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Know the Issues
Colorectal cancer is the second leading cancer killer
in North America, second only to lung cancer. This year, more than 153,760
Americans will be diagnosed with colorectal cancer and 52,180 will die
of the disease. However, when colorectal cancer is detected early and
treated promptly, suffering and loss of life can be significantly reduced.
What is colorectal cancer?
Colorectal cancer includes cancers of the colon, rectum,
appendix, and anus. When abnormal cell growth occurs, a tumor develops.
If the cells of a tumor develop the ability to invade and thus spread
into the intestinal wall and to other sites, a malignant or cancerous
tumor develops. Most colorectal cancers develop from initially benign
colorectal polyps - growths inside the colon or rectum - that later
become cancerous.
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What are the known risk factors for colorectal cancer?
- Age: Although colorectal cancer can strike at any age, more
than 9 out of 10 new cases are in people age 50 or older.
- Gender: Colorectal cancer affects both men and women
- Ethnic background and Race: Jews of Eastern European
descent (Ashkenazi Jews) may have a higher rate of colon cancer. Because
of disproportionate screening, minorities, particularly African-Americans
and Hispanics, are more likely to be diagnosed with colorectal cancer
in advanced stages. As a result, death rates are higher for these
populations.
- Diet and Exercise: A diet made up mostly of foods that
are high in fat, especially from animal sources, can increase the
risk of colorectal cancer. People who are not active have a higher
risk of colorectal cancer.
- Smoking and Alcohol: A Recent studies show that smokers
are 30% to 40% more likely than nonsmokers to die of colorectal cancer.
Heavy use of alcohol has also been linked to colorectal cancer.
- Personal history of bowel disease: A personal history of
colon cancer or intestinal polyps and diseases such as chronic ulcerative
colitis, Crohn's Disease, and Inflammatory Bowel Disease increase
a person's risk of developing colorectal cancer.
- Family history/genetic factors: A person who has a specific
inherited gene syndrome (such as Familial Adenomatous Polyposis (FAP)
or Hereditary Non-Polyposis Colon Cancer (HNPCC)) is at increased
risk for developing colorectal cancer. People with a strong family
history of colorectal cancer (defined as cancer or polyps in a first-degree
relative - parent or brother or sister - younger than 60 or two first-degree
relatives of any age) are also at increased risk for developing colorectal
cancer.
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What are the symptoms of colorectal cancer?
The following symptoms might indicate colorectal cancer:
- A change in bowel habits
- Diarrhea, constipation, vomiting
- Narrower than normal stools
- Unexplained weight loss
- Constant tiredness
- Blood in the stool
- Feeling that the bowel does not empty completely
- Abdominal discomfort - gas, bloating, fullness, cramps
- Unexplained anemia
If you experience any of these symptoms for more than
a few days, talk with your doctor about them. Colorectal cancer can
be present in people without symptoms, known family history, or predisposing
conditions, such as inflammatory bowel disease. Regular screening will
help identify precancerous polyps and colorectal cancers earlier.
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Why is screening for colorectal cancer important?
Colorectal cancer screening saves lives in two ways:
- By finding and removing precancerous polyps before they become cancerous
- By detecting the cancer early when it is most treatable
All men and women over the age of 50 should be routinely
screened for colorectal cancer. People with a high risk for CRC and
those with family history should talk with their doctors about being
screened at an earlier age.
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What are the screening tests for colorectal cancer?
Experts are not in total agreement on which screening
tests should be used or how often adults without known risk factors
for colorectal cancer should be screened. However, all professional
guidelines emphasize the importance of a regular screening program that
includes annual fecal occult blood tests (FOBT), periodic partial or
full colon exams, or both. Leaders in the field have estimated that,
with widespread adoption of these screening practices, as many as 30,000
lives could be saved each year. That's over 50% of the colorectal cancer
deaths expected this year.
Screening
tools currently approved:
- Colonoscopy: Considered the Gold Standad. Using a slender,
flexible, lighted instrument called a colonoscope, a doctor (a gastroenterologist)
looks at the inside walls of the full length of the colon. If abnormalities
are found, they can be removed or biopsied during the same procedure.
- Flexible Sigmoidoscopy: Using a slender, flexible, lighted tube,
the physician looks inside the rectum and the lower portion of the
colon. If polyps or suspicious lesions are found, the test is usually
followed up by a full colon exam by either double contrast barium
enema or colonoscopy.
- Double Contrast Barium Enema: After the person being examined
has been given an enema containing a white dye called barium, the
doctor (a radiologist) takes x-rays of the colon. A positive test
is usually followed up with a colonoscopy.
- Fecal Occult Blood Test (FOBT): Once a year, for three days in
a row, a person checks his or her own stool for hidden (occult)
blood with a special kit from a pharmacy or provided by a physician.
A positive stool test is usually followed up by a full colon exam
by either double contrast barium enema or colonoscopy.
Additional screening tools currently being researched and used:
- DNA-based Stool Test: This test examines DNA taken from a stool
sample, looking for genetic defects that could indicate the presence
of pre-cancerous polyps or colorectal cancer. This test is obtained
from a physician, and the sample collection can be done in the privacy
of your home with no advance preparation or dietary restrictions.
The test is non-invasive, painless and easy to administer. It involves
placing a container over the toilet to collect the bowel movement
and sending the sealed container to a medical lab for analysis.
If something abnormal is detected, a traditional colonoscopy is
usually required for further examination. Final studies are being
completed to determine the test's accuracy; early results indicate
the test is likely to be highly accurate.
- Virtual Colonoscopy: Sometimes called a computed tomography colography,
this is a non-invasive procedure, meaning the screening is done
completely outside the body. A virtual colonoscopy requires the
same advance preparation as a standard colonoscopy. During the virtual
colonoscopy procedure, the physician inserts a small tube into the
rectum to fill the colon with air. Then, instead of inserting a
colonoscope into the rectum and through the colon like in a traditional
colonoscopy, the physician uses MRI or CT scan technology to examine
the colon from outside the body. The physician then carefully analyzes
these images. If an abnormality is found, a traditional colonoscopy
is required for further examination. This less invasive method of
screening for colon cancer could become more common, if results
from a newly published clinical trial are proven by further research.
Doctors from the National Naval Medical Center report in the New
England Journal of Medicine (Vol. 349, No. 23: 2191-2200) that virtual
colonoscopy using computed tomography (CT) scans was just as effective
as traditional optical colonoscopy at finding precancerous polyps
in people at average risk of colon cancer.
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Does Medicare cover colorectal cancer screening?
All Medicare beneficiaries are entitled to regular
colorectal cancer screening. Congress passed a law directing Medicare
to pay for three of the four screening tests for colorectal cancer screening.
Annual FOBTs are paid for all patients when ordered by the patient's
doctor. Flexible sigmoidoscopy is paid for every four years for average
risk patients. Colonoscopy is paid for every two years for high-risk
patients.
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Who should be screened?
Colorectal cancer screening should be a part of routine
healthcare for people over the age of 50. People at higher risk for
colorectal cancer should be screened earlier. These people should discuss
colorectal cancer screening with their doctors to determine the right
plan for them.
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How many people are being screened for colorectal cancer?
Unfortunately, screening rates are low. In a recent
survey of Americans over 50 conducted by the Centers for Disease Control
(CDC), only 41% reported having had either an FOBT (the take-home stool
card test) or a partial colon exam (by sigmoidoscopy) within the time
intervals recommended by major professional groups. This number falls
short of the 86% of women who were screened for breast cancer.
Some reasons for low colorectal cancer screening rates
include:
- lack of public awareness about colorectal cancer and of the benefits
of regular screening
- inconsistent promotion of screening by medical care providers
- uncertainty among healthcare providers and consumers about insurance
benefits
- characteristics of the screening procedures (e.g., imperfect tests,
negative attitudes towards the screening procedures)
- absence of social support for openly discussing and doing something
about "the disease down there"
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How is colorectal cancer treated?
Treatment for colorectal cancer is most effective
when the cancer is found early. Colorectal cancer treatment may include
surgery, radiation, chemotherapy, or any combination of these. Surgery
is the first line of defense against colorectal cancer. Some patients
may have radiation and/or chemotherapy prior to surgery. Others might
have one or both afterwards, and some will not have either.
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What is being done to find better ways to treat colorectal
cancer?
Comprehensive cancer research programs are now carried
out in many institutions throughout North America. For more information
about colorectal cancer research and treatment, visit the CCA website
(www.CCAlliance.org) or call the National
Cancer Institute's Cancer Information Service at 1-800-4-CANCER. Recent
research has made advances in the treatment of colorectal cancer, and
many new drugs are being tested in clinical trials. Several additional
chemotherapeutic drugs, such as Camptosar (CPT-11), Eloxatin (Oxaliplatin),
Erbitux, Avastin and Xeloda, are now FDA-approved. In addition, clinical
trials are investigating novel therapies such as vaccines (immunotherapy),
monoclonal antibodies, gene therapy, and starving tumors of their blood
supply (anti-angiogenesis). A great deal more research is needed.
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Colon
Cancer Alliance, Inc.
175
Ninth Avenue
New York, NY 10011
Office: 212-627-7451
Toll Free Helpline: 1-877-422-2030
Fax: 866-304-9075 ©
copyright 1999-2000, Colon Cancer Alliance.
CCA is a not-for-profit 501(c)3 corporation.
EIN # 86-0947831
The
information provided by the CCA on this website should not be
used for diagnosing or treating a health problem or a disease.
It is not a substitute for professional care. If you have or suspect
you may have a health problem, you should consult your health
care provider.
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CCA
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