Colon Cancer: It doesn’t have to kill you

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Americans still do not know the relatively easy steps for minimizing the effects of colorectal cancer. Colorectal cancer, cancer of the colon (the large intestine) and rectum (the lowest part of the colon), is the third most common cancer in the United States, with colon cancer the more prevalent. The American Cancer Society estimates that every year there will be 106,680 new cases of colon cancer and 41,930 new cases of rectal cancer. Of those affected by both, about one-third—55,170 people—die.

The Risk Factors
Colon cancer is a very slow-growing cancer and is relatively easy to cure in the early stages. Right now for most people, we recommend a baseline screening, called a colonoscopy, at age 50. Assuming everything is normal, you won’t need another screening for about 10 years. Other risk factors might encourage your doctor to recommend cancer screening earlier or more often. Family history is a large risk factor. A report at the latest conference of the American College of Gastroenterology (the doctors who perform the colonoscopies) found the prevalence of colon polyps (an indicator for colon cancer) was 48 percent for African-Americans, but only 29 percent in Caucasians and 27 percent in Hispanics. We don’t know why, but because of this higher risk, it’s now recommended that African-Americans start regular screenings at age 45 instead of 50, and perhaps even younger if there’s a family history.

Screening Test for Colon Cancer
The good news is that, thanks to improvements in screening methods, the death rate for colon cancer has gone down; the American Cancer Society says it’s dropped 15 percent in the last 15 years. The bad news is not enough people have colonoscopies. Whereas 86 percent of women get annual Pap smears to look for cervical cancer and 75 percent of men have regular screenings to check for prostate cancer, only 45 percent of Americans have colonoscopies—even those at risk. Other tests include an annual fecal blood test and a sigmoidoscopy, which examines only about one-quarter of the colon. 

What Is a Colonoscopy?
A colonoscopy is an outpatient procedure performed by a gastroenterologist. The test admittedly can be a bit uncomfortable for the patient. That’s why you’re given a mild sedative before and are kept for an hour or so afterward to make sure it has worn off. Still, we recommend you don’t go alone, especially if your only way of getting home is to drive. There’s more preparation for a colonoscopy than for, say, a mammography, but considering the payoff—especially since the test is  only needed once every 10 years for most people—it’s worth the effort. Your intestine has to be cleansed the night before, so you shouldn’t eat after 6 p.m., except for light broth or other recommended fluids. You will also need to take a laxative. Some doctors also recommend a drink like Gatorade to help keep your electrolytes stable during this cleansing.

The test involves inserting a small, slender tube about the thickness of a finger into the colon. Small puffs of air are used to keep the colon open so the doctor can see clearly. It all takes about 15 minutes to a half hour. Some patients experience cramping for a short time afterward. It is possible for the tube to perforate the colon, but that is an extremely rare occurrence and the colon can be repaired.

During the colonoscopy the doctor is looking for growths called polyps. Most polyps are noncancerous, especially if they’re small. If the doctor sees any, they’re easily removed right there to avoid the risk of their becoming cancerous. Only when something unusual is seen does the patient have to submit to other steps.   

Dr. Sorra, a gastroenterologist, is president of the medical staff at Long Island College Hospital.