This minor procedure saves lives, but only if you have it.
Bruce Raaka had recently retired as an endocrine and cancer researcher at the National Institutes of Health when he was diagnosed with colorectal cancer in 2012 at age 62. His symptoms, including bleeding, prompted a colonoscopy that he concedes should have been done years before.
The cancer had spread to his liver, requiring surgery to remove all but the left lobe. The liver, however, is unique among the body’s organs in its ability to regrow. Raaka survived his cancer and today serves this warning:
Get a colonoscopy if you are age 50 or over, at regular intervals as recommended by your doctor based on your medical history. Don’t put them off. Ever.
At age 48, Raaka had a colonoscopy that found nothing wrong. After changing jobs, however, he switched doctors about 10 years later and had not had a colonoscopy since. Even then, he didn’t have one, his doctor saying they would get to it “next time.”
“I don't know what would have happened if I had gotten a colonoscopy then,” he says with regret. “I was so disappointed when I was diagnosed (two years later). I am sure that it either would not have progressed to my liver or would not have gotten as far along. Maybe I would have had fewer complications with the cancer.”
His other regret: the doctor had asked Raaka for a fecal occult blood test, which screens for early colon cancer by identifying blood in the stool, in turn catching benign intestinal polyps before they become cancerous or very early cancer.
He didn’t do it. It’s a distasteful and undignified process that involves smearing small bits of fecal matter onto a card and mailing it to a lab, but the potential risk makes it seem a lot less repugnant in retrospect, Raaka concedes.
Regardless of your diagnosis and treatment plan, be careful when you look for information about colon cancer, Raaka also warns. A lot of readily available information is conservative, scary, and does not take newer, more effective treatments into account.
“You’re better off staying as positive as you can and, if you are comfortable with your oncologist, listen to him and do what he tells you to do. Your physician will also be conservative with you. They all have to be,” he adds. But at the same time, today’s doctors are practicing at the leading edge of current medical science.
Current guidelines call for colonoscopies at regular intervals once you reach age 50. Your medical history and a familial history of colorectal cancer will determine how close those intervals are. It could be every year, it could be every five years, it could be every 10. People with a family history of colon cancer may need screening earlier.
Recent studies are finding that colon cancer is dramatically increasing in younger people, and screening guidelines are likely to change. Meanwhile, doctors are urging younger people with symptoms to have a colonoscopy as soon as possible.
While there is no scientifically established relationship between colon cancer and diet, says Eric Liu, MD, it is “assumed” that certain kinds of foods, such as smoked, charred, or barbequed meats and the carcinogens they contain, play a role. Too much red meat and a low fiber diet also may affect your risk.
Preventive recommendations include baby aspirin and calcium, which have been shown to have a protective effect in the colon. “A healthy diet with a lot of fiber” is believed helpful as well, adds Liu, a surgical oncologist and chief medical advisor for The Healing Net Foundation.
“Exercise, not smoking, drinking lots of water, all those sorts of general things” that are healthy overall should help, says Liu.
But, “by far,” the most important preventive measure you can take is a colonoscopy. Colon cancer generally develops slowly, and doctors can remove potentially precancerous but benign polyps found on the wall of the colon during the procedure. Even if you have cancer, surgery can be far less consuming if the disease is caught early through colonoscopy, Liu says. He also urges a second opinion in all cases.
“Support is extremely important. No one should go through cancer alone. There are a lot of resources and many support groups. I also want to convey to patients that there is a lot of hope. There is a lot of research devoted to (colon cancer) that is improving treatment, diagnostic techniques, and a personalized approach to it.”
February 19, 2020
Christopher Nystuen, MD, MBA