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Published on March 30, 2018

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Colon Health Q and A: Doctor’s Answers

Colon cancer awareness is highlighted in March, but there’s never an off-season for staying ahead of this deadly disease.

Avera Medical Group Gastroenterologist Bryan Feyen, DO, offers insights on the topic of colon cancer, how to avoid it and how to best keep yourself and those you love safeguarded.

Question: How prevalent is colon cancer?

Answer: If we exclude skin cancers, colon cancer is the third-most common cancer diagnosed in men and women in the United States, with almost 150,000 new cases each year. About one man in every group of 22 will face it and about one woman in 24. The sad fact remains that about 50,000 people will die from this cause of cancer, and it’s made sadder by the fact it is preventable.

Q: At what age should concern for this form of cancer increase?

A: For people who are at average risk, we advise them to have a colonoscopy at age 45, both men and women, but there are some exceptions. If there’s a family history of this cancer, you should speak with your doctor and in some cases, having it sooner is best. For African-American men and women, it’s best to begin colonoscopies at age 40, based on data. Individuals who have bowel conditions, such as Crohn’s disease, should also work with their doctor to see about having a colonoscopy before age 45.

Q: Are there certain risk-factors for colorectal cancer?

A: Yes, and age is the biggest risk, in that the older you are, the more likely you’ll face this cancer. Family history and the other conditions I mentioned also are parts of the risk consideration. Since the disease is more common in people ages 50 and older, that’s why 50 is the “magic number” for most people to start colonoscopies. Many common-sense behaviors, such as not smoking, eating a balanced diet, getting lots of exercise and not drinking too much – all are good steps to take to reduce your personal risk.

Q: You mentioned data – are there trends developing with this cancer?

A: In the United States, we are seeing a decline in diagnosis among people who are 45 and older, and that could be from the growing awareness of the necessity for colonoscopy and people following through and getting them. At the same time, we are seeing a rise in cases diagnosed in people who are younger than 45, and that could be due to lifestyle changes, such as more sedentary work environments and the availability of processed foods, especially red meat and overly processed meats.

Q: What would be the signs someone was possibly facing colorectal cancer?

A: It has a vague set of symptoms, and that can make it hard to spot, but if a person is feeling washed out and tired along with changes in bowel habits, these could be signs. If a person has dark, tar-like stools, or blood in their stool, that is a red-flag and something that should lead you to make an appointment with your doctor. Cramping or changes – more frequent need to go, or a decline in frequency – also can be signs. It’s always best to have it be a false alarm than to wait. In addition, anemia can be a sign of this cancer.

Q: Why is the colonoscopy pushed so hard by doctors like you?

A: It’s the gold standard exam, and it allows a physician like me to actually interrupt the cancer pathway. Colorectal cancers develop as polyps, which are small masses, in your colon or rectum. They come in various shapes, and some are flat and hardly noticeable. Others are more pronounced. During colonoscopy, we can visually identify any polyps in the colon, and what’s more, we can remove them during the exam. This is the only exam that actually interrupts the cancer sequence.

Q: How does the colonoscopy work?

A: A patient will come in with a spouse, family member or friend because we’ll administer medication that will have you fall asleep, so you need to have someone who can drive you home after the exam. The exam takes about 30 minutes in most cases. Once the medication is administered, we’ll insert the scope into your rectum and examine the entire colon, looking for polyps or any abnormalities. If we find them, the scope, which is a tiny high-definition camera, is equipped with a small noose-like attachment that allows us to remove them. We find polyps in about a quarter of patients who have the exam. The polyps we removed go to the lab, where they can be tested. In some cases, we find they are harmless, and in some cases, that tissue could be cancerous or pre-cancerous tissue.

Q: People often dread the preparation that goes with this exam – why is that?

A: Yes, the preparation can seem unpleasant. You’ll drink a significant portion of a solution that will clean out your digestive system, and you’ll be on a short-term diet of only clear liquids. The prep is critical because you want your doctor, to be able to see your colon as clearly as possible. You’ll drink the solution the night before, and spend some time in the bathroom, and you finish it in the morning before you come in. The exam itself is like a power nap – most patients report that they remember nothing about it at all – just waking up in the room. From arrival to departure, you’ll be with us for about two or three hours.

Q: Are there alternatives to this exam?

A: There are options, and most of them are focused on stool-sample testing. They can help people who do not want a colonoscopy, but the catch is that if we find something abnormal after completing one of these tests, the next step is to have a colonoscopy – and that’s why skipping directly to the test where we can examine and treat polyps is best. The best place to begin is with a conversation with your physician, because he or she can spell out all the approaches and find the best one for you.

Q: Any other comments?

A: Since colorectal cancer symptoms can be mild, slowly progress and vague, we encourage everyone to be aware of this life-threatening disease. If signs are ignored, waiting can be deadly. The preparation is mildly unpleasant, but compared to developing cancer – it’s nothing. The one thing we stress with colonoscopy is you will know – you’ll know that we removed the potential threat if it’s found. You have the peace of mind that comes with knowing, and that’s priceless.

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