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Colon Cancer - Early detection, easily performed, greater survival
By Dr. Jesse I. Spector
Colon cancer is one of the most common forms of malignancy diagnosed in the United States today. Breast cancer always seems to get more publicity and prostate cancer is becoming also a media event in this country. As always ling cancer continues to be one of the deadliest of malignancies and because of the fact that it is almost always associated with cigarette smoking, is probably the most preventable. However, it is really colon cancer that in a very quiet way seems to constantly stay at the forefront of frequency of malignancies and continues to be very troublesome in terms of our ability to obtain a cure with the frequency that we would like to see.
The major problem with colon cancer is that it can develop and grow over a period of time without a person having any symptoms evident and by the time it becomes large enough to cause problems such as pain or bleeding into the stool, it can already have reached a size where it might have spread already to other areas of the body, making it impossible to obtain a cure.
Each year in the United States there are approximately 200,000 new cases of colon cancer diagnosed, and about 45,000 people in the United States will die each year directly attributable to the spread of colon cancer. This is therefore a very formidable illness and it based on this information that I would now like to discuss means to prevent colon cancer becoming a life threatening condition.
Is early detection important and, if so, why?
Early detection of colon cancer is extremely important since if it can be found at an early stage, the potential for cure is extremely high, whereas with more advanced colon cancer the ability to obtain a cure decreases dramatically. Therefore, early detection for this type of malignancy has a tremendous potential for being a very treatable condition.
Who is at risk? It is just men?
Colon cancer does not respect gender, and there is an equal frequency of colon cancer in men and women. There do not appear to be any protective issues that one can comment on in terms of frequency, outcome with treatment, and potential for cure between men and women.
What are the colon cancer screening procedures to detect colon cancer?
Currently, we have two screening procedures that are routinely considered as aprt of an intelligent preventative program. One tests a stool sample for the presence of blood. Very often small quantities of blood related to a cancer of the colon cannot be detected visibly by the patient or the physician, but a very simple chemical test on a small stool sample can detect blood in the stool and can alert the physician to the need to further evaluate a patient to exclude the diagnosis of colon cancer. This test called an occult blood determination requires only a small sample of stool being obtained on a wooden applicator stick and applied on a special card, which can then be brought in or mailed to the physician’s office. This is extremely simple and very cost effective way to detect colon cancer. There are benign explanations for blood being in the stool such as hemorrhoids, so a positive blood test is not necessarily indicative of colon cancer.
Dietary patterns also may influence the appearance of blood in the stool, since patients who tend to eat rare meat may have blood on the occult blood test purely based on the ingestion of the meat product. Being off of meat for several days prior to doing one of these tests can clarify that issue.
The second procedure of screening is either a barium enema with an examination of the lower part of the intestine with a device called a sigmoidoscope. This procedure of sigmoidoscopy can be done in the doctor’s office and it is not particularly uncomfortable. An alternate procedure that has gained more popularity and does seem to be more accurate is colonoscopy, which is a much longer flexible scope which can directly examine the entire large bowel. Colonoscopy is recommended in all people as a baseline once they reach age 50. There are guidelines for follow up colonoscopy depending on family history of colon cancer or the presence of polyps in the intestine in patients whose polyps are benign, but who might require closer follow up into the future, since some of these could turn into malignant lesions later on. Colonoscopy when performed by a skilled gastroenterologist is usually not a particularly uncomfortable procedure, and certainly has a great deal to offer in terms of detecting very early small curable colon cancers.
In the current day and age of medical sophistication, there is a much greater emphasis being applied towards preventing cancers or detecting them at a very early stage. In elderly individuals one of the great detriments to being able to accomplish this aim embarrassment that occurs with this type of investigation such as studying the stool for blood or undergoing a colonoscopy. This type of thinking hopefully will become a thing of the past when one realizes that by pursuing these preventative tools, a person can live a potentially much longer healthier life to enjoy the fruits of many years of labor, whereas if embarrassment reins the outcome of a neglected tumor can result in a totally unnecessary shortened survival. I would certainly hope that we are reaching the time in the early part of the 21st century where old secretiveness that used to be the common way of dealing with cancer will give way to a much more enlightened approach to preventing illness, or detecting it at an early enough stage to allow the elderly to go on with a longer more fruitful life.
Jesse I. Spector, M.D. is an oncologist with Berkshire Hematology and Oncology.