Colon Cancer

It’s important to keep in mind that we’re in an era where we have the opportunity to prevent colon cancer from occurring. With colonoscopy, we can remove growths before they cause cancer. Colon cancer starts as polyps, which are warty growths. It takes a long time for them to grow and develop into cancer. But, if they aren’t removed, they may become cancerous and eventually spread to the lymph nodes and liver and result in death.

But if colon cancer already exists in the colon, patients might experience symptoms such as rectal bleeding, changes in the shape of their stool, abdominal pain and weight loss.

Colonoscopy is the gold standard for detecting colon cancer. It’s the most sensitive test for finding cancers and precancerous growths. If nothing is found during a screening colonoscopy, patients can typically wait 10 years before their next screening. If precancerous polyps are found, then the recommended time before the next colonoscopy may be shorter.

Other less invasive screening options include the fecal immunochemical test (FIT) and Cologuard. With the FIT test, screening is required once a year. With Cologuard, screening is every three years. Both of these fecal tests are good screening tests, but they’re not as effective as colonoscopy for finding cancer or precancerous polyps. Also, they’re only recommended for those who have an average risk of colon cancer — not for those who are high-risk patients or for those who have previously had precancerous polyps or cancer.

The most important risk factor is age. Everyone’s risk goes up for colon cancer as they get older. However, over the past several decades, the incidence of colon cancer has been declining in those over 50. But, at the same time, it’s been increasing in those under the age of 50. It used to be that only 7 percent of colon cancer cases involved those under 50. But it’s risen to 15 percent. So, now, the recommended age to begin screening for colon cancer is 45 for the entire American population.

At any given age, men are at a slightly higher risk for colon cancer than women. But because women live longer on average, there are more cases of colon cancer in women over a lifetime.

All races and ethnicities can develop colon cancer. Those who are Black or Native American have the highest risk, followed by those who are white, Asian or Hispanic.

Cigarette smokers, those with diabetes and those who are overweight also have a higher risk of developing colon cancer.

About 15 percent of the population has a family history of colorectal cancer. If you have a first-degree relative who had colon cancer, your risk goes up, and beginning screening before age 45 may be appropriate. It increases even further if multiple first-degree relatives have had colon cancer or if you have a first-degree relative who developed colon cancer before age 60. In these two groups colonoscopy should be performed every five years.

It’s important to remember that age is the dominant risk factor for colon cancer. But if someone under [the screening age of] 45 has colorectal symptoms, they should view this as being serious and seek medical attention.

When colon cancer is detected early — when it’s still at Stage I—the survival rate is above 90 percent. Treatment might involve surgery, but not chemotherapy.

At Stage II, colon cancer has gone deeper into the wall of the colon but hasn’t spread to the lymph nodes. The survival rate at this state is 80 percent, often with surgery alone.

At Stage III, the disease has spread to the lymph nodes and the survival rate is 60 percent. Also, both surgery and chemotherapy will be required for treatment.

Finally, Stage IV is when the disease has spread to a distant organ — most often the liver. At this point, there’s a large drop off in the survival rate.

The biggest issue is they don’t want to go through the bowel preparation. They’ve heard that it’s not pleasant. But, while it’s hard to make it completely simple and easy, we’ve tried to improve the bowel preparation process. For example, there is now a tablet prep available, as well as lower volume preps. Patients should talk with their gastroenterologist about these options.

Another reason people are hesitant to get screened for colon cancer is they fear the colonoscopy procedure itself. However, because we generally use deep sedation, the procedure is painless. And, once it’s done, patients get back to normal very quickly.

Some individuals are in denial about being at risk and don’t believe they need to be screened. But we’re all at some level of risk — particularly as we age.

Finally, some think the whole idea of talking about the colon and the toilet and poop is too gross to be considered. But everybody has a colon and is at risk. So, have a discussion with your doctor. Remember, if you have no symptoms and no previous precancerous polyps and don’t want colonoscopy, you can also be screened with fecal tests.

When I was training to become a physician, I was attracted to gastroenterology because I liked doing procedures. As a gastroenterologist, I perform a lot of them.

My own research interests are first in improving detection during routine screening and surveillance colonoscopy. At IU, we did the first large screening colonoscopy study in the late 1980s. Subsequently, we showed that colonoscopy does not detect all precancerous polyps, which led to a quality improvement movement for colonoscopy in the U.S., which I’ve led since its inception and is now a worldwide movement.

I specialize in resection of large polyps that haven’t become cancer yet but are considered too challenging or risky to remove by the doctors who found them at a prior colonoscopy. I have the largest practice in the U.S. for resection of these polyps. These are polyps that would have had to be removed during surgery in the past. But now, we’re able to remove them during colonoscopy.

I also see many patients who have had a prior colonoscopy that could not examine the entire colon, typically because of abnormal colon anatomy. I have the world’s largest experience in performing colonoscopy for these patients, with over a 97 percent success rate in completing colonoscopy.

I really enjoy what I do. It’s not work for me. I’m totally committed to trying to improve colonoscopy and colon cancer prevention. And at IU we’ve had a lot of firsts in this area.