Colon Cancer – What is it? How do you detect it?

1. Colon Cancer – What is it? How do you detect it? William Dailey, MD, MS GVMH - Windsor

2. Colon cancer is: • Cancer of the colon or rectum • Your colon: • is another name for your large intestine. • is about 6 feet long. • turns food you eat into waste matter or a bowel movement as it passes through the colon. • Your rectum: • is the last 8-10 inches of the large intestine. • bowel movements travel through the rectum and pass out of the body through the anus.

3. Your Colon and Rectum

4. How long does it take cancer to develop, and what are your chances? • In most people, colorectal cancers develop slowly over a period of several years. • 10 to 20 years • Chances of developing colorectal cancer sometime in your life: • A man has a 1 in 17 chance. • A woman has a 1 in 18 chance.

5. Why does it develop? • Colorectal cancer usually begins as a non-cancerous (or benign) polyp. • A polyp • is a growth inside the colon or rectum that is not normal. • can be several types. • is not always cancerous.

6. When Cancer Forms in a Polyp • It can eventually grow through the lining and into the wall of the colon or rectum. • 95 percent of colorectal cancers grow from cancerous polyps and move into the inside layer of the wall of the colon and rectum.

7. Importance of Screening and Early Detection • Once a non-cancerous (benign) polyp is removed, it will never have the chance to develop into cancer. • Regular screenings for colorectal cancer and removal of polyps • Reduce a person’s lifetime risk of dying by 80 percent. • When colorectal cancer is detected early • It is highly curable!

8. Lower Your Risk of Developing Colorectal Cancer by: • Increasing physical activity • Exercise at least 30 minutes a day on the majority of days. • Not smoking • In the USA, 1 in 5 colorectal cancers in men and 1 in 8 colorectal cancers in women may be due to cigarette smoking. • Improving your diet • Limit your alcohol use. • Limit high-fat diets. • Limit red, charred, or processed meat.

9. Age and Race Factors for Colorectal Cancer • Age • 90 percent of all colorectal diagnoses happen after age 50. • Race and Ethnicity • Everyone is at risk! • Risk Rankings • African-Americans • Whites • Asian Americans/Pacific Islanders • Hispanics • American Indians

10. Personal History Risk Factors for Colorectal Cancer • Personal History of Cancer • If you’ve already been treated for colorectal cancer, you’re at an increased risk for developing it again. • Personal History of Polyps • If you have had a polyp removed • You are no longer at risk of that particular polyp developing into cancer. • If you have had an adenomatous polyp removed, you are more likely to have other polyps in the future. • Adenomatous polyps are groups of polyps with abnormal cells that multiply and may eventually become cancerous.

11. Having Inflammatory Bowel Disease and Type 2 Diabetes Are Risk Factors • Inflammatory bowel disease (IBD) includes: • Ulcerative colitis and • Crohn’s disease • The overall increased risk of colorectal cancer for someone with IBD is estimated to be 4-20 times higher than normal. • Personal history of type 2 diabetes • Increases your risk of having colorectal cancer and colorectal polyps by 50 percent

12. Family History and the Role of Genetics • You have a higher risk of developing colorectal cancer if: • One or more immediate family members were diagnosed with colorectal, uterine, or stomach cancer • Immediate family members include: • Parent • Sibling • Child

13. Early Detection Makes a Difference • Approximately 56,000 Americans die from colorectal cancer each year. • It is the 2nd leading cause of cancer in the nation. • The most effective way to reduce your risk of colorectal cancer is to get screened routinely. • Start at age 50. • Start earlier if you are at higher risk. • Personal health history • Family health history

14. What if something is found? • If you have polyps • They can be removed before they turn into cancer. • Finding and removing adenomatous polyps can decrease colorectal cancers by 60-90 percent. • If cancer is found • It is often curable in its early stages.

15. Don’t want to get screened? • Embarrassed? • Doctors need to know about changes in your bowel habits or rectal bleeding. • Everyone has “private parts,” and it’s important to keep them healthy! • Don’t want bad news? • Getting screened can find bad things early, which increases the amount of time you can spend with your family. They need you! • Doctor didn’t say you need to get tested? • Bring it up with him or her – it’s important!

16. What test do I take to get screened? • There are several tests to screen for colorectal cancer. • Some tests are used alone, while others are used in combination with other tests. • Talk to your doctor about which type of test is best for you!

17. Fecal Occult Blood Test (FOBT) • Recommended to be done yearly • Checks for hidden blood in the stool • Your doctor gives you a test kit • At home, you place a small amount of your stool from 3 bowel movements on test cards. • You then return the cards to your doctor’s office or a lab where the stool samples are tested for hidden blood. • If blood is found, a colonoscopy will be needed. • A disadvantage of this test • The test is often negative in people who have adenomatous polyps and colorectal cancer.

18. Flexible Sigmoidoscopy (Flex Sig) • Recommended every 5 years • Examines the lining of your rectum and lower part of your colon • Uses a thin, flexible, lighted tube called a sigmoidoscope • It is inserted into your rectum and lower part of your colon. • If polyps or lesions are found, a follow-up test is needed. • Disadvantages: • Patient discomfort – but not painful • Only looks at lower part of colon, therefore polyps in the upper colon can go undetected. • If a polyp is found, it needs to be followed by a colonoscopy to remove the polyp.

19. Combination FOBT and Flex Sig • Some experts recommend using both of these tests to increase the chance of finding polyps and cancers. • It is recommended every 5 years.

20. Colonoscopy • Similar to the Flexible Sigmoidoscopy except: • It allows the doctor to look at the lining of your rectum and entire colon. • Done as an outpatient procedure • Done with “conscious sedation” • An IV line is inserted to help you remain calm and comfortable. Some patients sleep though the procedure. • Not everyone needs sedation. • Uses a thin, flexible, lighted tube called a colonoscope • It is inserted into your rectum and colon. • The doctor can also find and remove polyps and some cancers using the colonoscope. • It is recommended every 10 years for: • Individuals with no family or personal history of colon cancer and no symptoms.

21. Colonoscopy (continued) … • Procedure takes 15–30 minutes. • May take longer if polyps are removed. • Called a polypectomy • A wire loop is passed through the scope to cut the polyp from the lining of the colon using an electrical current. • Polyps are collected and sent to the lab for evaluation.

22. Double Contrast Barium Enema (DCBE) • This test allows the doctor to see an x-ray image of the rectum and entire colon. • First you are given an enema with a liquid called barium that flows from a tube into your colon, followed by an air enema. • The barium and air create an outline around your colon, allowing the doctor to see if anything is wrong. • Recommended every 10 years. • Many disadvantages: • Detects only 50 percent of adenomatous polyps greater than 1 cm in size and only 33 percent of polyps .5 cm in size • May miss up to 15 percent of colorectal cancers • Does not allow removal of polyps

23. Worried about How Much It Will Cost? • If you are 50 years old or older and have Medicare • You are eligible for colorectal screenings! • For more information, call or visit: • 1-800-MEDICARE (1-800-633-4277) • http://medicare.gov/Health/ColonCancer.asp • If you have private insurance • Most insurers are now paying for some form of colorectal screening • Often including screening colonoscopy

24. Think about the future • Your family needs you. • If you’re 50 years old or older • Get screened! • You have the power to determine your future! • Any questions?