Colorectal Cancer Q&A

As reported in St. Louis Woman magazine, "Ask the Doctor"
March 2008

March is National Colorectal Cancer Awareness Month, and St. John’s Mercy is taking this opportunity to provide important information about this prevalent disease. The following questions were answered by Michael E. Presti, M.D., gastroenterologist, of St. John's Mercy Medical Center.

Q: What is colorectal cancer?

A: Colorectal cancer is cancer found in the colon or rectum. Because colon and rectal cancers have many features in common, they are referred to together as colorectal cancer. Most of these cancers develop slowly over a period of several years, and they often begin as polyps – abnormal growths of tissue that start in the lining of the colon or rectum and grow into the center. Removing polyps early may prevent them from becoming cancer.

Excluding skin cancers, colorectal cancer is the third most common cancer in both women and men. The American Cancer Society (ACS) estimates that more than 150,000 colorectal cancer cases are expected in 2008. The number of deaths due to colorectal cancer has decreased, which is attributed to increased screening and polyp removal.

Q: What are the symptoms of colorectal cancer?

A: Early colorectal cancer often has no symptoms, which is why screening for this type of cancer is so important. As colorectal cancer advances, symptoms depend on the location of the tumor within the colon or rectum and may include: rectal bleeding or blood in the stool; abdominal pain; or changes in bowel habits such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days.

Symptoms vary by individual and may resemble other conditions such as infections, hemorrhoids and inflammatory bowel disease. Always consult your physician for a diagnosis.

Q: What are the risk factors for colorectal cancer?

A: Risk factors may include:

• Age – The disease can occur at any age, but your risk of colorectal cancer increases after age 50. According to the ACS, nine out of 10 people found to have colorectal cancer are older than 50.
• Diet – Colorectal cancer is often associated with a diet high in fat and calories, and low in fiber.
• Weight and Inactivity – People who are overweight and inactive have a higher risk of colorectal cancer.
• Smoking – According to the ACS, smokers are 30 to 40 percent more likely than nonsmokers to die of colorectal cancer. Smoking increases the risk of many other cancers, too.
• Diabetes – People with diabetes have a 30 percent greater chance of developing colorectal cancer and have a higher death rate from this cancer.
• Polyps – Benign growths on the wall of the colon or rectum are common in people over age 50 and are believed to lead to colorectal cancer.
• Personal history – People who have had colorectal cancer, as well as ovarian, uterine, or breast cancers, have a slightly increased risk for colorectal cancer.
• Family history – People with a first-degree relative (parent, sibling or child) who has had colorectal cancer have an increased risk for colorectal cancer.
• Inflammatory bowel disease – People who have ulcerative colitis (an inflamed lining of the colon) and Crohn’s colitis have an increased risk for colorectal cancer.

Q: How can colorectal cancer be prevented?

A: Colorectal cancer is one of the most preventable forms of cancer. With appropriate screening, most cases of colorectal cancer can be prevented and/or detected at an earlier, more treatable stage. When diagnosed at an early stage, patients with colorectal tumors have a 90 percent survival rate.

The ACS recommends that both men and women at average risk have one of the following five screenings beginning at age 50:

• Yearly stool blood test (fecal occult blood test or fecal immunochemical test), or
• Flexible sigmoidoscopy every five years, or
• Yearly stool blood test plus flexible sigmoidoscopy every five years (the ACS prefers this option of the first three)
• Double contrast barium enema every five years, or
• Colonoscopy every 10 years

Depending on your medical history and risk factors, your physician may recommend earlier or more frequent screenings. Talk with your physician about a screening schedule that is best for you.

In addition, it is important to manage the risk factors you can control, such as diet and exercise. Eating more fruits, vegetables, and whole grain foods, and avoiding high-fat, low-fiber foods, plus appropriate exercise (even small amounts on a regular basis) can be beneficial. Discuss other prevention strategies with your physician.

Q: How is colorectal cancer treated?

A: Your treatment plan will be determined by your physician based on your overall health, medical history, the extent of the disease and other factors. Treatment may include surgery, radiation therapy, chemotherapy and newer, targeted therapies (called monoclonal antibodies). Depending on the stage of your cancer, two or more types of treatment may be used at the same time or used one after the other.

Speak with your physician, a gastroenterologist or a medical oncologist for further information about treatment options for colorectal cancer.

Michael E. Presti, M.D.
Gastroenterologist
St. John’s Mercy Medical Center
621 S. New Ballas Road, Suite 1001-B
St. Louis, MO 63141
(314) 251-5663

Sources of Information for this Article

• American Cancer Society, (http://www.cancer.org/docroot/lrn/lrn_0.asp)

More information on Colorectal Cancer