By James J. O’Mailia, M.D., Gastroenterologist
As a gastroenterologist for nearly 30 years, I have seen the face of colon cancer in all of its ugly forms. My own family has suffered this scourge and therefore, I have both a professional and personal history with this disease.
Colon cancer (or colorectal cancer) seemingly exploded onto the nation’s psyche in the mid-1980s with the diagnosis of President Ronald Reagan while in office. Using the rudimentary methods of the day – and quite fortunately – doctors found a cancer in his colon and removed it successfully. This incident joins a long line of other celebrities with colon cancer who were not so fortunate. To name a few: the great Packer’s coach Vince Lombardi, actress Audrey Hepburn, Peanuts cartoonist Charles Schulz and jazz singer Eartha Kitt. Because of colorectal cancer awareness and screening, and the methods used to eradicate it, cancer rates have dropped steadily in older adults over the past 30 years.
When I started practice, colorectal cancer presented in persons older than 60 years of age. Over a short period of time, the age of presentation plummeted, at first to those in their 50’s, followed by those in their 40’s – until recently, when the National Institutes of Health (NIH) warned physicians of an alarming rise in the incidence of colorectal cancer in both men and women in their 30’s and younger. In the meantime, it’s estimated that, in 2015, colon and rectal cancers will cause 50,000 deaths in the United States; only lung cancer will top that statistic.
Although genetics play a large role in colorectal cancer, 75% of cases occur in persons without a known family medical history of colorectal cancer. The good news is that 90% of colorectal cancers can be prevented with proper test screening and removal of pre-cancerous growths called polyps.
Patients routinely ask me, “What causes colon cancer?”
We still do not fully know, but what we do know is that it is an equal opportunity killer, in that it affects both men and women, and it is caused by an interaction between various internal gene factors and external lifestyle factors.
Internal, or intrinsic, factors that increase the risk of developing colorectal cancer include: age over 50, personal history of colorectal cancer or certain types of polyps, family history of colorectal cancer, history of inflammatory bowel disease, ethnicity such as Native Americans, African Americans and certain gene types of European Jews. External factors include: tobacco use, heavy alcohol use, diet high in red meat, physical inactivity, obesity, Type 2 diabetes and environmental factors. Together, internal and external factors seem to affect the genes that control how cells grow to then stop working normally. Without this genetic control, abnormal cells develop out of control – and become a cancer.
The warning signs and symptoms of colorectal cancer vary, depending on the location of the cancer in the colon. However, if you have a change in bowel habits, rectal bleeding, abdominal cramping or steady pain, it’s always best to speak with your doctor for recommendations, such as routine colon evaluations with a goal toward cancer prevention.
Currently, basic initial screening is recommended at age 50, whether you have symptoms or not. For those with a colorectal family history, screening should begin at age 40, and for African Americans, screening should begin at age 45. However, again, whatever your adult age, if you have the symptoms mentioned, see your doctor for further guidance.
There are several ways to evaluate, but most gastroenterologists prefer colonoscopy, the gold standard of testing as the “one-stop” diagnostic and prevention tool. Always ask your doctor which method is best for you.
It is important to find out if any of your close blood relatives have had colon polyps or colorectal cancer, and to then let your doctor know. If the answer is “Yes”, you may have the gene and the greater risk. About 10% of all colon cancers are inherited. If the answer is “No”, it is still best to get an evaluation at the recommended age.
Much consternation is devoted to the colonoscopy bowel prep. Many years ago, I myself tried the usual prep and was up all night with the famed dreaded symptoms. It was enough for me to understand why the apprehension and complaints about colonoscopy as a whole. I chose to develop a prep that gradually and safely empties the colon using a 3-day regimen of certain over-the-counter products and certain standard foods – right up to the night before the procedure. Thankfully, this has changed the way my patients think of the word “Colonoscopy”.
Be well and stay well.
James J. O’Mailia, MD, PA
1553 Matthew Dr.
Fort Myers, FL 33907