Colon and rectal cancers are the second most common cancers in men, third amongst women and continue their decimating role as the overall number two cause of death from internal organ system cancers in spite of everything we have learned about the genetics, the pathophysiology and the myriad of risk factors behind this deadly disease. There is a very understandable and straight forward explanation to this conundrum. Clearly, early detection leading to treatment is the obvious path…but…
EARLY SYMPTOMS are usually non-existent. EARLY SIGNS are even less prevalent usually not obvious before stage II classification. IF present, symptoms or signs are non-specific alternating constipation and diarrhea, abdominal bloating and cramps, thin stools and rectal blood spotting. Systemic signs are even more vague predominantly loss of appetite, nausea, weight loss, weakness, fatigue and later, anemia. All of which have a myriad of other potential conditions.
Typical premalignant lesion is a polyp or adenoma anywhere on the bowel wall in almost 98% of cases eventually, usually slowly, evolving in to an adenocarcinoma. (There are a very few rare forms of lymphoma, carcinoid or melanoma representing the remainder of bowel cancers). Risk factors include age (usually over 50 but I have seen as young as 24) genetics (direct family connection, inherited polyposis, and racial N.A. Black and Jewish. Life style factors play a role…smoking, obesity, diet heavily dominated by processed meats and grilling releasing carcinogens and the ubiquitous heavy alcohol consumption track record. Irritable bowel diseases including Crohn’s and ulcerative colitis demonstrate a prevalence linkage. More worrisome with the rising prevalence of type II diabetes in seniors is its linkage with rectal cancers.
We know so much about this cancer yet it remains such a scourge for one obvious reason. TOO MANY PATIENTS BALK AT THE TESTING PROCESS!
Stool sampling for blood is non-specific as there are many other reasons for blood to be present and not all cancers bleed. Cologuard stool DNA testing (the “home test” alternative) is flawed with a significant number of false positives and negatives and in limited testing only 69% accurate with premalignant lesions. CT SCANS AND MRI, even PET scanning often described as “virtual” scoping are expensive, involve delays in booking often give false positives and negatives and mandatory require direct scoping for affirmation.
THE GOLD STANDARD IS COLONSCOPY Scoping not only directly assesses the entire length of the bowel but allows for excisional biopsy of early lesions for both diagnostic and curative goals. The testing is painless, low risk and involves a brief IV induction of hypnotic for relaxation with no post procedure memory. I routinely hear two standard complaints by procrastinators, the aesthetic of having a length of hose introduced in to your nether regions by an unfamiliar masked countenance you’ve probably met only once before and briefly…and then there is the dreaded prep whose brief discomfort is too gleefully described in aggrandized embellishments by friends with prior scoping experience. In rebuttal (no pun intended…it just happened) I offer one absolute clear incentive if any of the above indicates a personal risk perspective.
BOWEL CANCER IS THE SECOND LEADING CAUSE OF CANCER DEATH IN CANADA …and the single prevalent explanation for this ongoing statistic is delay in diagnosis.
Dr. David Carll