Lester Rosen, MD – Cleveland Clinic Colorectal Surgeon
Colon cancer is the second most common cause of cancer death in the United States. Approximately one out of every 18 people will develop colorectal cancer in their lifetime. Find out what you should know about colon cancer – Lester Rosen, MD, Cleveland Clinic colorectal surgeon, shares some important facts.
Is colorectal cancer preventable?
When colon cancer is found at an advanced stage, the chance of cure is much less than when it is detected early. Fortunately, colon cancer is preventable by having regular checks of the colon called screenings. Colon cancer can be formed within a growing polyp, and colonoscopic removal of a "young" polyp without cancer prevents colorectal cancer, while colonoscopic removal of a polyp with early cancer can be curative. Flexible sigmoidoscopy is recommended every five years with annual hemoccult.
All patients should read their colonoscopy report to ensure that their bowel preparation was acceptable, and their exam was complete to the end of the colon called the Cecum. Colonoscopy is the best test available, however, polyps can be missed in various clinical situations. Even if cancer is found, it is curable in over 90% of patients, if caught early. Most polyps and curable cancers do not produce symptoms. Therefore, do not wait for symptoms to develop, see your doctor for colon checks on a regular basis while you are feeling well.
Who is at risk of colorectal cancer?
We are all at risk of developing colorectal cancer. Over 75% of patients who get colorectal cancer have no identifiable risk factors. However, some patients either have a personal history of colorectal polyps or cancer, ulcerative or Crohn's colitis, or a strong family history of colon cancer. These patients are at moderate to high risk. The risk is particularly strong if the first degree relative with cancer was less than age 50.
Symptoms of colon cancer include a change in bowel habits, abdominal pain, rectal bleeding or anemia. Patients with symptoms should have an examination of the whole colon called colonoscopy. Also, a risk factor is age greater than 50. For this reason, people with no symptoms or any of the risk factors should be screened for colorectal cancer starting at age 50.
Screening Options include:
- Fecal blood testing (FOBT) every year: This is a test on smears of stool. It can detect microscopic blood by a chemical reaction. The test is positive if any of six windows change to a blue color. If it is positive, a colonoscopy should be performed.
- Flexible sigmoidoscopy every 5 years: This is a test where a physician passes a thin, flexible tube into the lower colon and examines the lining. It is done in addition to the yearly fecal occult blood testing. If an adenoma is found during the flexible sigmoidoscopy, a colonoscopy should be performed to remove the polyp and search for polyps higher in the colon. It is recommended that flexible sigmoidoscopy be combined with an annual FOBT.
- Barium enema plus sigmoidoscopy: A barium enema is an x-ray. It is not accurate enough to check for colorectal polyps and can even miss cancers. It should not be used for colorectal cancer screening unless a colonoscopy cannot be performed. If it is used, it should be coupled with a flexible sigmoidoscopy to see the part of the lower colon that is not well seen on x-ray.
- Colonoscopy every 10 years:
Colonoscopy is a test where a thin flexible tube is inserted into the complete colon. If the examination results are normal, this test is done every 10 years. Colonoscopy is the preferred colon cancer screening test. It is also the test of choice if patients have any symptoms that could be suggestive of colorectal cancer such as intestinal bleeding, unexplained abdominal pain or change in bowel habits. No additional FOBT or sigmoidoscopy should be done between colonoscopy examinations. If any polyps are seen during the exam, they should be removed and sent to the laboratory for analysis. If adenomas are found, generally follow up colonoscopy is performed in 3 to 5 years. Many patients with adenomas require lifelong colonoscopy at 3 to 5 year intervals.
Cleveland Clinic Florida’s Digestive Disease team is comprised of colorectal surgeons, gastroenterologists, general surgeons and other specialists. They work collaboratively, in order to provide the most accurate diagnosis and individualized treatment plans for conditions such as colon cancer, irritable bowel syndrome, Crohn’s and Colitis, liver and pancreatic cancers, as well as many others. This team effort allows for the best outcome in patient care.