Even if you are not an avid movie buff, you may have been stunned by the recent news of the death of Black Panther star, Chadwick Boseman at age 43. Boseman had been fighting colon cancer for four years.
Although still quite rare, the incidence of colorectal cancer in younger people has been climbing, and the reason is not clear. Previously recommended at age 50, new guidelines by the American Society of Colorectal Surgeons and the American Society of Surgeons recommend that screening colonoscopy should begin at age 45.
Medicare, Medicaid and other insurance companies now cover screening at this age.
We spoke with Dr. Nasrin Ghalyaie of Nature Coast Surgical Specialists. Dr. Ghalyaie is board certified and fellowship trained in colon and rectal surgery. She emphasized that the new guidelines apply to everyone of age 45 and older, regardless of risk factors or family history. The recent increase of finding colon cancer in those 45 and older are not related to genetic factors.
Dr. Ghalyaie is actively researching the biology and causes of early onset cancers, which is thought to be environmental.
A 45-year-old individual with a normal result can wait another 10 years for their next colonoscopy. If colon polyps are discovered, your gastrointestinal surgeon may recommend a repeat procedure in 2-5 years. Polyps are small growths on the lining of the colon that have the potential to become cancerous.
Dr. Ghalyaie emphasized that while screening is important for everyone 45 and older, anyone who has symptoms such as abdominal pain, bloating, changes in bowel habits for more than two weeks, or unexplained weight loss should be evaluated by diagnostic colonoscopy as early as age 20.
The “gold standard” of screening is the colonoscopy. This procedure is performed in an outpatient setting, where a tube bearing a light and a camera is INSERT IGNOREed into the lower intestine. The camera snaps photographs of any abnormalities, and a device can be fed through an instrument channel in the tube to remove a polyp or obtain a sample of a tumor. After removal, the specimen is sent to a pathology laboratory where it is evaluated for malignancy.
Dr. Ghalyaie is board certified as a general surgeon and holds an additional certification in colorectal surgery. Her extensive training means she has additional training as a fellowship in colorectal surgery as well. She explained, “It’s specific training for us to be able to address our patients in the most minimally invasive surgery to offer them robotic and laparoscopic surgery and to actually address colorectal cancer in a multi-disciplinary fashion.”
Other screening devices have emerged in recent years, however Dr. Ghalyaie still recommends the colonoscopy. Capsule Endoscopy, as seen recently, is primarily used to study the small intestine, and is not able to collect samples of any abnormalities found. Hence, if any abnormalities are found in the large intestine, a full colonoscopy is performed.
Another method, CT (computed tomography) colonography was found to be more inconvenient to the patient. With this method as well, a full colonoscopy is performed if any abnormality is found, resulting in two procedures for the patient.
Anyone who has undergone a procedure for either colonoscopy will tell you that the worst part is preparing for the procedure. Dr. Ghalyaie told us that there are newer preparations that taste better and require less intake, and that new “preps” should be discussed with your gastroenterologist or colorectal surgeon.
The best part about the procedure is that after awakening from your deep sleep, you are able to carry on with your regular routine after a very quick recovery period.
Colon cancer has a high survival rate when caught early. Cancer stages are classified from stages 0-4. A stage 0 tumor is called “in-situ,” which is not invasive, and has not yet begun to spread into surrounding tissues. Dr. Ghalyaie estimated that stage 3 colon cancer can have a 60-70% 5-year survival rate, and even stage 4 cancer has a better survival rate than other cancers of the gastrointestinal system.
Risk for colon cancer can be reduced by diet and lifestyle changes. Dr. G says that “A diet high in fiber and low in saturated fat and red meat actually decreases the risk for colorectal cancer. Increased physical activity and exercise and has proven association with decreasing the incidence of colorectal cancer.“ Smoking, caffeine and alcohol has not been proven to increase risk, however, these substances have been known to come with risks.
Dr. Ghalyaie said also that having diabetes does not cause colon cancer, however individuals with diabetes have a greater incidence of its occurrence. Obesity also increases risk.
Family history of colorectal cancer and certain genetic conditions are at greater risk also. Individuals with familial adenomatous polyposis (FAP) develop polyps as a result of this condition. Persons with Lynch syndrome (also known as hereditary nonpolyposis colorectal cancer or HNPCC) develop cancer as its alternative name suggests.
After treatment, Oak Hill follows the patient in a 5 year program to check for any recurrence. For the first 3 years, patients are monitored every 3 months with physical exams, blood tests, CT imaging. For the next three years, these occur every 6 months. After 5 years, the patient is considered to have the same risk for recurrence as the general population has for developing colorectal cancer.