March marks National Colorectal Cancer Awareness Month. Colon cancer causes more than 600,000 deaths annually worldwide and is the second-leading cause of cancer death in the U.S. However, with timely screenings, this cancer can be prevented. Dr. Chris Lascarides, a board-certified gastroenterologist at Stony Brook University Digestive Disorders Institute, talks about what people need to know about this disease.
What is the most important thing to know about colon cancer?
That it can be prevented. Colon cancer starts as polyps in the colon. It takes approximately seven to eight years for a polyp to develop into cancer, and during this time, a person may not experience any symptoms. Unlike other cancers, the cancer cells do not spread outside the polyp during this time period. Essentially, this means if you find and remove the polyp, you eliminate the risk of cancer. In all other cancers, we promote early detection because the earlier you start treatment, the better the outcomes. With colon cancer, early detection and removal of polyps means that cancer may not develop at all.
How is it detected?
There are several screening options. Colonoscopy is considered the gold standard because it is the only test that can identify and treat polyps in the entire colon. If a polyp is detected during screening, it often can be removed and biopsied at that time, eliminating the need for additional procedures. Once a polyp is found, we recommend that the patient have a colonoscopy to monitor any changes.
Depending on the number and size of the polyp, the doctor will determine the best interval between tests, ranging from three to five years.
While people often dislike undergoing a colonoscopy, it is important to know that recent changes make it a gentler experience. For example, Stony Brook uses different kinds of bowel preparations — some are even in pill form. The patient’s physician will determine which preparation the patient will best tolerate. In the past, patients remained awake for the procedure, but now, with innovations in anesthesia, patients undergo a short, fast-working and deep sedation that has minimal side effects, including no memory of the procedure.
Stony Brook offers additional screening methods, including flexible sigmoidoscopy, barium enemas and fecal occult blood testing. For patients who are reluctant to undergo a colonoscopy as their initial screening, we strongly recommend annual fecal immunochemical testing, which is more sensitive than fecal occult blood testing. If that test is positive, we suggest a follow-up diagnostic colonoscopy since there is an increased likelihood of finding an advanced colon polyp or colon cancer.
Another method, CT colonography or virtual colonoscopy, is less invasive than the standard method because it uses a CT scan to look at the lining of the colon. It still requires bowel preparation. If a polyp is detected, the patient will need an additional procedure to treat and biopsy it.
What are the guidelines for screening?
Men and women with no family history of colon cancer should have their first screening colonoscopy at age 50, then every ten years after that. For those at high risk, a colonoscopy is needed every five years. People with a family history of colon cancer should start screenings at age 40 or 10 years earlier than the age that their relative had cancer. For example, if your father had colon cancer at age 45, you should get your first screening at 35. Also, recent studies show that because African-Americans have a higher risk of colon cancer, they may want to start screenings at age 45.
What distinguishes Stony Brook’s approach?
Men and women with no family history of colon cancer should have their first screening colonoscopy at age 50, then every five years after that. Think of it as a preventive maintenance procedure similar to a check up. People with a family history of colon cancer should start screenings at age 40 or 10 years earlier than the age that their relative had cancer. For example, if your father had colon cancer at age 45, you should get your first screening at 35. Also, recent studies show that because African-Americans have a higher risk of colon cancer, they may want to start screenings at age 45.
If you are over age 50 and have not yet had a colonoscopy, schedule one soon by calling Stony Brook's Direct Access Screening Colonoscopy Program at (631) 444-COLON (444-2656).
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