Colorectal Cancer Awareness

by Paulette Avery RN, MSN

Colorectal cancer is the second leading cause of cancer deaths in the U.S., and March is Colorectal Cancer Awareness Month. For Patricia Ancelet, Metro reader and resident of Redwood Heights, this month is a painful reminder of the recent death of her mother, Charlotte Cortese, from colon cancer, and a call to action. On March 20 Ancelet, an active member of the Colorectal Cancer Coalition, will testify before Congress about her mother's 21-month battle with colon cancer, with the goal of securing more money for research against this deadly disease.

Like any cancer, better outcomes occur when colon cancer is caught early. As a result, regular screening is recommended, beginning at age 50, earlier when there is a strong family history of the disease. Unfortunately, Charlotte Cortese's cancer was not diagnosed until it was at an advanced stage where treatment is difficult and usually unsuccessful. According to a study released in 2006 at the American College of Gastroenterology's annual scientific meeting, an increase in the rate of cancer screening tests has resulted in a decrease in new cases of colon cancer from 1988 to 2002.

Several tests can detect colon cancer early, when it is easily treated, or can find and remove polyps that may become cancerous. The first test is a fecal occult blood test (FOBT). The FOBT involves collecting stool specimens on three different days. The specimens are analyzed for the presence of occult (hidden) blood, which may indicate cancer. Because certain foods such as red meat and citrus can cause a false-positive result, doing the test involves avoiding these foods for several days before collecting the specimens. If the results are positive, additional tests are needed to determine the cause of the bleeding.

A newer test, similar to the FOBT, is the fecal immunochemical test (FIT). The FIT is more specific than the FOBT and has fewer false positives.

The second test is a flexible sigmoidoscopy, which involves the insertion of a small, flexible, lighted tube into the rectum and lower colon. The tube can be connected to a video camera and monitor to allow better viewing. The test may be uncomfortable but should not be painful. If abnormalities are found, a colonoscopy is the next step.

The third test is a colonoscopy, which allows doctors to view the entire colon and also to remove small polyps. Larger polyps can be biopsied. Because it takes longer and is more involved, patients receive medications to relax them during the procedure.

Current guidelines for colorectal cancer screening from the American Cancer Society are as follows:

A FOBT every year beginning at age 50, or

Flexible sigmoidoscopy every 5 years, or

A double-contrast barium enema every 5 years, or

A combination of the FOBT yearly, plus sigmoidoscopy every 5 years (considered the preferable choice).

In addition to the above, a colonoscopy every 10 years.

If an abnormality is found, future screening should occur more frequently.

Unfortunately, because many people find the tests unpleasant, these recommendations often are not followed. Tests such as a virtual colonoscopy have been developed but are, at this point, less effective than the above options. I hope that as technology continues to improve, testing methods that are more acceptable to most people will soon be available, and screening will become more universal.

Paulette Avery is a registered nurse and a freelance writer who specializes in health issues.