Friday, March 11, 2011 at 12:05 pm by Jeanine Worms, PA-C
Importance of Colon Health Maintenance
Colon cancer is the fourth most common cancer in the United States for both men and women. Annually, approximately 42,920 Americans die from colorectal cancer which accounts for 9% of all cancer deaths. As March has been dedicated colorectal cancer awareness month, this month’s blog will focus on educating the community on colon cancer, tips on prevention, and appropriate procedures that can help with preventing this disease.
What is the colon and its function?
The colon (also called the large intestine) is the last part of our digestive system. It receives what is left of the food we eat after it has passed through the esophagus, stomach, and small intestine. The colon is approximately 6 feet long and the last 6 inches are considered the rectum and the anal canal.
The main role of the colon is to absorb fluid and concentrate waste and the unusable or non-absorbable portions of digested food into stool. The stool is then stored in the last portion of the colon, the sigmoid and the rectum, before it exits through the anus.
What is colorectal cancer and how does it develop?
The human body is made up of small cells that are normally continuously growing and then dying in a natural controlled manner. When this cell cycle becomes uncontrolled, cells can keep growing and dividing leading to abnormal cell overgrowth in the body also known as a tumor. These tumors can be considered benign (non-cancerous) if they do not invade other tissues.
In the colon, cell overgrowth usually first appears as a small mass, or polyp. The cells in these polyps are often benign but uncontrolled growth can lead to destruction of other tissues as they transition into a cancerous tumor.
Once these cells invade other tissues the cancer is able to spread to other parts of the body through blood vessels and the lymphatic system.
Who is at risk?
The risk of developing colorectal cancer is influenced by both environmental and genetic factors.
Individual risks include age, history of polyps and other colon diseases such as colitis. Age appears to be one of the most significant risk factors as 90% of cases are found after the age of 50. People who have been diagnosed with inflammatory bowel disease (Crohn’s disease or ulcerative colitis) have increased risk due to chronic inflammation of the colon.
A family history of colorectal cancer including first degree relatives can also increase ones risk of developing this form of cancer. There are hereditary conditions known as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC) also known as Lynch syndrome that can increase one’s risk of cancer as well.
Race influences risk of colorectal cancer as it has been found the African American population has an increased risk compared to other ethnicities.
Environmental factors that appear to be correlated with colorectal cancers include high fat, low fiber diets as well as increased alcohol/tobacco consumption, obesity, and sedentary lifestyles.
What are the signs or symptoms of colorectal cancer?
What can be done to prevent colorectal cancers?
The most important way to prevent colorectal cancer is appropriate screening to watch for signs of growths, or polyps, that could become cancerous. Because abnormal growths can cause small amounts of bleeding your healthcare clinician may evaluate your stool for blood that is not easily visible by having you submit stool samples. They may also perform a rectal exam to feel for larger growing lesion in the anal or rectal areas. More invasive screening procedures are also available to better evaluate the colon including colonoscopies. These procedures are also referred to as a "scope" procedure.
A colonoscopy is an evaluation of the entire colon from the rectum to the ascending colon. The procedure uses a colonoscope, a small thin tube that has a light and lens on the end used for viewing. This scope is also used for removing polyps or tissue samples, which can then be checked under a microscope for abnormal cells. The patient is kept comfortable during this procedure with sedation medications which make people feel drowsy.
Due to the slow progressive nature of this disease, health care clinicians utilize colonoscopies as early detection screening tools. This form of cancer is known to have a high cure rate when detected early and therefore it is very important to begin screening at the recommended screening intervals.
When should people start colonoscopy screenings for colon cancer?
For the average person without increased risk it is recommended to start screening at age 50. A colonoscopy should be repeated every 10 years if no abnormalities are found.
For those with increased risk for colon cancer including family history, personal history of polyps or cancer, inherited colorectal cancer syndromes (FAP or HNPCC), or history of inflammatory bowel disease (Crohn’s, ulcerative colitis), it is recommended to start screening prior to age 50 or more frequent testing.
What occurs if there are abnormal findings on the colonoscopy?
If abnormal cells or a growth are identified from a colonoscopy further treatment or more frequent colonoscopies may be recommended. If the abnormal cells are localized to a certain area of the colon, removing this particular portion may be curative. When a polyp is removed it is called a polypectomy and if a portion of the colon is removed this is called a colectomy, or colon resection. If a cancer is no longer localized to one area, colon resection along with chemotherapy or radiation may be recommended.
Take Home Points:
Submitted by Jeanine Worms, PA-C
1. MedlinePlus (U.S. National Library of Medicine National Institute of Health). Colorectal Cancer. http://www.nlm.nih.gov/medlineplus/colorectalcancer.html Accessed February 2011.
2. Ahnen, DJ, Macrae, FA. Colorectal Cancer: Epidemiology, risk factors, and protective factors. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011
3. National Cancer Institute; U.S. National Institute of Health <http://www.cancer.gov/cancertopics/pdq/screening/colorectal/Patient/page2 > Accessed February 2011.
4. Dragovich, T. Colorectal adenocarcinoma < http://emedicine.medscape.com/article/277496-diagnosis > Accessed February 2011.
5. Mayo Clinic. Colon Cancer. < http://www.mayoclinic.com/health/colon-cancer/DS00035/DSECTION=symptoms> Accessed February 2011.
For More Images:
National Cancer Institute. Colorectal Cancer Screening. <http://www.cancer.gov/cancertopics/pdq/screening/colorectal/Patient/page3#Keypoint10> Accessed February 2011.
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