UCHealth: Preventing colon cancer
Colon and rectal cancer, often referred to as “colorectal cancer,” is the third most common type of cancer and also the third leading cause of cancer death in men and women, according to the American Cancer Society.
Yet, it’s possible that these dangerous cancers can cured if caught early.
“Colon cancer is potentially preventable,” said Dr. Daniel Langer, a board-certified gastroenterologist and member of the medical staff at UCHealth Yampa Valley Medical Center. “By following recommended colon cancer screening guidelines, we are much more likely to detect pre-cancerous colon polyps or colon cancer at an earlier stage when treatment is most effective.”
Understanding the colon
The colon is nearly five feet long and is divided into segments. It works as part of the body’s digestive system.
“The colon collects chyme, which consists of fluid and indigestible solids, extracts water out of the solids, and passes the remaining waste to the rectum where it is stored until evacuated during a bowel movement,” said Langer. “It plays an important role in the maintenance of water balance in the body. The colon also contains trillions of bacteria that make up the microbiome and help break down residual waste.”
Why polyps form
The body’s cells have a series of “checks and balances” in place to prevent unwanted growth. With age, the checks and balances can become disrupted in some people.
“Mutations take place within the cellular DNA which allows cells to grow more than they should. Over time, this growth can become more aggressive, leading to the formation of polyps,” said Langer. “Over time, if the polyps experience uncontrolled cell growth and an accumulation of mutations, some can turn into cancer.”
While not all polyps become cancerous, it’s important to remove them during a colonoscopy and have them tested to help determine cancer risk. Removing polyps has been shown to decrease the incidence of colon cancer.
Colonoscopy remains the gold standard for the early detection of colon cancer and colon cancer prevention.
“It’s the only colon cancer screening test that allows us to identify and remove pre-cancerous polyps before cancer develops,” said Langer. “At-home stool collection tests such as occult blood or Cologuard can detect cancer, but these tests are not good at detecting pre-cancerous polyps and are not considered a cancer prevention test. If the stool test is positive, then a diagnostic colonoscopy is required for further investigation.”
According to the U.S. Preventive Services Task Force, average risk individuals with no personal history of colon polyps or family history of polyps or colon cancer should begin screening colonoscopies at age 45.
“This recommendation was updated in 2018 to account for an increased incidence in people under age 50, which was the prior recommendation,” said Langer. “However, there are individual factors to take into account. If you have a first-degree relative – your parent, sibling or a child – who has been diagnosed with colon cancer or has had pre-cancerous polyps removed, we recommend beginning colon cancer screening by colonoscopy at age 40 or ten years before the first-degree relative’s age at time of diagnosis, whichever is earlier.”
A negative colonoscopy provides up to 10 years of protection.
In average risk individuals, it is recommended to repeat colonoscopy at 10-year intervals until somewhere between the ages of 75 and 85. Patients and providers should discuss whether there is need for subsequent screening based on individual risk in the context of overall health and life expectancy.
Tips for a smooth colonoscopy experience
When people hear the word “colonoscopy,” thoughts often turn to the necessary preparation for the procedure.
The day before a colonoscopy, patients need to stop eating solids and consume a liquid laxative that will force them to expel stool from their colon.
“A good bowel prep is very important as it allows for a better view of the colon walls,” said Langer. “Without a thorough bowel prep, there is a higher risk of missing polyps or even cancer.”
Patients drink the laxative mixture the night before and morning of the procedure; the exact timing depends on the procedure time. It’s important to follow the instructions carefully. The laxative is safe and doesn’t cause significant fluid shifts or dehydration. Langer recommends keeping the prep drink cold, quickly drinking one glass at a time, and “chasing” each glass of prep with a small sip of tea or juice to help mask any aftertaste.
In recent years, there have been some improvements in the procedure. Doctors have used carbon dioxide instead of air to inflate the colon for better visualization during the procedure.
“The carbon dioxide is easier for the colon to absorb so that patients are not uncomfortable after the procedure,” said Langer. “Also, with improvements in sedation, the patient is usually very comfortable and doesn’t remember the procedure. They often feel like they had a nice nap.”
“We can find cancer at any stage, but the earlier, the better,” continued Langer. “If you put off colon cancer screening because of the pandemic, there’s no better time than the present to have your colon screened for polyps and cancer.”
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