Rafid J. Hussein, D.O.

Colorectal cancer is the second leading cause of deaths from cancer in the United States. Nearly 150,000 people in the U.S. are diagnosed with colorectal cancer every year. More than a third will die from the disease.

“Colorectal” refers to the colon and rectum, which together make up the large intestine. Colorectal cancer can originate anywhere in the large intestines, usually developing first as polyps, abnormal growths inside the colon or rectum.

It is important to note that not all polyps will turn to cancer. The non-cancerous polyps are often referred to as hyperplastic. Some polyps do have an increased risk of turning into cancer – these are known as adenomatous polyps. They comprise up to 66% of all polyps. Because there is a risk of having this type, there is a need for colonoscopy. The benefit of colonoscopy is that polyps can be detected, and they can be removed and analyzed in the laboratory for cancerous changes. It is at the polyp stage that colon cancer can be prevented.

Approximately 75% of colorectal cancers occur in people with no known risk factors. Although the exact cause of most colorectal cancers is not yet known, risk factors include: a personal or family history of colorectal polyps or cancer; inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease; a diet low in fiber and high in fat and calories; a sedentary lifestyle; diabetes; smoking; alcohol; and certain hereditary disorders (just 5%). Colorectal cancers occur in anyone. More than 90% of those diagnosed are age 50 or older, showing risk increases with age.

Most, if not all, cases of colorectal cancer develop with few, if any, symptoms at first. If present, symptoms may include:

• rectal bleeding or blood in the stool
• change in bowel habits including diarrhea or constipation or a change in consistency for more than a couple of weeks
• narrow stools
• general, persistent abdominal discomfort, such as cramps, gas, or pain
• abdominal pain with a bowel movement
• feeling that your bowel doesn’t empty completely
• unexplained weight loss
• chronic fatigue

Since these symptoms are associated with other health conditions, it’s important to see your doctor and determine the cause. It is crucial to remember that, in the beginning stages of cancer, the most treatable form presents with no symptoms.

Having regular screening tests can reduce your risk and save your life. Since colorectal cancers almost always develop from precancerous polyps in the colon or rectum, screening is the best way to find and remove them. Screening tests can also find cancer early, when treatment works best and the chance for a full recovery is high.

Patients should discuss with their doctor the benefits and risks of each screening option, and then decide which test to use and when to start, depending on age and medical history. Tests can be used alone or in combination.

Digital rectal exam – done in the office, and useless for screening colon cancer, the doctor uses a gloved finger to check only the first few inches of the rectum

Fecal Occult Blood Test – a lab checks for hidden blood in the stool, a nonspecific test, and if there is a negative result, it does not exclude colon cancer

Flexible Sigmoidoscopy – after a strong laxative or enema is used, the doctor uses a narrow, flexible, and lighted tube, usually in the office, to look at the inside of the rectum and the lower portion of the colon; this is an incomplete test that examines only a third of the colon; it is non-sedated and mildly uncomfortable

Colonoscopy – the best test as of 2007 to examine the colon; the colon is cleansed typically using 3 oz. of preparation or a series of pills (no horrible tasting liquids); the doctor uses a longer tube to look inside the rectum and the entire colon; polyps may be removed and tissue collected for closer examination; since you are given a quick-acting sedative, most people do not remember their actual procedure

Double Contrast Barium Enema – conducted in a radiology center or hospital, and after using a strong laxative/enema, x-rays are taken of the rectum and colon following a barium solution enema and an injection of air; this test can be uncomfortable and cannot remove lesions

Virtual Colonoscopy – this test creates 3-dimensional views of the colon and still requires preparation by cleansing; no polyps or abnormalities found during this procedure can be removed; this non-sedated test is fairly uncomfortable due to air insufflation

Genetic Testing – a promising new technology, which could become an option in the future, looks at DNA present in the stool for genetic changes

Most people consider preparing for colon screening much worse than the exam itself, but both the preparation and the tests have been greatly improved during recent years. Since big problems can start small, finding them early makes colorectal screening a vital part of every adult’s preventive health. The Gastroenterology Department is always happy to address any questions or concerns about colonoscopy and its value to your health care.