How to spot and treat colorectal cancer

“Let’s be proactive about preventing colorectal cancer from even starting!”

— Dr. Dale

From How to spot and treat colorectal cancer

By Dr. Manny Alvarez Published August 12, 2017

After a twenty-year period in which the development of colorectal cancer among white Americans under the age of 55 was reported as declining, new evidence shows an increase in the disease. A recent study conducted by the American Cancer Society, using data from the National Center for Health Statistics, uncovered this worrying development and experts are urging an increase in awareness of the disease to help combat the rise.

Colorectal cancer describes colon cancer and bowel cancer. They typically occur in the lower part of the large intestine and are accompanied by a range of symptoms. If caught early, there’s a 50 percent chance that treatment will be a complete success. Late diagnosis often results in a less positive outcome.

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Causes of colorectal cancer

Over the years, medical research experts have discovered the causes of different types of cancers and other serious illnesses. Many causes are connected with diet and lifestyle, but there are some that are less obvious or easy to alter.

When it comes to colon cancer and bowel cancer, causes of the debilitating disease include:

• A diet high in saturated fats and low in fiber

• Sedentary lifestyle

• Obesity

• Smoking

• Excessive intake of alcohol

• Old age

• Family history of colon cancer or bowel cancer

• Polyps in your rectum or the lowers parts of your large intestine

• History of irritable bowel illness such as colitis and crohns disease

Common symptoms

To help raise awareness of the disease and give you a better understanding of when you should be concerned, here are the most common symptoms of colon and bowel cancer:

• More frequent visits to the toilet, without any significant changes in your lifestyle

• Constipation

• Diarrhea

• Blood in stools (feces)

• Feeling as though your bowel isn’t empty, even after going to the toilet

• A bloated abdomen

• Feeling full, even if you haven’t eaten for some time

• Any regular, unexplained pain in the abdomen

• Unexplained fatigue or tiredness

• Inexplicable weight loss

• Vomiting

• A lump in your tummy or back passage when your doctor examines you

• Unexpected development of iron deficiency in men, or in women post-menopause

Of course, a number of these symptoms are associated with other, sometimes less serious, illnesses too. However, if you experience a combination of three or more and have no explanation as to why they’ve begun, you should book an appointment with your doctor.

Even if it turns out to be something else entirely, your doctor will be happy to examine you and rule the possibility of colorectal cancer out as quickly as possible.

How colorectal cancer is treated

We know that no one wants to be diagnosed with colon cancer or bowel cancer. But, if you are unfortunate enough to have the disease, the current treatment to beat it can be successful – particularly if you’re diagnosed early on.

The treatment you receive for colorectal cancer depends on a number of factors, including the stage of the cancer, the exact location of the disease and your age, too – among others. The main treatments are surgery, radiotherapy and chemotherapy.

Surgery

With colorectal cancer, surgery is the most common treatment. That’s because it is usually possible to remove the polyps that typically cause the caner and also remove the infected part of the bowel or colon. A colostomy bag is often required for a short period of time and between surgeries. But, once the bowel is repaired, the need for a bag is eliminated.

In cases where the diagnosis is early and the cancer hasn’t spread far, surgery is able to cure the sufferer completely. In other cases, further treatment may be required.

Radiotherapy

As in other types of cancer, radiotherapy is where high energy radiation beams are used to try and shrink the cancer cells. It can also be used in an attempt to stop the cancer cells from multiplying and spreading.

Radiotherapy tends to be used in conjunction with other treatments. It can be used to try and shrink the cells before surgery. Or it can be prescribed after surgery too, in an attempt to try and stop the cells from multiplying.

Chemotherapy

A common treatment for colon cancer, chemotherapy uses strong chemical medicines to destroy the cancer cells. It can also be used in combination with other treatments to facilitate a more successful outcome.

Indeed, studies have shown that when chemotherapy is used in patients with advanced colon cancer and familial history of colorectal cancer, they have a lower chance of a recurrence of the disease.

When in doubt, speak to your doctor

As with other forms of cancer, colorectal cancer is a potentially debilitating disease. But, if it’s diagnosed and treated early, the results are more likely to be successful.

If you feel there might be something sinister happening to you that could be related to colon cancer or bowel cancer, make an appointment to see your doctor as soon as you can. They will either put your mind at rest or follow up on your concerns and help ensure you get well again.

The discomfort and upset of having colorectal cancer won’t be pleasant. But removing those cells from your body and enjoying an active and healthy life afterwards is a much better outcome than what could happen if you don’t follow up on your concerns.

Colon cancer deaths rise among younger adults, and no one knows why

“It’s never too early to have a colonoscopy.”

— Dr. Dale

From Colon cancer deaths rise among younger adults, and no one knows why

Adults in the United States are dying from colon and rectal cancers at an increasing rate about age 50, when they should just be beginning screenings, according to a new study from the American Cancer Society.

Since routine screening is generally not recommended for most adults under 50, the cancers found in younger adults are often in advanced stages and more deadly, said Dr. James Church, a colorectal surgeon at the Cleveland Clinic in Ohio.

Church, who was not involved in the new study, said he has seen this trend in death rates up close. Last year, on separate occasions, Church saw two 36-year-olds with stage IV colon cancer, he said.

In both of those patients, who had no relation to each other, the cancer spread to their livers, making it so he couldn't operate. Both died, he said.

"They both had young families, both little girls, and they lost their father in one case and their mother in the other, forever, because of this nasty disease when it's advanced," Church said.

"It makes a big impact on me, and it makes me keenly interested in trying to solve this issue," he said. "Everybody in colorectal surgical circles is seeing increased incidence of colon cancer in the young, defined as younger than 50."

The new study, published Tuesday in the medical journal JAMA, is a followup to one that found that incidence rates of colon and rectal cancers are rising in American adults under 50, the recommended screening age.

According to the previous study, adults born in 1990 could have twice the risk of colon cancer and four times the risk of rectal cancer at the same age had they been born in 1950.

The reason for the rise in both incidence and death rates remains unclear.

"We've known that there's this increasing trend in people under 50 for incidence, but a lot of people were saying, 'Hey, this is good news. This means people are getting more colonoscopies, and cancer's being detected earlier,' " said Rebecca Siegel, an epidemiologist at the American Cancer Society and lead author of the new study.

Now, "what (the new study) indicates is that the increase in incidence is a true increase in disease occurrence and not an artifact of more colonoscopy use," she said. "If it was just colonoscopy use, you wouldn't expect to see an effect on death rates, or even you might see a decline in death rates."

Colorectal cancer, which includes both colon and rectal cancers, is the third-leading cause of cancer-related deaths in women in the United States and the second leading cause in men, and this year, it's expected to result in about 50,260 deaths, according to the American Cancer Society.

Globally, colorectal cancer is the third most common cancer, according to the World Cancer Research Fund International.

A 'surprising' racial divide

The new study included data on colon and rectal cancer diagnoses and death reports for adults ages 20 to 54 in the United States from 1970 to 2014.

The mortality data came from the National Cancer Institute's Surveillance, Epidemiology and End Results Program, as reported by the National Center for Health Statistics, which tracks cause-specific mortality rates.

After analyzing the data, the researchers found that colon and rectal cancer mortality rates among 20- to 54-year-olds declined overall from 1970 to 2004 but then increased by 1% annually from 2004 to 2014. In 2014, the total colorectal mortality rate in that age group was 4.3 people per 100,000.

Additionally, "when we looked at the trend by race, the increase in death rates is confined to whites, and in blacks, we see a slight decline over the entire 45-year study period in death rates," Siegel said.

"That's very surprising, because whites and blacks have similar patterns in the major risk factors for colorectal cancer, like obesity," she said. "A lot of people want to look to the natural culprit, obesity, but that probably isn't what's completely driving this increase in colorectal cancer."

It turns out that what's driving the increase in both colorectal cancer incidence and death rates remains a mystery, Siegel said.

"It's important to mention that still the risk for colorectal cancer is low in people under 55. We don't want to be alarmists. The risk is low," Siegel said.

"In whites, the increase over the past decade was a 14% increase in the rate. So it's not enormous, but it's concerning, because the trend has changed direction," she said. "It was declining, and now it's increasing."

Some key factors that can impact mortality rates include the stage of cancer at the time of diagnosis, treatments received by patients and the molecular subtype of the cancer, said Dr. Nancy You, a colorectal cancer surgeon and associate professor of surgical oncology at the MD Anderson Cancer Center in Houston.

Still, while such large population-level studies are excellent for showing large-scale trends, they often don't allow for deciphering the causes for those trends, said You, who was not involved in the new study.

For instance, the data analysis in the study didn't reveal the proportion of advanced versus early-stage colorectal cancers over time or whether the proportion of patients who received stage-specific treatments changed over time, You said.

"The study also did not compare the cancer-specific mortality rates of young versus older adults with colorectal cancer in the same time," You said.

"Finally, young age-of-onset rectal cancer appears to differ from young age-of-onset colon cancer, because the rise in incidence rates of rectal cancer is much more dramatic," she said. "The mortality rate difference based on colon versus rectum would also be interesting for a future analysis."

You added that, between 2004 and 2014, there were many advances in surgical and chemotherapy treatments for colorectal cancer.

"So the findings reported here raise the concern that 'why are such treatment advances failing to deliver their promise of improving survival among young adults?' " she said.

All in all, the study "tells us that we need to get messages out for people when they turn 50, they need to call and schedule their colorectal cancer screening, because increasing death rates for people who should be screened is very concerning," said Siegel, the study's lead author.

The Affordable Care Act required coverage of colorectal cancer screening tests, but patients still should check with their health insurance providers to determine coverage for colorectal cancer screening, which can range in cost.

Screenings can be performed using a fecal blood test, a stool DNA test, a sigmoidoscopy, a virtual colonoscopy or the standard colonoscopy, according to the National Cancer Institute, which also notes that other tests to screen for colorectal cancer are not generally recommended.

Jim Risk, a 51-year-old patient at the Cleveland Clinic who was not involved in the new study, agreed that the study's findings are a reminder for more adults to get screened and to pay attention to potential colorectal cancer symptoms, which include diarrhea, blood in the stool, cramping or bloating.

Risk was 40 when the Cleveland Clinic's Church diagnosed him with stage I rectal cancer.

'Had I ignored it ... I probably wouldn't be alive today'

About 10 years ago, Risk experienced rectal bleeding, and at first, he figured it was a result of a lingering hemorrhoid, he said.

Yet after he casually mentioned the bleeding to his primary care physician in an annual physical exam, Risk's doctor recommended that he get a colonoscopy to make sure the bleeding was nothing more serious.

So Risk visited the Cleveland Clinic's main campus, where "they pulled basically a golf-ball-sized polyp out of me," he said.

Colon polyps are growths of tissue on the lining of the colon and rectum, and some polyps can become cancerous. Risk's polyp was tested for cancer, and a week later, Church called him with the test results.

"He was sort of stumbling around with his words, and that's when I knew I had a problem," said Risk, who is now healthy after surgical treatment for the cancer.

"I was unbelievably blessed. I caught it very early, and had I ignored it another year, I probably wouldn't be alive today," he said. "You have to be a good steward of your own body, and when you feel that there's something going on, you're probably better off getting it checked out as early as possible."

Even in the new study, the researchers wrote that escalating mortality rates in young and middle-aged adults "highlight the need for earlier (colorectal cancer) detection" through age-appropriate screening and timely followups for symptoms.

Risk said, "I think I've had 11 colonoscopies in my life, and the prep work is horrible, but just go in and just do it and get it over with."

To reduce your risk of colon and rectal cancers, Siegel recommended maintaining a healthy body weight, staying physically active, avoiding drinking alcohol excessively and avoiding smoking.

Meanwhile, regular screening tests may find colorectal cancer early, when treatment is likely to be more effective.

Yet whether there should be changes in screening recommendations remains to be debated, Church said. Some colorectal cancer screening tests can come with risks or false positive results.

For instance, the risk in colonoscopies includes a possible reaction to sedatives or anesthesia, bleeding, perforation of the colon, pain in the abdomen or even an extremely rare risk of fatal complications, according to the National Institutes of Health.

"The big question that we're struggling with is, as a society of doctors, should we screen people earlier? Is it worth it? And part of the big issue is, we don't know why there is this increased incidence of colon cancer in young people," Church said.

"We were taught in medical school that colon cancer is more common as you get older, and we didn't expect the rates going up," he said. "What we can do right now is pay attention to symptoms and pay attention to risk factors like family history, and by we, I mean largely primary health docs and patients."

5 Poop Problems You Should Actually Discuss With a Doctor

From 5 Poop Problems You Should Actually Discuss With a Doctor

You probably don’t call up your doctor after every bout of constipation and diarrhea, but it’s understandable that you’d be concerned if you start experiencing poop problems on the regular.

While changes in your bowel movements could simply be due to switching up your diet or catching an intestinal bug, they can also be a sign of a more serious condition that needs treatment. “Any change in bowel habits needs to be addressed with a doctor, especially those that occur without changes in diet or in connection with other issues,” Bruce Yacyshyn, M.D., a professor in the Division of Digestive Diseases at the University of Cincinnati College of Medicine, tells SELF.

You’re probably not crazy about the idea of talking poop with your doctor, but—trust us—they've heard it all before. Here are a few things those doctors want to hear about (though this is by no means an exhaustive list):

1. You have diarrhea with pain.

Sure, diarrhea is never going to feel good, but if you consistently have it with stomach cramping and abdominal pain, it could be a sign of IBS-D, a form of irritable bowel syndrome that causes chronic or recurrent diarrhea. That pain is a big indicator that you might have IBS, Kyle Staller, M.D., a gastroenterologist at Massachusetts General, tells SELF. “People tend to throw around the term ‘IBS’ casually, but pain associated with a change in bowel movements is the criteria,” he says. Naturally, diarrhea happens sometimes, but Dr. Staller says symptoms of IBS-D typically crop up at least one day a week over a series of three months.

Consistent pain with diarrhea can also be indicative of an inflammatory bowel disease (IBD), like Crohn's disease or ulcerative colitis. Crohn's disease affects the lining of the digestive tract while ulcerative colitis impacts the innermost lining of your colon and rectum, causing ulcers to form in your digestive tract. These inflammatory bowel diseases share many of the same symptoms, some of which may also overlap with IBS. So rather than attempt to self diagnose, make an appointment with your doctor when you're experiencing symptoms like recurring painful diarrhea.

2. You have constipation with pain and bloating.

Again, this could be a sign of IBD or a specific type of IBS characterized by constipation, called IBS-C. IBS-C can be triggered by several factors, including hormonal changes, certain foods, or stress, Rudolph Bedford, M.D., a gastroenterologist at Providence Saint John's Health Center in Santa Monica, Calif., tells SELF. But regular constipation and pain are the key components that should send you to a specialist.

3. You’re alternating between painful constipation and diarrhea.

Having IBS doesn't necessarily mean you'll have diarrhea or constipation—some people can alternatively experience both in a form of the condition known as IBS-M (the M stands for “mixed”). Like IBS-D and IBS-C, patients with IBS-M have pain when they experience diarrhea or constipation, Dr. Staller says. And it happens more than once or twice. “Typically it’s long-term,” says Dr. Bedford. “This has been going on for weeks, if not months.”

4. There’s blood or mucus in your poop.

Blood in your stool or rectal bleeding are typically indicative of ulcerative colitis, while mucus in the stool could be a sign of IBS. However, these could also be a sign of other bowel conditions, like Crohn's disease. While some people can experience mild cases of the ulcerative colitis, it can be debilitating or even lead to life-threatening complications, according to the Mayo Clinic. Regardless, noting blood in your stool is always something to bring up to your doctor. And keep in mind that blood in the stool can present as red or black, depending on where it's coming from.

5. You've been getting a fever and cramping with diarrhea.

A fever with diarrhea that happens over a short period of time can be the sign of a viral condition, like gastroenteritis. But if it’s happening regularly, it could be indicative of Crohn’s disease. Crohn’s can be difficult to diagnose because the symptoms can overlap with irritable bowel syndrome, Dr. Yacyshyn says. “But Crohn’s disease patients tend to have fevers, chills, [and] abdominal pain that’s more associated with meals,” he says. Other common signs of Crohn's disease include fatigue, blood in the stool, and reduced appetite or weight loss, though the symptoms of gut disease can vary widely from person to person.

If you’re experiencing any of these symptoms, talk to your doctor. Some of these conditions can get worse with time, making it especially important that you act sooner rather than later. While you may feel weird talking poop with your doctor, it’s important to remember that you can’t get help until you actually speak up about your symptoms.