March is Colorectal Cancer Awareness Month. Share these gems with your family, friends, and patients. Take the time to reflect on your personal history and encourage yourself and others to get screened when appropriate.
1. The large intestine or the large bowel consists of the colon, rectum, and anus. The colon and rectum have a cumulative length of 150 cm or 4.9 feet.
2. Gastrointestinal contents are received from the small bowel and enter the colon. The colon’s main function is recycling and reabsorption of nutrients such as water, electrolytes, and other metabolites. The contents then travel to the rectum; its main function is to eliminate stool and serve as a reservoir. After all the water and nutrients have been absorbed, the waste is expelled out of the anus as stool.
3. In the United States, colorectal cancer is the third most common cancer and the second leading cause of cancer death in both men and women. Colorectal cancer occurs equally in men and women. Racial disparities do exist – the incidence rates of colorectal cancer are 24 percent higher in black men and 19 percent higher in black women when compared respectively with white men and white women.
4. The American Cancer Society recommends that colorectal cancer screening start at 45 years for a person with average risk.
5. Risk factors for colorectal cancer include family history (either first degree relative with colorectal cancer or a diagnosed hereditary syndrome), a personal history of polyps, obesity, tobacco, and alcohol.
6. Symptomatic colon and rectal cancers can commonly present with either bleeding or obstruction. Bleeding can present as frank blood per rectum or red, maroon, or black stools. A partial obstruction can first present as constipation or as a decrease in the caliber of stools. It is important to know your normal, i.e., how many bowel movements you have per week and the character of your stools; a change from having regular, bulky stools to pencil-thin stools may be a sign that you need further workup. Other non-specific symptoms include unexplained fatigue, weight loss, and abdominal pain.
7. The best screening option is a colonoscopy because it can both diagnose and prevent (by removing precancerous polyps) colon cancer. However, any screen is better than no screen at all. Other options include computed tomography colonography and stool sample tests such as high sensitivity guaiac-based test, fecal immunochemical test, and the stool DNA test.
8. A colonoscope is a flexible camera inserted into a patient’s anus while they are sedated; the scope travels from the rectum and through the colon to carefully assess the inner lining of the large intestine. Patients are given a “prep” to drink to prepare for this evaluation, which induces multiple bowel movements. This serves to clear the colon of any fecal burden. Prior to your scheduled colonoscopy, if your bowel movements are not clear to yellow in color, your doctor may ask you to take enemas to appropriately clear your colon.
9. General knowledge of colonic and rectal polyps is important. Not all polyps are precancerous. There are many different types of polyps that can be found on a colonoscopy: some are flat, and others have stalks. Some have high-risk features under the microscope, and others are completely benign. While many patients know that they have had a colonoscopy and state their doctor found “a few polyps,” most are unsure of the significance. It is important to know the year of your colonoscopy, what type of polyps were identified, and when your next colonoscopy should be. This is how you can take control of your health, know your risk, and plan for your next screening.
10. Colon and rectal cancers can be treated with surgery, chemotherapy, radiation, and immunotherapy depending on the size, location, depth, and spread to other organs at the time of diagnosis. Early detection of precancerous and cancerous lesions affects patient outcomes. Thus, it is important for you and your loved ones to get screened.
Maseray S. Kamara is a general surgery resident and can be reached on Instagram @drkamara.
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