WARNING SIGNS OF COLORECTAL CANCER

Colorectal cancer (CRC) is the second most deadly but preventable cancer. That is why screening for this condition is recommended by the age of 45, and even earlier if you are at increased risk. Many patients diagnosed with colon cancer during testing have never experienced symptoms at all, or you can say that advanced screening methods enable early detection before CRC begins to cause problems. With that said, a few red-flag signs may signal CRC but are not diagnostic of this disease and may be due to other less harmful causes.

1. Changes in bowel habits

This includes diarrhea, constipation, or change in the consistency, size, or shape of your stool. Notify your health care provider if you have been passing hard, dry, pellet, or watery stools for more than a few days. 

Also, narrow or pencil-thin stools — that last longer than a few days — may portend obstruction of the colon due to cancer. 

Besides, your bowel habits can also change as a result of factors that aren’t so serious, so it's always best to consult your doctor who can come up with a clear diagnosis underlying the altered bowel habits.

2. Blood in the stool

This is by far the most alarming of all the signs. Bright red blood in your toilet bowl or maroon blood on the toilet paper after having a bowel movement can be a sign of CRC. Typically, right-sided colon cancer causes maroon-colored bleeding, whereas bright red stools are likely to be due to left-sided masses.

Colon cancer bleeds because of the rupture of new blood vessels that form in response to chemicals released from the tumor.

3. Not passing any stool

The inability to pass any stool at all calls for an emergency due to bowel obstruction from the tumor.

4. A feeling of incomplete bowel emptying

A feeling that you still have stool in your rectum or a sensation of rectal pressure after a bowel movement may be due to a mass in your rectum.

5. Unexplained weight loss

Sudden, dramatic, unintentional weight loss (weight loss that occurs without trying) is a common symptom of several types of cancer, including colon cancer. 

Significant unexplained weight loss is either:

1. When you’ve lost more than 5% of your usual body weight in the last 6–12 months, or

2. When your usual clothes don't seem to fit anymore, and when a relative or friend also points out that you've been losing weight (in case you haven't been tracking your weight).

6. Abdominal cramps

Abdominal pain (or cramps) that comes and goes is a common but vague symptom of colon cancer. However, the pain can also suddenly increase in intensity, suggesting bowel perforation, or rupture of the bowel, which is an emergency.

7. Pallor, fatigue, pounding heartbeat

Pale skin, lethargy, and a fast heart rate likely indicate a shortage of your red blood cells, called anemia, secondary to bleeding. The presence of anemia may hint at CRC when present with other warning signs and symptoms. Nonetheless, we'll screen for colon cancer if you're over the age of 45 and only have anemia. Most commonly, patients with right-sided colon masses present with anemia.

If you experience any of the above signs and symptoms, contact my office at 310-360-6807 or click the button below to schedule an appointment.

Celiac Disease Symptoms

“Think you may have celiac disease? Here’s a good reference for symptoms.”

— Dr. Dale

From Celiac Disease Symptoms

Celiac disease can be difficult to diagnose because it affects people differently. There are more than 200 known celiac disease symptoms which may occur in the digestive system or other parts of the body. Some people develop celiac disease as a child, others as an adult. The reason for this is still unknown.

Some people with celiac disease have no symptoms at all, but still test positive on the celiac disease blood test.  A few others may have a negative blood test, but have a positive intestinal biopsy. However, all people with celiac disease are at risk for long-term complications, whether or not they display any symptoms.

Does Your Child Have Celiac Disease?

Digestive symptoms are more common in infants and children. Here are the most common symptoms found in children:

• abdominal bloating and pain

• chronic diarrhea

• vomiting

• constipation

• pale, foul-smelling, or fatty stool

• weight loss

• fatigue

• irritability and behavioral issues

• dental enamel defects of the permanent teeth

• delayed growth and puberty

• short stature

• failure to thrive

• Attention Deficit Hyperactivity Disorder (ADHD)

Do You Have Celiac Disease?

Adults are less likely to have digestive symptoms, with only one-third experiencing diarrhea.  Adults are more likely to have:

• unexplained iron-deficiency anemia

• fatigue

• bone or joint pain

• arthritis

• osteoporosis or osteopenia (bone loss)

• liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis, etc.)

• depression or anxiety

• peripheral neuropathy ( tingling, numbness or pain in the hands and feet)

• seizures or migraines

• missed menstrual periods

• infertility or recurrent miscarriage

• canker sores inside the mouth

• dermatitis herpetiformis (itchy skin rash)
  

Classical, Non-Classical and Silent Celiac Disease

According to the World Gastroenterology Organization, celiac disease may be divided into two types: classical and non-classical.

In classical celiac disease, patients have signs and symptoms of malabsorption, including diarrhea, steatorrhea (pale, foul-smelling, fatty stools), and weight loss or growth failure in children.

In non-classical celiac disease, patients may have mild gastrointestinal symptoms without clear signs of malabsorption or may have seemingly unrelated symptoms. They may suffer from abdominal distension and pain, and/or other symptoms such as: iron-deficiency anemia, chronic fatigue, chronic migraine, peripheral neuropathy (tingling, numbness or pain in hands or feet), unexplained chronic hypertransaminasemia (elevated liver enzymes), reduced bone mass and bone fractures, and vitamin deficiency (folic acid and B12), late menarche/early menopause and unexplained infertility, dental enamel defects, depression and anxiety, dermatitis herpetiformis (itchy skin rash), etc.

Silent celiac disease is also known as asymptomatic celiac disease. Patients do not complain of any symptoms, but still experience villous atrophy damage to their small intestine. Studies show that even though patients thought they had no symptoms, after going on a strict gluten-free diet they report better health and a reduction in acid relux, abdominal bloating and distention and flatulence. First-degree relatives (parents, siblings, children) , whether or not experiencing symptoms, should always be screened, since there is a 1 in 10 risk of developing celiac disease.

The number of ways celiac disease can affect patients, combined with a lack of training in medical schools and primary care residency programs, contributes to the poor diagnosis rate in the United States. Currently it is estimated that 80% of the celiac disease population remains undiagnosed.

Celiac Disease Symptoms Checklist

CDF offers a Symptoms Checklist to help you and your physician determine if you should be tested for celiac disease.

Complete the Symptoms Checklist

Who Should Be Screened for Celiac Disease?

According the the Celiac Disease Center at Columbia University Medical Center, “anyone who suffers from an unexplained, stubborn illness for several months, should consider celiac disease a possible cause and be properly screened for it.”

First-degree relatives (parent, child, sibling) should also be screened since they have a 1 in 10 risk of developing celiac disease compared to the general population risk of 1 in 100.

Non-Celiac Wheat Sensitivity

Some people experience symptoms found in celiac disease, such as “foggy mind”, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet, yet do not test positive for celiac disease. The terms non-celiac gluten sensitivity (NCGS) and non-celiac wheat sensitivity (NCWS) are generally used to refer to this condition, when removing gluten from the diet resolves symptoms.

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My Colonoscopy shows polyps, now what?

After undergoing a scheduled screening colonoscopy at the age of 45, you come to know that something called a polyp was found and taken out during the procedure. In such scenarios, I often have patients coming in with these questions: What is a polyp? Is it cancerous? If not, then why did you have to snip it off? 

Finding a polyp during a colonoscopy might sound alarming. With that said, the good news is most of the polyps are benign, meaning they aren’t cancerous. But because a small percentage of polyps can become cancerous, I prefer to remove any colon polyps you have.

What are Colon Polyps?

Polyps are small outgrowths that project from your colon’s inner lining into its hollow space (called lumen). The two most common kinds of polyps are:

• Hyperplastic polyps. If your pathology report mentions these polyps, you were likely born under a lucky star. These polyps virtually don’t evolve into cancer. But they’re still snipped off to be on the safe side. 

• Adenomas. These are gland-like growths on the lining of your colon. Not all adenomas are harmful. However, given the fact that more than 95% of colon cancers begin as adenomas, these polyps need to be taken out and tested for any cancerous changes. The adenomas can grow in several patterns such as: 

  • Tubular: tube-like

  • Villous: finger or tube-like (carries the highest potential to become cancerous)

  • Sessile: flat polyps

  • Pedunculated: with a stalk

  • Serrated: saw-tooth like appearance
    

How long does it take for a Polyp to turn into Cancer? 

Thankfully, the series of events that drive the conversion of adenoma to cancer occur at a very slow pace. Hence, most of the polyps take about 10 years to progress into cancer, if at all. We all have genes that prevent the tumor cells from being activated. A mutation (alteration) of these genes in one of the parent (stem) cells that line your colon is what triggers the adenoma-to-cancer transformation. These stem cells are continually dividing to generate cells at a faster rate. And as additional cells divide, they pick up even more mutations, thus raising your risk of colon cancer. 

When do I need to follow-up?

About 30% of polyps in the colon have a tendency to rear their heads again despite complete removal of the existing ones. This is especially true if the polyp removed was an adenoma (as per your biopsy report). Hence, you’ll need to have a follow-up colonoscopy in 5 years to ensure that no more adenomas are beginning to grow again. 

The timing of the next colonoscopy depends on the results of your first colonoscopy, such as:

• the number of polyps removed 

• the type and size of the polyp

• the presence of any high-grade precancerous (abnormal) changes

In general, the more adenomas you have and the larger they are, the higher their risk of turning into cancer. Having any abnormal changes on top of that further amplifies the cancer risk.

If you have any questions regarding your last colonoscopy, or if you’d like to schedule an appointment for a repeat colonoscopy, you can contact my office at 310-360-6807. Alternatively, you may book an appointment online by clicking below.