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March Is Colorectal Cancer Awareness Month — Don't Assume!

March Is National Colorectal Cancer Awareness Month! Colorectal cancer screening saves lives. If everyone 50 years old or older were screened regularly, as many as 60% of deaths from this cancer could be avoided.

Paula I. Denoya, MD, a Stony Brook colorectal surgeon
Dr. Paula I. Denoya

Colorectal cancer — also known as colon cancer — is the second leading cause of cancer-related deaths in the United States. It affects both men and women. Every year, more than 140,000 Americans are diagnosed with colorectal cancer, and more than 50,000 people die from it.

Awareness of colorectal cancer and its common signs is well worth it, because when detected early this cancer can be treated effectively.

Here, Paula I. Denoya, MD, a member of the faculty of our Colon and Rectal Surgery Division, answers frequently asked questions about colorectal cancer, with special attention to its common warning signs, detection, and treatment.

Q: What is colorectal cancer?

A: Colorectal cancer arises from the lining of the colon or rectum, usually from cells that secrete mucus. In many cases, it starts out as a polyp, which is a premalignant, benign lesion or an overgrowth in the lining of the colon. If left alone, a polyp can grow into cancer. However, with screening, polyps can be detected and removed, thus preventing cancer altogether.

Q: What are the signs and symptoms?

A: Colorectal cancer is often symptomless, which is why screening is so important. Some people do experience telltale signs, however. Ten warning signs of colorectal cancer are:

  • Blood in stool
  • Persistent diarrhea
  • Persistent vomiting
  • Cramping abdominal pain
  • Persistent bloating
  • Unexplained weight loss
  • Decreased stool size
  • Unexplained fatigue
  • Change in bowel habits
  • Incomplete emptying of bowel

Anyone experiencing these symptoms should speak with their primary care physician.

Q: Who is at risk?

A: According to the American Cancer Society (ACS), colorectal cancer is the third most common cancer in men and women. Gender does not seem to be a factor, but age is, and risk increases after age 50.

People considered to be at higher risk include those with a family history of polyps, colon cancer, or uterine cancer; individuals with inflammatory bowel disease; anyone with a personal history of polyps; and persons with inherited syndromes such as familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer.

The ACS recommends that people undergo screenings starting at age 45. Individuals at high risk should start screenings earlier and have more frequent follow-ups."

Colorectal cancer can be prevented, and it is extremely curable if caught early.

Colon Anatomy | From Gray's Anatomy (1918)
The colon, as depicted in Gray's Anatomy (1918;
click on image to enlarge).

Q: How is colorectal cancer detected?

A: Colonoscopy is considered the gold standard because it is the only test that can identify and treat polyps in the entire colon. Further, if a polyp is detected during screening, it often can be removed and biopsied at that time, eliminating the need for additional procedures. (See our 2012 blog post, "New Report Affirms Lifesaving Role of Colonoscopy: Death Risk Is Cut in Half.")

While people often dread undergoing a colonoscopy, it is important to know that recent changes make it a gentler experience. For example, Stony Brook uses many different kinds of bowel preparations — some are even in pill form. The patient's physician will determine which preparation the patient will best tolerate.

In the past, patients remained awake for the procedure, but now, with innovations in anesthesia, patients undergo a short, fast-working, and deep sedation that has minimal side effects including no memory of the procedure.

Stony Brook offers additional screening methods, including flexible sigmoidoscopy, barium enemas, fecal occult blood testing, and CT colonography, also known as virtual colonoscopy.

Virtual colonoscopy was invented at Stony Brook in the 1980s. While less invasive than a traditional colonoscopy because it uses a CT scan to look at the lining of the colon, it still requires bowel preparation. It is generally used with patients who may have an existing colon blockage or for whom a colonoscopy carries risks, for example, from anesthesia. Unlike a colonoscopy, in which a polyp can be removed during the screening procedure, during a virtual colonoscopy, if a polyp is detected, the patient will need an additional procedure to treat and biopsy it.

Q: If cancer is detected, how is it treated?

A: Colorectal cancers respond well to treatment, and often treatment is relatively uncomplicated. About 30% of cases can be treated with surgery alone. Cancers in later stages respond well to chemotherapy and radiation, and overall, the five-year survival rate approaches 65%.

Colorectal cancer is treatable — know your options.

For patients with colorectal cancer in the lower part of the colon, both the rectum and the anus are often removed. The patient, then, typically needs a permanent colostomy, which collects stool in a bag attached to the belly (abdominal wall).

For some low rectal cancers, Stony Brook's colon and rectal surgeons perform a more advanced type of surgery that eliminates the need for a colostomy and preserves bowel function. Called sphincter-sparing surgery, this procedure allows for removal of the cancer and "spares" the anal sphincter muscle.

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Q: What distinguishes Stony Brook's approach?

A: Stony Brook Medicine offers the latest protocols and treatments for colorectal cancers — delivered by a multidisciplinary team — including the new transanal endoscopic microsurgery, a less invasive procedure than the traditional approach for reaching lesions high up in the rectum.

We are renowned leaders in the use of minimally invasive laparoscopic surgery for treating colorectal cancer, which offers patients considerable benefits.

Using the da Vinci® Si robotic surgical system, our surgeons offer patients another option beyond traditional open surgery and laparoscopic procedures. The major advantage of this minimally invasive technique is that it provides surgeons with enhanced visibility and mobility.

This improves accuracy, provides cleaner "margins" (which means that no cancer cells are seen at the outer edge of the tissue that was removed) and helps ensure that all the lymph nodes (difficult to see and reach by conventional methods) can be removed during the procedure.

Benefits to the patient having robotic surgery include less bleeding, less scarring, less pain, and a lowered risk of infection.

In addition, we are working to advance the practice of medicine through clinical trials. We currently offer several clinical trials investigating novel approaches to chemoradiation therapy for rectal cancer and new chemotherapy and immunotherapy options for colorectal cancer.

For standard treatment approaches, we work closely with oncologists, radiologists, pathologists, and other specialists on the colorectal cancer multidisciplinary team at Stony Brook University Cancer Center to provide comprehensive cancer care to our patients.

If you are over age 50 and have not yet had a colonoscopy, schedule one soon by calling Stony Brook's Direct Access Screening Colonoscopy Program at 631-444-COLON (2656) . You can request an appointment online, too.

"Don't Assume" is the Colorectal Cancer Alliance's 2019 National Colorectal Cancer Awareness Month public awareness campaign. Its goal is to challenge assumptions and misconceptions about colorectal cancer by dispelling myths, raising awareness, and connecting people across the country with information and support. Learn more about the campaign.

Watch this 1-minute video featuring Meryl Streep who explains why screening for colorectal cancer is a smart thing to do:

Watch this News 12 LI news clip (1:55 min) featuring Minsig Choi, MD, director of medical oncology at Stony Brook Cancer Center:

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