This year, almost 150,000 people in the United States will get diagnosed with colon cancer. Almost 53,000 people will die. This makes colon cancer the second leading cause of cancer death in United States. Despite the dismal statistics, and unknown to most people, colon cancer is also the most preventable of all known cancers.
Reason colon cancer is the most preventable cancer is that it can be detected in the pre-cancer or benign stage, before it develops into an invasive cancer. This only takes a simple screening procedure, a colonoscopy that can detect ‘polyps, small benign growths that can be removed at colonoscopy and therefore never become cancer. By detecting these polyps with colonoscopy, you can literally ’nip colon cancer in the bud’ before it becomes a cancer.
While treating a full-blown colon cancer can be very involved with surgery, chemotherapy and radiation, removing a polyp is a simple 15 minute procedure (a colonoscopy) and survival is near 100%.
The best way to catch colon cancer in its benign, polyp stage is to get a regular screening colonoscopy. The age at which you get this screening depends on your so-called ‘risk factors’ which include your family history, smoking history, weight, age and other factors–see below.
General Signs & Symptoms of Colon Cancer
Unfortunately, there are no “early signs” of colon cancer. Colon cancer is almost always silent until it has grown to an advanced stage where bleeding, abdominal pain, change in bowel habits and other symptoms occur. The only way to detect early stages of colon cancer or colon cancer in the benign polyp stage is to do screening with colonoscopy or other screening tests for colon cancer. Sometimes, we use the metaphor of changing the oil in your car. It would be a bad practice to wait until you heard strain sounds coming from the engine of your car to change the oil. At that point, likely your engine would be ruined or greatly damaged. The way to avoid this situation is to routinely change the oil, sometimes this is called ‘preventive maintenance.’ The very same is true of colon cancer. Regular screening primarily with colonoscopy will prevent more serious damage, advanced tumors radiation chemotherapy and even worse.
Even if you do have ‘signs’ of colon cancer, in most cases this does not turn out to be colon cancer, it’s usually caused by hemorrhoids or other causes of bleeding. If you do in fact have colon cancer, it still possible to treat and ‘cure’ the cancer but it usually involves more extensive measures such as surgery, radiation chemotherapy etc. Colon cancers caught in the early stages result in better than 90% survival rates. Clearly, the preventative strategy utilizing screening colonoscopy is superior and much easier.
Normally, screening for colon cancer has traditionally started age 50, if you don’t have any of the additional risk factors such as smoking, family history, obesity, previous history of a polyp or history of inflammatory bowel disease like ulcerative colitis. If that is the case, then screening should begin at age 40. If you have had a family member with early onset colon cancer that is at age 50 or earlier, you should be screened when you are 10 years younger than that family member when they developed it. So for example, if your father had colon cancer at age 49, you should be screened at age 39.
Recent epidemiologic studies have indicated that colon cancer is actually increasing in younger patients less than the age of 53. This is interesting, because death rates from colon cancer in people older than 53 is declining, likely due to the increase utilization of colonoscopy screening to detect polyp and early stage colon cancer. Every year, there has been a 3% increase in the rate of colon cancer in younger patients. Recently, the American Cancer Society and some other medical professional organizations have recommended screening at age 45 for the general population that does not have any additional risk factors. Again, the sooner the diagnosis, the better! That is the better the outcome, the earlier a cancer or polyp is diagnosed.
What Do Doctors Look for During Colon Exams?
During a colorectal cancer screening called a colonoscopy, doctors are looking for abnormal tissues called polyps. The presence of polyps can indicate a risk of cancer, but removing them is a quick process. This can be done at the time of the colonoscopy and generally does not require any other procedures. Another type of colon cancer screening is the stool DNA test, also known as Cologuard. The doctor takes a sample of your stool and tests it for any DNA changes in your cells that could mean colon cancer or precancerous conditions are present. However, Cologuard does not detect large advanced polyps and some cases of colon cancer. In my personal experience (Dr. Keith Berger), I have found far too many incidences of cancers or large polyps not detected and many cases of false positives where there is no pathology despite the test being positive. Therefore, I do not recommend Cologuard over colonoscopy. The manufacturer themselves warning against using Cologuard when there are additional risk factors for colon cancer as well.
What Causes Colon Cancer?
No one really understands what causes colon cancer, but some of it is genetic but only a small percentage say 10% and the rest is probably from environment, diet etc. Colon cancer happens because of changes to the DNA in our cells. Cancer is usually caused by a DNA mutation. It causes cells to grow out of control.
Stages of Colon Cancer
The best way to beat cancer, as we said is to catch it early. When cancerous cells get detected early before cancer has spread to other organs, the odds of surviving increase dramatically. In fact, when colorectal cancer gets discovered early, the survival rate is as high as 90 percent. However, only 4 out of 10 colon cancers get caught early.
Stage 0 is the lowest level of colon and any type of cancer. A stage 0 colon cancer diagnosis means that cancer has not grown beyond the colon’s interior lining also known as the mucosa.
Stage 1 colon cancer means cancer has grown into the colon wall itself. It also means cancer has not spread outside of the colon wall or into the lymph nodes.
A diagnosis of Stage 2 colon cancer means it has penetrated the wall of the colon and into some of the nearby tissue. But, cancer has not yet spread to the lymph nodes.
A stage 3 diagnosis means cancer has spread to the lymph nodes. It also means cancer has not spread to any other organs or parts of the body.
Stage 4 colon cancer indicates that it has spread to other organs and tissues. Typically, colon cancer spreads to the liver first. It can also spread to the lungs, brain, and peritoneum.
Colon Cancer Risk Factors
Risk factors are anything that increases your chance of getting colon cancer. This could include something from your family history, so you should talk to your doctor to find out if you have any of the following risk factors. Keep in mind that having a risk factor does not in any way guarantee you will develop colon cancer.
MORE IMPORTANTLY, NOT HAVING A RISK FACTOR DOES NOT GUARANTEE THAT YOU WILL NOT GET COLON CANCER. IN FACT, 90% OF ALL COLON CANCERS OCCUR IN PEOPLE WITH NO RISK FACTORS. THEREFORE, YOU CANNOT USE THE ABSENCE OF RISK FACTORS TO PROTECT YOURSELF AGAINST COLON CANCER. YOU STILL NEED TO HAVE SCREENING!
A History of Inflammatory Bowel Disease
Having inflammatory bowel disease (IBD), ulcerative colitis, or Crohn’s disease increases your risk of colorectal cancer. If you suffer from any of these diseases, you should start getting screened for colon cancer earlier than age 45.
A History of Adenomatous Polyps
Having a history of adenomatous polyps, or adenomas, indicates a higher risk of developing colorectal cancer. Having many or large polyps puts you at an even greater risk. If you’ve ever had colorectal cancer you are also at greater risk of developing other types of cancers.
A Family History of Colorectal Cancer or Polyps
Although the majority of colon and rectal cancers occur in people with no family history of this particular cancer, as many as one out of three people with colorectal cancer have family members with the same disease. If you have a parent, sibling, or child with colon cancer, you are at an increased risk of developing it. The risk increases if any of your immediate relatives developed colon cancer before age 50.
Five percent of people who have colon cancer also have inherited genetic mutations related to cancer. The most common ones include Lynch syndrome and familial adenomatous polyposis.
If you are a smoker, your risk of colon cancer definitely increases. Therefore, we recommend early screening at age 40.
If you are greatly overweight or obese, you are also at higher risk for colon cancer. Therefore your screening should start at age 40 or 45.
Colon Cancer Treatment Options & Outcomes
Colon cancer treatment approaches and cancer care depend largely on the stage and type of cancer. Surgery is a most common method of treatment followed by radiation and chemotherapy. The type of outcome a person with colon cancer can expect depends on many factors, especially whether the cancer was detected during the early stages or after it had time to spread. Early-stage cancer has a better than 90% survival versus late stage cancers.
Colonoscopy is usually the only treatment required to treat stage 0 colon cancers. This involves removing the polyp or cancer area using a colonoscope.
Since stage 1 colon cancers have entered the layers of the colon wall, surgery usually takes care of it. There are newer forms of colon cancer surgery (robotic, laparoscopic, trans-anal minimally invasive surgery or TAMIS) that involve less invasion and recovery times are much quicker. It is possible that there will be no further treatment required if no cancer cells are present at the margins of the resected polyp.
If cancer cells are present at the edges of the polyp, further surgical or radiation therapy may be necessary.
Even with stage 2 colon cancer, surgery may be the only required treatment. The surgeon will remove any cancerous polyps and affected portions of the colon or lymph nodes. There are several situations in which your doctor may also recommend chemotherapy as part of colon cancer treatment. This is done when there is a chance that the cancer may return or spread even after surgery. Chemotherapy is important if the cancer appears abnormal, has grown into blood vessels or lymph nodes, or is obstructing the colon.
The treatment for stage 3 colon cancer begins with surgery to remove the section of the colon affected by cancer. After surgery, you will typically go through chemotherapy. Chemotherapy is standard for stage 3 cancers.
In some cases, when the cancer is more advanced, it may be advantageous to get radiation therapy in conjunction with chemotherapy. This can help to shrink or reduce the cancerous cells and area so they are easier to remove.
Surgery is unlikely to resolve state 4 colon cancer. Surgery will make it possible for you to live longer, but it will not cure the disease. Typically you will also receive chemotherapy and radiation therapy. When cancers metastasize it means cancer cells have spread to other organs in the body. This makes fighting cancer more complicated.
In some cases, your doctor will do surgery and then chemotherapy. In other cases, the surgeon will recommend chemotherapy and radiation therapy first to attempt to shrink the cancerous area before surgically removing it.
How to Lower Your Risk of Colon Cancer
The best way to lower your risk for colon cancer is to prevent it entirely by catching it in the benign polyp stage on a regularly scheduled screening colonoscopy. Colonoscopy is considered the ‘gold standard’ that is the most accurate test for screening for colorectal cancer. There are other tests such as fecal blood tests, CAT scans, Cologuard among others but these are much less accurate and can miss a late stage polyp or early cancer. There are also false positives particularly with Cologuard. Moreover, a colonoscopy allows of the opportunity to remove benign precancerous polyps which cannot be done with the other screening tests.
You can lower your risk of colon cancer by keeping your weight ideal, eating enough fiber, limiting your red meat and processed foods intake, avoiding smoking, excessive alcohol and staying physically active. Moreover, these health practices will lower your risk of heart disease and other cancers as well, and likely improve your life expectancy. While diet, fiber, exercise and avoidance of smoking and excessive alcohol and over eating can reduce the risk of colon cancer, this does not in any way eliminate your risk of colon cancer and we often find precancers and cancers in otherwise healthy people. Your best insurance policy is to get a colonoscopy.
Colon Cancer Takeaways
There will be approximately 150,000 new cases of colon cancer in the US this year with 53,000 fatalities making colon cancer the second leading cause of cancer death in the United States. The good news is that colon cancer is one of the most preventable cancers because of the opportunity to remove the benign precancerous polyps in the colon on a colonoscopy and thus ’nip colon cancer in the bud’ before there is any cancer at all. Colonoscopy should be done routinely starting between the ages of 40 and 50 depending on your risk factors at a time when you have no symptoms. Colonoscopy is a 15 minute procedure that can be done in a physician’s office (usually a gastroenterologist or colorectal surgeon) that is safe and comfortable and can save your life. Early detection with preventive screening colonoscopy is key.