Testing for Bowel Cancer
- Valerie Thompson After losing a bit of weight and feeling tired,
- Bowel cancer is a general term for cancer that begins in the large bowel, but generally we use the term colorectal cancer in the United States. Possible symptoms to look out for can include a change in bowel habits, a feeling that you need to have a bowel movement that’s not relieved by having one, rectal bleeding, blood in the stool, cramping or belly pain, weakness and fatigue and unintended weight loss.
- The test that Thompson took, a FIT (fecal immunochemical test), only test for blood in the stool. In the United States, we also have the option of taking a Cologuard test for at-home testing which tests for blood in the stool as well as DNA markers for colon cancer and precancerous polyps. But our experts say that these tests should not replace your recommended colonoscopies because they aren’t as effective.
Thompson, an English woman who receives a pension, had just gotten back from a trip to Australia when she started to feel a bit off. But before she left, Thompson had taken an at-home cancer screening test. When the results arrived, she was beyond shocked.Read More
After her at-home results came back, Thompson underwent a colonoscopy before officially receiving her diagnosis. She then had chemotherapy and is doing well today, but, sadly, her husband’s cancer was not caught so early.
“If I had ignored the test, the bowel cancer may not have been picked up early and I may not be here today,” she said. “Sadly my husband was also diagnosed with bowel cancer at a later stage and he lost his life to the condition. It’s so important to act fast. The tests can be life saving.”
The at-home test was sent to Thompson as a part of the “NHS Bowel Cancer Screening Programme” where people from age 60 to 74 who are registered with a doctor in England and live in the country are automatically sent a bowel cancer screening kit every 2 years. The website also states that the program “includes 56 year olds” and can include people over 75 if you ask for a kit every two years by phoning the free bowel cancer screening helpline.
What Is Bowel Cancer?
Bowel cancer is a general term for cancer that begins in the large bowel, but generally we use the term colorectal cancer – or colon cancer or rectal cancer depending on the location of the cancer – in the United States.
Bowel cancer, like all cancers, presents its own unique challenges for patients on the road to recovery. But Dr. Heather Yeo, a surgical oncologist and colorectal surgeon at New York Presbyterian Weill Cornell Medical Center, wants to remind people how far the treatment of this disease has come.
“One of the most exciting things about my job is that we’ve made a lot of progress on treatment options,” Dr. Yeo says in a previous interview with SurvivorNet. “However, patients are still — while they’re living longer, they are still living with colon cancer, and so I think it’s really important that we talk about how some of the things in your life affect you.”
Colorectal (bowel) cancer might not immediately cause symptoms, but these are possible symptoms to look out for:
- A change in bowel habits, such as diarrhea, constipation or narrowing of the stool that lasts for more than a few days
- A feeling that you need to have a bowel movement that’s not relieved by having one
- Rectal bleeding with bright red blood
- Blood in the stool, which might make the stool look dark brown or black
- Cramping or abdominal (belly) pain
- Weakness and fatigue
- Unintended weight loss
It is important to note, however, that displaying some of these symptoms does not mean you have colorectal cancer. You could also have colon cancer and not display any of these symptoms. Regardless, it is important to bring up any symptoms to your doctor should they arise.
Dr. Yeo also reminds people of the importance of colorectal screenings such as colonoscopies because most colorectal cancers can be prevented early with screening.
“In the United States, on a national level, colorectal cancer has been decreasing for the last 20 years,” Dr. Yeo says. “And much of that is thought to be directly due to screening for colon cancer.”
Even still, colorectal cancer cases are rising among younger people. And in the United States alone, rates have increased every year from 2011 to 2016 by 2 percent among people younger than 50. Because of this increase, the United States Preventive Services Task Force has recently updated its colorectal cancer screening recommendations to begin at age 45 instead of 50.
“We know that colon cancers can be prevented when polyps are found early,” Dr. Yeo said. “Lowering the screening age helps somewhat with this. But access to care is a real problem.”
And increasing access is crucial to making sure that we don’t see racial disparities within the world of colorectal cancer. Whites and Asians are significantly more likely to be up to date with their colonoscopies than African Americans, Latinos and Native Americans.
Research suggests that tailoring colon cancer screenings to each person’s individual risk may be beneficial. If you are not yet 45 but have concerns about your risk, talk to your doctor. Ask about your individual risk based on your lifestyle and family history and find out when screenings would be right for you.
At-Home Tests for Bowel Cancer
Though we’ve discussed the importance of colorectal (bowel) cancer screening, we should also discuss that not all screening methods are created equal. With the at-home bowel cancer screening kit that Thompson received, for example, it should be noted that these tests aren’t as effective as a full colonoscopy when it comes to catching pre-cancerous polyps.
But first let’s look into what kind of test Thompson took. Hers was a stool test called a FIT (fecal immunochemical test). These types of tests only test for occult (hidden) blood in the stool using antibodies. The reason they test for blood is because blood vessels in larger colorectal polyps or cancers are often fragile and easily damaged by the passage of stool which can cause them to bleed.
Cedars-Sinai Medical Center says the FIT tests are about 79 percent accurate at detecting colon cancer. Another option for people looking into at-home tests is Cologuard. This option is a bit pricier, but, according to Cedars-Sinai, it is about 92% accurate at detecting colorectal cancer. A pricier option than FIT, Cologuard is about 92 percent accurate at detecting colorectal cancer because this test also looks for DNA markers of colon cancer and precancerous polyps in addition to blood in the stool.
But even still, our experts still say that full colonoscopies, not at-home screening tests, are still considered the gold standard of colon cancer screening.
“Cologuard is really good at picking up more advanced cancers,” Dr. Yeo said. “But unlike a colonoscopy, they can’t pick up the pre-cancerous lesions called polyps that we need to take out to prevent cancer.”
But why is a traditional colonoscopy more effective, you may ask? For starters a colonoscopy means that a flexible tube with a camera on it (a colonoscope) is inserted into the anus (patients are usually “put under” with anesthesia or given relaxing sedatives to minimize the discomfort). This procedure also requires a full bowel “cleanout” which allows doctors to effectively spot cancer, polyps or anything abnormal.
And according to a 2014 study in the New England Journal of Medicine, the Cologaurd test misses more than 30 percent of polyps that will soon become cancer and 57 percent of polyps that may become cancer. This is a huge issue of concern because when polyps are found during a colonoscopy, doctors can potentially stop the cancer from growing before it even begins.
“We really need colonoscopy to pick up the pre-cursor to cancer, which are polyps,” Dr. Yeo said. “By taking the polyps out, you can actually prevent cancers.”