the virtual colonoscopy. Because
the object of the test is to find very small polyps (which could be
precancerous or early cancers) it is necessary to be sure that the colon
is free of all residue and fecal material so that there is no confusion
in the results of the test.
Upon arrival to the Radiology Department, you will change
into a hospital gown. You will lie on the CAT scan table and a thin
tube, about the diameter of a rectal thermometer is placed into your
rectum, through which air is introduced into your colon. The air is
necessary to distend the colon to allow polyps or any abnormalities
in the colon to stand out from the normal colon surface. You will hold
your breath at different intervals while the CAT scan sweeps over your
abdomen as you lay on your back. The procedure is repeated while you
lie on your stomach as well. The procedure takes about 10 minutes. You
may experience some mild cramping during the procedure. Following this
you are free to return to your daily routine of activity.
Easy Steps to Prevent Colon Cancer
It’s never easy to change your lifestyle, but making
several relatively simple lifestyle modifications may significantly
lower your risk of developing colon cancer. Professionals at The Colon
Cancer Prevention Center at Hackensack University Medical Center recommend
the following:
Exercise regularly and maintain a healthy body weight:
Controlling your weight can reduce your risk. Try to exercise at least
30 minutes on most days. Staying active stimulates movement through
your bowel, reducing the time it may be exposed to harmful substances
that may cause cancer.
Limit fat: High-fat diets increase one’s risk of
colon cancer. Limit foods from animal sources that are high in fat,
especially saturated fat, such as red meat, milk, cheese, ice cream,
and coconut and palm oil. Restrict fat intake to less than 30 percent
of daily calories.
Eat foods rich in fiber: Dietary fiber may provide protection
from colon and other cancers. Fiber reduces constipation, which irritates
the inside wall of the colon. Try to get 25 to 35 grams of fiber in
your daily diet.
Eat plenty of fruits and vegetables: These contain vitamins,
minerals, fibers, and antioxidants, which may protect you from cancer.
Know the Signs, Heed the Warnings
Although some patients never experience any symptoms of colon
cancer until the cancer has advanced to a late stage, there are several
signs and symptoms that you should report to your physician if you have
noticed them for more than two weeks. These may indicate the presence
of colon cancer:
:: A change in bowel habits: diarrhea, constipation,
or stool
:: consistency changes
:: Narrow, “pencil-thin” stools
:: Rectal bleeding: blood in your stool on more than one occasion
:: Persistent, abdominal discomfort, such as cramps, bloating,
or
:: pain
:: A feeling that your bowel doesn’t completely empty
:: Sudden, unexplained weight loss or loss of appetite
:: Constant fatigue
A Variety of Treatments
There are a variety of treatment options available at Hackensack
University Medical Center for patients who have been diagnosed with
colon cancer. Your physician will determine, with your input, what is
the best course of treatment based on the size and location of the tumor,
its grade of malignancy, whether it has spread to any other parts of
the body, and your general health. Treatments include:
Surgery:
As many as half of all cases of colon cancer can be cured with surgical
treatment to remove the cancerous tumors and/or tissues. Even if the
cancer has spread to other parts of the body, surgical treatment may
still be recommended to reduce the possible complications of bowel obstruction
or bleeding. Laparoscopic surgery, where a surgeon operates through
small incisions in your abdomen, may be an option.
If your surgeon cannot reconnect the healthy sections
of the colon or rectum, the surgeon may create a new opening through
your abdominal wall for the elimination of waste (a colostomy). A colostomy
may be temporary or permanent. A special bag attached to your abdomen
will collect waste. After surgery, follow-up therapy may include chemotherapy
or a combination of chemotherapy and radiation therapy to reduce the
risk of recurrence.
Chemotherapy:
The standard treatment to prevent recurrence and the further spread
of colon cancer is a drug called fluorouracil (5-FU) used in combination
with levamisole or leucovorin following surgery.
New chemotherapeutic drugs are now being studied in clinical
trials throughout the country. Among them is an investigational agent
known as irinotecan HCI (CPT-11), which has shown promise in treating
people with advanced metastatic colon cancer. Chemotherapy for high-risk
patients whose cancer has spread to the liver continues to be an active
area of research. In some cases drugs that can be delivered directly
to the liver are used.
Radiation therapy:
Cancer of the colon is usually not treatable with radiation therapy
because the colon is not firmly attached to anything in the body to
keep it from moving around during treatment.
Future treatment advances:
Scientists are now working on several new treatments that may someday
be available. These include gene therapies and immunotherapies, perhaps
combined with standard chemotherapy, that are designed to use the body’s
own genetic and immunologic defenses to battle cancer.
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