Did you know that colorectal cancer is the third most common cancer in men and women and the second leading cause of cancer death?
However, colorectal cancer can be prevented through colonoscopy. This is a procedure that detects and removes precancerous polyps before they may become cancerous.
- Colorectal cancer begins as an abnormal growth typically arising from the innermost mucosal layer of your large intestine or rectum.
- This growth is known as an adenomatous polyp. It can progress to cancer through the buildup of genetic mutations.
- It usually takes years for an adenomatous polyp to develop into colon cancer, although some may progress faster.
A colonoscopy is a procedure in which a gastroenterologist (GI doctor) examines the lining of your colon and rectum with a long, flexible scope, while you are comfortably sedated. During this procedure, precancerous polyps can be found and removed before polyps can become cancerous.
“Colonoscopy can prevent colorectal cancer by detecting and removing precancerous colon polyps when they are in their earliest stages,” says Michael Schwartz, M.D., Peninsula Pathology Associates, a pathologist in the Riverside Cancer Care Network.
“In fact, several studies have shown that colonoscopy can lead to a reduction in colorectal cancer incidence and mortality by at least 50%,” he said.
The best prevention for colorectal cancer is regular, on time colonoscopy and the removal of any precancerous polyps found.
Are All Colon Polyps Cancerous?
Colon polyps can be classified as non-neoplastic or neoplastic. Neoplastic polyps however may progress to colorectal cancer over time.
The most common non-neoplastic polyps include:
- Inflammatory polyps
- Lymphocytic aggregates
- Hyperplastic polyps
The two most common neoplastic polyps include:
- Conventional adenomas
- Sessile serrated adenomas (sessile serrated lesions)
Conventional adenomas account for nearly two-thirds of all polyps. They are classified as a tubular, tubulovillous, or villous based on how they look under a microscope. These polyps typically occur throughout the colon and can also involve the rectum. Sessile serrated adenomas account for approximately 15% of all polyps and most commonly involve the right colon.
How Common Are Colon Polyps?
- As one ages, the risk for developing colon polyps increases.
- Twenty-four percent of individuals in the 30–40-year age old group and 37% in the 40 to 49-year-old age group have polyps.
- Some studies have shown that over 50% of individuals greater than 50 years old will also have polyps. Because of an increased incidence of large, advanced polyps and colorectal cancer in younger adults, the recommended age to begin screening has been lowered to age 45, for those at average risk.
Are Colon Polyps More Common in Men or Women?
- Polyps are more common in men than woman; one study showed that men have 1.77 times the risk of adenomas compared with women.
- The lifetime incidence is approximately equal as woman tend to live longer.
- African Americans have a higher incidence of colorectal cancer mortality compared with other racial groups. This may be because they are at higher risk of having larger polyps and with increased villous histology.
- Hispanics have a 25% lower risk of large adenomas than whites.
- Asian Americans have an adenoma prevalence like whites.
Various hereditary disorders also place some patients at a much higher risk for polyps and colorectal cancer. Some of these disorders include:
- Familial adenomatous polyposis (FAP)
- Lynch syndrome
- Gardner's syndrome
- MUTYH-associated polyposis (MAP)
- Peutz-Jeghers syndrome and serrated polyposis syndrome
What If Colon Polyps Are Found?
Once your GI doctor has removed or biopsied any polyps during your procedure, the tissue is sent to the pathology laboratory.
- Once in the lab, each polyp’s tissue undergoes special processing which requires at least one day to perform.
- With the help of lab technologists, the tissue is converted into a glass slide for the pathologist to look at under the microscope. The pathologist will then give the diagnosis to the GI doctor.
Based on the size, number and types of polyps identified, along with their appearance under the microscope, your GI doctor will determine when you should be scheduled for your next colonoscopy.
When Should I Have Follow-Up Procedures?
Returning for your next colonoscopy at the time recommended by your GI doctor is an important part of preventing colorectal cancer.
If you have a history of colon polyps this places you at higher risk for developing new polyps. If new polyps are detected, they too can be removed before they become cancerous.
Sharing this information with your first-degree relatives helps them prevent cancer too (father, mother, sister, brother, son, daughter).
- People having a first-degree relative with a colorectal polyp have a 40% higher risk of polyps themselves.
- One study found that having a family member diagnosed with polyps at an age less than 50 years increases one’s own risk of polyp by four times compared to a family member diagnosed with a polyp after age 60.
- The study also found that having a first-degree relative with a history of colorectal cancer increases one’s risk of colon cancer by a factor of 1.76.
Based on these findings, the United States Multi-Society Task Force on Colorectal Cancer now recommends that patients with a first-degree family relative with colorectal cancer or an advanced polyp start screening colonoscopy at age 40 or 10 years before the age of the youngest affected relative, whichever is sooner.
What If Colorectal Cancer is Detected?
If colorectal cancer is detected or has spread, at the direction of your doctor, our laboratory and partner reference labs may detect genetic alterations. This information helps your cancer doctor to select the best chemotherapy or immunotherapy for your cancer.
“This ‘precision medicine’ allows your doctor to use the specific genetic profile of your tumor to select the best treatment. This helps increase the chance of survival while reducing the exposure to potential toxicities,” says Dr. Schwartz. The goal of precision medicine is to target the right patient with the right treatment at the right time.
How Can Riverside Gastroenterology Specialists Help?
A high-quality colonoscopy performed by a skilled GI doctor matters. Indicators such as adenoma detection rate and withdrawal time are markers of quality. The withdrawal time is the time the GI doctor is looking for polyps through the scope during your colonoscopy.
Adenoma detection rate is the average number of polyps found during your procedure. The GI doctors at Riverside far exceed the national average for both measures.
What this means to you is that your Riverside GI doctor thoroughly examines your colon and rectum, finding an above average number of polyps in their patients, that left undetected, could become cancerous.
Riverside Gastroenterology is recognized by the American Society of Gastrointestinal Endoscopy as an Endoscopy Unit Recognition Program honoree. This is the only national program honoring GI endoscopy units that have shown a commitment to delivering exceptionally high-quality and safe GI procedures. This also means that care here is delivered compassionately for all our patients.
How important is the preparation before the procedure?
To make sure your colonoscopy is a success, follow the prep instructions for your procedure for a thorough bowel prep. A thorough bowel prep gets your colon clean so your gastroenterologist can see small polyps and remove them.
Lifestyle Changes You Can Make
While there are some risk factors you have no control over, such as age, gender, race, ethnicity and family history there are lifestyle changes you can make to reduce your chances of developing colorectal cancer.
These changes include:
- Quit smoking
- Limit alcohol
- Maintain a healthy weight
- Eat a healthy diet
- Exercise regularly
It is estimated that up to two-thirds of colorectal cancers are caused by risk factors that you can change:
- Smoking is an important risk factor for the development of colonic polyps and colorectal cancer. This is because cancer-causing substances in smoke pass through the circulatory system and into the colonic mucosa, interfering with cell development.
- Drinking greater than one alcoholic beverage per day has been shown to have a clear relationship with the development of both colon polyps and colorectal cancer.
- One large study found that a 5-unit increase in body mass index (BMI) was associated with a 19% higher risk of colorectal adenoma. Another study noted a 2-3% increase in colorectal cancer risk with each increase in BMI unit.
- A large study found a 16% decrease in the risk of adenomas in the most active men and women compared to those with a sedentary lifestyle.
- Red meat has been linked with an increased risk for colorectal adenomas and colorectal cancer; conversely, a diet low in saturated fats, meat, and dairy and high in vegetables, fruits, and nuts (Mediterranean diet) or a vegetarian diet decreases the risk of colorectal cancer.
Are there other screening options available?
While colonoscopy is the only screening that can find and prevent colorectal cancer, there are other at-home screening options available that can detect if colorectal cancer may be present. These tests include:
- Fecal immunochemical test (FIT), performed yearly when normal results are.
- Stool DNA test (Cologuard), performed every three years when normal results are found.
Any abnormal finding from at-home tests should immediately be followed with a colonoscopy.
How Can I Schedule a Colonoscopy?
You may not have any signs of colorectal cancer in its early stages. With screening, colorectal cancer is one of the most easily detected and preventable types of cancer.
To make an appointment, call 757-316-5777 or click to make an appointment online.
