By MOIN KOLA, MD
As COVID-19 has surged and patients are choosing to delay much needed diagnostic care, I wanted to emphasize for patients and primary care physicians the importance of early screening for colon cancer.
Colon cancer is the fourth most common cancer diagnosed in men and women in the United States. Colon cancer is the second leading cause of cancer deaths in men and women in the United states. It is estimated that around 150,000 of new colorectal cancers will be diagnosed in the United States in 2020. The rate of new diagnosis of colorectal cancer per year in men is 42.1 per 100,000 men and 32.3 per 100,000 women. Increasing age appears to be the most important risk factor. African Americans appear to have slightly more incidences compared to other ethnicities at an overall rate of 40.4 per 100,000 in men and women combined. Recently, with the advent of new therapies, the current five-year survival rate with colorectal cancer is around 63 percent. Factors that may increase the risk of colorectal cancers include increasing age, African American ethnicity, personal or family history of colon cancer or polyps, sedentary lifestyle, high fat diet, obesity, Diabetes, cigarette smoking, drinking alcohol and personal history of Inflammatory Bowel Disease like ulcerative colitis.
Colon cancer is asymptomatic in the initial stages. As it grows, it leads to symptoms like rectal bleeding, change in bowel habits like constipation, erratic bowel habits or diarrhea. Other possible symptoms include sense of incomplete evacuation, loss of weight or appetite, abdominal pain or development of anemia. Any such symptoms should prompt patients to seek medical intervention to detect colon cancer at the earliest stage.
Most colon cancers start with a polyp, a small lump in the colon. Over a period of time, this grows and at a certain stage it makes a biological switch from benign to malignant. It is, therefore, possible to detect this disease at the benign stage when it is a polyp that can be resected and stopped from progressing to cancer.
There are several colon cancer screening tests. However, the most effective and commonly performed test is a colonoscopy. During this procedure, the doctor inserts a small tube with a camera mounted on its tip to examine the colon under intravenous sedation. The colon needs to be cleaned out a day prior to the colonoscopy so the doctor can take good look into the colon, then evaluate for the presence of polyps or cancers. The bowel clean-out typically involves drinking a clear liquid diet and some sort of bowel cleansing solution a day prior to the colonoscopy. On the day of the colonoscopy, the individual will need to be accompanied by a responsible adult to drive them home. If a polyp is seen on the colonoscopy, it will be resected and submitted for pathology to determine its nature. Colonoscopy is generally a safe procedure. Few of rare risks of colonoscopy includes a reaction from sedation or anesthesia, bleeding from site of biopsy or polyp resection or a perforation in the colon or rectum. The recovery from the procedure and sedation is fairly quick. The doctor will go over the results of the procedure and typically give a copy of the report after procedure. The interval between colonoscopies is determined by several factors like type of polyp, pathology of the polyp, size of polyp, nature of bowel preparation and family history of colon cancer or polyp.
The other modalities of colon cancer screening include stool tests and abdominal CT scan or CT colonography. The two kinds of stool tests are first, detection of occult (hidden) blood in the stool and second, detection of abnormal DNA in the stool called cologard. The stool tests are available as options for colon cancer screening in average risk populations. CT colonography is a noninvasive exam that involves performing a CT scan of the abdomen that uses advanced computer software to examine the colon. If any of these tests are positive, then a colonoscopy should be undertaken to evaluate for colon cancer.
The stool test for occult blood was first introduced to detect colon cancer. However, this concept has evolved over the years. The emphasis now is to prevent colon cancer. This is possible if the lesions can be detected when they are at the polyp stage so they can be removed before they turn into cancers. This is best achieved with colonoscopy which allows detection, resection and removal of polyps.
There are no interventions available to prevent colon cancers. However, certain lifestyle measures may help to reduce the risk of developing colon cancers. These include no cigarette smoking, consumption alcohol in moderation, maintaining healthy body weight, regular exercise and consumption of a high fiber diet.
Dr. Moin Kola is a Board-Certified Gastroenterologist with the Digestive and Liver Center of Florida who has provided Gastroenterology services in Central Florida for 10 years. Dr. Kola completed his Gastroenterology fellowship at Case Western Reserve University and Inflammatory Bowel Disease (IBD) visiting fellowship with Crohn's and Colitis Foundation of America at the Cleveland Clinic.
He began his gastroenterology training in England and holds the distinction of being a member of Royal College of Physicians of the United Kingdom.
Dr. Kola's expertise include colon cancer screening, gastroesophageal reflux disease, peptic ulcer disease, inflammatory bowel disease, celiac disease, irritable bowel syndrome, fatty liver disease and various and various other gastroenterology and liver disorders. Dr. Kola is a member of American College of Gastroenterology (ACG) and American Society of Gastrointestinal Endoscopy (ASGE).