Colorectal cancer: Prevention starts with screenings

Colorectal cancer – or cancer of the large intestine – is the second leading cause of cancer-related deaths for both men and women in the United States. However, it is also considered one of the most preventable cancers. With regular screenings, polyps – or unwanted growths in the colon – can be detected and removed. So why aren’t we catching this early and saving more than 50,000 lives every year? The answer is simple: people aren’t getting screened.

We sat down with Jane Bolin, Ph.D., professor at the Texas A&M Health Science Center School of Public Health, and Vanessa O’Neal, community outreach coordinator with the Cancer Screening, Training, Education and Prevention (C-STEP) program, to find out the basics of colorectal cancer screening and prevention.

Signs and symptoms

While detection before symptoms begin is the best way to prevent colorectal from progressing, it’s important to be familiar with common symptoms and warning signs:

• Change in bowel habits, such as diarrhea, constipation or narrowing of stool that lasts for more than a few days
• A feeling that you need to have a bowel movement that is not relieved by doing so
• Rectal bleeding
• Bloody stool, which may make it look dark
• Cramping or abdominal pain
• Weakness and fatigue
• Unintended weight loss

“During the early stages of colorectal cancer, there may be no symptoms present, which is why it’s important to screen for early detection,” Bolin said.

The colonoscopy

While the idea of having a colonoscopy probably fills people with an understandable amount of apprehension, getting screened regularly after the age of 50 is the best way to detect polyps.

For those with a family history of colorectal cancer, talk with your physician about starting screenings at the age of 40, or 10 years before the youngest case of polyps or colorectal cancer occurred in your family.

For individuals at average risk for colorectal cancer, it is recommended that they have a colonoscopy every seven to 10 years. Those with a family history of colorectal cancer should consider more frequent screenings.

So what should you expect before, during and after a colonoscopy?

A colonoscopy is usually done in a clinic setting by a physician that has received specialized training in the procedure. The afternoon or evening before the procedure, patients will ingest a prep drink, similar to a laxative. The drinks are designed to clear out your digestive tract, emptying the colon. Cleaning out the system allows the physician to get a better view of the entire colon so that even the smallest polyp could be detected. After all, it only takes one polyp to develop cancer. Additionally, patients will be asked to avoid eating solid foods a day before the procedure.

The colonoscopy itself should only take a few hours. Beforehand, the physician will sedate the patient and depending upon the physician’s guidelines the patient may be completely sedated or undergo a conscious sedation. A colonoscope – a thin, flexible tool with a camera and light attached at the tip – will be inserted through the anus and move slowly through the rectum and colon to look for polyps and cancer. During the colonoscopy, the patient may feel like they need to have a bowel movement or some cramping, but it is important to breathe deeply and relax stomach muscles. If a polyp is found, it will be removed during the procedure.

After the colonoscopy, the patient may need to remain at the clinic for an hour or two before they are released. Since air is pumped into the intestine during the procedure, patients may experience gas for a few days afterwards. If a polyp was removed during the procedure, the individual may find blood in their stool for a few days. The physician will explain when regular diet and activities can be resumed.

Alternatives to the colonoscopy

While colonoscopies are the most thorough way to detect cancer, there are some alternatives methods of screening that require more frequent testing, for those who prefer less invasive methods:

• Double-contrast Barium Enema should be conducted every five years. The test uses x-rays to find abnormalities such as cancer or polyps
• CT Colonography (Virtual Colonoscopy) also uses x-rays to detect polyps or cancer. It should be done every five years.
• Fecal Occult Blood Test (FOBT) tests stool samples for hidden traces of blood. In contrast with other alternatives, FOBT should be done annually.
• Fecal Immunochemical Test (FIT) is another stool test that searches for latent blood and should be conducted every year
• Stool DNA Test is a recently approved screening method for colorectal cancer. The test examines DNA in a stool sample for certain gene changes that are present in colon cancer cells. This method of screening should occur every three years.

“If any of these methods result in a positive test result, a colonoscopy should then be done,” Bolin explained.

Lifestyle changes to reduce your risk

Other than regular screenings, there are some additional changes you can make to reduce your risk of developing colon cancer. Exercising for at least 30 minutes, five days a week can help you maintain a healthy weight and lower your risk. Try to consume more fiber through vegetables, fruit and whole grains, while limiting your intake of red meats and alcohol.

“Colorectal cancer can largely be prevented by maintaining a healthy lifestyle and having preventative screenings,” Bolin said. “ In fact, the Centers for Disease Control and Prevention reports that deaths from colorectal cancer could be reduced by 60 percent if everyone age 50 and over had regular screening tests.”

That’s why efforts like the Texas C-STEP, run by Texas A&M Health Science Center, are so integral. The program, supported by the Cancer Prevention and Research Institute of Texas (CPRIT), provides financial assistance for colonoscopies to uninsured or underinsured residents in 17 Central Texas counties. For more information, visit the Texas C-STEP website.