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Who Gets Colon Cancer?

By Tim Turnham, PhD, Chief Executive Officer of the Colon Cancer Alliance.

Who gets colon cancer? Unfortunately, a lot of people, and people from every walk of life.

She is not quite 60 and has taken care of herself all of her life: trips to the gym; a long-time vegetarian; regular checkups with her doctor. None of that matters now, though—she is dying of a cancer she never should have had to face.

Standards of care specify that everyone should be screened for colon cancer at age 50, if not before. But no-one ever told her. If she’d been screened, they would have found abnormal cells in her colon and removed them before they ever had the chance to become cancer. Now, instead of being cancer free, she is dying. The cancer has spread through her body. She will not live to see her grandchild graduate from college, or to celebrate her 50th anniversary.

Her story, in many ways, is typical. Most people who get colon cancer are over 50 years old. They are poor or rich. Health nuts and couch potatoes. All races. All incomes. All levels of education. One out of 18 people in the United States will be diagnosed with colorectal cancer. For the vast majority of them, the one unifying factor is this—they were not screened when they should have been.

Colorectal cancer is a cancer located in what is more commonly called the large intestine. It makes sense that cancers would from there. After all, cells in this 6-foot long tube are exposed continually to the components in our food that the body cannot use. For the most part, we are able to deal with the damage this causes. The body’s natural mechanisms get rid of damaged cells and we never know the difference. We can help our body out in this process. Living an active life helps. Eating less fatty food helps. Avoiding obesity helps. All of these factors, though, help in ways that are measurable, but rather modest. Some people’s genetic make-up means that their body is not able to deal with the odd cells as well as it should. And sometimes a cancer starts just through bad luck. In fact, 75 percent of patients with colorectal cancer have no family history of the disease. That is why screening is so important.

Colorectal cancer starts as a group of abnormal cells called a polyp. Not all polyps become cancers, but all colorectal cancers start as polyps. As a polyp develops into a cancer it starts growing. Sometimes it grows into the large intestine, and ultimately causes blockage. Sometimes it bleeds into the intestine. But, sometimes it grows away from the intestine and invades other tissues. When this happens you don’t generally feel any pain or experience any symptoms. Most patients with colorectal cancer are diagnosed after the tumor has eaten through the intestine and has spread cancerous cells into the lymph system and surrounding tissue. A disturbingly high number of people are diagnosed after the cancer has already caused tumors in other organs, like the liver or lungs. Once this happens, the chances of living another five years are less than 10 percent.

The only way to know for sure that this isn’t happening to you is to be screened. What is screening for colon cancer? Unlike mammography for breast cancer, several different screening approaches are available for colorectal cancer. Each has their benefits and drawbacks. By being informed you can choose what is best for you. Here are some screening tools:

Flexible Sigmoidoscopy: Your physician will insert a short probe into the rectum to examine the first several inches of your lower intestines. This is considered an acceptable screening technique, but it only sees the first part of the colorectal area. Some critics of this technique argue that it is like a woman having a mammogram on only one breast.

Fecal Occult Blood Test (FOBT): This is a chemical test that looks for traces of blood in the stool. Blood can come from a number of different health problems, so a positive test does not mean that you have colon cancer. Also, some clusters of abnormal cells, or polyps, do not bleed. So a negative test does not mean that you have no abnormal, pre-cancerous cells. This is an old test, using chemicals derived from tree bark. Newer versions of the test use antibodies to detect blood (iFOBT) and are more accurate and sensitive. These tests are inexpensive, but must be conducted every year to be effective.

Colonoscopy: This test can offer the best picture of colon health, but it is also the most expensive and requires the most work. The night before the test, you take a “prep” that causes diarrhea and empties the bowel. You are given anesthesia for this test, so you need to take the day off work and to have someone drive you home. The doctor uses a flexible scope with a light and camera on the end. This scope is inserted through the rectum and travels through about six feet of intestine. Any abnormal cells are removed during the procedure, before they have the chance to become cancerous. If the colonoscopy shows no problems, you will probably not need to be tested again for 5 to 10 years.

Novel Approaches: Many new tests are being developed. A virtual colonogram uses x-ray technology to create a digital image of the colon. This still requires that the bowel be prepped, but a “prep-less” version is under development. In another approach, miniature cameras are mounted in a clear plastic pill. You go to the doctor’s office in the morning, swallow the pill and are given a small monitoring device to wear during the day. As the pill goes through the colon, the cameras send digital images to the monitor. The pill gets flushed away. Finally, a new stool-based test looks for proteins that are shed by cancer cells. This promises to be more accurate than the FOBT, but may not indicate if polyps are present.

Most people should get screened when they turn 50, but there are a couple of exceptions. If you have a family history of colon cancer or of polyps, you should get screened earlier. And, while most people have no symptoms, if you do experience blood in your stool, abdominal pain, or prolonged unexplained constipation you should ask about getting screened.

Finally, colon cancer is not just reserved to older people. Every year about 15,000 people are diagnosed with early onset colorectal cancer.

He is in his 20’s, far too young to have colon cancer. He had all the indications, though, and had them for months. A simple test would have determined the presence of cancer and put him into treatment early in the disease progression. His doctors dismissed this possibility and failed to prescribe the test.

Two years went by before someone finally took his symptoms seriously. By this time the cancer had spread to his liver and his lungs. His chances of seeing his 30th birthday are less than 10 percent.

So this is the bad news—most colorectal cancer has no symptoms, no family history, and no cause directly related to diet. The good news, though, is that with simple screening you can reduce your risk of having this disease by more than 80 percent. Who gets colon cancer? Bottom line, the vast majority of people who get this cancer are those who did not get screened when they should have.

For more information about how you can protect yourself and your loved ones visit the Colon Cancer Alliance at www.ccalliance.org.




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