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As regular readers of this column know, I’m a gastroenterologist at St. Luke’s and today I wanted to talk about a disease that’s close to my heart — colon cancer. Most of my family members on my dad’s side died of colon cancer, including my aunt, who was only 35 years old.
Colorectal cancer is the second leading cause of cancer mortality in America. But according to the CDC (Centers for Disease Control and Prevention), if everyone aged 50 years or older were screened regularly, as many as 60 percent of deaths from colon cancer could be avoided.
Most colorectal cancers start as polyps that grow on the inner lining of the colon or rectum. These growths spread very slowly, taking from 10 to 20 years to become cancerous. Regular screening tests can identify and remove polyps before they become cancerous. It’s highly treatable if caught early.
Signs and Symptoms
Unfortunately, most people with colorectal cancer don’t experience any symptoms in the early stage of the disease. That’s why screening tests, such as a colonoscopy, are so important. If symptoms do occur, they usually include change in bowel habits, abdominal pain, or rectal bleeding. Problems related to silent blood loss such as weakness, fatigue, dizziness, and pounding or racing heart, all due to anemia (low blood count), are often ignored and blamed on the pace of daily life.
Causes and risk factors
Genetics play a role, but more than half of the colon cancer cases occur without any known cause. Alcohol use, smoking and eating a high fat diet and being overweight increases the risk for colon cancer, and those are certainly modifiable risk factors.
Colonoscopy nuggets and myths
The gold standard for diagnosis of colorectal cancer is colonoscopy. Let me bust some myths about it being such a scary or dangerous experience. Unlike what you might have heard, colonoscopy is a very well tolerated procedure with very little risks. The preps have also become a lot better. I never prescribe the terrible Golytely prep, which in my mind tastes like “monkey sweat” (not that I’ve ever tasted monkey sweat but I’ve tasted Golytely and that came to mind!). Once I had an attending who made us drink Golytely on rounds and I swore to myself I would never torture my patients with it. I use a mixture of pills, gatorade and miralax, which is low volume and well tolerated.
The prep happens the day before the procedure. The patient can still go to work that day as long as they stick to a liquid diet and start their prep in the afternoon.
The procedure itself happens under sedation and most patient wake up asking “when are you getting started Doc?” They find it hard to believe that we are done already! We’ll even play your favorite music as you go off to sleep!
And don’t worry about modesty. Rest assured — private parts are covered throughout the procedure and the focus is on the TV screen showing the “real goods” (i.e. your colon).
Prevention
Aside from getting regular screenings, what can you do prevent colon cancer? Eating plenty of fruits and vegetables, as well as foods rich in omega-3 fatty acids (such as fish) can help reduce the risk of colorectal cancer. Many foods that contain antioxidants (such as blueberries, cherries, tomatoes, squash, mushrooms and bell-peppers) are beneficial against many types of cancer. Avoid high glycemic index foods such as white breads, pastas and sugar. Use healthy oils such as olive oil and stay away from crisco and margarine (high in trans-fatty acids). Limit alcohol consumption, quit smoking, and reduce your intake of high fat and fried foods, particularly red meats. And exercise!
Long-term use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are being investigated in the prevention and treatment of colorectal cancer. Preliminary studies suggest that vitamin D supplementation alone may be associated with up to a 50 percent reduction in colon cancer risk.
This concludes this episode of Dr. Aga’s adventure into my own specialty. I hope you have learned that colon cancer is preventable!
Dr. Aga Bednarz is a gastroenterologist with St. Luke’s.
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