"I'm sorry, you have colon cancer " are words a patient should never have to hear from their physician.
Unfortunately, though, this is a disease faced by many patients today. Colon cancer is the third most common cancer in males and females. What is not known by many people is that it is preventable, and usually has no early symptoms. Symptoms of colon cancer such as thin stools, blood in the stool or abdominal pain from an obstructing tumor in the colon are late findings.
Colon cancer usually begins as a precancerous polyp, with a period of time of approximately 10 years from the time the polyp arises, until a cancer is present. Because of the polyp-cancer sequence, the progression can be interrupted if the lining of the colon is examined. The most common method is with a colonoscopy. This procedure involves a flexible instrument which contains a camera that is used to examine the lining of the colon. This is done as an outpatient procedure, coupled with the use of sedation.
The colonoscope also contains a channel that allows biopsy instruments to be introduced to sample and hopefully, completely remove the polyp. This allows a pathologist to examine the tissue removed and determine if a cancer is present. If the polyp is precancerous, then simply removing the polyp is adequate treatment. The patient will then require ongoing examinations, usually at 2-3 year intervals to ensure the removed polyp does not return, and that a new polyp does not emerge in another area of the colon.
The American Cancer Society recommends that all patients should have a colonoscopy beginning at age 50. If there is a family history in a first-degree relative (parent, sibling, or child), then the recommendation changes to a decade earlier than the cancer diagnosis. For example, if a parent was diagnosed at age 50, the children should begin their screening at age 40.
If there is no family history of colon cancer, then the interval between colonoscopies is every 10 years. If there is a family history, the interval is every five years. Again, if polyps are found, then the interval of follow-up colonoscopies is 2-3 years.
A colonoscopy is usually performed at a hospital, as an outpatient procedure. It usually takes 15-45 minutes to be completed, and the result can be lifesaving. Most patients have very little recall of the procedure since they are sedated with medications. The procedure does require a prep of the colon the day before (which everyone complains about), so that the lining of the colon is able to be visualized, and any polyps or tumors can be biopsied. Patients who have undergone the procedure say that it is not unpleasant, and usually that the day before their scope, when they complete the prep, is the worst part of the process.
Colon cancer is very treatable when discovered at an early stage, with a cure rate of about 90 percent. Unfortunately, if the disease is discovered at an advanced stage when it has spread to other organs, then the cure rate drops dramatically, to approximately 10 percent.
In summary, colon cancer is preventable, with a relatively straightforward examination that patients should be offered. You can discuss the test with your primary care provider, who may then refer you to a specialist, such as a surgeon or gastroenterologist, who may then complete the procedure. This relatively simple test can dramatically make a difference in your health and I encourage you to consider it.
Editor's note: Patrick Bulinski, M.D., is the general surgeon at Baraga County Memorial Hospital.