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Colon Cancer Screening Can Be A Lifesaver

September 8, 2009 11:59 AM with Dr. Manoj Mehta

Manoj Mehta, MD, Gastroenterologist, talks about the importance of colon cancer screening and prevention and how the procedure CAN save lives.

Moderator (Moderator) - 11:55 AM:
Welcome! Today’s chat: Colon Screening Can Be A Lifesaver will begin shortly. Please start submitting your questions and Dr. Manoj Mehta will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Colon Cancer department to obtain more information about colon cancer.

Dr. Manoj Mehta (NorthShore) - 11:58 AM:
Hello and welcome. I am Dr. Manoj Mehta, a board certified gastroenterologist at NorthShore University HealthSystem. I have an office in Kenilworth, and practice primarily at Evanston and Glenbrook Hopsitals. I see inpatients and outpatients on a daily basis. I am available today to answer any questions you might have.

  John Novak (Homewood, Il) - 11:59 AM:
I had a colon resectioning operation over 1 yr ago to remove a small tumor. My scar is about 8 inches long and still very visible (I use a moisturizer everyday) plus the belly area around the scar is still a bit tender with a bit of a bulge about 1 inch in diameter to the right of my belly button. I had a 6 month CAT and was deemed ok, but should I be concerned about the ongoing tenderness? It's not severe but is noticeable.
Dr. Manoj Mehta (NorthShore)
This is probably a better question for your surgeon, as it deals with postop tenderness and scarring. A concern with the bulge would be a small herniation, but it sounds like your CT did not show this. I would follow-up with your surgeon in the office.

  Holly (Highland Park, Illinois) - 12:00 PM:
At what age should I start screening for colon cancer?
Dr. Manoj Mehta (NorthShore)
General guidelines for people without a family history of colorectal cancer or polyps are to start at age 50. People of Ashkenazi Jewish descent, African-American descent, with family history, or with a personal history should start earlier. Generally, high-risk groups start at age 40. The exception is African-Americans, who start at 45.

  David (Chicago, IL) - 12:03 PM:
My family has no prior history of any form of colon cancer. I am in my early 30s and have a few older coworkers (40+) that have had screening colonoscopys already. Should I too have one when I get into my 40s?
Dr. Manoj Mehta (NorthShore)
As the other questioner had asked, guideline suggest starting at 50 if you do not fall into one of the high-risk groups. This being said, we do find colon cancers in younger patients at times. The 20's are actually the fastest growing age-group for colorectal cancers. Still, guidelines state 50.

  Jose (Chicago, Illinois) - 12:06 PM:
As a diabetic, am I more prevalent to this disease?
Dr. Manoj Mehta (NorthShore)
Data suggests that people with diabetes develop colon cancer more frequently than those without. They also do not do as well with the available treatment options and have a higher rate of recurrence. Whether this can be modified by tighter control of the diabetes is unknown.

  Reagan (Atlanta) - 12:08 PM:
My mother is a colon cancer survivor and I have had many GI issues, which have been mostly reflux issues. I am 36 and I am wondering if I should be pre-emptive and receive a colonoscopy now, rather than waiting until I am 40?
Dr. Manoj Mehta (NorthShore)
For you, traditionally we would start at 40 with colonoscopies. The exception is if your mother was diagnosed very young (below 50). In other words, if she had colon cancer at 36, it would not make sense for you to wait till 40. In these instances, the rule of thumb is ten years younger than your family member with colon cancer. So, in the example above, 26. For you, reflux and colon issues are generally separate. An upper endoscopy would be reasonable right off the bat. If you have "other GI issues" and are concerned about colorectal cancer, personally I would have no problem pursuing a colonoscopy as well.

  Patrick (Chicago, Illinois) - 12:11 PM:
All the recent rave is colon cleansing. How effective is it, if at all, and what is the best way of performing it?
Dr. Manoj Mehta (NorthShore)
Rave is a good word. It does seem to be a fad, but there is little science behind it. One of the things we contend with is a giant medical system which is inherently difficult for most people to comprehend. We realize the system is foreboding and unapproachable. In that, there is potential for distrust and doubt. There are many who would take advantage of these vulnerabilities, and by touting something as "off the radar" of conventional medicine, there is almost an audience-in-waiting. Ultimately, these choices are your own. But be careful with that.

  Dan (Arlington Heights) - 12:16 PM:
I have a standing order to get a colonoscopy so I understand why a screening is important and necessary. My concern is the actual procedure. I'm a bit hesitant because of the invasiveness of the procedure. What advice or guidance can you offer to help mitigate my apprehension?
Dr. Manoj Mehta (NorthShore)
The best advice I can give is to talk to someone who has had it. Almost everyone will tell you the preparation is the hard part, but the test itself is relatively easy. You will be sedated and examined through the bottom. I realize conceptually this can invoke a great deal of anxiety. But, honestly, 99% of the time the expression afterwards is that of disbelief over how easy it was!

  Jose (Chicago, Illinois) - 12:18 PM:
What are the different stages of colon cancer?
Dr. Manoj Mehta (NorthShore)
There are a number of staging systems, but generally 1-4 would be a traditional scale. Stage 1 is confined to the colon lining, 2 and 3 deeper through the lining, and 4 spread to distant organs. It is important to realize that colorectal cancer screeing via colonoscopy is really a misnomer. We are not looking for colon cancer, which implies a late finding. We are looking for polyps which are the precursors of colon cancer. By removing polyps, we can prevent cancers. I think "colorectal cancer test" implies you either have it or don't, and many people (understandably) don't want to know if they have it anyway. This couldn't be further from the truth, and why I think the term cancer screeing is a poor one in this instance.

  Holly (Highland Park, Illinois) - 12:22 PM:
What are common warning signs of colon cancer?
Dr. Manoj Mehta (NorthShore)
Again, symptoms develop late in disease, which is why we screen patients at regular intervals rather than waiting for symptoms. However, to answer your question: weight loss, change in bowels, unexplained abdominal pain, anemia, rectal bleeding, occult blood in the stool, or bowel obstruction can be signs of colon cancer.

  Robert (Chicago, Illinois) - 12:24 PM:
Aside from the screening guidelines you mentioned earlier, what should I be looking for (ie, symptoms) that would prompt me to get a colonoscopy? I'm 42 years old.
Dr. Manoj Mehta (NorthShore)
See the prior question :)

  Holly (Highland Park, Illinois) - 12:24 PM:
What is a fecal occult blood test? What does it measure or show?
Dr. Manoj Mehta (NorthShore)
The fecal occult blood test (FOBT), is a stool sample which is analyzed for blood. Occult means it is not visible, but measurable chemically. So, this is blood you would not see but may be dissolved in the stool. FOBT is a screening test, but a weak one as bleeding(even from a frank tumor) can be intermittent.

  Dan (Arlington Heights) - 12:26 PM:
Thank you for your response. Could you elaborate on what is involved with the preparation?
Dr. Manoj Mehta (NorthShore)
Unfortunately, any bowel exam will require a prep. Even newer modalities on the horizon such as a virtual colonoscopy will still require a prep. The quality of your prep is proportional to the likelhood of finding polyps, and therefore equals the benefit you gain! Specifically, patients are generally on a clear liquid diet the day before the test. Laxatives are consumed in the afternoon or evening. Sometime we give half in the evening and half early the day of the test. Nothing to eat or drink after midnight, except for any prep left or any medications with a little water. There are a number of preps available, but all of them have a significant colume and taste, well, not good. There are no pills available for this. Fleet's Phosphasoda was used routinely in the past, but is not being used now due to concerns about kidney damage.

  James (Morton Grove, IL) - 12:30 PM:
I have family history of polyps but no colon cancer. My family has had several other types of cancer (brain, breast, non-smokers lung). Does this put me in the high-risk category?
Dr. Manoj Mehta (NorthShore)
Yes. There are some cancer-family syndromes to be aware of. Breast cancer is fairly common, but of course has a genetic component. Non-smokers lung cancer is (as far as I know) usually related to Radon exposure. Brain cancers, uterine cancers, endometrial cancers, thyroid cancers, and colon cancers can be clustered into cancer family syndromes with common genetics. You could have Genetic Counselling, which will assess your individual risk based on your exact family history. They can tell you what cancers you might be at risk for and propose screening guidelines unique to you. There is a Genetics Center at NorthShore.

  Andrea (Glenview) - 12:34 PM:
What prompts the development of polyps in the first place? Does it have anything to do with the types of foods people eat?
Dr. Manoj Mehta (NorthShore)
Colon polyps develop from a wide variety of factors. Part, of course is genetic, and has to do with our ability to repair local genetic mutations. These mutations (locally in the lining of the gut) lead to polyps. Everyone has these mutations all the time. Polyps, then, sometimes grow into cancers. Beyond genetics, diets low in fiber, high in meat (nitrosamines), low in antioxidants, low in calcium, and low in selenium and other trace vitamins and minerals, are predisposed to grow polyps.

Moderator (Moderator) - 12:35 PM:
Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes. Please submit any final questions you have.

  Patrick (Chicago, Illinois) - 12:37 PM:
Does a more fiber-filled diet help in the prevention of colon cancer?
Dr. Manoj Mehta (NorthShore)
The answer is yes, although frequently people ask this when I tell them I've found a polyp. My suspicion is this might be too little too late. In other words, the propensity to grow polyps might be started younger in life, when we don't know what fiber is and could care less. By the time we are growing polyps, I do not think that making radical chages will alter the course of events in the future.

  Jose (Chicago, Illinois) - 12:40 PM:
Is surgery the only way to cure colon cancer?
Dr. Manoj Mehta (NorthShore)
Well, the transition from polyp to cancer is a gradual one, so we do sometimes see what we call "cancerous polyps". They are on the edge between a polyp and an invasive cancer. By removing these polyps, we have cured the patient of that cancer. So at this stage, it can be accomplished through colonoscopy. Even surgically, cancers can often be removed laparoscopically through a few small incisions. The key is finding a surgeon experienced in laparoscopy. We have several at NorthShore.

  Patrick (Chicago, Illinois) - 12:42 PM:
Can changing my diet lower my risk of colon cancer? If so, what do you recommend?
Dr. Manoj Mehta (NorthShore)
Lifelong diets high in fiber, low in red meat, low in fats, and with supplemental vitamins and minerals are protective. Whether adopting this diet laer in life helps is unknown. But it absolutely can't hurt.

  Jim (Buffalo Grove, IL) - 12:44 PM:
You mention a virtual colonoscopy. How does this procedure work and is it a viable option to the traditional colonoscopy?
Dr. Manoj Mehta (NorthShore)
A traditional colonoscopy has the ability to not just identify polyps but remove them. So they are not really equivalent. A virtual colonoscopy is more like a barium enema (lower GI x-ray). Instead of plain x-rays, though, it uses a CT scanner. I think if it were not for the high-tech name "virtual colonoscopy", most people would correctly perceive this as a high-tech lower GI. If you've ever had one, you would understand the limitations. Currently, the concensus is that virtual colonoscopy is not ready for prime time. This may be an option in the future, however.

  Seth (Chicago) - 12:47 PM:
Are there any downsides to screening? Can it do more harm than good in any instances?
Dr. Manoj Mehta (NorthShore)
Any screening test is only worth its trade-offs. That's why we select the patients, and do not just do it on everyone. We call the threshold a "pre-test probability". So, if you are young, have no family history, and are suffering from GERD, the pre-test probability is low. Since there are risks, the risk-benefit ratio becomes skewed if we don't select patients well. And in those instances, yes, the risks might outweight the benefits. This being said, after 50, the risks are outweighed by the benefits in even the general population, so screeing is advocated for almost all comers.

Dr. Manoj Mehta (NorthShore) - 12:53 PM:
We are approaching the end of the timeframe we had been allotted. I want to thank everyone who joined in. I think we had a lot of great questions and I really enjoyed chatting with you. Please feel free to call my office if there are any other questions or concerns you may have. Thanks again! Manoj K. Mehta, MD 847-256-1855

Moderator (Moderator) - 12:53 PM:
Thank you again for participating in our chat today. For more information please visit our Screening pages.

Also, a transcript of this chat will be available shortly.

This chat has ended.

Thank you very much for your participation.