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The American Cancer Society estimates that there will be 153,760 new cases of colorectal cancer diagnosed in the U.S. in 2007. That means a person in the U.S. is diagnosed with colorectal cancer every 4 minutes. 9 in 10 new cases are people 50 or older. However, colorectal cancer does not discriminate and can happen to men and women at any age.

Colorectal cancer is cancer that starts in either your colon or your rectum, which together make up the lower part of your digestive tract. It is the fourth most common cancer for women. Cancer usually does not start in both the colon and rectum. But both types of cancer have a lot in common. So they are often referred to as “colorectal” cancer.

Most cancers in the colon or rectum begin as a polyp. A polyp is an abnormal growth of tissue and can occur in other places besides your colon or rectum, such as inside your nose. Not all polyps become cancers. But over a period of years, some polyps, if they are allowed to grow, do.

When found early, colorectal cancer can be cured more than 90 percent of the time. Don't be shy about telling your doctor if you have any of the following symptoms:

  • Bleeding from the rectum
  • A change in bowel movement pattern that continues over time
  • General discomfort in the abdomen (frequent gas pains, cramping pain, feeling of bloating or fullness)
  • Vomiting
  • Constant fatigue
  • Chronic constipation

Risk factors for colorectal cancer:

  • Older than age 50.
  • People in immediate family have had colorectal cancer.
  • Have had colorectal cancer before.
  • Have had polyps in colon or rectum.
  • Have the condition familial adenomatous polyposis, also called FAP.
  • Have the condition hereditary nonpolyposis colon cancer, also called HNPCC.
  • Smoke.
  • Don’t have a bowel movement at least once a day.
  • Have had ovarian, uterine, or breast cancer.
  • Are overweight.
  • Drink more than one alcoholic drink a day.
  • Eat a lot of red meat.
  • Have inflammatory bowel disease, also called IBS.

Colorectal cancer can be present in people without symptoms, known family history, or predisposing conditions, such as inflammatory bowel disease. Regular screening will help identify pre-cancerous polyps and colorectal cancers earlier.

The Harvard Center for Cancer Prevention recently reported that regular screening, combined with a healthy lifestyle, can prevent over half of all colon cancer deaths in the United States. Primary prevention through polypectomy, or the removal of polyps, substantially reduces the risk of developing colorectal cancer.

Screening Methods

The following options are acceptable choices for colorectal cancer screening in average-risk adults. These tests as well as others are also used when people have symptoms of colorectal cancer and other digestive diseases. Since each of the following tests has inherent characteristics related to accuracy, prevention potential, costs, and risks, individuals should have an opportunity to make an informed decision when choosing a screening test.

Screening Method
Advantages
Disadvantages
Fecal Occult Blood Test (FOBT) Inexpensive; covered by most insurance

Simple to complete

Strong evidence from randomized controlled trials of reduction in mortality with screening
Requires patient action for completion of test (restricted diet and stool collection)

Patients may find test unpleasant to do

High false positive rate
Flexible sigmoidoscopy Moderate cost; covered by most insurance

Many primary care providers can do the test in their office

5 year screening interval

Evidence from case-control studies of reduction in mortality with screening
Requires enema preparation

Patients may find test uncomfortable or embarrassing

Small risk of perforation or bleeding

Screens only about half the colon
Double contrast barium enema Screens full colon

5 or 10 year screening interval
Requires laxative preparation

Patients may find test uncomfortable or embarrassing

May be covered as a screening test in place of sigmoidoscopy
Colonsocopy Screens full colon

10 year screening interval

Evidence for reduction in mortality with screening, from follow-up of patients with adenomatous polyps

Sedation given to patient to minimize discomfort
Typically requires 2-days of clear liquids & laxative preparation

Patients may find test uncomfortable or embarrassing

Small risk of perforation or bleeding

Usually not covered as a screening test for patients of average risk

 

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