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Colorectal Cancer: The Importance of Screening and Early Detection

Monday, Nov 26, 2018
Colonoscopy

A cancer that doesn't have to kill

Colorectal cancer, including colon and rectal cancers, is the second leading cause of cancer death in men and women in the United States after lung cancer. Colorectal cancer happens most often in people aged 50 years or older, and the risk increases with age.

Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum. During a screening procedure, a physician can remove polyps before they turn into cancer.

"Screening via colonoscopy in particular is powerful as it not only detects colorectal cancers but also prevents it by finding polyps," said Doylestown Health colorectal surgeon Robert Akbari, MD. "No other cancer screening method I'm aware of is both diagnostic and preventive."

Screening can also find cancer earlier, when it is most effectively treated. Precancerous polyps and early-stage colorectal cancer don't always cause symptoms. That is why having a screening test is so important.

Screening recommendations

Research by The American Cancer Society (ACS) finds that new cases of colorectal cancer are occurring at an increasing rate among younger adults. Based on medical and family history, colonoscopy screening may begin at age 45. The ACS recommends that people who think that they be at higher risk of colon cancer—because of family history or a personal history of inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease)—talk with their doctor about the most appropriate screening option for them.

The case for colonoscopy

"The gold standard for colorectal cancer screening is really colonoscopy at this point in time," said Dr. Akbari. "Other screening methods can be useful in certain circumstances, but if they are positive (for example if a stool test shows blood), a colonoscopy is usually the next step." 

Research suggests that colonoscopy reduces deaths from colorectal cancer by about 60 to 70%.

In this test, the doctor uses a colonoscope (a flexible lighted tube with a lens for viewing and a tool for removing tissue) to look at the rectum and entire colon. Air (or carbon dioxide) is pumped into the colon to expand it so the doctor can see the colon lining more clearly.

During colonoscopy, any abnormal growths in the colon and the rectum can be removed. The colon needs to be completely cleared out so the doctor can get the best look at it.

For people with average risk, colonoscopy is recommended every 10 years.

Don't be afraid of colonoscopy

Unfortunately, only a little more than half of people who should get tested for colorectal cancer get the tests that they should, according to the American Cancer Society.

The procedure is usually covered by insurance. "Insurers understand that screening saves them money in the long run and are generally willing to cover the test," said Dr. Akbari.

You'll be given detailed instructions about preparing for the test (bowel prep), which includes fasting and taking laxatives.

"Today's bowel preps are less volume and easier to tolerate than the older ones," Dr. Akbari said. "They are simply laxatives that clean your system out. Sure, they don't taste great, but they are certainly worth the benefits."

During the actual exam, which takes about 30 minutes, you'll most likely be sedated and kept comfortable.

"The colonoscopy itself is a breeze to most people," added Dr. Akbari. "It's not uncommon for people to say," So when do we start?' when they are waking up afterwards."

Other types of screening tests

There are other tests that find polyps and cancer. Talk to your doctor about which test is right for you.

Stool tests

A sample is collected and sent to the lab to look for blood in the stool. These include Guaiac-based fecal occult blood test (gFOBT) and fecal immunochemical test (FIT).

A stool DNA test (FIT-DNA) checks for abnormal sections of the genetic material DNA from cancer or polyp cells.

Stool tests are recommended every one to two years.

Double-contrast barium enema

This is an x-ray test of the colon and rectum.

Sigmoidoscopy

A flexible, lighted tube is put into the rectum and lower colon to check for polyps and cancer. Air (or carbon dioxide) is pumped into the colon to expand it so the doctor can see the colon lining more clearly. The lower colon must be cleared of stool before sigmoidoscopy, but the preparation is less extensive than that required for colonoscopy. People are usually not sedated for this test. Abnormal growths can be removed for testing (biopsied).

Sigmoidoscopy is recommended every five years (with or without stool tests).

CT Colonography (Virtual colonoscopy)

A procedure that uses a series of X-rays called computed tomography to take a series of pictures of the colon. A computer puts the pictures together to create detailed images that may show abnormalities on the inside surface of the colon.

CT colonography is recommended every five years.

About Doylestown Health Colorectal

Doylestown Health Colorectal Specialists provide expert assessment, diagnosis, and treatment for a wide range of disorders of the colon, rectum, anus and small intestine. Our board-certified physicians offer compassionate, personalized care, continuing patient education and state-of-the-art technology, using advanced colon and rectal surgery and minimally invasive robotic surgery techniques.

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