Posted by This post is going to delve slightly into the anatomy and physiology of the colon, but it serves mostly to stress to you the importance of regularly screening this part of the body for cancer. Colorectal cancer is the second most common type of cancer in the US and 140,000 people get diagnosed every year. Catching it early is crucial because it’s sneaky and can spread fast to other organs. Find it early, and 92% of people live at least 5 years after diagnosis.
The colon, also called the large intestine, is a deep dark abyss— it’s where waste of the body, in the form of stool, accumulates. Why I call it a deep dark abyss is because it’s the end of the digestive tract—only certain bacteria can live there, and not much oxygen exists there (when you compare it to the mouth which has immediate oxygen access and is the first part of the digestive tract). It’s about 5 feet long and 2.5 inches in diameter. Its diameter gives it the name “large” intestine because the small intestine, while MUCH longer, is more narrow. Not much nutrient absorption happens in the colon at all. But water filters into the colon and helps to pass the stool along (so if you have constipation issues due to hard stool, amp up your water intake). The large intestine starts where the small intestine ends…and this connection is where the appendix lives. This happens around the lower-right section of your abdomen (photo below for reference).
A colonoscopy is truly the best way to ensure nothing looks odd inside the large intestine. There are certainly other tests like X-rays and CT scans that can show us superficial things about the colon, but there’s nothing like a live camera inside the actual organ to tell us what’s going on. In the general population, a person with minimal to no complaints regarding the colon would get a screening colonoscopy every 10 years. Many times, folks need a colonoscopy every 3-5 years instead of 10 because maybe some abnormalities were found on their first one, and you need closer monitoring. OK but what does the camera see in there that would warrant another, closer look? Good question!
A polyp is something you’ve probably heard of. Polyps are cells that grow from the lining of the colon and can be precancerous. Most of them don’t get to that point, but if left untouched and not removed from your colon, they can turn into cancer. They’re really easily removed during your colonoscopy, and each one gets sent to a pathologist to ensure cancer isn’t a concern. They kind of look like a chunky, bubbled-up skin tag (picture below). Chances are, if you’re a middle-aged adult, and you went tomorrow to get a random colonoscopy, you’d have a polyp. You only need checked every several years because a polyp grows really slowly, thus takes a while to turn to cancer. But it is VERY important to begin getting a colonoscopy at 50 years old, then at regular intervals. There are some exceptions to the “50” rule, though.
Think of your immediate family (mother/father/siblings). Did someone get diagnosed with colon cancer? At what age? Do you have irritable bowel disease? Here are some guidelines to see if you should get a colonoscopy earlier than 50:
- Immediate family member diagnosed prior to age 60? Get your first colonoscopy 10 years prior to their age of diagnosis OR at age 40, whichever comes first. Example: Dad diagnosed at 48— get yours at 38.
- Do you have Crohn’s disease in the colon or ulcerative colitis? Get your colonoscopy 8 years after the onset of your first symptoms, and get re-scoped every 1-3 years.
- People with familial adenomatous polyposis (FAP) syndrome see their first colonoscopy around 10 years old! People with this genetic condition have a near certain diagnosis of colon cancer at some point in their lives (usually at 39 years old or so). Their first polyp is usually seen in their teens, and they’ll have thousands in their colon over their lifetime. They end up getting most of their colon removed, eventually.
There is a noninvasive test you can do yearly that has no camera or anesthesia involved (I saw your excitement perk just now)— it’s called a fecal immunoglobulin test. It’s basically that Cologuard test you see on TV. You provide a stool sample to your PCP or to your gastrointestinal specialist via an at-home kit, and they run it for abnormalities like blood in the stool or DNA shed in the stool that is from a precancerous polyp. If your test comes back “positive,” you need a colonoscopy to see why. The blood in the sample could just be from an internal hemorrhoid, but it’s important to be sure. I had two patients just this week with positive results on their kits, so it’s a great initial test to see if you’re a candidate for the scope. If the kit shows normal results, you can breathe easily for another year (unless new, sudden symptoms pop up)!
So what is concerning for colon cancer and when should you call your healthcare provider for validation?
- Are your stools suddenly different? Like, you’re always regular, but now you have significant diarrhea or constipation that you cannot explain. If you think it’s weird, reach out.
- Do you suddenly have blood in your stool?
- Are you losing weight without trying? Like, 5 or 10 pounds this month without any lifestyle changes.
- Do you feel like your bowel movements aren’t emptying you out?
- Are you having strange, new abdominal pains? Even lower back pain that’s new and you cannot explain it (outside of muscle strain or arthritis in your spine that you’ve known about, for instance). The rectum is down by the tailbone, so keep that in mind, also.
Wellness is about preventing disease and being aware of threats to your health. The colon is a very important part of the body to keep an eye on. If you’re “of age” or have the aforementioned risk factors, please reach out and ask for a colonoscopy consult. You’ll rest easy knowing you did.
References:
American Cancer Society. Signs and symptoms of colorectal cancer. 2019. Retrieved November 8, 2019 from https://www.cancer.org/latest-news/signs-and-symptoms-of-colon-cancer.html
Colorectal cancer alliance. Fecal immunochemical test. 2019. Retrieved November 7, 2019 from https://www.ccalliance.org/screening-prevention/screening-methods/fecal-immunochemical-test
NIH. Familial Adenomatous Polyposis. 2019. Retrieved November 7, 2019 from https://ghr.nlm.nih.gov/condition/familial-adenomatous-polyposis
Wilkins T et al. Colorectal Cancer Screening and Surveillance in Individuals at Increased Risk. American Family Physician. 2018 Jan 15;97(2):111-116.
Image sources :
Image 1: https://www.mana.md/can-you-prevent-colorectal-cancer/
Image 2: https://www.healthline.com/health/colorectal-polyps
Cover Image: https://medlineplus.gov/colorectalcancer.html
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