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to Section One | to Arts & Entertainment
posted Friday, March 4, 2016 - Volume 44 Issue 10
HEALTH WATCH: Colorectal Cancer Screening
Section One
ALL STORIES
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HEALTH WATCH: Colorectal Cancer Screening

by Isabelle Trepiccione MD
Second Year Residency Program
Swedish Family Medicine,
First Hill

March is Colorectal Cancer Awareness Month, so that is the focus of this month's article! The term 'colorectal cancer' refers to those cancers that start in the colon (aka the large intestine) and/or the rectum. Colorectal cancer is the third most common cancer in men and women in the United States. According to the Centers for Disease Control and Prevention (CDC), each year, about 140,000 Americans are diagnosed with colorectal cancer, and about 50,000 people die from it. This makes colorectal cancer the second leading cause of cancer deaths in the United States. Colorectal cancer, especially in the early stages, may not be associated with any symptoms at all. Symptoms that are associated with colorectal cancer may include bloody stools, dark stools, abdominal pain, or change in bowel habits.

Your doctor may have already talked with you about colorectal cancer screening, which is the process of testing individuals without any symptoms of this disease. Most colorectal cancers develop from precancerous polyps or abnormal growths in the lining of the colon and rectum. These precancerous polyps can take years to become cancerous. Sometimes, they can be identified and removed during the screening test preventing the development of colorectal cancer in the first place. Screening is important because it allows us to identify cancers in the colon and rectum early increasing one's chance of survival.

There are a number of different types of screening tests. Determining which one is right for you can be done through a conversation with your healthcare provider. Here are some options:

o Colonoscopy: A thin, flexible tube with a small camera attached (called a colonoscope) is inserted into the anus and advanced into the rectum and colon to allow the physician to see the lining of the lower gastrointestinal tract. In order for the physician to see everything well, the entire colon and rectum need to be cleared out the night before the procedure. This is done with the help of a laxative, a liquid medication that causes temporary diarrhea. This test requires the patient to be mildly sedated. Colonoscopy can identify established cancers as well as identify and remove precancerous polyps. This is the only screening test that can prevent colorectal cancer from developing in the first place. Colonoscopy is the more expensive option, but it is covered by many insurance companies without co-pay.

o Stool tests: Stool samples are collected by the patient at home and sent to a lab by mail. The lab technicians can look for abnormalities (usually blood) in the stool, which may indicate the presence of a cancer in the colon or rectum. If this test is positive, the appropriate follow up test is a colonoscopy.

o Flexible sigmoidoscopy: Similar to a colonoscopy as explained above, but only looking at half the length of the colon and rectum.

o CT colonography: A special CT scan that looks specifically at the inside of the colon and rectum.



Over time we have been able to identify things that increase a person's chance of developing colorectal cancer. Some of the most common risk factors include:



o Family history of colorectal cancer.

o Personal history of colorectal cancer or known polyps

o Increasing age; most colorectal cancers (90%) occur in people older than 50.

o Personal history of inflammatory bowel disease (like Crohn's disease or ulcerative colitis)

o Inherited cancer syndromes

o Lifestyle factors such as obesity, inactivity, smoking, and heavy alcohol use



For most individuals without risk factors for colorectal cancer, the recommendation is to start screening at 50 years of age. How often a person should get screened depends on the cancer screening method. Colonoscopy can be done once every 10 years, flexible sigmoidoscopy and CT colonography are generally performed every 5 years, and finally, stool testing is done yearly. In individuals with risk factors for colorectal cancer or for those who have had abnormal screening tests in the past, testing may need to start earlier or may need to be performed more often.

Talk to your medical provider about your risks for colorectal cancer, and together, you can decide on the appropriate timing and type of screening test for you. For more information contact Swedish at http://www.swedish.org/services/primary-care, 1-800- SWEDISH (1-800-793-3474) or at www.swedish.org

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