An interview with Shekar Narayanan, MD, FACS, FASCRS, colorectal surgeon and MD Anderson Cancer Network™ certified physician.
Last year, 3,250 Hoosiers were diagnosed with colorectal cancer and 1,170 died from colorectal cancers. Colorectal cancer is highly treatable if detected early, so why are the death numbers high in our state?
One reason is that colorectal cancer is often diagnosed after it has become more advanced. Currently Hoosiers are behind the national norm in terms of cancer screening in most categories. So who should be screened and when?
Men and women age 50 should have a colonoscopy of their large intestine (called the colon) and the rectum.
If you have a family history of colon cancer you are at high risk. In fact, 25 percent of colorectal cancer cases have a family history. Being African American or having (unusually large) polyps that show precancerous changes within the cells will also put you in a high-risk category. It is recommended that high-risk groups be screened at age 45 and repeat colonoscopies within five years.
When it comes to screening for colorectal cancer, there are options.
Hemoccult® and FIT®
These are stool-based tests that patients can take home and perform. This test is used to check the stool or fecal matter for specific changes in DNA (the genetic blueprint of each cell) that indicate signs of colorectal cancer. While helpful in determining risk for colon cancer, they are less specific to the evidence of cancerous cells. For this reason a positive blood test means most patients will have a follow-up colonoscopy to look for polyps.
Dr. Narayanan explains, “The take-home, stool-based test is one way to screen for colorectal cancer, but compliance is not very good because the patient has to follow specific instructions, repeat the test for several days and follow a timeline that includes mailing in the test into a lab for analysis.”
A colonoscopy is an outpatient procedure, but is much more comprehensive than a stool-based take-home test. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the physician to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.
“Today the scopes we use (for colonoscopy) have improved greatly with an embedded digital camera that gives the physician and the colonoscopy team better visibility of the left and right side of the colon,” said Dr. Narayanan. “The benefit of colonoscopy is that we can identify flatter polyps* (suspicious of being precancerous) and see more of the colon than you see with the limited view of a sigmoidoscopy,” he said.
Colonoscopies have also become patient-friendly in recent years and are a much more comfortable process. To understand the procedure in more depth, physicians encourage further education and to hear from other patients.
Schedule a screening
For more information about colon cancer or to schedule a colonoscopy, call 800-777-7775.
*Polyps: Benign growths on the wall of the colon or rectum