Colon Cancer

Overview: Colon and Rectum Cancer
Can Colorectal Cancer Be Prevented?

Even though we don't know exactly what causes colorectal cancer, there are some steps you can take to reduce your risk.

Screening tests: First, you should follow the early detection screening guidelines mentioned below to help find colon or rectal cancer. When these cancers are found and treated early, they can often be cured. Screening can also find polyps. Removing these polyps helps prevent some cancers.

People who have a history of colorectal cancer in their family should check with their doctor for advice about screening tests or other tests to find cancer early.

Diet and exercise: The American Cancer Society recommends choosing most of your foods from plant sources, eating at least 5 servings of fruits and vegetables every day and limiting the amount of high-fat foods you eat. Some studies suggest that taking a daily multivitamin containing folic acid or folate can lower colorectal cancer risk. Other studies suggest that getting more calcium can help. Getting enough exercise is important as well. The American Cancer Society recommends at least 30 minutes of physical activity on 5 or more days of the week.

Aspirin and other drugs: Aspirin appears to prevent the growth of polyps. A drug called Celebrex also reduces polyps for some people whose family members tend to develop polyps. But these medicines can have side effects. For this reason, experts do not advise the general public to take them to try to prevent colorectal cancer. If you are at high risk for colorectal cancer, talk to your doctor about what you should do.

Other factors: People with a family history of colorectal cancer may benefit from starting screening tests when they are younger and having them done more often than people without this risk factor.

Overview: Colon and Rectum Cancer
How Is Colorectal Cancer Found?

Screening tests are used to look for disease in people who do not have any symptoms. In many cases, these tests can find colorectal cancers at an early stage and greatly improve the chances of successful treatment. Screening tests can also help prevent some cancers by allowing doctors to find and remove polyps that might become cancer. There are several tests used for colorectal cancer.

Stool blood test (fecal occult blood test – FOBT): This test is used to find small amounts of hidden (occult) blood in the stool. A sample of stool is tested for traces of blood. People having this test will receive a kit with instructions that explain how to take stool samples at home. The kit is then sent to a lab for testing. If the test is positive, further tests, such as a colonoscopy, will be done to pinpoint the exact cause of the bleeding.

A newer kind of stool blood test is known as FIT (fecal immunochemical test). It is very much like the FOBT but is perhaps a little easier to do and it gives a fewer number of false positive results. If it is positive, further tests will be done.

Flexible sigmoidoscopy (flex-sig): A sigmoidoscope is a slender, lighted tube about the thickness of a finger. It is placed into the lower part of the colon through the rectum. This allows the doctor to look at the inside of the rectum and part of the colon for cancer or polyps. Because the tube is only about 2 feet long, the doctor is only able to see about half of the colon. The test can be uncomfortable but it should not be painful. Before the test, you will need to take an enema to clean out the lower colon.

Colonoscopy: A colonoscope is a longer version of the sigmoidoscope. It allows the doctor to see the entire colon. If a polyp is found, the doctor may remove it. If anything else looks abnormal, a biopsy might be done. To do this, a small piece of tissue is taken out through the colonoscope. The tissue is sent to the lab to see if cancer cells are present. This test can be uncomfortable. To avoid this, you will be given medicine through a vein to make you feel relaxed and sleepy.

Medicare now covers these two tests for people at average risk who have Medicare coverage. More details can be found in the section, "Medicare Coverage."

Barium enema with air contrast: A chalky substance is used to partly fill and open up the colon. Air is then pumped in to cause the colon to expand. This allows good x-ray films to be taken. You will need to use laxatives the night before the exam and have an enema the morning of the exam.

Virtual colonoscopy: You might think of this as a super x-ray of the colon. Air is pumped into the colon to cause it to expand, and then a special CT scan is done. Right now, this test is not among those recommended by the ACS or other major medical organizations for finding colon cancer early. More studies are needed to find out if it is as good as or better than other methods of finding colon cancer early.

American Cancer Society Colorectal Cancer Screening Guidelines

Beginning at age 50, both men and women at average risk should follow 1of the 5 screening options below:

1. yearly stool blood test (FOBT) or fecal immunochemical test (FIT)
2. flexible sigmoidoscopy every 5 years
3. yearly stool blood test plus flexible sigmoidoscopy every 5 years

(Of the first three options, the ACS prefers the third option, that is, FOBT or FIT every year plus flexible sigmoidoscopy every five years.)

Or you may have:
4. double contrast barium enema every 5 years
5. colonoscopy every 10 years

For the stool blood test, the take-home, multiple-sample method should be used.

If something abnormal is found, a colonoscopy should be done. If any polyps are found they should be removed if possible.

While a digital rectal exam (DRE) is often done as part of a regular physical exam, it should not be used as a stand-alone test for colorectal cancer. For a DRE, the doctor examines the patient’s rectum with a gloved finger.

If anything abnormal is found on any of the tests, a colonoscopy should be done.

People with certain risk factors should begin screening earlier or have screening more often. For more information, please see Colrectal Cancer Early Detection. Talk to your doctor about your own risk and when you should have screening tests.

Medicare Coverage

For people on Medicare, this is what is covered:

Stool blood test (FOBT or FIT) each year for those 50 and over

Flexible sigmoidoscopy (flex-sig) every 4 years for those 50 and over at average risk

Colonoscopy every 2 years for those at high risk

Colonoscopy once every 10 years for those 50 and over at average risk

Barium enema with air contrast instead if a doctor believes that it is as good as or better than flex-sig or colonoscopy.

What would someone on Medicare expect to pay for these tests?

Stool blood test: people age 50 and older pay no coinsurance and no Part B deductible Flex-sig: Patient pays 20% of Medicare-approved amount after the yearly Part B deductible Colonoscopy: Patient pays 20% of Medicare-approved amount after the yearly Part B deductible Barium enema: When used instead of flex-sig or colonoscopy, patient pays 20% of Medicare-approved amount after the yearly Part B deductible

How Is Colorectal Cancer Diagnosed?

Most people with early colon cancer don’t have symptoms. Symptoms usually appear with more advanced disease. If something suspicious turns up as a result of screening or if you have symptoms, you will need further tests. Symptoms of colorectal cancer include:

* a change in bowel habits such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days
* a feeling that you need to have a bowel movement that doesn't go away after doing so
* bleeding from the rectum or blood in the stool (often, though, the stool will look normal)
* cramping or steady stomach pain
* weakess and tiredness

Just because you have these symptoms does not mean you have cancer. But you need to talk to your doctor to be sure. It is also possible to have colon cancer and not have any symptoms.

If there is any reason to suspect colon or rectal cancer, the doctor will ask you questions about your symptoms and risk factors (take a medical history) and do a physical exam. Then you will need to have further tests to find out if the disease is really present and if so, to see how far it has spread. Some of these tests are the same ones that are used for screening people who do not have symptoms.

Stool blood test, flex-sig, barium enema, and colonoscopy: your doctor may do one or more of these tests. They were described earlier.

Blood tests: Your doctor will order a blood count to see if you have too few red blood cells (anemia). People with colorectal cancer often become anemic because of bleeding from the tumor. You might also have blood tests to check your liver function because colorectal cancer can spread to the liver causing problems. There are other substances (tumor markers) in the blood that can help tell how well treatment is working. But these tumor markers are not used to find cancer in people who have not had cancer and who appear to be healthy; rather, they are most often used for follow-up of people who have already been treated for colorectal cancer.

Biopsy: In a biopsy, the doctor removes a small piece of tissue. The tissue is sent to the lab where it is looked at under a microscope to see if cancer is present.

Ultrasound: Ultrasound uses sound waves to produce a picture of the inside of the body. Most people know about ultrasound because it is often used to view a baby during pregnancy. This is an easy test to have. You simply lie on a table while a kind of wand is moved over your skin.

Two special types of ultrasound might be used for people with colon or rectal cancer. In one, the instrument that gives off sound waves is placed into the rectum. In the other test, used during surgery, the instrument is placed against the surface of the liver to see if the cancer has spread there.

CT scan (computed tomography): A CT scan uses x-rays to take many pictures of the body that are then combined by a computer to give a detailed picture. A CT scan can often show whether the cancer has spread to the liver, lungs, or other organs. CT scans can also be used to help guide a biopsy needle into a tumor. CT scans take longer than regular x-rays. The patient has to lie still on a table while the CT scan is being done. A contrast "dye" may be injected or a special drink used to help outline the area being viewed.

A new way to use a CT scan is to do a "virtual colonoscopy." After stool is cleaned from the colon and the colon is filled with air, a computer can put together a picture of the inside of the colon. This method requires the same preparation as for a colonoscopy and there is some discomfort from the bowel being filled with air. If anything not normal is seen, a follow-up colonoscopy will be needed.

MRI (magnetic resonance imaging): Like CT scans, MRI displays a cross-section of the body. However, MRI uses radio waves and strong magnets instead of radiation. As with CT scans, a contrast dye may be injected, although this is used less often. MRI scans are helpful in looking at the brain and spinal cord. They take longer than CT scans and you may have to be placed inside a tube. This can feel confining and upset people with a fear of closed spaces.

Chest x-ray: This test may be done to see whether colorectal cancer has spread to the lungs.

PET scan (positron emission tomography): In this test, a type of radioactive sugar is used. The cancer cells absorb high amounts of the sugar. PET is useful when your doctor thinks the cancer has spread, but doesn't know where. PET scans are now more accurate because they can be combined with a CT scan.

Angiography: For this test, a tube is placed into a blood vessel and moved until it reaches the area to be studied. Then a dye is injected and a series of x-ray pictures is taken. When the pictures are complete, the tube is removed. Surgeons sometimes use this method to find blood vessels next to cancer that has spread to the liver. The cancer can then be removed without causing a lot of bleeding.


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The information on this page has been extracted from
http://www.cancer.org/docroot/CRI/
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