Prevention and Screening

Colorectal cancer is preventable when polyps are found and removed. It is highly curable when found in its early stages. It is important to have screening tests that examine the entire colon because cancer can occur anywhere in the colon.

Overview Discussion of Screening & Prevention

Foods and Prevention

Signs and Symptoms
This cancer usually does NOT exhibit signs in its early stages. As the disease progresses, any of the following may be seen:

  • Blood in the stool
  • Diarrhea
  • Constipation
  • Bowel obstruction, causing nausea, vomiting and abdominal distention
  • Abdominal pain
  • Pelvic pain
  • Anemia
  • Weight loss
  • Loss of appetite
  • Fatigue

Screening

CCNetwork’s Screening Proposal

We believe that whenever possible, cancer should be prevented. In the case of colon cancer there are a growing number of experts that have been quoted as saying that screening early enough could end colon cancer.

For a full discussion of this very real possibility and why CCNetwork is fighting for screening to begin at age 18

Screening Guidelines

There are several organizations and government organizations who have developed and published screening guidelines.

Keep in mind though, the only one that wants screening for all adults is CCNetwork. “Screening for All, Colon Cancer for None.”

Lists of National Guidelines

Screening Tests

FOBT (Fecal Occult Blood Test)/Stool Test
Flexible Sigmoidoscopy
Digital Rectal Examination
Anal Pap Smear
Barium Enema
Colonoscopy
DNA Stool Test
Diagnostic Tests

 

Screening is done on individuals who do not have any indications (signs or symptoms) that may indicate cancer. If symptoms exist than diagnostic workups are done rather than screening. These test may be used in screening for colorectal cancers (anal, rectal, colon, appendiceal):

FOBT (Fecal Occult Blood Test)/Stool Test
Small amounts of stool are placed on a paper card and sent to a lab for testing. This test does NOT detect cancer. It detects blood which MAY be an indicator of cancer as well as many other health problems. A positive test mandates a complete diagnostic work-up, including a colonoscopy.

PROS:

  • Simple
  • Cost effective
  • Can be done in the doctor’s office as a quick test but full test must be done at home

CONS:

  • Viewed as unsanitary by some people using it
  • Patient must retrieve samples from stool in toilet bowl
  • Does not detect cancer; only detects blood present in the stool

For more information, go to our Testing Preparations page. Also, check out the the National Committee for Quality Assurance page for a tool to help measure screening rates among health plans.

 

Flexible Sigmoidoscopy
This test can detect lower colon and rectal cancer as well as polyps – which can be a precursor to colorectal cancer. A tube is inserted in through the anus and allows the physician to view the rectum and the lower one third of the colon. A positive diagnosis of polyps mandates a complete diagnostic work-up, including a colonoscopy.

PROS:

  • More cost effective than the more thorough and complete tests
  • Can be done in the doctor’s office

CONS:

  • Can only examine the lower 1/3 of the colon
  • Research has repeatedly demonstrated that in actual practice this test is not being used to its full effectiveness and therefore is rarely examining the entire third of the colon that it could view

Digital Rectal Examination
This test may help in detecting anal cancers but is less effective in detecting rectal or colon cancer. The physician examines the area by inserting his finger into the anus and feeling for abnormalities.

A positive diagnosis of polyps mandates a complete diagnostic work-up, including a colonoscopy.
PROS:

  • Inexpensive
  • Can be done in the doctor’s office

CONS:

  • Is not useful for detection beyond the anus and beginning of the rectum

Anal Pap Smear
Using the same lab test that is used for detecting cervical cancer an anal pap smear should be performed. This can detect anal cancer in its very earliest stages. This test should be done along with another choice of colorectal cancer screening.

PROS:

  • Inexpensive
  • Uses technology that is already solidly tested

CONS:

  • Can only detect anal cancers

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Barium Enema
A barium enema is given followed by a series of x-rays of the abdomen. This test has recently been determined to be a less desirable test for colorectal cancer detection.

PROS:

  • Lower cost that Colonoscopy
  • Non-invasive (air contrast is however)

CONS:

  • Radiation has health risks associated with it
  • In practice it is frequently not used effectively
  • Misses too many polyps

Colonoscopy
The following preps are the commonly used preparations associated with colonoscopy.

  1. Fleet Phospho Soda (two small vials of liquid)
  2. Go Lytely (gallon of liquid)
  3. Visicol (pills)

There are other options that are not commonly used as well.

This is the most thorough method for evaluating the colorectal area. Biopsies can be taken of any abnormal areas at the same time as the screening or diagnostic test is being done. Any polyps found can be removed during this procedure.

PROS:

  • Examines the entire colorectal passage: anus, rectum, colon, up to the connection with the appendix
  • High detection rate for polyps

CONS:

  • More expensive than other types of screening
  • Has a very small risk of perforation

Vitual Colonoscopy

PROS:

  • Examines the entire colorectal passage: anus, rectum, colon, up to the connection with the appendix
  • High detection rate for polyps
  • Can view other areas at the same time

CONS:

  • More expensive than other types of screening
  • Can not remove polyps nor take a biopsy
  • If something is found a regular colonoscopy may still be required
  • Considered by some to still be experimental

DNA Stool Test
This test is still in Phase III clinical trials but has demonstrated the ability to detect many cancers, including colorectal cancer. The stool is captured in a container that fits over the toilet seat. The container is then sealed and shipped to the lab. The patient does not have to handle the stool directly at all. Because this test is detecting mutated DNA it can detect not only cancer but detects the presence of polyps in many cases.

PROS:

  • Cost effective
  • Detects cancer not blood
  • Sanitary – no sample manipulation
  • No bowel preparation
  • No medication or dietary restrictions
  • Requires only a single stool specimen

CONS:

  • Has only a 50% detection rate for polyps and colon cancer
  • Only available through one lab (LabCorp)

Please visit Exact Sciences for more information on the Pre-Gen Plus test. More information is also available from LabCorp.com.

 

Diagnostic Tests
When symptoms are present, diagnostics are done rather than screening. Your physician may order diagnostic tests. Some of these tests may include:

 

  1. Colonoscopy
  2. Biopsy
  3. CBC
  4. Liver Function tests (Albumin, GGT, ALkP, ALT, AST, Bilirubin, LDH)
  5. Tumor Markers such as CEA or GCC
  6. Ultrasound
  7. Computed Tomography (CT)

Awareness

Surveillance
Surveillance is done for cancer survivors as continual follow-up to prevent or detect early any cancer or polyp recurrences.Unfortunately, colon cancer has a recurrence rate of over 40%. The majority of recurrences in patients who have undergone complete resection of a colorectal cancer will occur within 5 years, and usually within 3 years of surgery.

Frequency of Testing:
Published guidelines suggest the following surveillance schedule post-surgery. Your physician may tailor this schedule to fit your individual needs.

  • Years 1-2 Every 3 months
  • Year 3-4 Every 6 months
  • Year 5 Annual

Tests used for surveillance:

  • All the tests above as well as
  • Magnetic Resonance imaging (MRI)
  • Positron emission tomography (PET)
  • Angiography
  • Tumor Markers such as CEA or the GCC-B1™ Blood Test

Awareness News

The Colossal Colon
The Colossal Colon is an over sized model of a colon, approximately 40 feet long and 4 feet tall. Visitors who crawl through will see polyps, cancer, diverticulosis, and many other colon diseases, making it a colon cancer educating tool like no other!

The Colossal Colon is the brainchild of Molly McMaster, who was diagnosed with colon cancer on her 23rd birthday – and is dedicated to the memory of Amanda, who died of colon cancer at age 27. Check out what Dave Barry’s had to say about it: Click here to register for the Miami Herald.

 

Increasing Awareness in Oklahoma

Proclamation signed on January 22, 2002, by Oklahoma State Governor Frank Keating, designating the month of March 2002 as Colorectal Cancer Awareness Month in Oklahoma.

Lawton, Oklahoma
Lawton, Oklahoma Mayor’s office
City Council Meeting on February 26, 2002 Mayor Cecil Powell will be issuing a Proclamation designating the month of March 2002 as Colorectal Cancer Awareness Month in Lawton, Oklahoma.

Articles

DNA Colorectal Cancer Test
Mayo Clinic researchers in collaboration with scientists at EXACT Laboratories, have developed DNA colorectal cancer test for detecting cancer throughout the colon, which has shown 91% sensitivity. The test requires a stool specimen to analyze the DNA shed from the surface of colorectal tumor. This non-invasive test safely and accurately detected 91% curable-stage cancer of the colon and rectum. Because of the high rate of accuracy, the test could require fewer, unnecessary colonoscopies to be performed. Further more the method detected 73% precancerous polyps. By detecting polyps and endoscopically removing them, colorectal cancer can be prevented. The collaborative study demonstrated the feasibility of DNA stool analysis as a screening approach and paved the way for a three year clinical trial.

(PTI Science Service, Jan 16-31, 2001)

 

Lutein-Containing Foods Can Help Prevent Colon Cancer
Carotenoids, substances found in many fruits and vegetables, have biological properties that offer protection against cancer.

A new study examined how specific carotenoids protect against particular types and stages of colon cancer. Of all the carotenoids tested, lutein had the greatest protective effect. Click here for entire article.

 

Internet Helps Cancer Patients Cope
NEW YORK (Reuters) — Traditional support groups help cancer survivors bear the burden of their illnesses. Now, online networks — so-called “cyber solace” — can offer many of the same benefits and more, according to a study at the University of Delaware (UD).

Advantages to participating in online chat with other cancer survivors and their families include 24-hour availability — even to homebound patients — and an offer of anonymity that may be appealing to some, said lead researcher Dr. Paula Klemm, assistant professor and assistant chairperson of nursing at UD. Her study was published in the January/February issue of Computers in Nursing. Click here for entire article.

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