Colon and Rectal Cancer Detection and Treatment
Carrier Pigeon - Courier News Weekly
September/October 1999

by John H. Marks, MD, Colorectal Surgery, Lankenau Hospital

Colon and rectal cancer is the most common internal cancer afflicting men and women in Eastern Pennsylvania, and the second leading cause of cancer deaths in the United States. What makes this so regrettable is that this cancer is preventable. Colorectal cancer is almost always preceded by a non-malignant polyp, which can be found through relatively minor screening methods (colonoscopy). The polyp can be extracted and cancer prevented. When colorectal cancer does develop and is detected and treated early, the cure rate is well beyond 90%.

The colon is the passage which joins the small intestine to the rectum, ending at the anus, the opening where waste matter passes out of the body. Colorectal cancer develops from a combination of genetic (hereditary) and environmental factors. If we identify an hereditary risk, regular screening programs reduce the risk of cancer. We can also modify environmental risk factors such as the western high fat, low-fiber diet.

People with one or more first degree relatives (a parent or sibling, for example) who have had colorectal polyps or cancer are at high risk for developing the disease, as are those who have had cancer in the colon or rectum. Ashkenazi Jews (those of European descent) are at higher risk, as well as people with breast or uterine cancer or those who have had external abdominal irradiation, long-standing ulcerative colitis, or Crohn’s disease.

Symptoms of colorectal cancer are uncommon and may appear late in the disease. They include a change in bowel habits such as diarrhea or constipation lasting over time; unexplained weight loss; unexplained abdominal discomfort such as pain or bloating; and/or rectal bleeding. If you are having any of these symptoms, contact your physician immediately.

The most important factor in successful and less-extensive treatment of colon cancer is early detection through regular screenings. People at risk should have their stools checked for blood annually starting at age 40. At age 50 (and some of us advocate starting earlier, at age 40 or 45), they should have a flexible sigmoidoscopy in conjunction with a one-time barium enema study. Flexible sigmoidoscopy should be performed at three- to five-year intervals until the age of 50, when it should be done annually. A barium enema or colonoscopy may be performed every ten years. Flexible sigmoidoscopy is a short and painless procedure, usually performed in a physician’s office with minimal inconvenience. For a colonoscopy, the patients are examined comfortably under sedation usually in an outpatient facility.

For people at high risk, colonoscopy should begin at the age of 40. (Those individuals with a very strong family history of colorectal cancer in conjunction with other cancer should start screenings at the age of 25.) Except in the very high-risk patient, if the colonoscopy is negative, the procedure should be repeated every three years; if polyps are found, it should be repeated in one year. Flexible sigmoidoscopy should be performed in the off years. Of course, these recommendations are general – your physician will discuss with you his or her specific recommendations.

If abnormalities are discovered with a flexible sigmoidoscopy, a colonoscopy should always be done. The vast majority of polyps can be removed during the colonosocopy. If a removed polyp is cancerous, it may require no further treatment, or simple abdominal surgery. To operate on colon cancer, we are now selectively using minimally-invasive techniques (laparoscopy) that get patients out of hospital more quickly and feeling better faster. The National Cancer Institute is conducting a high-priority trial to evaluate laparoscopic colectomy for cancer, and I am the only colorectal surgeon in the tri-state area involved in this trial.

People may delay screenings because of embarrassment and fear that if something is found they will have to lead a life with a colostomy – voiding into a bag outside the abdomen. Our leading-edge research, sometimes using radiation or chemotherapy with special surgical techniques of our design, makes a permanent colostomy almost never necessary for colon cancer and rarely necessary for rectal cancer.

Next on the horizon may be a test that uses a simple blood sample to find as few as five cancerous cells in 50 million blood cells. This technical advance, which I recently presented at a national meeting, may allow us to monitor cancer treatment response and to detect early recurrence. It may someday serve as a screening test.

We can do much to change colorectal cancer from an unmentionable to a preventable disease by remembering that screening and surveillance examinations reduce our risk for colorectal cancer, as does following a high-fiber diet, which is low in animal fat, particularly beef. Certain protective elements may be selenium, as well as nonsteroidal anti-inflammatory drugs and aspirin. By following these simple guidelines, we don’t have to be afraid of the dark.