Conquering Colon Cancer

Early Detection is Key to Survivability

As of 2020, colorectal cancer is the fourth most common cancer in the United States, trailing lung, breast and prostate cancer. It is also the second leading cause of death from cancer. The Centers for Disease Control and Prevention (CDC) reports that 90 percent of colon cancers are found in people over the age of 50, with men presenting with the disease more often than women. Anthony Eclavea, DO, an interventional radiologist with ThedaCare Regional Medical Center-Appleton and Chair of the ThedaCare Gastrointestinal Cancer Center of Excellence, explains why regular screening is critical to improving the survival rate.

Schedule Regular Screenings

“When cancer develops in the colon, it typically begins as a polyp, and often presents no symptoms,” said Dr. Eclavea. “That’s the worrying part of colon cancer – people don’t know they have it. That’s why regular screening is so important. The earlier we find any cancer, the better. Early detection means a person’s overall survival rate and quality of life is better.”

That’s the worrying part of colon cancer – people don’t know they have it.

Anthony Ecavea, DO, ThedaCare

Dr. Eclavea said a colonoscopy is the gold standard for screening.

“People who have a normal risk of developing colon cancer are advised to begin screening at age 50 and repeat that screening every 10 years if no cancer-causing polyps are found,” he explained.  “Higher-risk patients will have more frequent colonoscopies, in the three-to-five year range, based on the number and size of polyps found or known familial syndromes.”

Understand Your Risk

“Research shows that on average, people have a 20 percent greater chance of having cancerous polyps after age 50, and that percentage increases as people reach age 70 and beyond,” he said. “People of African-American descent have a 20 percent greater chance of developing colon cancer. For that reason, the American College of Gastroenterology recommends they begin regular screenings at age 45.”

People who have had another cancer or who have a family history of colon cancer should discuss when to begin screening with their health care provider.

The CDC and Dr. Eclavea list the most common risk factors for colon cancer as:

• Being overweight
• Leading a sedentary lifestyle
• Eating a diet low in fresh fruits and vegetables and/or high in red, processed or    charcoal-grilled meats
• High alcohol consumption – more than two drinks per day
• Smoking

Dr. Eclavea added some researchers also consider low levels of Vitamin D a risk factor.

“That makes getting outside to exercise a great idea,” he said. “You are being active and you are getting Vitamin D from the sun, so that’s doubly effective prevention method.”

Take Note of Possible Symptoms

While stressing that colon cancer is often asymptomatic, Dr. Eclavea noted there are some symptoms that could indicate its presence, including:

• A change in bowel habits or consistency of the stool
• Rectal bleeding or blood in the stool
• Frequent abdominal cramps, gas or pain
• Weakness or fatigue
• Unexplained weight loss

He added that occasionally other physical testing may indicate the possibility of colon cancer.

“If a patient has a low level of red blood cells or becomes anemic, that could be a signal that there’s a polyp bleeding in the colon, which may or may not cause their stool to darken” he said. “These are very subtle things, but if we ignore them, we may miss the opportunity to catch a cancer early. It is rare that colon cancer can cause an obstruction or present as a palpable mass in someone’s abdomen.”

Know What to Expect

While noting there are other screening options, Dr. Eclavea again said having a colonoscopy is the best screening method.

“During a colonoscopy, the doctor inserts a flexible scope into the patient’s bowel after they’ve completed a bowel prep,” he explained. “The scope travels the length of the large colon to look for polyps or other abnormalities. If the doctor discovers a polyp, he or she can remove the polyp, biopsy it, and tag the colon to show where it was located. That’s very efficient from a patient’s perspective.”

Dr. Eclavea noted other screening options include fecal immunological tests (FIT), which look for traces of blood in the stool, and other tests, which examine the stool for traces of blood and also DNA markers from polyps.

“Both of these tests are non-invasive and better than no screening,” he said. “It is important to remember there can be false negatives and positives with both. If a problem is detected, a colonoscopy is required anyway.”

Dr. Eclavea also explained other screening alternatives.

“For people who can’t have a colonoscopy for some physical, financial or other reason, these alternative tests are better than no screening,” he said. “There are other options, too, including MR or CT colonography. Both of these options also require bowel prep and take some time. After these scans, imaging software allows us to virtually look inside the colon.”

Dr. Eclavea noted that not all polyps become cancerous.

“There are benign polyps that do not have a tendency to become cancerous,” he explained.
“These polyps don’t require increased screening intervals. Adenomatous polyps, however, can become malignant and cause cancer. The most common cancer-causing polyps are adenomatous. If they are found during a colonoscopy, the patient will be advised to have more frequent colonoscopies to monitor the development of such polyps. The timing of increased screening will revolve around how many polyps were found and the size of the polyps. In general, the larger the polyps, the greater the risk of cancer.”

Practice Prevention

Ways to prevent colon cancer include maintaining an appropriate weight, exercising regularly, eating a healthy diet and limiting alcohol and smoking.

Dr. Eclavea also noted as of 2020, the National Comprehensive Cancer Network has endorsed low-dose aspirin as a preventive measure for colon cancer. It stated, “There is substantial evidence of the protective effect of low-dose (81 mg) aspirin when taken for five to 10 years…. The decision to offer aspirin should take into consideration risk of bleeding, life expectancy and long-term compliance.”

If caught early, colon cancer can be survivable.

“The only way to catch it early is to follow the recommended screening guidelines for your population group. Know your risk level, talk with your health care provider about your family history of cancer, especially colon cancer, and follow the advice of cancer professionals.”

“The only way to catch it early is to follow the recommended screening guidelines.”

Anthony Eclavea, DO, ThedaCare

In treating all cancers, Dr. Eclavea noted that ThedaCare is an accredited cancer institution and follows the guidelines of the National Comprehensive Cancer Network in determining the best course of treatment for a patient.

He explained that ThedaCare medical teams hold weekly, multidisciplinary tumor review boards to discuss each cancer patient’s scenario to determine their best treatment plan moving forward.

“We have a wonderful complement of disciplines in our GI Cancer Center of Excellence,” he said. “We have skilled surgeons, medical oncologists, radiation oncologists, pathologists and interventional radiologists along with genetic counseling, navigators, palliative care, dietary counseling, physical therapy and cancer care teams to help the patient move through their treatment program. Our goal is to bring comprehensive, world-class cancer care the area so patients don’t have to travel anywhere else for treatment. The ability to stay home with family and friends has a huge impact on a cancer patient’s survival.”