March is national Colorectal Cancer Awareness Month, to raise awareness of the importance of testing and early detection. With recommended screening, this cancer can be prevented (by removing polyps before they become cancerous) or detected early, when it can be more easily and successfully treated.
Colon cancer nearly always starts with polyps, fleshy growths on the inside lining of the intestine. “Polyps are common, particularly with advancing age,” says Sharon Hayward, MD, surgeon with Our Lady of Victory Hospital in Stanley. “But some polyps have the capacity to become malignant and spread cancer cells throughout the body. Screening tests are capable of detecting not only cancer, but polyps that can be removed before they become cancerous.”
Polyps take considerable time to grow into cancers, and they often produce no symptoms. Dr. Hayward suggests being on the lookout for the following symptoms:
- BLEEDING is the most common sign. As a polyp or tumor grows larger, the passage of feces is likely to irritate it and cause it to bleed. But bleeding doesn’t always occur, and it doesn’t always mean colon cancer. If you notice bright red blood on bathroom tissue or have blood stains on your underwear, it’s probably because of hemorrhoids or a minor tear near your anus. Bleeding from polyps is more likely to be hidden and, as a result, detectable primarily through a test such as the Fecal Occult Blood Test (FOBT). The test requires smearing small samples of stool on a chemically treated card or pad that are then examined under the microscope.
- CRAMPING, PAIN: Abdominal discomfort can occur when a tumor is growing in the colon and forming an obstacle for normal movement of waste.
- WEIGHT LOSS: Anyone feeling constant pain in the gut is certainly not going to feel like overeating. As the pain grows, appetite wanes, and the result is weight loss.
- ANEMIA: Particularly on the spacious right side of the colon, a tumor may become quite large and cause considerable bleeding before other symptoms occur, resulting in anemia and symptoms such as fatigue, weakness, dizziness and shortness of breath.
- OBSTRUCTION: On the left side, the colon is narrower. And in this part of the colon much of the water has already been removed from the stool. As a result, cancer on the left side is more likely to cause partial or complete obstruction of the bowels. Chronic constipation, often defined as having fewer than three bowel movements a week, is common among healthy individuals. It can also be a sign of colon cancer.
- THIN STOOL: A blockage near the end of the colon sometimes results in pencil thin stools–squeezed on the way out by the tumor. Any change in bowel habits can be a sign of colon cancer. But most individuals are inhibited about discussing their bowel habits, even with a physician.
The American Cancer Society recommends yearly screening with the Fecal Occult Blood Test for everyone 50 and older and for others with risk factors such as a family history of colon cancer.
More thorough screening, recommended at less frequent intervals, should be performed with an endoscope or thin lighted tube to examine the lining of the colon. Dr. Hayward said, “Sigmoidoscopy is less invasive and does not require anesthesia, as colonoscopy does. But it explores only the last two feet or so of the colon. If we do find a polyp here, we will recommend colonoscopy to look at the entire colon and remove any polyps that are found. Both procedures require emptying the colon through the use of laxatives and enemas.”
Virtual colonoscopy, not yet widely available, uses a CT scan to take images of the colon. Some patients might find this test attractive because it does not require that a scope be inserted into the colon. However, it still requires bowel preparation.
People concerned about the cost of the screening should be advised that Medicare provides coverage of colorectal cancer screenings for the early detection of colorectal cancer. All Medicare beneficiaries age 50 and older are covered; however, when an individual is at high risk, there is no minimum age required to receive a screening colonoscopy or a barium enema rendered in place of the screening colonoscopy.
Medicare provides coverage for the following colorectal cancer screenings subject to certain coverage, frequency, and payment limitations:
- Screening Fecal Occult Blood Test (FOBT)
- Screening colonoscopy
- Screening sigmoidoscopy
- Screen Barium enema (as an alternative to a covered screening flexible sigmoidoscopy or screening colonoscopy)
Dr. Hayward adds, “Whatever symptoms you have or don’t have, there are screening tests that allow early detection of colon cancer.”