BUT – who wants to talk about poop?!! I do!
Colorectal cancer (that of the large intestine and rectum taken together) is the third most common cancer in both men and women in the U.S. and the second highest cause of cancer deaths in the U.S. This is why people need to know about the disease.
The incidence of colorectal cancer increases with age. However, the incidence in older people has decreased over the past several years by about 1% per year, partly due to the increase of regular screenings in people 50 years of age and older. Since the mid-1990s, the rate of colorectal cancer has more than doubled among adults younger than 50, with a concomitant increase in deaths in this age group. Data suggests that environmental factors play a role in the development of the disease. This report has caused a great deal of concern in the medical and public health communities.
First, a little anatomy lesson to clarify what I am talking about. The colon is also known as the large intestine. Please see the labeled diagram. The colon begins on the right side of the abdominal cavity at the cecum, where the small and large intestines meet. The colon travels upward (called the ascending colon), curves under the liver to cross the abdomen (called the transverse colon), curves again to form the descending colon, the sigmoid colon, and finally, the rectum. The contents of the colon are expelled through the anus and are commonly known as bowel movements, B.M.s, feces, stool.
The large intestine’s main job is to absorb water from the stool, which enters the colon in a liquid state but becomes more concentrated as the water is absorbed, becoming a formed stool in the descending colon. The sigmoid colon and rectum store the stool before a bowel movement.
In the U.S., the general recommendation is that people begin screening for colorectal cancer at age 50 (the recommended age for black people is 45) or ten years before the age that a first-degree relative was diagnosed with colorectal cancer. However, the American Cancer Society, the U.S. Preventive Services Task Force, and the U.S. Multi-Society Task Force on Colorectal Cancer have all recently recommended lowering the age for moderate risk persons to start colorectal cancer screening. The new standard lowers the age from 50 to 45 years of age, except for those with inflammatory bowel disease, genetic disorders predisposing to colon cancer, a family history of the disease, or a person who has bowel symptoms. Then it is recommended that a person start screening earlier.
How cancer develops in the colon:
The lining of the colon and rectum is called mucosa, the same as tissue lining the cheeks of our mouths, the G.I. tract, the reproductive tracts, the nose, sinuses, etc. Mucosa anywhere in the body tends to develop polyps, extensions of the mucosa that protrude from the surface. With the passage of stool across these intestinal polyps and the exposure of the polyps to possible carcinogens/irritants in our food and environment, these polyps can become chronically irritated and go through cell development that can lead to cancer.
Risk factors:
Generally accepted risk factors can be substances that directly affect the stool, generalized body exposures, chronic G.I. disorders, or disorders having a genetic basis. At this time, these are:
- Sedentary lifestyle
- Overweight or obesity – especially at an early age (See my blog on childhood obesity.)
- Smoking
- Low fiber, high fat diet
- Diets high in processed and red meats
- Heavy alcohol intake
- Aging
- Family history of colonic polyps or colon cancer
- Conditions such as inflammatory bowel disease
- Genetic disorders such as familial polyposis or Lynch Syndrome
Diagnostic tests:
There are a variety of tests that can be done on the stool to identify “occult” blood, that is, blood that is not actually seen. These can be performed by a clinician in the office or collected by the patient and brought to the office for evaluation. These types of tests are not specific to cancer, and if found to be positive, further testing must be done. It is also recommended that they be performed annually.
A newer test, called Cologuard, tests for both abnormal DNA, shed from a polyp or cancer, and occult blood. This is the only test of its type approved for use in the U.S. It is recommended that this test be done every three years.
The “gold standard” test for detecting colorectal cancer is a colonoscopy. Under sedation and after a bowel prep to clear out the feces, a small flexible tube with a camera attached is threaded through the entire length of the colon all the way to the cecum. If any polyps are found, they are removed. If any other abnormalities of the colonic mucosa are seen, they can be biopsied. Any polyps or other biopsies are sent to the laboratory where a specialized physician, called a pathologist, examines the specimens under the microscope and reports the results to the person’s physician/practitioner.
If the colonoscopy is normal, it is generally recommended that it be repeated in 10 years. If the patient falls into one of the genetic categories, has a positive family history for polyps/cancer, has inflammatory bowel disease, or has an abnormal biopsy, then more frequent colonoscopies will be recommended. If the colonoscopy identifies cancer, the patient will be referred to a colon and rectal surgeon for further evaluation and treatment.
Symptoms of colon cancer:
People may have no symptoms. However, if any of these symptoms persist for more than a few days up to a week or two, a health care provider should be consulted. Rectal bleeding or blood in the stool requires immediate attention, even if the person thinks “it is just hemorrhoids.”
- Blood in the stool or rectal bleeding
- A change in the size, shape, or color of the stool
- Abdominal pain/cramping
- Constipation alternating with diarrhea
- Unintended weight loss
- Feelings of excessive fullness and bloating
- Nausea and vomiting
- Loss of appetite
- Unexplained fatigue
- Anemia
How to take care of yourself:
- Look at your poop!!! Become accustomed to the color, size, and, possibly, smell of your poop. If there are any changes, you will become aware as soon as possible.
- Know the symptoms of colon cancer and if you experience any, see your health care provider. Be persistent if you have not been thoroughly evaluated. Get a second or third opinion, if necessary.
- Discuss any colorectal cancer risk factors you might have with your health care provider.
- Be sure to begin regular colorectal cancer screening at the appropriate time depending on your age, family history, and personal history.
Lifestyle changes you can make to decrease your risk of colon cancer:
- Increase your physical activity
- Maintain lean body weight
- Don’t smoke
- Don’t drink excessively (one drink per day for women, two for men)
- Change your diet – Eat more fruits, vegetables, and whole grains.
- Eliminate fried foods and added fats and oils. Discontinue processed meats (hot dogs, cold cuts, bacon, ham, etc.). Decrease or eliminate eating red meat and decrease the size of meat servings to three ounces or less.
This is a difficult world in which we live. Most of us are connected to our computers or devices as part of our work, thereby decreasing our amount of physical activity. T.V. is loaded with food ads, most of which are for foods that are unhealthy for us. The grocery stores have gotten larger and larger with huge sections of frozen, prepared foods with mystery ingredients and whole rows of sweetened cereals, drinks, and snack foods. None of these items helps us to stay healthy or helps to decrease our risk of cancers. We must educate ourselves about the causes of diseases and be willing to modify our lifestyles to help protect us from their development.
I hope this blog has helped you better understand the issues surrounding colorectal cancer and has encouraged you to take steps to protect your health.
Nothing in this blog is meant to replace medical care and advice by your provider.
