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Colorectal Cancer –Symptoms & Screening Options

March 14, 2012 1:59 PM with Dr. Joel Retsky

March is Colon Cancer Awareness Month. The majority of colon cancer occurrences happen to those with little to no genetic risk, making it important to know the signs, symptoms and treatment options. Join Joel Retsky, MD, gastroenterologist at NorthShore as he answers your questions about the screening options (including colonoscopy) and key symptoms for diagnosing colon cancer. Your participation and early questions are welcomed.

Angela (Moderator) - 1:50 PM:
Welcome! Today’s chat: Colorectal Cancer – Know the Symptoms and Screening Options will begin shortly. Please start submitting your questions and Joel Retsky, MD will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the, Preventing Colorectal Cancer page on our website. We will do our best to answer all of your questions, but because this is such a popular chat, the physician may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.

Dr. Joel Retsky (NorthShore) - 1:52 PM:
Thank you for attending this chat. As you know March is colon cancer awareness month. I am happy to answer any questions about colon cancer and colon cancer screening.

  Megan H. (Chicago, IL) - 2:00 PM:
Hello, I am 24 years old and was diagnosed with Crohn's Disease a year ago. I am curious if there is a correlation between having Crohn's and getting colon cancer later in life?
Dr. Joel Retsky (NorthShore)
Crohn's disease can be a risk factor for colon cancer if the Crohn's disease involves the colon. The risk depends on how much of the colon is involved with Crohn's disease and for how long. The risk begins to rise after 8-10 years of Crohn's disease involving the colon and rises at a rate of 1/2 - 1 % per year. Therefore, we start surveillance of the colon for colon cancer after 8-10 years of disease.

  Adam (Chicago, IL) - 2:03 PM:
I know that getting a colonoscopy is one way to test for colon polyps and cancer. Are there other methods too?
Dr. Joel Retsky (NorthShore)
There are other methods but they are thought to be much less effective and have not been proven to reduce the risk of colon cancer or to reduce the risk of dying from colon cancer. These include barium enema, testing the stool for blood and the newest is virtual colonoscopy (known as CT colonography.) The virtual colonoscopy has had problems in that most centers that have tried to reproduce the results orginally published have been unsuccessful and have had much higher miss rates. Colonoscopy is the best and only proven method.

  Anna (louisville, KY) - 2:07 PM:
I have an ileostomy, partial colectomy, rectovaginal fistula repairs and sphincter repair. My diagnosis is unsure colitis/chrons disease. I am undergoing a colonoscopy Tuesday and another fistula repair. Told to be sure to bring ostomy supplies. Do they also go through my stoma?
Dr. Joel Retsky (NorthShore)
It depends what they are looking for. If they are looking to see if there is active Crohn's disease they may look through the stoma. You should check with the doctor's office to understand what procedure they will be doing.

  Samuel (Chicago, IL) - 2:09 PM:
I have a family history of colon cancer on both my maternal and paternal sides. What lifestyle habits can I adopt now to help reduce my risk? Am I at a greater risk for getting colon cancer if it runs in my family?
Dr. Joel Retsky (NorthShore)
You are at increased risk to develop colon cancer due to your family history. The risk is related to who had colon cancer or precancerous polyps in your family. With one first degree relative (parent, sibling or child) with colon cancer or precancerous polyps your risk is increased 2-3 times the standard risk (standard risk is 6% for individuals with no risk factors.) If you have 2 first degree relatives with colon cancer or precancerous polyps your risk is 4-5 times the standard risk. If they are second degree relatives (grandparents, aunts/uncles, cousins) the risk is 1.5 times the standard risk. All of these warrent early (high risk) screening for you. Typically people with a family history begin at age 40 or 10 years before the youngest relative had colon cancer or precancerous polyps - whichever comes first.

  Janice (Glenview, IL) - 2:14 PM:
I’ve often heard the preparing for a colonoscopy is more uncomfortable than the procedure itself. Are there particular side effects that are often associated with colonoscopy?
Dr. Joel Retsky (NorthShore)
The prep is the worst part but in general is not bad and is well tolerated. There are a few side effects of the preparation which include slight risks of dehydration and electrolyte changes (and a few rare risks) but these are quite uncommon and can usually be prevented with proper planning. The risks of colonoscopy are a risk of perforation or a risk of bleeding. These are also very uncommon (about 1 in 1000 to 1 in 2000 by published studies from universities).

  Daniel (Evanston, IL) - 2:19 PM:
At what age do you recommend getting a colonoscopy? Are young people also at risk for getting colon cancer?
Dr. Joel Retsky (NorthShore)
The age to begin screening depends on risk factors. If there are no risk factors (ie. no family history of colon cancer or colon polyps and no symptoms such as blood in the stool or change in bowel habits) standard screening begins at age 50. If there is a family history then the individual is in a higher risk category and screening begins at age 40 or 10 years before the youngest in the family was found to have colon cancer or colon polyps, whichever comes first. If there are symptoms, colonoscopy is considered as a diagnostic rather than a screening exam and is done at the time of the symptoms.

  Nicole (Evanston, IL) - 2:23 PM:
I recently started to notice blood in my stool. Is this a sign of colon problems? What other signs might indicate problems?
Dr. Joel Retsky (NorthShore)
Blood in the stool should never be ignored. Not all bleeding is due to serious causes and it could be something minor, however, you should get this evaluated ASAP. If the bleeding is due to colon cancer, waiting for development of other symptoms will be too late.

  Kurt (Glenview) - 2:27 PM:
I have a colonoscopy scheduled in the next few weeks. I can’t help but to be anxious and embarrassed about this procedure. Do you have any recommendations to help ease this stress?
Dr. Joel Retsky (NorthShore)
I often hear these same concerns. You should know that everyone eventually should have a colonoscopy so you are not alone. You should think about colonoscopy just as any other testing you do for health maintenance. After the procedure is over you will likely be pleasantly surprised how easy it was for you.

  Nancy (Chicago, IL) - 2:32 PM:
Is it true that Vitamin D can help fight colon cancer? What other foods can help prevent it?
Dr. Joel Retsky (NorthShore)
There is the possibility that some foods, dietary supplements or medications can decrease the risk of colon cancer and some that can increase the risk. None of these have been proven by randomized trials. The information is on these has usually come by extracting information from large databases created for other purposes (such as from studies of heart disease.) Therefore, they are not proven and one must be cautious in the interpretation of the findings. Aspirin, calcium supplementation and folic acid are thought to possibly reduce the risk of colon cancer however there are risks to taking any medication. The risk of a bleeding complication from aspirin is thought to be higher than the potential benefit in reducing the risk of colon cancer. Therefore, aspirin soley for reducing the risk of colon cancer is not recommended. A high fiber diet may also reduce the risk of colon cancer.

  Dean (Skokie) - 2:38 PM:
In a recent colonoscopy, I was told that a couple adenomas were removed. What does this mean? Will this put me at increased risk of developing colon cancer at a later date?
Dr. Joel Retsky (NorthShore)
Adenomas are precancerous polyps; meaning that if they were left in long enough they may have turned to colon cancer. The basis of colonoscopy to reduce the risk of colon cancer is to remove the adenomas and prevent development of colon cancer. You are at increased risk for development of more adenomas and colon cancer. Therefore, you should have follow up colonoscopies on a regular basis. Your doctor should tell you when you will be due for the next one. Also, your family members are at increased risk due to your polyps and they should check with their doctors as to when they should begin high risk screening.

  Elena (Chicago) - 2:41 PM:
Are there other gastrointestinal conditions that increase my risk of getting colorectal cancer? I was recently diagnosed with ulcerative colitis and am wondering if this puts me at increased risk?
Dr. Joel Retsky (NorthShore)
Ulcerative colitis does increase the risk of colon cancer. The risk begins to rise after 8-10 years of disease and rises at a rate of 1/2-1% per year thereafter. Surveillance for colonoscopy begins after 8-10 years of disease and includes colonoscopy every 1-2 years from years 8-20 and then colonoscopy every year after 20 years of disease.

  Deedra (Skokie) - 2:45 PM:
My father was recently diagnosed with colorectal cancer. What treatment and surgery options exist? What can I expect from these and in his recovery?
Dr. Joel Retsky (NorthShore)
First the cancer must be staged to determine the options. If it is limited to the colon, surgery is usually performed to remove the cancer and then the need for chemotherapy is determined based on the surgical findings. If the cancer involved the rectum (very end of colon) preoperative radiation is usually given. If the cancer has spread chemotherapy is usually given.

  Joshua (Chicago) - 2:48 PM:
I’ve heard that there are ethnic groups that are at a higher risk of developing colon cancer. Is this true? Who is at a greater risk?
Dr. Joel Retsky (NorthShore)
Yes there are populations at increased risk. African Americans are at higher risk and screening is usually recommended to begin at age 45 in African Americans.

Angela (Moderator) - 2:50 PM:
Thank you everyone for your great participation. The chat will be ending in approximately 10 minutes. Please submit your final questions.

  James (Springfield, IL) - 2:51 PM:
I have a colonoscopy in about 10 days. Are there specific things that I should be doing now to prepare for it? How soon afterward will I know the results?
Dr. Joel Retsky (NorthShore)
It is best not to eat nuts, seeds or popcorn for 1 week prior to the colonoscopy because sometimes these don't wash out as well and can clog the scope if we suction them out. You should receive the preparation (clean out) instructions from your doctor's office. If you take any aspirin, antiplatelet or anticoagulant medication you should discuss these with your doctor. Also, diabetic medications need to be adjusted by your doctor for the day of the preparation. The doctor should give you a report of the findings immediately after the procedure but biopsy results can take a few days to a week.

  Ana (Chicago) - 2:55 PM:
How treatable is colon cancer? If caught early, is it something that can return?
Dr. Joel Retsky (NorthShore)
It really depends on the stage of the colon cancer at the time of diagnosis. Early stage colon cancer (not spread from the colon) can usually be cured by surgery. Advance colon cancer (spread to lymph nodes or other organs) has a higher risk of recurrence and needs additional treatment, usually chemotherapy.

  Ross (Evanston) - 2:57 PM:
What different tests are available for screening for colon cancer? If I don’t have a family history, is one of these tests better or more recommended that another?
Dr. Joel Retsky (NorthShore)
Colonoscopy is far superior to the other tests for all risk categories (ie. standard risk or increased risk.) If you have no family history and no symptoms you are at standard risk as are most individuals who get colonoscopies. Colonoscopy is the only test proven to reduce the risk of colon cancer and reduce the risk of dying from colon cancer. Therefore, other testing should only be considered if there is a medical reason not to proceed with colonoscopy. The other tests are barium enema, testing the stool for blood and virtual colonoscopy.

Angela (Moderator) - 3:01 PM:
Thank you for participating in our online chat today. An online transcript will be available shortly. To learn more about Colon Cancer Prevention, read our recent blog post.

This chat has ended.

Thank you very much for your participation.