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Colorectal Cancer: Risks & Prevention

Dr. Jeffrey Nathanson March 13, 2014 1:00 PM This chat has ended. Thank you for participating.
Brenna (Moderator) - 12:36 PM:
Our online chat Colorectal Cancer: Risk & Prevention will begin at 1 PM. You can submit questions now or at any point during the chat.

Dr. Jeffrey Nathanson (NorthShore) - 12:59 PM:
Hi. My name is Jeff Nathanson and I'm a gastroenterologist at NorthShore University HealthSystem. March is Colon Cancer Awareness month and I'm excited to be able to help answer any questions or concerns that people may have about colon cancer, colonoscopies, or gastrointestinal symptoms in general.

Paolo (Harwood Heights, Illinois) - 1:01 PM:
At what age should I begin colonoscopy screening?

Dr. Jeffrey Nathanson (NorthShore):
It is recommended that "average risk" individuals get their first colonoscopy at age 50. The reason age 50 is chosen is that the risk of colon cancer starts to go up as you get older. However, if you have a family history of colon cancer, your risk is greater and it is recommended that you get a colonoscopy earlier. Typically this would be at age 40 or 10 years earlier that that family member's colon cancer was diagnosed (for example, if your family member's cancer was diagnosed at age 48, you should get your first colonoscopy at age 38). In the uncommon situation in which there are several members of your family who have had colon cancer - or even if other types of cancer run in your family at a young age - you should talk to your regular doctor as there may be a role to perform colonoscopy at an even younger age.

Joanne (Glenview Il) - 1:09 PM:
What suggestions do you have for those of us who don't dread the test but look at the prep and start to gag and break out in a cold sweat??

Dr. Jeffrey Nathanson (NorthShore):
I get this question all the time so thank you for sharing. It is true that the prep is often considered "the worst part" of the procedure. However, there have been several preps introduced in the last few years that are much smaller volume (not the old "gallon jug") and are easier to tolerate. Chilling the prep on ice, mixing it with a clear beverage (my favorite is Crystal Light), or sucking on a candy at the same time can all help. In addition, if you slow it down and take a break from drinking the prep for a bit, often any nausea will pass. Finally, if you are very prone to nausea, you may want to talk to your doctor about taking a dose of an antinausea medicine just prior to starting.

Susan - 1:16 PM:
Will all polyps become cancerous eventually? What do they develop at all?

Dr. Jeffrey Nathanson (NorthShore):
Good question as this often a point of confusion. First, lets be clear that when we say a polyp were are not referring to a cancer. Instead there are two categories of polyps - precancerous polyps (called "adenomas") and non-precancerous polyps. A precancerous polyp is a benign growths that, if left in the colon, has the potential to keep growing and growing and, eventually, the "switch can go off" and it can turn into a cancer. Non-precancerous polyps are a bunch of other kinds of benign growths that, even if there were left in the colon, would never have the potentional to grow into a cancer. In general, we believe that precancerous polyps grow quite slow (typically over many years) from a precancerous growth before it eventually turns into a cancer. For reasons we don't fully understand, not all precancerous polyps grow into cancers, but all cancers must start as a precancerous growth. The goal of colonoscopy is to remove these precancerous growths before they turn into cancers

aynur (skokie) - 1:24 PM:
I am working as a vascular technologist. I lost my 2 uncles and father from colon cancer. I had an issue 2 months ago ( pain in abdomen) went ER. I wonder if I get colonoskopy and gastroskopy same time. Thank you

Dr. Jeffrey Nathanson (NorthShore):
I'm sorry about your uncles and father and its certainly a very good idea that you be proactive and address your risk of colon cancer by getting a colonoscopy. A small subset of individuals with a lot of colon cancer in the family may be at risk for a hereditary colon cancer syndrome due to one of a few specific gene mutations. It is important that this be sorted out as the risk of colon cancer may be much greater for that individual (as well as other family members) and sometimes other organ systems can be affected as well. You should definitely talk to your doctor about this. As for your abdominal pain, this too should be discussed with your doctor. An upper endoscopy (or gastroscopy) looks at the esophagus, stomach, and the top of the small intestine. Sometimes there are problems there that can cause stomach pain (i.e. ulcers) but you need to discuss with your doctor or a gastroenterologist first. Yes, the colonoscopy and upper endoscopy can be done at the same time.

Nick (Chicago) - 1:30 PM:
Why is colon cancer so difficult to treat if it is not in its early stages? What are the survival rates of people who discover colon cancer in the later stages?

Dr. Jeffrey Nathanson (NorthShore):
The good news is that if colon cancer is caught early, the survival rate is very good. When it is caught early, it does not extend beyond the outside wall of the colon and is usually cured with surgery alone. However, if it has spread to either lymph nodes or other organs such as liver, patients may need chemotherapy as well and, unfortunately, patient outcomes aren't nearly as good. That is why it is imperative to undergo screening colonoscopies. First, and most important, precancerous polyps can easily be removed before they ever turn into cancers. Second, colonoscopies have shown to catch cancers earlier and therefore outcomes are better. If you wait until symptoms develop, often the cancer is more advanced and, overrall, patient outcomes are not nearly as good.

Gabriel (Wilmette) - 1:36 PM:
How often should you be getting a colonoscopy? Is it the same time frame for everyone?

Dr. Jeffrey Nathanson (NorthShore):
For the "average risk" individual, the first screening colonoscopy should be performed at age 50 and, if there are no polyps and the visibility is good, that person will not need another screening colonoscopy for 10 years. If polyps are seen, the timeframe for the next colonoscopy depends on the number and type of polyps. If the polyps are typical precancerous polyps that are not particularly big, the next colonoscopy is usually 3 to 5 years later If someone has a family history of colon cancer, often it is recommend that they come back sooner then 10 years, even if no polyps are seen (how soon will depend in part on how closely related that relative is as well as his/her age at colon cancer diagnosis). Finally, if the visibility is not good due to a poor bowel prep, often that individual is brought back sooner for the next colonoscopy as well. One last point - these time frames are for screening. If a person develops symptoms (ie. blood in stool), they may need a colonoscopy sooner

Ann (Glenview) - 1:46 PM:
Are there any risks associated with colonoscopy that people should know before they have one?

Dr. Jeffrey Nathanson (NorthShore):
Overall, colonoscopy is an extremely safe procedure. In all comers, the risk of a complication is about 1 to 2 per 1000. Risks include reactions to the sedatives, causing bleeding, or, very rarely causing a tear in the colon (perforation). When bleeding or perforation rarely does occur, it is usually in the setting of the removal of a large polyp. Even then, the risk is not more than a few percent. The risk of death is 0.007%. Keep in mind that one's lifetime risk of colon cancer is 6% (higher in individuals with a family history of colon cancer) and almost all of these can be avoided with appropriate colonoscopy screening.

Brenna (Moderator) - 1:49 PM:
There are 10 minutes left in the chat. Please submit your final questions.

Luis (Evanston) - 1:53 PM:
What are the symptoms?

Dr. Jeffrey Nathanson (NorthShore):
Symptoms of colon cancer can include bleeding, a change in bowel habits, unexplained weight loss, or the incidental finding of a new onset anemia (low blood count). Rarely it can manifest with abdominal pain or a bowel obstruction. However, often there are no symptoms of colon cancer until it is quite advanced. That is why it is really the ideal disease to screen for. There is a long lag period between the development of precancerous polyps and the progression to colon cancer during which time there are no symptoms, but if discovered, these precancerous polyps can be readily removed. If you wait for symptoms, you are waiting too long.

Leo (Chicago, IL) - 1:57 PM:
Im 33 years old. Am I suppose to get screened at this age?

Dr. Jeffrey Nathanson (NorthShore):
If you have no family history of colon cancer (and you have no symptoms), you do not need a screening colonoscopy until age 50. If you have a family history of colon cancer, you should get your first colonoscopy at age 40 or 10 years younger that that family member was diagnosed with the cancer. So, for you, unless you have a family member with colon cancer age 43 or younger, you do not yet need a screening colonoscopy.

Brenna (Moderator) - 2:00 PM:
Thank you for your participation in today's chat. If you have further questions or wish to make an appointment for a colonoscopy, you can access Dr. Nathanson's Find a Doctor profile here.
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