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Doctors recommend universal screening due to prevalence of colorectal cancer
The specialist: Dr. Randolph Steinhagen on colorectal cancer
As chief of Mount Sinai Medical Center's Division of Colon and Rectal Surgery, Steinhagen treats patients who suffer from disorders like colorectal cancer and inflammatory bowel disease (IBD). He has been at Mount Sinai for more than 30 years.
Who's at risk
Colorectal cancer is a malignancy that arises at the end of the intestinal tract in the colon or rectum. "By definition, cancer has the ability to break off from the region where it arose and spread to other parts of the body," says Steinhagen. "Colorectal cancers frequently spread to the liver."
About 150,000 cases of colorectal cancer are diagnosed in the U.S. each year, making it one of the most common cancers in this country. "Overall, it's the second most common cancer after lung cancer," says Steinhagen. "It's responsible for 40,000 to 50,000 deaths a year."
It's so prevalent that doctors recommend universal screening, usually starting at age 50. While there are risk factors for colorectal cancer, Steinhagen stresses that "the short answer is - everyone is at risk of colorectal cancer." Men and women are equally affected, and your risk goes up with age. You're considered at high risk if you have IBD or a family history of colorectal cancer or any syndrome associated with polyps.
Doctors believe that all colorectal cancers start out as benign polyps. "These polyps can be seen and removed in colonoscopy, thus preventing colorectal cancer," says Steinhagen. "That's why we push for people to go for colonoscopy." Because of this link between benign polyps and cancer, you're considered at higher risk if you have a parent who has had polyps removed.
Signs and symptoms
Most colorectal cancers give no warning signs until they are well advanced. "At the earliest stages, when it's just a benign polyp or even early cancer, there are no symptoms," says Steinhagen. "That's why it's important for people to go for colonoscopy even if they're asymptomatic." For most other types of cancer, screening tests hope to catch cancers early, but colonoscopy actually identifies polyps for removal before they become cancerous. "In colorectal cancer, we can use screening for prevention," says Steinhagen. "There aren't too many other situations where we can prevent the disease this well."
Most doctors recommend that patients with no risk factors start getting colonoscopies at age 50. If no polyps are detected, the test can be repeated every 10 years. "If you find polyps or another abnormality, it is done more often, depending on what is found," says Steinhagen.
A minority of patients do experience symptoms like a change in bowel habits (which can involve moving your bowels more or less often), blood in the stool, feeling an unrelieved need to move the bowels, unexplained weakness, weight loss or anemia. "But the absence of signs and symptoms is not reassurance that colorectal cancer isn't present," says Steinhagen.
Traditional treatment
The treatment of colorectal cancer usually starts with removing polyps during a colonoscopy. For many patients, this is enough to prevent the cancer. "If there's a cancer already present, we biopsy the cancer and move on to more radical forms of treatment," says Steinhagen.
"Basically, the treatment for colorectal cancer is a surgical procedure called resection," he notes. "We remove the piece of colon where the cancer is growing, remove the surrounding lymph nodes and then reconnect the ends of the colon." After surgery, the patient does not generally have any impairment of bowel function. Chemotherapy is usually only added if the tumor is more advanced, and radiation is only used for advanced rectal cancer.
Colorectal resection is major surgery that takes two to four hours and usually requires a four- or five-day hospital stay, followed by a few weeks recuperating at home. "Colorectal cancer can often be treated laparoscopically, depending on the tumor, patient and surgeon," says Steinhagen. "There's a cosmetic benefit and a slight recovery benefit to laparoscopy, whose main advantage is a smaller incision."
Colorectal cancer is potentially deadly and needs to be taken seriously, but patients continue to hold common misconceptions that the disease is even worse than it is in reality. "What I tell patients is, first of all, colorectal cancer is not a death sentence - the prognosis is excellent," says Steinhagen. If the cancer is found early, the cure rate is close to 85%; even when the cancer is more advanced, the cure rate is 60% to 70%. "Also, only very, very rarely is a colostomy bag required - that's less than 5% of the time," says Steinhagen. "We can usually reconnect the plumbing so everything works."
Research breakthroughs
Though thousands of Americans still die of colorectal cancer each year, doctors are increasingly able to treat more and more of the cancers they diagnose. "First of all, there are new chemotherapy drugs - and there are more new ones coming - that have continued to improve the results for patients with advanced tumors," says Steinhagen. "Plus, there are new techniques and devices, including robotic surgery, that hold the promise of doing more and more surgeries with even better results."
Questions for your doctor
The first question to ask is, "At what age should I have my first colonoscopy?" While the answer is usually 50, your doctor may recommend an earlier screening if you have any risk factors. If you're feeling anxious about the test, ask, "Is colonoscopy safe? Does it hurt?" Colonoscopies are very safe, with a low rate of complications. As for pain, "Most of the time, patients don't feel anything," says Steinhagen. "And many don't even recall the procedure, due to the anesthesia used."
What you can do
Get a colonoscopy.
Colorectal cancer is one of the cancers that doctors can prevent effectively. "Removing benign polyps can prevent cancer from forming," says Dr. Steinhagen.
Don't ignore changes.
If you have changes in your bowel habits, go for a checkup. "Finding colorectal cancer early will save your life," says Steinhagen.
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