Colon Cancer

Are you 50 years or over? Do you have a family history of colon cancer or polyps? Do you have colitis or Crohn’s disease? Do you have a history of colon polyps or cancer? Do you have a history of prostate, breast, uterus, ovarian or cervical cancer? Do you smoke or drink excess alcohol? Are you Hispanic or African American in ethnic origin? Are you significantly obese?

If you answer yes to any of these questions , you may be at a higher risk for developing colon cancer & polyps.

If polyps are found during the colonoscopy, the specialist would have removed and sent it for microscopic examination - biopsy.

If the biopsy shows that the polyp

1. is cancerous- you may need surgery to remove the portion of the colon where the polyp was removed.
2. is precancerous - (all variety of adenomas) - you will need a periodic colonoscopy at a a regular interval depending on the number of other risk factors you may have -such as family history of colon cancer, number & size polyps you had & how "bad" the precancerous polyps were on biopsies.
3. Hyperplastic- usually of no concern. However, this subject has become a debate point lately & some scientists do believe that these polyps too may be a sign that you are at a risk of developing precancerous polyps later on.

There are other rare types too but that subject is beyond the discussion in this forum.

The purpose of the screening colon test is 1. look for colon cancer 2. look for precancerous polyps & remove them so that cancer can be prevented.

Colonoscopy is the only test which can do the second task & it has the highest sensitivity & specificity out of all the other tests. As such the preferred test is colonoscopy. However, this test involves sedation with medications & has a slightly higher risk of complications than the other tests. As such, very frail, elderly people or people who have severe multiple medical problems or problems with sedation or worried about the risks may consider other "less " invasive tests such as testing for hidden blood in the stool, CT colography & Barium x rays etc. If these tests become abnormal, then colonoscopy will be indicated to find what this "abnormality" is.

If your PCP suspects colon cancer, the next step is to see a Gastroenterologist who will schedule a colonoscopy to confirm the diagnosis. Once this is done, surgery is likely the next step. Subsequent chemotherapy & radiation will depend on the extent of spread of cancer, age & the medical condition of the patient.

There is no link whatsoever between colon cancer & IBS. However, the problem is that some of symptoms of colon cancer are similar to that of IBS. As such, it is important to evaluate the digestive symptoms by appropriate investigations by physicians if indicated. I have seen colon cancer patients being "labelled" as IBS patients for several months until the late stages of the cancer & finally diagnosed by colonoscopy. Again, please be assured that IBS never leads to colon cancer.

The word Screening means that this is done to detect any disease before that person experiences symptom/s related to that disease. Colon cancer screening test is to look for colon cancer & precancerous polyps. There are many tests available but the gold standard test is colonoscopy. Others include testing stool for occult/hidden blood by chemical, Barium enema xray, CT scan of the colon (also called virtual colonoscopy or colography) & flexible sigmoidoscopy. All have their own short comings & I will explain as to what a colonoscopy entails as colon screening is almost synonymous with colonoscopy.

Colonoscopy is a direct visual examination of the large intestine (colon) using a lighted flexible video endoscope. This flexible video camera ( looks like a 1cm diameter rubber tube) is introduced in to the rectum & advanced all the way to the entire colon, inspecting for polyps & cancer. This is done under sedation as an outpatient and takes usually 20-30 minutes to complete the procedure. Precancerous polyps can be removed during the colonoscopy. One needs to clean the colon with laxatives prior to the colonoscopy. As this is done under sedation, she/he cannot drive home on their own after this test. An adult needs to accompany & transport her/him home.

For more information on colon cancer & related issues please visit http://www.fightcolorectalcancer.org.