Colonoscopy: The ‘Minor Inconvenience’ That Saves Lives

**By Vlad V. Simianu, MD, MPH**

Helen Nind

Helen Nind

Learning she had colorectal cancer last year surprised Helen Nind. The 55-year-old mother of two had no family history of the disease, no symptoms and generally felt healthy. But the suspicious polyp that was found and removed during her first colonoscopy proved malignant.

According to the American Cancer Society (ACS), colorectal cancer is the third most common cancer diagnosed in both men and women in the U.S. In 2019, the ACS estimates there will be more than 101,000 new cases of colon cancer and more than 44,000 new cases of rectal cancer.

Risk factors
Research has shown that links between colorectal cancer risk and a person’s diet, weight and activity level are some of the strongest for any type of cancer. Lifestyle-related risk factors include:

  • Being overweight or obese. Carrying excess weight raises the risk of colorectal cancer in both men and women, but the link seems to be stronger in men.

  • Physical inactivity. A sedentary lifestyle is associated with a greater chance of developing colorectal cancer. Being more active can help lower your risk.
  • Dietary choices. A diet high in red and processed meats may increase your colorectal cancer risk.
  • Smoking. People who have smoked tobacco for a long time are more likely than non-smokers to develop colorectal cancer and die from it.
  • Drinking alcohol. Colorectal cancer has been linked with moderate to heavy alcohol use.

“The minor inconvenience . . . is nothing compared to what the alternative might be. If they can catch a problem early, the treatment is going to be much easier.” — Helen Nind

There are also risk factors for colorectal cancer that aren’t related to lifestyle, including:

  • Age. Risk goes up with age, which is why screening colonoscopies have been recommended starting at age 50. However, due to an increase in the disease among younger adults, some national medical organizations are considering lowering the recommended age for screening.
  • Family history. Nearly one in three people who develop colorectal cancer have other family members who have had it. People with a history of colorectal cancer in a parent, sibling or child are at increased risk. The risk is even higher if that relative was diagnosed with cancer when they were younger than 45, or if more than one first-degree relative is affected.
  • Inflammatory bowel disease (IBD). Colorectal cancer risk increases if you have IBD, ulcerative colitis or Crohn’s disease.
  • Inherited syndromes. About 5% of people who develop colorectal cancer have inherited gene changes (mutations) that contribute to the disease. The most common inherited syndromes linked with colorectal cancers are Lynch syndrome (hereditary nonpolyposis colorectal cancer, or HNPCC) and familial adenomatous polyposis (FAP).
  • Racial and ethnic background. African Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the U.S. Jews of Eastern European descent (Ashkenazi Jews) have one of the highest colorectal cancer risks of any ethnic group in the world.
  • Type 2 diabetes. People with type 2 diabetes are at increased risk for colorectal cancer. They also tend to have a less favorable prognosis after diagnosis.

Treatment
Helen Nind underwent robotic-assisted surgery to remove the cancerous polyp and surrounding tissue. As part of the surgery, a number of her lymph nodes were removed and examined. Unfortunately several were cancerous, requiring a regimen of chemotherapy.

When I asked Helen what she would tell someone facing colon cancer, she recommended having a family member or friend attend appointments as another set of ears. This person can also help take notes and remember information shared at the visit and ask questions the patient may not think about.

“Someone I know who had been through cancer treatment advised me to keep a diary to note any changes or health concerns,” says Helen. “I found this very helpful for recalling things when meeting with my care team.”

Screening guidelines
The current ACS recommendation is that people at average risk of colorectal cancer start regular screening at age 45. This can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test), or with an exam that looks at the colon and rectum, such as colonoscopy. As part of the screening process, all positive results from stool-based screening tests should be followed up with a colonoscopy.

Although Helen put off her colonoscopy after turning 50, she now regularly encourages people to follow screening guidelines. “The minor inconvenience of the prep was not as bad as I had thought,” she says. “It is nothing compared to what the alternative might be. If they can catch a problem early, the treatment is going to be much easier.”


Simianu_2018Vlad V. Simianu, MD, MPH, is a general surgeon who practices at Virginia Mason Hospital and Seattle Medical Center. He specializes in colon, rectal and anal cancer with an emphasis on minimally invasive techniques. Other areas of expertise include Crohn’s disease, ulcerative colitis, diverticulitis, polyposis syndromes, rectal prolapse and pelvic floor disorders. Dr. Simianu is actively conducting research on colorectal cancer and diverticulitis.

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