Some Adults May Need to Get Colonoscopies Early
- American film director Chuck Lorreknown for creating and producing sitcoms like “Two and a Half Men” and “The Big Bang Theory”revealed this week how he underwent a colonoscopy after being diagnosed with ulcerative colitis (chronic inflammatory bowel disease) in his 20s.
- A colonoscopy is a procedure doctors use to screen for colon cancer.
- People with an average risk of colon cancer should start getting colonoscopies at age 45.
- However, experts say that some conditions, like Crohn’s disease or colitis, can cause inflammation that overtime can lead to cancer. People with these conditions should speak to their doctors about the appropriate screening schedule.
While most average risk adults can wait to screen for colon cancer until their 40s, people with certain conditions may need to screen earlier.Read More
“I didn't know what to do, I didn't know where to go. I had no money and no insurance. I managed to find my way to the Cedars of Lebanon, which was a teaching hospital.”
Chuck Lorre talks about his semi-public colonoscopy when he was just 22 years old, at the groundbreaking of Project Angel Food's The Chuck Lorre Family Foundation Campus.@ProjAngelFood pic.twitter.com/AZ2ueGtO7x
— Marc Malkin (@marcmalkin) August 3, 2023
He continued, “I was fortunate enough to get an anesthetic-free colonoscopy in front of a classroom of students, and I have often thought of that as great preparation for a lifetime in television.”
Thankfully, Lorre didn’t need to undergo a colectomy to cure his ulcerative colitis.
“I had nowhere to go. I was blessed, an angel came into my life and put me on a nutrition program and I somehow went into remission,” Lorre said.
“So it wasn't western medicine that got me well, it was food. I went into remission after about six months on a really wonderful nutrition program. And I'll never forget, that changed my life… I was 22 years old and looking at a colectomy,” he added, expressing how happy he was to be a part of a program that’s provides “food as medicine.”
The National Institutes of Health (NIH) defines ulcerative colitis as “a chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation and ulcers on the inner lining of your large intestine.
The NIH notes that ulcerative colitis can arise at any age, however, the condition is most likely to show up in people between the ages of 15 and 30.
What is a Colonoscopy?
A colonoscopy is a procedure doctors use to screen for colon cancer by looking inside your colon.
This procedure requires your colon to be “cleaned out.” To clear out your colon, your doctor will prescribe a “bowel prep,” which is a liquid you drink the night before the procedure. The prep acts as a laxative that causes you to have multiple loose stools before your procedure.
Once your colon is cleared out, the gastroenterologist performing the procedure can have a clear look to evaluate if any polyps or masses are present.
The American Cancer Society recently recommended that beginning at age 45, patients undergo a colonoscopy every 10 years. However, more frequent colonoscopies are recommended if a polyp (a sort of pre-cancerous growth) is found. While most major national organizations put no maximum age limit on colonoscopy screening, government guidelines suggest people 76 and over talk to their doctor about whether further screening is needed.
Depending on the size and number of polyps found, it is recommended that patients undergo a repeat colonoscopy within three to five years.
Dr. Zuri Murrell, a colorectal cancer surgeon and Director of the Cedars-Sinai Colorectal Cancer Center, broke down the colonoscopy procedure for SurvivorNet.
"When we see a polyp, we actually physically take the polyp out through the colonoscope," Dr. Murrell said.
"What does that mean? That means we basically put a wire through with a little bit of a little flange at the end and we pull the polyp out. Now, note there is no pain with that [because] nside the colon, there are no pain fibers," Dr. Murrell added.
The advantage of a colonoscopy is that your doctor can remove any polyps found during the test. Many colon cancers can be caught on colonoscopy before they develop, or when the polyps are small enough to be removed without surgery.
Conditions That Increase Colon Cancer Risk
It’s important to know that colon cancer risk is high for people who are living with ulcerative colitis and some people who have Crohn’s disease.
“When you have Crohn's and colitis, inflammation in the intestines over time can lead to abnormal growths that can develop into colon cancer,” Dr. Berkeley Limketkai, the director of clinical research at UCLA’s Center for Inflammatory Bowel Diseases in Los Angeles, previously told SurvivorNet.
Expert Colon Cancer Resources
- 5 Possible Signs of Colon Cancer; Don’t Be Afraid to Look in the Toilet!
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- Biomarkers in Colon Cancer
- Alcohol Intake Has a Big Impact on Colon Cancer Surgery
- Colon Cancer Screening Options And Genetics: Myth Busting With Dr. Heather Yeo
- Biomarkers in Colon Cancer: Understanding KRAS, BRAF, and HER2
“If you have these conditions, you can keep inflammation under control, and lower your risk, by sticking to your treatment plan and staying up to date on recommended screenings.”
Ulcerative colitis and Crohn's disease are two different inflammatory bowel diseases that affect colon cancer risk differently.
Colitis is a lifelong condition that causes inflammation of the lining of the colon, which can accumulate and damage the colon.
Crohn's disease is also a lifelong condition, but it can cause chronic inflammation in any part of the GI tract from the mouth to the anus
For some people, that may be the colon, but most commonly it's the small intestine and the beginning of the large intestine. Both colitis and Crohn's can cause intense abdominal pain and diarrhea, among other symptoms. Treatment can sometimes put these conditions into remission.
Keeping Up With Recommended Screenings
Because colitis causes inflammation in the colon, it raises colon cancer risk for everyone who has it. That risk increases the longer someone has colitis. As a part of routine care, people who have had colitis for eight years or more may get a colonoscopy to screen for colon cancer every one to three years, depending on their individual level of inflammation.
In the general population, guidelines recommend colon cancer screening once every ten years starting at age 45. Follow up screenings sooner than ten years are based on whether you have any abnormalities.
Doctors use colonoscopies to check for abnormal growths (polyps) in the colon that can be cancerous or develop into cancer. People with colitis tend to develop a different kind of polyp than other people do, and these polyps are more likely to contain atypical or pre-cancerous cells.
"So those polyps are one step closer to developing into cancer, whereas a lot of the polyps we find in the general population are benign," Dr. Limketkai said.
Crohn's disease is a little bit different. Because this condition can affect any part of the GI tract, Crohn's disease only raises risk for colon cancer if the inflammation is in the colon, which varies from one person to the next.
"If it spares the colon, then we don't have to do all the surveillance that we do in colitis," Dr. Limketkai explained. "Of course, you may need to have colonoscopies for other reasons, and while you're doing that, you're getting a screening anyway."
When it comes to inflammatory bowel disease, the major risk factor for colon cancer is untreated disease. Treatment, which may include a combination of medication, dietary changes and routine endoscopies, keeps inflammation under control. Sticking to that treatment can help keep colon cancer risk to a minimum, too.
Colon Cancer Appearing More in Younger People
It’s great to see Chuck Lorre sharing his colonoscopy experience in part, so people can feel more comfortable with getting this procedure at a younger age.
Although the average age people are diagnosed with colon cancer is 68 for men and 72 for women, according to the American Cancer Society, the National Cancer Institute reports that since the 1990s, colorectal cancer cases have been rising among adults younger than 50.
Research published in CA: A Cancer Journal for Clinicians found the proportion of cases in people younger than 55 years old "increased from 11% in 1995 to 20% in 2019."
"We know rates are increasing in young people, but it's alarming to see how rapidly the whole patient population is shifting younger, despite shrinking numbers in the overall population," cancer epidemiologist and lead study author Rebecca Siegel said.
Researchers are still trying to determine why younger people are being diagnosed in greater numbers. Some experts point to risk factors which include obesity, physical inactivity, and smoking as a possible explanation for the increase.
"We don't know for sure why we are seeing earlier onset and death from colon cancer," Dr. Heather Yeo, a surgical oncologist who specializes in colorectal cancers at Weill Cornell Medicine, told SurvivorNet.
"It is likely a combination of factors, including diet and genetics as well as access to care and some environmental factors," Dr. Yeo added.
Questions to Ask Your Doctor
If you are facing a colon cancer diagnosis, here are some questions you may ask your doctor:
- What are my treatment options based on my diagnosis?
- If I'm worried about managing the costs of cancer care, who can help me?
- What support services are available to me? To my family?
- Could this treatment affect my sex life? If so, how and for how long?
- What are the risks and possible side effects of treatment?
Contributing: SurvivorNet Staff