Colon and Rectal Cancer: The Facts

What is it?

The colon and rectum are part of the digestive tract and together make up the large intestine. Colorectal Cancer (cancer of the Colon or Rectum) begins as a small growth in the lining of the colon or rectum. These grape-like growths may eventually form malignant, or cancerous, tumors. It is not known exactly what causes Colorectal Cancer, but there are certain risk factors that increase one's probability of developing it. Who gets it? The majority of people with Colorectal Cancer (9 out of 10 people) are over the age of 50. However, in some cases this type of cancer can, and does, develop at a younger age.

There are certain risk factors that increase the chances of developing Colorectal Cancer at any age. Some of the most common factors are:

• Strong family history of Colorectal Cancer or polyps
  
• Previous personal history of polyps or inflammatory bowel disease
  
• High fat, low fiber diet
  
• Smoking and excessive drinking
  
• Obesity and lack of exercise
  

In the U.S. this year, an estimated 129,400 people will be diagnosed with Colorectal Cancer. Men and women in Rhode Island have over a 10% higher chance of developing colon cancer than the national average. The average person has a 1/18 chance of developing Colorectal cancer at some point in their lifetime. Contrary to popular belief, women are affected by Colorectal cancer almost as frequently as men. In fact, Colorectal Cancer is the third leading cause of cancer death among women.

How is it detected?

Men and women over 50 not in a high-risk group (see above) should use the following guidelines:

• Fecal Occult Blood Test: Annually
  
• Sigmoidoscopy: every 5 years
  
• Colonoscopy: every 10 years
  
• Barium Enema: every 5-10 years
  

*Those in a high risk group, especially family history of colorectal cancer, should begin the above screenings at age 40 and have a colonoscopy every 3-5 years.

African-Americans are at a higher risk than non-Hispanic whites and should begin screening at ages 40 to 45.

Clinical Screenings

Some of the most common procedures used to screen for Colorectal Cancer include:

• Rectal Exam (digital rectal exam or DRE): During an office visit, the doctor or health care provider inserts a gloved finger into the rectum to feel for anything not normal. This simple test, which is not painful, can detect many rectal cancers.
  
  
• Fecal Occult Blood Test: A chemical test that can detect blood in a bowel movement, a symptom of Colorectal Cancer. A sample of stool is examined for blood. A test kit will explain how to take a sample at home. It is then returned to the doctor's office to be checked.
  
  
• Sigmoidoscopy: A visual examination of the lower portion of the colon and rectum. A slender, lighted tube is placed in the rectum. This allows the doctor to look at the inside of the rectum and part of the colon for cancer or polyps. This can be performed by most gastroenterologists and many internists.
  
  
• Colonoscopy: A visual examination of the entire colon and rectum, performed while the patient is sedated. A longer, flexible tube is placed through the rectum into the colon. It is long enough to reach the full length of the colon. The tube is linked to a video camera and display. The doctor can look at the picture to find cancer or polyps. Because the tube is longer, the doctor is able to see much more of the colon's lining. Polyps can be removed using a wire loop that goes through the tube. Pieces of the polyp can be sent to a lab to see if cancer cells are present. If the doctor sees anything unusual, a biopsy may be done. A small piece of tissue is taken out through the colonoscope. The tissue is sent to the lab to see if it is cancerous or benign.
  
  
• Barium Enema (double contrast barium enema or barium enema with air contrast): An x-ray examination of the entire colon and rectum. An enema of a chalky substance is used to partly fill up and open the colon. Air is then added to expand the colon. After that, x-ray films are taken.
  

Symptoms

In most cases, having symptoms means having a later stage disease, which is why screening for early detection is so important.

Common signs and symptoms sometimes associated with colorectal cancer include:

• A change in bowel habits
  
• Diarrhea, constipation, or feeling that the bowel does not empty completely
  
• Blood (either bright red or very dark) in the stool
  
• Stools that are narrower than usual
  
• General abdominal discomfort (frequent gas pains, bloating, fullness, and/or cramps)
  
• Weight loss with no known reason
  
• Constant tiredness
  
• Vomiting
  

These symptoms may be caused by colorectal cancer or by other conditions. It is important to check with a doctor.

Is it curable?

When detected early enough, Colorectal Cancer has a survival rate of over 90%. Unfortunately, only 37% of cases are detected at this early stage. Colorectal Cancer detected in later stages have increasingly lower survival rates. Early detection can mean the difference between life and death.

Rhode Island residents have survival rates that are about 20% lower than the national average. The biggest factors in increasing survival rates are prevention and early detection. Prevention and early detection greatly increase your chance of survival.

It's easier to prevent cancer than to treat it....

Certain lifestyle and dietary habits can greatly reduce your risk of developing Colorectal Cancer (as well as other cancers). Some of these include:

• Regular exercise
  
• Low fat, high fiber diet*
  
• Not smoking
  
• Moderate, if any, consumption of alcohol
  
• Taking one aspirin a day
  

*Recent Clinical Trials have found that adopting a low-fat, high-fiber diet for 3 to 4 years does not influence the reappearance of polyps. Previous recommendations were based upon traditional diets of whole populations and long-term (10-20 years) data in other studies. These new trials are important because they may show that short-term dietary changes may not be as effective as a lifetime commitment to change.

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