Colorectal Cancer: Schedule Your Screening

March marks Colorectal Cancer Awareness Month. Read our article for more information on prevention and screening.

Ernesto Reina, of North Wales, kept putting it off. Every time his primary care physician urged him to get a colonoscopy at his annual checkup, he always found an excuse not to do it — year after year. Ernesto didn’t drink or smoke, ate healthily and walked regularly. He felt good overall. A colonoscopy is a hassle, he thought.

Then at his annual checkup when he was 66 years old, he mentioned to his doctor that he was experiencing diarrhea and she insisted (again) he get a colonoscopy. Ernesto finally felt he had to do it — he scheduled the colonoscopy for January 2018. It was then that Kiley Walp, DO, a gastroenterologist with Doylestown Health Gastroenterology, performed the colonoscopy and discovered he had colon cancer. Fortunately, imaging that followed showed it was an early stage but still required surgery.

Colorectal Cancer Surgery

Ernesto was promptly scheduled for surgery. The operation was a success — the colorectal surgeon removed part of his colon to eliminate the cancer, and Ernesto needed no further cancer treatment. Unfortunately, he developed complications from the surgery, which required him to stay in the hospital about a week and a half longer than anticipated, and he missed two weeks of work.

“I realized that if I had gotten my colonoscopy earlier, it would have been better for me,” says Ernesto. “I may not have developed colorectal cancer or needed surgery.”

It’s been four years since that surgery and Ernesto remains clear of cancer.

He was one of the lucky patients. His cancer was found early and surgically treated. Sadly, many people discover their cancer too late. In fact, colorectal cancer is the second most common cause of cancer deaths, according to statistics from the American Cancer Society.

Risk Factors for Colorectal Cancer

The risk of developing colorectal cancer increases as you age and if you are overweight or obese, are sedentary, eat a poor diet (high fat, low fiber) as well as regularly consume alcohol and tobacco, according to information from the Centers for Disease Control and Prevention (CDC). Other risk factors include having:

• Inflammatory bowel disease such as Crohn’s disease or ulcerative colitis
• A personal or family history of colorectal cancer or polyps
• A genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome)

Symptoms

While Ernesto experienced diarrhea, which can be a symptom of colon cancer, it’s not a primary one and most of the time, it’s not related to colon cancer, Dr. Walp adds.

The CDC notes that symptoms of colorectal cancer can include:

• A change in bowel habits
• Blood in or on your stool (bowel movement)
• Diarrhea, constipation or feeling that the bowel does not empty all the way
• Abdominal pain, aches or cramps that don’t go away
• Losing weight and you don’t know why

While these are helpful to know, Dr. Walp says that the top two most telling symptoms of colorectal cancer tend to be:

• Rectal bleeding
• Iron deficiency anemia (low iron)

“Many people think when there’s blood in the stool, they chalk it up to hemorrhoids and don’t address it,” Dr. Walp explains. “Colorectal cancers often will ooze blood so you may not even see it in the stool but you can under the microscope. So slow oozing of blood will eventually cause iron deficiency anemia. In adults if there is a new iron deficiency anemia found in bloodwork, it is considered colon cancer until proven otherwise.”

Still, it’s important to note that colorectal cancer may not show any symptoms, especially in the early stages, notes Dr. Walp. “Unfortunately, we find colorectal cancers in patients without symptoms often,” she says. “That’s why it’s so important to do the colorectal cancer screenings.”

Screening Tests

When it comes to colorectal cancer, the ultimate goal is prevention through screening. In 2018, the U.S. Preventive Services Task Force lowered their recommended screening age for colorectal cancer from 50 to 45 because of the increased incidence of colorectal cancer in younger people. The current recommendation is that adults aged 45 to 75 should be screened for it.

Colonoscopy

Screening tools like colonoscopy are very effective in detecting and preventing colorectal cancer. In fact, colonoscopy provides a 100% detection rate in picking up colorectal cancer, according to Dr. Walp.

During a colonoscopy, the gastroenterologist uses the scoping instrument that consists of a tube with a camera on the end to look at the entire colon and rectum.

Because all colorectal cancers start as polyps, the gastroenterologist is looking for evidence of them. Once spotted, the gastroenterologist will remove any concerning polyps — thus, preventing colon cancer from developing.

If polyps are found, that person will need a repeated colonoscopy in anywhere from three to seven years. If no polyps are found, most people don’t need another colonoscopy for 10 years.

Cologuard®

Another screening test that can be helpful for people without GI symptoms, who have no family history of polyps or colorectal cancer, is Cologuard. This is an at-home stool test that can pick up abnormal DNA in the stool that is shed from polyps, especially bigger ones. It is noninvasive and carries no risk of complications, notes Dr. Walp.

“If for some reason patients refuse colonoscopy, it’s a great option for healthy people with no history of polyps or family history of cancer,” she explains. It needs to be repeated every three years.

FIT Test

One other screening test that can identify colorectal cancer, that is also less invasive than a colonoscopy, is called a FIT test (fecal immunochemical test). It uses antibodies to detect blood in the stool. This highly sensitive test gets sent to a lab and needs to be done annually.

“It’s a good method for people who don’t want to undergo colonoscopy,” Dr. Walp adds.

Doylestown Health Gastroenterology provides all of these screenings and offers an Open Access Colonoscopy Program that allows healthy patients without a history of cancer or polyps to schedule a screening colonoscopy without an initial office visit.

The Impact of COVID-19

Sadly, colorectal cancer screening took a backseat for many during the pandemic. When COVID-19 emerged in 2020, people were too afraid to go to hospitals to get their colonoscopies and other screenings, so they delayed them. As a result, Dr. Walp and her colleagues have discovered that many individuals who did so now tend to have more advanced disease.

“We’ve found that people who delayed screenings have bigger polyps and are more difficult to remove. Other patients might have to undergo a second procedure or surgery when the polyp could have been removed when it was smaller. And we find colorectal cancer that has metastasized (spread) that might not have two years ago,” she reports.

Ernesto knows the dangers of delaying a colonoscopy. And now he is incredibly thankful for his decision to have one four years ago. “It’s a grave mistake to delay your colonoscopy. It’s for prevention. Don’t hesitate,” he says. “It’s the best feeling for me every time I am finished with my colonoscopy to hear the doctor tell me, ‘You’re fine now. No evidence of cancer.’”

• For more information on colorectal screening or to schedule a test, contact Doylestown Health Gastroenterology at 215.345.6050.