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| Colorectal Cancer is Preventable, Treatable, and Beatable
Tri-City Voice, March 4, 2009
Physician Shares Insight On Different Screening Options
Last month, visitors to New York's
Times Square thought they had seen
everything. But the 8-foot-high,
20-foot-long pink replica of a human
colon was beyond even their
expectations. That's right. Super
ColonTM had come to the Big Apple.
Unable to stem their curiosity, people
walked through the giant inflatable,
interactive structure, getting a
close-up look at healthy tissue, as well
as tissue at various stages of
colorectal cancer. It was all part of
the kick-off of National Colorectal
Cancer Awareness Month, which occurs
every March. Presented by the Prevent
Cancer Foundation, Super Colon has been
traveling the country since 2003, making
more than 100 stops.
"We celebrate Colorectal Cancer
Awareness Month to remind everyone that
colorectal cancer is still the second
leading cause of cancer-related death in
this country," says Annamalai Veerappan,
M.D., a Fremont gastroenterologist who
is on the medical staff at Washington
Hospital. "That's why colorectal cancer
screening is so important. Through
screening, we can not only detect the
disease in its earlier stages, we can
literally prevent it from occurring in
the first place."
Each year, nearly 150,000 Americans are
diagnosed with colorectal cancer and
more than 50,000 die of the disease,
reports the Centers for Disease Control.
Most colorectal cancer develops from
pre-cancerous lesions called polyps that
can grow in the colon. Over a 10-year
period, the polyps can become cancerous.
By removing them, doctors can prevent
the disease from developing.
"Removal of the polyps effectively
reduces the risk of cancer in about 90
percent of the cases," reports Dr.
Veerappan. "Seventy-five to eighty
percent of colon cancers arise from
precancerous polyps."
Everyone should be screened for
colorectal cancer beginning at age 50.
If you have a family history of the
disease, especially if the person is an
immediate relative, like a parent or
sibling, you should beginning screening
at age 40 or at the age when you are 10
years younger than your relative when
they developed the disease. If you have
a personal history of ulcerative
colitis, you are also at higher risk for
developing colorectal cancer and you
should start screening within seven to
10 years after you began having
symptoms.
Other factors that put you at higher
risk for colorectal cancer include:
- Age (More people develop the
disease as they grow older.)
- Diet (People who eat high fat diets,
lots of red meat or diets low in fiber
are at higher risk.)
- Lifestyle (People who are more
sedentary or who smoke are at higher
risk.)
It's important to get screened, even
if you don't have any symptoms. By the
time someone has symptoms of the
disease, the cancer has usually advanced
and there is a far lower chance of a
cure.
There are five types of screening tests
for colorectal cancer. Each has
advantages and disadvantages. With the
exception of the fecal occult blood
test, it is necessary to cleanse the
colon before the tests are done.
"Right now, colonoscopy is the gold
standard in screening," explains Dr.
Veerappan. "It detects and makes it
possible to remove even small polyps
throughout the colon. It does require
that the patient be sedated, and there's
a risk of bleeding or a tear occurring
in the colon in about one out of every
1,000 cases."
Another type of colorectal cancer test
is the fecal occult blood test, which
checks for hidden blood in the stool.
This test can be done at home by placing
a small amount of your stool from three
consecutive bowel movements on special
test cards and returning the cards to
your doctor's office or lab to be
checked.
"We recommend that you do this test
annually, however sometimes there are
false positives and false negatives,"
adds Dr. Veerappan. "If blood is
detected, further tests need to be done.
Colon polyps seldom bleed, so it's
unlikely that their existence would be
determined by this test. When this test
is positive for blood, the patient has
cancer about 5 percent of the time."
With the flexible sigmoidoscopy, another
type of screening, the doctor uses a
narrow, flexible, lighted tube to look
inside the rectum and lower part of the
colon. With this test, only the lower
one fourth of the colon is examined. If
polyps are found, a follow-up
colonoscopy will still be necessary to
remove them.
The next type of test is the barium
enema, which is now considered to be
out-of-date and not completely accurate.
Again, if polyps are detected, you would
still need to have a colonoscopy.
Finally, the virtual colonoscopy,
combines a sophisticated CT scan with a
modified barium enema to detect
abnormalities in the colon.
"The advantage of this test is that it
is less risky than the colonoscopy and
you do not have to be sedated. However,
you are exposed to a large amount of
radiation, and this should be a
consideration, especially in having
repeat tests," says Dr. Veerappan. "In
the next few years, if certain
improvements are made, I believe the
virtual colonoscopy may replace the
colonoscopy as the preferred method of
screening."
It's recommended that people whose
colonoscopy is clear, should have the
test repeated every ten years. With the
virtual colonoscopy and flexible
sigmoidoscopy, the test should be
repeated every five years.
For more information about colorectal
cancer, its prevention and treatment,
please go to the following web sites:
www.cdc.gov,
www.preventcancer.org and
www.cancer.org.
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