Colorectal Cancer: What You Don't Know Could Hurt You!

Seminar on October 6 Explains Risks, Screenings and Treatments

Some cancers, such as prostate cancer, occur only in men. Other cancers, such as ovarian and uterine cancer, occur only in women. Cancers of the colon and rectum – colorectal cancers – are “equal opportunity” cancers that affect both men and women in substantially equal numbers. According to the American Cancer Society (ACS), colorectal cancer is the third most commonly diagnosed form of cancer among both men and women.

“The most common cancer in men is prostate cancer,” says Dr. Arun Srivatsa, a gastroenterologist with Washington Township Medical Foundation. “Breast cancer is the most common cancer among women, but it also can occur in some men. Lung cancer and colorectal cancer are the second and third most common cancers, respectively, in both men and women.”

The ACS estimates that approximately 132,700 cases of colorectal cancer will be diagnosed in 2015, with 93,093 new cases of colon cancer and 39,610 new cases of rectal cancer. An estimated 49,700 people will die of colorectal cancer this year. Screening tests that can detect colorectal cancer early could prevent many of those deaths. The Centers for Disease Control and Prevention (CDC) estimates that up to 60 percent of colorectal cancer deaths could be prevented if all people over 50 years of age were screened routinely.

“Fortunately, the death rate from colorectal cancer has been dropping in both men and women for more than 20 years,” Dr. Srivatsa notes. “Some data show that more people are having colonoscopies as recommended, and that appears to detect more pre-cancerous polyps and colorectal cancers early, when the disease is easier to cure.”

To help people in the community learn more about colorectal cancer, Washington Hospital is offering a Health & Wellness Seminar featuring Dr. Srivatsa on Tuesday, October 6, from 1 to 3 p.m. At the seminar, he will discuss the prevalence of colorectal cancer, screening and treatment technologies, specific warning signs and symptoms, and how to reduce your risks for colon and rectal cancers. The event will take place in the Conrad E. Anderson, M.D. Auditorium in the Washington West Building at 2500 Mowry Avenue in Fremont. For more information or to reserve your spot, go online to www.whhs.com and click on events, or call 800.963.7070.

Risk Factors for Colorectal Cancer

The risk of developing colorectal cancer increases as you age. That’s why the ACS and CDC both recommend colonoscopy screenings at least every 10 years for people over age 50. It is considered a preventive exam that is covered by most insurance providers.

“People who are at a higher risk for colorectal cancer should be screened at an earlier age and be screened more often,” Dr. Srivatsa advises. “For example, people who have a family history of colorectal cancer, with either a parent or a sibling who has been diagnosed, should be screened every three to five years. Plus, they should start screenings 10 years before the age of onset in their parent or sibling, or at age 40 – whichever is earlier.”

In addition to age and a personal or family history of colorectal cancer, some other risk factors include:

• A personal history of adenomatous (pre-cancerous) intestinal polyps
• Inflammatory bowel disease
• Smoking
• Lack of exercise
• Obesity
• A diet high in red meat (beef, pork or lamb) or processed meats (bacon, sausage, cold cuts or hot dogs)
• Excess consumption of alcohol

“Obviously, you cannot control risk factors such as your age or family history of colorectal disease,” Dr. Srivatsa says. “You can make lifestyle changes such as quitting smoking and exercising more to reduce your other risks, however. Diet is also an important consideration. A diet that is high in consumption of red meat, saturated fat, refined carbohydrates and alcohol will increase your risks. Conversely, a diet that includes more fruits, vegetables, dietary fiber, calcium, vitamin B9 (folate or folic acid) and other antioxidant vitamins can decrease your risks.”

Warning Signs and Symptoms

Unfortunately, colorectal cancer generally does not produce any symptoms until the disease is fairly advanced. The absence of symptoms should not be a reason to delay or ignore cancer testing, but anyone who has the following symptoms – especially if they are over age 40 – should definitely consult a physician:

• A change in bowel habits, such as diarrhea or constipation, that lasts for more than a few days.
• Bleeding from the rectum or in the stool.
• Stools that are narrower than usual.
• Unexpected weight loss with no known reason.
• Cramping or gnawing stomach pain.
• Decreased appetite.
• Weakness and fatigue.
• Jaundice (yellowish color of the skin and the whites of the eyes).

Presence of these symptoms does not necessarily mean you have cancer, but it’s best to check with your doctor and to find out if you need to schedule a screening.

Screening and Treatment Technologies

“There are various screening tests for colorectal cancer, but the ‘gold standard’ is a colonoscopy,” says Dr. Srivatsa. “With a colonoscopy, we can detect prscancerous polyps and remove them at the same time. Tests that only detect cancer – such as the fecal occult blood test that measures blood in the stool or barium enema x-rays – don’t allow for removing polyps. The vast majority of colorectal cancers start as a polyp.”

In a colonoscopy, a thin, flexible tube with a miniature camera is inserted through the rectum into the colon, allowing the doctor to look at the inside of the large intestine. During the procedure, the patient is under moderate anesthesia and is unaware of what’s happening. Flexible sigmoidoscopy is a similar procedure that allows doctors to view and remove polyps, but it views only about the first half of the colon, instead of the entire colon. Plus, anesthesia is generally not used for sigmoidoscopy, so there may be some discomfort during the procedure.

Another high-definition diagnostic tool is endoscopic ultrasound (EUS), which combines endoscopy and ultrasound to obtain detailed images. With EUS, a small ultrasound device is embedded in the tip of the endoscope, which can be inserted via the rectum.

“Endoscopic ultrasound can be used for staging colorectal cancer, providing information about the spread of cancer within the colon and to adjacent tissues and lymph nodes,” Dr. Srivatsa says.

Treatments for colorectal cancer depend on the stage of the cancer, its location and whether it has metastasized to other areas of the body such as the liver, lungs, brain or bones.

“Surgery is the mainstay of treatment for colorectal cancers,” Dr. Srivatsa explains. “Surgery alone is often the only treatment required for stage I colon cancer, while chemotherapy could be used in addition to surgery for stage II and stage III colon cancer. Stage IV colon cancer treatment might involve surgery, chemotherapy and additional surgery to remove metastasized sites. Treatments for rectal cancer are similar to those for colon cancer, with the addition of radiation treatment to chemotherapy for stages II and III.”

At Washington Hospital, surgery for colorectal cancers is performed by laparoscopy, sometimes with robotic assistance. The objective is to remove tumors completely, with no cancer cells in the margins of tissue surrounding the tumors. The surgery also is designed to remove any nearby involved node-bearing tissue and to avoid “spillage” or disruption of tumors.

“Laparoscopic surgery is as effective as more traditional open surgery for treatment of colorectal cancer,” Dr. Srivatsa emphasizes. “Plus, it affords the benefits of smaller incisions, less pain, a shorter length of stay in the hospital and an earlier return to the patient’s everyday activities. The key is to catch the cancer early. Advances in screening and treatment for colorectal cancer have led to dramatically improved survival rates. Today’s five-year survival rate for stage I colorectal cancer is approximately 93 percent.”

Learn More

To register for the seminar, “Colon Cancer: What You Need To Know,” on Tuesday, October 6, visit www.whhs.com and click on the banner near the middle of the home page for “Upcoming Health Seminars.”

For more information about colorectal cancer prevention, diagnosis and treatment, visit the Centers for Disease Control and Prevention website at www.cdc.gov and the American Cancer Society website at www.cancer.org.

For help in finding a gastroenterologist who can discuss your risks for colorectal cancer and the appropriate screenings, visit www.whhs.com, click on the tab for “Find My Physician,” and select “Gastroenterology” in the drop-down menu for “Search by Specialty.”