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Hanover Medical Specialists, P.A. is a multi-specialty practice in Wilmington, NC consisting of gastroenterology, cardiology, endocrinology and hematology / oncology.

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Colon Cancer Screening Can Save Lives
James Mertesdorf, M.D.

Colon cancer is the third most commonly diagnosed cancer and the second leading cause of cancer related death in the United States.  Each year, approximately 130,000 patients will be diagnosed and over 50,000 will die from this malignancy.  The five year survival for early stage cancers is over 90% while the 5 year survival for those diagnosed with disseminated metastatic cancer is less than 10%.  The encouraging news is that both normal risk and high risk individuals with a family history of colon cancer or colon polyps can be screened for colon cancer to reduce their mortality through the detection and removal of these premalignant colon polyps.

Colon cancer, fortunately, does not usually spring up out of no where.  Usually it begins as a premalignant polyp that takes an average of 5 to 10 years to develop into a colorectal cancer.  This is the window of opportunity to remove the premalignant polyps before they have the opportunity to develop into cancer.  Who should be screened for colon cancer?  The answer is everyone over age 40.  The average risk of colon cancer is approximately 6% during ones life time.  However, if your first relatives, such as your mother, father, sister, or brother has colorectal cancer, your risk increases to 12 to 18%.  In addition, 70% of individuals who develop colorectal cancer have no family history.  The current recommendations are to have a rectal exam beginning every year at 40 and to have your stools tested annually for occult blood with hemoccult cards beginning at age 50.  This hemoccult test can detect blood in minute quantities in the stool that are not able to be seen to alert one that there is a possibility of a polyp or colorectal cancer present.  In addition, the colon should be evaluated by one of three methods.  In the past, flexible sigmoidoscopy which is a short scope inserted into the lower colon has been the standard of care.  Alternatively an x-ray contrast test called a barium enema is an option. 

However, because of accuracy and comfort issues the barium enema has not become main stream.  The test which is favored because of its completeness, accuracy and the possibility of not only diagnosing but removing polyps at the time of the procedure is a colonoscopy.  This is an examination of the entire colon which is performed by a physician while the patient is usually sedated.  Any polyps which are discovered at the time of the colonoscopy can usually be removed through the scope.  After approximately a 30 minutes recovery time, the patient is driven home and observed for several hours by a family member or friend.  There is a small risk associated with colonoscopy including bleeding, infection and perforation of the colon.    The latter has an incidence of 0.2%.  Colonoscopy is recommended at age 50 and at 10 year intervals.  Usually between 75 & 80 years of age surveillance is no longer recommended.  People who are considered high risk include individuals with first degree relatives who have had colon cancer or premalignant lesions.  As these individuals have a 2 to 3 fold increased risk of colon cancer it is recommended they begin undergoing colonoscopy at age 50 or 10 years before the first degree relative had colon cancer.  If premalignant polyps are found repeat colonoscopy is performed in three years and then at 5 year intervals thereafter.

In addition to average risk individuals undergoing screening for colorectal cancer it is important that individuals if they see any blood per rectum even if they attribute it to hemorrhoids,  they require an evaluation to exclude colorectal cancer.   Unfortunately, bleeding associated with hemorrhoids at 20 is not always the cause of rectal bleeding when someone is 50 or 60 years of age.  The benefits of identifying individuals with premalignant polyps and removing these before they can develop into colorectal cancer out weighs the embarrassment and inconvenience of undergoing the procedure.    There are several other modalities being developed for screening colorectal cancer; including CT colography, ie virtual colonoscopy & DNA analysis of the stool for tumor markers.  These are currently being evaluated as alternatives to colonoscopy. 

Hopefully, screening for colon cancer will become an established part of health care screening in the same way that mammography for breast cancer has become an accepted screening exam.   

Dr. James Mertesdorf may be contacted at Hanover Medical Specialists, 1515 Doctors Circle, Wilmington, NC.  For information on scheduling a screening colonoscopy call 910-763-1219.

James M. Mertesdorf, M.D.