Understanding Colorectal Cancer Screening
What is Colorectal Cancer?
Colorectal cancer is cancer found in the colon (large intestine) or rectum. It often begins as a polyp, or noncancerous growth, found inside the colon or rectum (insert link here to additional information on polyps).
How common is Colorectal Cancer?
COLORECTAL CANCER IS THE 2nd LEADING CANCER KILLER IN OUR COUNTRY…BUT IT DOESN’T HAVE TO BE!
If caught early, colorectal cancer can be very treatable.
Excluding skin cancers, colorectal is the 3rd most commonly diagnosed cancer in both men and women in the United States 3rd to lung and prostate cancers in men, and lung and breast cancers in women. It is the 3rd leading cause of cancer-related deaths in men and in women, and when men and women are combined, it is the 2nd leading cause of cancer-related deaths in our country.
It is approximated that 145,000 new cases of colorectal cancer will be diagnosed in the United States in 2019, and 51,000 people will die from the disease(Society, 2019).
Who gets Colorectal Cancer?
Colorectal cancer occurs most often in people over the age of 50. The risk increases with age. Nonetheless,
ANYONE of ANY AGE can be affected, and BOTH men and women get colorectal cancer.
What are my chances of developing Colorectal Cancer?
The lifetime risk of developing colorectal cancer in our society is roughly 1 in 22 for men, and 1 in 24 for women(Society, 2019). This means that for every 22 or 24 men or women respectively in the United States, roughly 1 person will be diagnosed with colorectal cancer in his/her lifetime.
What are the risk factors for developing Colorectal Cancer?
1. Age (being older than 50), although in recent years there has been a noticeable rise in colon cancer diagnoses and colon cancer deaths among younger populations,
2. Gender (with males being at slightly increased risk compared with females),
3. Race (with African Americans being at increased risk),
4. Being obese or overweight,
5. Leading an inactive or sedentary lifestyle,
6. Consuming a diet high in red meats (such as beef, pork and lamb) and processed meats (like hot dogs and lunchmeat),
7. Smoking tobacco,
8. Drinking alcohol (moderate to heavy alcohol consumption increases your risk),
9. Having a family history of colorectal cancer and adenomatous polyps,
10. Having a personal history of certain types of cancers (such as breast, testicular and prostate) may increase your risk,
11. Having a personal history of Inflammatory Bowel Disease or IBD (such as Ulcerative Colitis or Crohn’s disease),
12. Having a personal or family history of a genetic syndrome such as Familial Adenomatous Polyposis, Attenuated Familial Adenomatous Polyposis, Gardner Syndrome, Lynch Syndrome, Juvenile Polyposis Syndrome, Muir-Torre Syndrome, MYH associated polyposis, Peutz-Jeghers Syndrome, and Turcot Syndrome.
If you think you may be at increased risk for colorectal cancer, please speak with your doctor about when to start screening, which test or tests are right for you, and how often you should be screened.
Call 908-788-8200 to schedule an appointment with our medical team for a comprehensive, personalized approach to your care.
Why is colorectal cancer on the rise in younger populations?
The answer is not completely clear.
Due in part to screening guidelines, fewer people over the age of 65 are being diagnosed with colorectal cancer and dying from the disease. Nonetheless, depending upon the source cited, a 1-2% per year rise in colorectal cancer deaths among those 55 years of age and younger was reported between 2007 and 2016 (Society, 2019). Additionally, these younger adults were more likely to be diagnosed with late-stage cancers.
According to the Colon Cancer Coalition, those diagnosed with colorectal during the fourth decade of life (so between 40 and 50 years of age) were roughly 30% more likely than other age group to be diagnosed with stages III and IV cancers (Coalition, 2019).
We are seeing a rise in colorectal cancer diagnoses and deaths in our country! Public health researchers suspect this may at least in part be due to a lack of awareness about the disease and/or a lack of assess to healthcare in the younger populations; however, no clear causative explanation is conclusive at this time. Our Western diet may play a role.
If you have any concern about colorectal cancer or other GI conditions please contact our office at 908-788-8200 to schedule a thorough and comprehensive medical evaluation. All information found on this website is for educational purposes only and not intended to be used as a substitute for quality medical care.
What are the symptoms of Colorectal Cancer?
People who have polyps or colorectal cancer may not always have symptoms, especially at first.
An individual can have polyps or colorectal cancer and not know it. This is why it’s so important to be screened for colorectal cancer based on the current screening guidelines.
1. Blood noticed in the stool or on the stool,
2. A change in bowel habits from what was previously normal for you (new constipation, anal leakage, incontinence, etc.),
3. The sensation as if you can not completely empty your bowels,
4. Abdominal pain, cramping, fullness, or aches that do not go away,
5. Unintended weight loss or losing weight and you don’t know why you are losing weight,
6. Iron deficiency anemia (This is a red flag in any man over the age of 50 or any post-menopausal woman.),
7. Unexplained fatigue,
8. Fevers, chills, sweats, and/or night sweats,
9. Back pain that keeps you up at night and/or doesn’t go away.
Who should be screened for colon cancer?
The US Preventative Services Task Force recommends 2019 -Currently recommends- *ALL adults 50-75 years of age be screened for colorectal cancer except *African Americans who should begin screening at 45 years of age *Anyone with a family history of colorectal cancer should begin screening 10 years prior to the age of diagnosis of the youngest affected relative or at age 40, whichever is earlier.
Everyone over the age of 50, or anyone under the age of 50 with a family history of colorectal cancer or other risk factors for the disease (such as known polyps, inflammatory bowel disease, Ulcerative Colitis, or Crohn’s disease) should be screened for colorectal cancer except African Americans who should begin screening at 45 years of age.
Can Screening Colonoscopy be discontinued?
Screening can be discontinued at 75 years of age if patients are up to date with screenings. The decision to be screened after the age of 75 should be made on an individual basis. Always discuss your options for care with your medical provider or schedule an appointment with our medical team for a comprehensive consultation.
Patients of ANY AGE with bleeding symptoms OR any symptoms suggestive of a gastrointestinal source be evaluated aggressively and promptly! COLORECTAL CANCER CAN AFFECT ANYONE OF ANY AGE!
If you have symptoms, call our office @ 908-788-8200 for an appointment.
How can I get checked for colorectal cancer?
Experts believe roughly 60% of colorectal cancer deaths could be prevented with colon cancer screening (Cancer, 2019).
Several different screening tests can be used to detect colorectal polyps and colorectal cancer. These include: stool studies to look for occult blood, stool DNA tests, sigmoidoscopy, colonoscopy, and virtual colonoscopy.
1. Complete colonoscopy every 10 years with annual FIT stool test.
a. Similar to flexible sigmoidoscopy, this is a procedure performed under anesthesia again at either the Somerset Ambulatory Surgical Center or Hunterdon Medical Center (based on your preference and your insurance coverage) where Dr. Sinha uses a longer, thin, flexible lighted tube to check for polyps or cancer inside your rectum and entire colon (or large intestine). During the procedure she can find and remove most polyps and some cancers. Colonoscopy is also used as a follow up test to anything unusual found during one of the other screening tests (for example, occult blood found in the stool). This remains the gold standard of care for colorectal cancer screening because it allows a trained gastroenterologist the ability to both identify and remove colon polyps all in the same procedure.
i. If polyps or other pathology are found, individuals may require repeat surveillance colonoscopy, sigmoidoscopy, or other screening tests more frequently.
ii. As with any study, there are limitations to colonoscopy. Most importantly, a good bowel prep is required in order for Dr. Sinha to see the lining of your colon clearly. Missed lesions can occur if stool is present in your colon; it can mask and hide polyps, particularly flat polyps.
2. Flexible sigmoidoscopy every 5 years, or every 10 years with FIT stool test annually.
a. Flexible sigmoidoscopy is a procedure performed under anesthesia at either the Somerset Ambulatory Surgical Center or Hunterdon Medical Center (based on your preference and your insurance coverage) where Dr. Sinha uses a short, thin, flexible lighted tube to look at your rectum and to check for polyps or cancer inside the rectum and lower third of the colon (or large intestine). During this procedure she only visualizes the rectum and sigmoid colon; she will not visualize the entire colon.
3. Stool studies performed annually to look for the presence of occult blood in your stool.
a. There are two types of fecal occult blood tests available today:
i. The fecal immunochemical test (or FIT) uses antibodies to detect hidden blood in the stool that could potentially be coming from a cancer. It only detects human blood from the lower intestines making it is a more specific screening tool for colorectal cancer compared with the stool Guiac test that many patients may be more familiar with. ii. The Guiac based Fecal Occult Blood Test (gFOBT) test picks up blood arising from anywhere in the GI tract making it less specific for colorectal cancer. For example, it might pick up blood arising from a bleeding stomach ulcer.
iii. FIT-DNA tests (or stool DNA tests) are another option combining the FIT test with a second test that detects altered DNA in the stool that could be suggestive of colorectal cancer.
4. Virtual Colonoscopy every 5 years.
a. Computed tomography (CT) colonography also called virtual colonoscopy uses x-rays and computers to produce images of your entire colon. The images are displayed on a computer screen for analysis.
b. Disadvantages of Virtual Colonoscopy are that polyps cannot be removed during this procedure and small polyps may be missed. Nonetheless, this may be a good option for individuals unable to undergo anesthesia or complete colonoscopy or sigmoidoscopy.
There is no single best test for any one person. Each test has its advantages and disadvantages. Talk with your doctor about which test or tests are right for you and how often you should be screened for colorectal cancer.
We recommend that you schedule an appointment with our medical staff at 908-788-8200 for a comprehensive medical evaluation to discuss if screening colonoscopy or another screening modality is an appropriate option for you.
Are there any tests new on the horizon or alternative options for colorectal cancer screening?
1. New on the horizon is the PillCam Colon System offered at our practice.
If you’ve had an incomplete colonoscopy with adequate prep, or evidence of lower GI bleeding and are at risk for colonoscopy or sedation, the PillCam Colon System may be an alternative option for you.
This is a pill that contains a camera that you swallow. It’s about the size of a vitamin. The camera takes pictures of your colon as it travels along your digestive tract. Images are transmitted to a recorder that you wear in a pouch and strap around your shoulder for a day. You do not need to be hospitalized or admitted for this procedure. You come to our office in the morning, swallow the pill, and then go about your day as usual while wearing the recorder. After the end of the day you return the recorder to our office. Dr. Sinha will review the images collected, and use the information provided to help determine the best plan for your health. The capsule is disposable and should pass naturally from your body with a bowel movement.
2. Another option is the Septin 9 Assay or blood test. Please note, this is NOT indicated as a first line option for colorectal cancer screening.
The Septin 9 Assay is a blood test that encodes SEPT9, a gene found on chromosome 17 that is hypermethylated in colorectal cancer but not in healthy colon tissue. Once hypermethylated within colorectal cancer cells, the Septin-9 protein is released into the bloodstream and can be detected in your blood.
The Septin 9 Assay does NOT pick up all colorectal cancer. Studies suggest detection rates are higher in late stage cancers. Testing to detect methylated SEPT9 is NOT indicated as a first line option for colorectal cancer screening, nor is there any adequate data to support the use of blood tests like the Septin 9 Assay in the routine detection of pre-cancerous polyps such as tubular adenomas.