Screening For Colon Cancer
- Christine Jarzabek, a 33-year-old mom of two from Ontario, Canada, is urging others to seek answers when something feels off, as she was dubbed a hypochondriac before her colon cancer diagnosis.
- Colon cancers start out as a polyp, or small growth, in the colon that causes no symptoms. Although polyps can’t be felt, they can be picked up by screening tests before they cause a problem. It takes up to 10 years for a colon polyp to become a full-blown cancer, which gives doctors time to remove the polyp before it causes a problem.
- The U.S. Preventive Services Task Force recommends state colon cancer screenings should begin at 45-years-old. This is in response to a rise in colon cancer diagnoses in younger adults. In the past, the disease had predominantly been found in adults 50-years or older, but for those predisposed to get it at a younger age, these new guidelines could potentially help catch it at an earlier stage.
- The best and most complete way of screening is a colonoscopy every 10 years. In general, you should get your first colonoscopy at age 45 but the guidelines differ depending on your risk category.
Jarzabek’s only symptom was blood in her stool, which she “didn’t think anything of it” over the course of a year as it would be sporadic, she told Newsweek in a recent interview, explaining, “It is so hard to be taken seriously. I was labeled as a hypochondriac by medics when I voiced my concerns.”
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Jarzabek is sharing her story in hopes to encourage others to pay attention to symptoms and seek medical advice when something feels off.
“If you think something is wrong, then don’t give up and keep on fighting for answers,” she warned.
Expert Resources for Colon Cancer Screening
- Everything You Need to Know About Colorectal Cancer Screenings
- All Americans Should Begin Colorectal Cancer Screening at Age 45, According to New Guidelines; Previous Age Was 50
- Can Sitting The Wrong Way While You Poop Increase Your Risk Of Bowel Or Colon Cancer? Assessing The Risks Of Sitting Vs Squatting
- Colon Cancer Screening Options And Genetics: Myth Busting With Dr. Heather Yeo
- ‘You Shouldn’t Die From Embarrassment’: Colon Cancer Can Be Prevented
- Management of Metastatic Colon Cancer
- A Coffee Enema Will Not Prevent Colon Cancer
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Referring to how younger people are getting diagnosed with colon cancer, Jarzabek said, “We shouldn’t be following statistics from decades ago. This world has done nothing but poison us with chemicals … in our food, products, plastics.
“We are discovering a lot now, and it is affecting us. Why are we shocked that the rates are skyrocketing? The recommendation for a colonoscopy needs to lower. I am lucky because I trusted my gut and continued to request it.”
Jarzabek also wrote in a recent video post, recapping her cancer journey, “Long story short I literally just kept seeing videos of how much colorectal cancer rates have increased in people in their 30’s, as well as hearing a friend’s story about losing her friend (our age) to colorectal cancer and leaving her children behind, I just thought of my own kids, and with a touch of anxiety, I decided I wanted to get myself checked!
“Because of my age, I was initially denied. I insisted and was eventually given one ONLY to see if previously discussed issues were ‘probably hemorrhoids’ and found literal cancer instead. So ya, actually being right in this kind of way is super weird and has a lot of emotions; In the end, I’m just happy it was found earlier rather than later.”
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She concluded, “Also, everyone in Oncology commending me for pushing to be seen and catching it this early has been so nice and validating.”
Speaking to Newsweek about how she pushed for answers, Jarzabek said, “I didn’t want to live off ‘probably fine.’ Eventually, I was given a colonoscopy to remove the hemorrhoids.'”
It wasn’t util after her doctors did the colonoscopy that a lump was found and several biopsies were taken.
Additionally, Jarzabek noted how she considered herself “active, healthy and fit with no other symptoms” that raised concerns. She admits to feeling “lucky” as early detection has saved her life.
Colon Cancer in Younger Adults
The average age people are diagnosed with colon cancer is 68 for men and 72 for women, according to the American Cancer Society — but the rate at which younger adults are diagnosed has been on the rise. The U.S. Preventive Services Task Force recommends that adults aged 45 to 75 be screened for colorectal cancer.
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 that the proportion of cases in people younger than 55 “increased from 11% in 1995 to 20% in 2019.”
Researchers are still trying to determine why younger people are being diagnosed in more significant 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.”
Understanding Colon Cancer
Colon or colorectal cancer affects your large intestine (colon) or the end of your intestine (rectum).
The cancer starts when abnormal lumps called polyps grow in the colon or rectum. If you don’t have these polyps removed, they can sometimes change into cancer. It takes up to 10 years for a colon polyp to become full-blown cancer, according to SurvivorNet experts.
Looking for Polyps During Colonoscopy
Most colon cancers can be prevented by regular screening. The screening usually involves a colonoscopy, in which a long, thin tube attached to a camera examines the colon and rectum. If no polyps are discovered, the next screening will not be needed for about 10 years.
“We know that colon cancers can be prevented when polyps are found early,” Dr. Yeo explained. “Lowering the screening age helps somewhat with this, but access to care is a real problem.”
What are Colon Polyps?
A colon polyp is a small group of cells that forms on the colon’s lining.
When you have a colonoscopy, the gastroenterologist looks for polyps inside your intestine. Although polyps can’t be felt, they can be picked up by screening tests before they become cancerous.
Almost all polyps that are removed are precancerous, meaning that they have not yet progressed to cancer.
WATCH: Helping You Understand Colorectal Cancer
A Colonoscopy Explained
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,” 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, the gastroenterologist performing the procedure can have a clear look to evaluate if any polyps or masses are present. Depending on the size and number of polyps found, it may be 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, previously explained the colonoscopy procedure to SurvivorNet.
“When we see a polyp, we actually physically take the polyp out through the colonoscope,” he explained. “What does that mean? That means we basically put a wire through with a little bit of a flange at the end, and we pull the polyp out. Now, note there is no pain with that. Inside the colon, there are no pain fibers. So there’s no pain,” 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.
What Increases Your Risk for Colon Cancer?
For some people, certain factors can increase their risk of getting colon cancer.
They include the following:
- Age. About 90% of cases are in people aged 50 or older, according to the U.S. Centers for Disease Control & Prevention (CDC). Yet it is possible to get this cancer earlier in life.
- Inflammatory bowel disease. Crohn’s disease or ulcerative colitis can, over time, cause cells in your intestines to turn cancerous.
- A family history of this cancer. Just under one-third of people who get colon cancer have family members with the disease.
- A genetic mutation. About 5% of colorectal cancers are caused by an inherited genetic mutation that causes syndromes such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (Lynch syndrome).
- Lack of exercise. Staying active can lower your risk.
- A diet that’s high in meat. Regularly eating red meats like burgers and steaks, and processed meats such as hot dogs and bacon might put you at higher risk. Eating more fruits, vegetables, and whole grains instead might lower your risk.
- Being overweight or obese. Having too much weight increases your risk of both getting colon cancer and dying from it.
- Alcohol use. Limiting alcohol to one drink daily for women and two drinks daily for men could help lower your risk.
- Tobacco use. Long-term smokers are more likely to get this cancer than nonsmokers.
Which Treatments are Best for You?
It’s important to understand that your doctor has many ways to treat colon cancer, depending on what stage the cancer is, including:
- Surgery
- Radiation therapy
- Chemotherapy
- Targeted therapy
- Immunotherapy
Surgery
Surgery is the main treatment for most early-stage colon cancers, according to the doctors SurvivorNet spoke with. The surgeon will remove the part of the colon or rectum where there is cancer, along with a small area of healthy tissue around it. Taking out as much of the cancer as possible is important for improving your outcome.
The surgery may be performed through small incisions (laparoscopy), or through a larger incision. Some people may need to wear a special bag (ostomy) to collect wastes after surgery.
Radiation Therapy
This treatment aims high-energy x-rays at the cancer to destroy the abnormal cells. The radiation can come from a machine outside your body, or be placed directly inside your body. Sometimes people get radiation before surgery, to shrink the tumor and make it easier for the surgeon to remove. This is called neoadjuvant radiation.
Chemotherapy
This treatment uses strong medicine to stop cancer cells from dividing, no matter where they are in your body. You may get a combination of chemotherapy drugs as your first treatment. Chemotherapy has been very well studied for colorectal cancer, and it is known to improve survival.
The most common therapy is a combination of chemo drugs called FOLFOX:
- FOL = leucovorin calcium (folinic acid)
- F = fluorouracil
- OX = oxaliplatin
Your doctor may add medications like irinotecan (FOLFIRI) or cetuximab, depending on how well your tumor shrinks with treatment and other specifics about your particular cancer. For FOLFOX, the medications are given through the vein and require regular doctor visits.
To determine exactly which chemotherapy regimen you get, your doctor will consider your age and how well you might tolerate the side effects of chemotherapy. Gene mutations (for example, BRAF and KRAS) and the location of the primary colon tumor also factor into the decision.
You can also get chemotherapy before colon cancer surgery, which is called neoadjuvant chemotherapy. Getting chemo first helps to shrink the tumor, which can make both the surgery and recovery easier, according to SurvivorNet’s experts. Chemo is also a treatment for cancer that returns after therapy.
Targeted Therapy
This treatment targets substances like proteins or genes that the cancer needs to grow. This makes targeted therapy more precise than chemotherapy, and less likely to damage healthy cells. One example of targeted therapy is bevacizumab (Avastin), which stops the growth of new blood vessels that feed tumors. Another group of targeted therapies are called epidermal growth factor receptor (EGFR) inhibitors, which block the cancer from growing.
Immunotherapy
This treatment makes your own immune system a more efficient cancer fighter. A group of drugs called checkpoint inhibitors, which includes pembrolizumab (Keytruda) and nivolumab (Opdivo), work by preventing cancer cells from hiding from your immune system. Checkpoint inhibitors may extend the amount of time before the cancer spreads.
Dr. Paul Oberstein, on which treatments doctors use to turn stage 4 colon cancer into a chronic but manageable disease
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?
Contributing: SurvivorNet Staff
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