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Colorectal Cancer

Colorectal cancer is the 3rd most common cancer in men and women. In 2001, it is estimated that 135,400 people in the US will be diagnosed and 56,700 will die due to these diseases. The incidence of colorectal cancer has decreased an average of 1.6% per year between 1985 and 1997, possibly due to the effects of screening. Similarly, the death rate due to colorectal cancer has also declined over a similar period. Colorectal cancer is clearly a major health concern in the US, and advances in prevention, early detection, and treatment should lead to enhanced outcomes related to these diseases.

Colorectal cancer can present with a variety of symptoms. Abdominal pain, bloating, flatulence, and the presence of blood in the stool are common. A change in the size or color of the stool may also be an indication of a polyp or cancer. Profound fatigue related to anemia may also be a clue to a cancer in the right (or proximal) colon.

Prevention

Many studies have suggested a link between diet and colon cancer. Recently, a report from the Harvard School of Public Health has provided strong epidemiological evidence that dietary fiber does not prevent colon cancer. Medications that inhibit cyclooxygenase, primarily COX-2, also may play a role in prevention of colon cancer.

Early Detection

Several organizations, including the American Cancer Society (ACS) and the US Preventive Services Task Force (USPSTF) , have recommended screening examinations for the early detection of colorectal cancer. Most physicians recommend a flexible sigmoidoscopy every 3-5 years starting at age 50. This should be accompanied by yearly fecal occult blood testing, a simple, non-invasive test to look for blood in the stool. Recently, two independent groups reported that colonoscopy was superior to sigmoidoscopy for screening purposes because it allowed for visualization of parts of the colon that cannot be reached with a sigmoidoscope (NEJM 343 (3): 162+, 169+). Whether or not the ACS and USPSTF will amend their recommendation remains to be seen, but a point of fact is that the majority of patients over the age of 50 are never screened by any method. Early detection only works if it is applied.

Familial Syndromes

It is clearly established that colon cancer can run in families. Several syndromes, such as Familial Adenomatous Polyposis (FAP) and Hereditary Non-Polyposis Colon Cancer (HNPCC or Lynch Syndrome) are important syndromes to recognize, as the risk of developing colorectal cancer is 100%. All people with these genetic traits deserve close surveillance and should be referred to a Risk Assessment Clinic at a center with experience in following high-risk patients. In persons with a first-degree relative with colon cancer, but in whom FAP or HNPCC is not known to exist, it is typically recommended that screening begin 10 years earlier than the age of the youngest family member to develop colon cancer.