COLON CANCER ( Part -I )
Colon cancer is the second leading cause of cancer death in Georgia & the USA. It is estimated that annually about 3,500 Georgians develop colon cancer and nearly half of them die as a consequence of the disease. Risk factors include family history of colon cancer, personal history of gynecological & breast cancers, obesity, high red meat & animal fat intake and age 50+. Contrary to the general belief, prevalence of colon cancer is indeed common among vegetarians and Asians, particularly people from Indian sub- continent. Today, we have tools available to detect colon cancer in the early stages and reduce the mortality. In this series of articles, we will go over the various facets of colon cancer including diagnostic & treatment modalities. In this issue we will discuss the symptoms, available tests & the demographics of colon cancer in a nut shell & the next two issues will deal with the selected topics relevant to the common myths & controversies. Please feel free to call us on any specific issues on the colon cancer & we will try our best to answer in the next few issues.
SYMPTOMS
Colon cancer is common among people over the age of 50, but can also occur in young adults as early as in their teens. Stomach pain, rectal bleeding, blood in the stool, low blood count (anemia), change in the bowel habits and weight loss are some of the symptoms of colon cancer. However, people may not exhibit any symptoms at all during the early stages of this malignant neoplasm.
SCREENING
Like Pap smear, prostate test and mammogram, colon cancer screening is recommended for all adults starting at the age of 50. Stool for hidden blood is the most simple and widely available screening test in this country. However, it is unreliable and may give false positive and false negative results. Virtual CT colography and Barium enema x-rays can detect colon cancer, but they are not sensitive enough to identify pre-cancerous polyps and small cancers. Further, if an abnormality is detected by these x-rays, patient has to undergo further testing (colonoscopy) for biopsy and confirmation. Sigmoidoscopy, an office based procedure can detect polyps and cancer in most part of the left side of the colon, but it can easily miss right sided colon cancer and polyps. Colonoscopy has become the gold standard for colon cancer screening and is widely available. A flexible tube like camera is inserted into the rectum under conscious sedation and the entire colon is examined for approximately 10-15 minutes. Polyps can be removed and biopsies can be taken during the procedure. Blood tests are also available to detect rare genetically inherited familial colon cancer syndromes.
THE PRESENT
Colon cancer is a preventable, detectable and treatable malignancy, but yet remains the second leading cause of cancer deaths in Georgia. If detected early, colon cancer cure rate can be high as 95%. The compliance for colon cancer screening in Georgia is poor, particularly among the Indian Community. The prevailing screening rate is only 40% for the people over age 50. It is recommended that everyone over the age of 50 should consider colon cancer screening as a part of their physical examination to beat this deadly but preventable cancer.
- to be continued
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Indran B. Indrakrishnan, M.D., FACP., FACG President, Georgia Gastroenterologic and Endoscopic Society Colorectal Prevention Task Force, DHR, Division of Public Health, Georgia Clinical Assistant Professor of Medicine, Emory University School of Medicine Gwinnett Digestive Clinic, Lawrenceville, examiner for MRCP(UK). Telephone: 678-377-8252.
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