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March 4, 2009 > Colorectal Cancer is Preventable, Treatable, and Beatable

Colorectal Cancer is Preventable, Treatable, and Beatable

Physician Shares Insight On Different Screening Options

Last month, visitors to New York's Times Square thought they had seen everything. But the 8-foot-high, 20-foot-long pink replica of a human colon was beyond even their expectations. That's right. Super ColonTM had come to the Big Apple.

Unable to stem their curiosity, people walked through the giant inflatable, interactive structure, getting a close-up look at healthy tissue, as well as tissue at various stages of colorectal cancer. It was all part of the kick-off of National Colorectal Cancer Awareness Month, which occurs every March. Presented by the Prevent Cancer Foundation, Super Colon has been traveling the country since 2003, making more than 100 stops.

"We celebrate Colorectal Cancer Awareness Month to remind everyone that colorectal cancer is still the second leading cause of cancer-related death in this country," says Annamalai Veerappan, M.D., a Fremont gastroenterologist who is on the medical staff at Washington Hospital. "That's why colorectal cancer screening is so important. Through screening, we can not only detect the disease in its earlier stages, we can literally prevent it from occurring in the first place."

Each year, nearly 150,000 Americans are diagnosed with colorectal cancer and more than 50,000 die of the disease, reports the Centers for Disease Control.

Most colorectal cancer develops from pre-cancerous lesions called polyps that can grow in the colon. Over a 10-year period, the polyps can become cancerous. By removing them, doctors can prevent the disease from developing.

"Removal of the polyps effectively reduces the risk of cancer in about 90 percent of the cases," reports Dr. Veerappan. "Seventy-five to eighty percent of colon cancers arise from precancerous polyps."

Everyone should be screened for colorectal cancer beginning at age 50. If you have a family history of the disease, especially if the person is an immediate relative, like a parent or sibling, you should beginning screening at age 40 or at the age when you are 10 years younger than your relative when they developed the disease. If you have a personal history of ulcerative colitis, you are also at higher risk for developing colorectal cancer and you should start screening within seven to 10 years after you began having symptoms.

Other factors that put you at higher risk for colorectal cancer include:
* Age (More people develop the disease as they grow older.)
* Diet (People who eat high fat diets, lots of red meat or diets low in fiber are at higher risk.)
* Lifestyle (People who are more sedentary or who smoke are at higher risk.)

It's important to get screened, even if you don't have any symptoms. By the time someone has symptoms of the disease, the cancer has usually advanced and there is a far lower chance of a cure.

There are five types of screening tests for colorectal cancer. Each has advantages and disadvantages. With the exception of the fecal occult blood test, it is necessary to cleanse the colon before the tests are done.

"Right now, colonoscopy is the gold standard in screening," explains Dr. Veerappan. "It detects and makes it possible to remove even small polyps throughout the colon. It does require that the patient be sedated, and there's a risk of bleeding or a tear occurring in the colon in about one out of every 1,000 cases."

Another type of colorectal cancer test is the fecal occult blood test, which checks for hidden blood in the stool. This test can be done at home by placing a small amount of your stool from three consecutive bowel movements on special test cards and returning the cards to your doctor's office or lab to be checked.

"We recommend that you do this test annually, however sometimes there are false positives and false negatives," adds Dr. Veerappan. "If blood is detected, further tests need to be done. Colon polyps seldom bleed, so it's unlikely that their existence would be determined by this test. When this test is positive for blood, the patient has cancer about 5 percent of the time."

With the flexible sigmoidoscopy, another type of screening, the doctor uses a narrow, flexible, lighted tube to look inside the rectum and lower part of the colon. With this test, only the lower one fourth of the colon is examined. If polyps are found, a follow-up colonoscopy will still be necessary to remove them.

The next type of test is the barium enema, which is now considered to be out-of-date and not completely accurate. Again, if polyps are detected, you would still need to have a colonoscopy.

Finally, the virtual colonoscopy, combines a sophisticated CT scan with a modified barium enema to detect abnormalities in the colon.

"The advantage of this test is that it is less risky than the colonoscopy and you do not have to be sedated. However, you are exposed to a large amount of radiation, and this should be a consideration, especially in having repeat tests," says Dr. Veerappan. "In the next few years, if certain improvements are made, I believe the virtual colonoscopy may replace the colonoscopy as the preferred method of screening."

It's recommended that people whose colonoscopy is clear, should have the test repeated every ten years. With the virtual colonoscopy and flexible sigmoidoscopy, the test should be repeated every five years.

For more information about colorectal cancer, its prevention and treatment, please go to the following web sites: www.cdc.gov, www.preventcancer.org and www.cancer.org.

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