There is a rite of passage for adults that most of us would rather not think about—time for a colonoscopy. Leading up to it we hear stories about the strange liquid we have to drink and the very idea of the procedure causes us to cringe; but most people who go through it admit that the whole process isn’t really that bad. And, in fact, going through the procedure is better than the alternative, which is not catching a very dangerous and often deadly disease.
Not including skin cancers, colorectal cancer is the third most commonly diagnosed cancer in both men and women in the U.S. and the third leading cause of cancer-related deaths in the U.S. Fortunately, better screening practices have been steadily improving the mortality rate of this cancer over the years, not only allowing doctors to catch cancer at an earlier, more easily treatable stage, but also by allowing polyps (small growths on the surface of the colon) to be caught and removed even before they develop into cancers.
But what happens if your physician finds a polyp or a tumor? What treatment options are available to you? And is there a chance that your family may be at risk for colon cancer as well?
Sentara Martha Jefferson Hospital has long treated colon cancer with survival rates that exceed the national average, and that is due, in large part, to routine colon screenings.
“Colon cancer is deadly,” said Blake Garmon, MD, of Sentara Martha Jefferson Internal Medicine. “But it’s easy to catch early with screening, which makes it more treatable, even preventable.”
Who Should Be Screened?
Traditionally, the recommendation is for men and women to have regular colon screenings beginning at the age of 50, and that they continue to receive screenings at regular intervals until at least the age of 75, if not longer (as recommended by a physician.
Recently, however, the American Cancer Society has changed their recommendations, encouraging people to begin screening at the age of 45.
“Though we don’t yet know why, we have found that colon cancers are showing up in a younger and younger population,” noted Zach Gregg, MD, colorectal surgeon at Sentara Martha Jefferson Medical & Surgical Associates. “That’s why we are seeing these changes, but we always recommend that you ask your physician. They may say you can wait, but depending on your family history, they may want to have you come earlier.”
Dr. Garmon said he refers patients to a gastroenterologist for screening at a younger age if they have a first degree relative or two second degree relatives who have had colon cancer.
“We generally send these patients for screening when they are 10 years younger than their relatives who had colon cancer, so we can be sure to catch anything that may arise as quickly as possible,” he added.
What Types of Screenings Are Available?
Although the colonoscopy is the most common colorectal cancer screening, there are a number of different tests. These include stool based tests, such as the fecal immunochemical test (FIT) and the guaiac-based fecal occult blood test (gFOBT). Visual exams include the colonoscopy, a CT colonography (virtual colonoscopy), and the flexible sigmoidoscopy.
With all these options, unless there is a health reason that you are not able to have one, the colonoscopy is the preferred test for providers.
“The colonoscopy is tried and true,” noted Dr. Garmon. “If possible, that’s the test I recommend, as if there are positive results on the others, they are going to end up there.”
Dr. Gregg agrees.
“I personally like the colonoscopy the best because it can be used for screening and can be an intervention as well,” he said. “Colon polyps can turn into cancer, and if you have a colonoscopy, we can detect those polyps before they become cancer and thus can prevent the cancer.”
Both physicians agree, though, that it is important that everyone talk to their health care provider about which tests might be good options, and to check insurance coverage for each test option.
In the past, testing would be done on some colorectal cancers if the doctors might suspect a genetic syndrome. For the past few years, however, Sentara Martha Jefferson Hospital has tested all adenocarcinomas of the colon and rectum, regardless of the patient’s age of diagnosis.
This program—Universal Tumor Testing—is a genetic mutation screening program that helps pinpoint someone who may be at an increased risk for mutation. And experts say the results have been helpful, as the team has been able to pick up individuals with genetic syndromes that wouldn’t have otherwise caught.
This type of testing is important to understanding the type of syndrome at work and is very helpful in directing the treatment and management of the disease. It can help a physician determine which procedure and medications would be most effective, for example.
While tumor testing does not diagnose a hereditary colorectal cancer syndrome, it can be suggestive of an inherited predisposition.
The most important thing to note, though, is that genetic predisposition does not mean you will definitely get colon cancer. Regardless of the findings, there are ways to reduce your risk of colon cancer through changes in your lifestyle. And if you are found to be at risk, you will likely be screened more frequently to ensure that if you do develop a tumor, it will be caught in an early stage of the disease and you will have better treatment options.
“Being on top of screening, whatever you choose to do, is critical,” said Dr. Gregg. “Whether your physician recommends a colonoscopy or another type of test, we definitely want you to be screened. The earlier we can intervene with colon cancer, the more likely it is we can cure or even prevent the cancer and extend your life.”
Ask your physician about colon screening. If you need a physician referral, call 1-800-SENTARA.