By MohAMED S. ALSALAHI, MD

Dear Doc:
I have seen commercials on television stating that March is National Colorectal Health Awareness Month and that colon cancer is preventable. Is this what a colonoscopy is for and when should I get screened?

Dear Reader:
So, what is colorectal cancer? Colorectal cancer, “colo” meaning colon and “rectal” meaning rectum, is cancer of the colon and/or rectum. A cancer is an abnormal growth of cells that have the ability to invade or spread to other parts of the body. So, colorectal cancer is uncontrolled cell growth that is localized in the colon and/or rectum. Depending on where the cancer is localized, it can be referred to as colon cancer or rectal cancer; however, due to their commonalty, colon cancer and rectal cancer are often grouped together.

Colorectal cancer is the third most commonly diagnosed cancer in both men and women. The lifetime risk of developing colorectal cancer is 1 in 23 (4.4%) for women and 1 in 21 (4.7%) for men. The American cancer society (ACS) has estimated that in 2017, there will be 95,520 new cases of colon cancer and 39,910 new cases of rectal cancer.

In the United States, colorectal cancer is second leading cause of cancer-related deaths in men and the third leading cause in women. According to the ACS, in 2017 it is expected to cause an estimated 50,260 deaths in the United States. Due to its prevalence (how common it is), and mortality rate (how many people it kills), health organization such as the AGA (American Gastroenterology Association) and the ACS have recommended that people over the age of 50 be screened for colorectal cancer. Due to a lack of awareness in communities, 1 in 3 Americans are not screened for colorectal cancer, and as such, they are at risk for developing colorectal cancer. With cancers in general, it is important to understand that the earlier the cancer is detected the better your odds of surviving are. Fortunately for us, colon cancer is easily treatable if detected early.

How does a colonoscopy prevent colorectal cancer?
Well, in order to answer this question it is important to understand how colorectal cancer develops. Colorectal cancer often begins as a growth that develops at the mucosa of the rectum or colon called glandular polyps (adenomatous polyps). A polyp, in simple terms, is just an abnormal growth of tissue that protrudes from the lining of the large bowel to the lumen of the colon or rectum. Overtime, the cells of some of these polyps grow out of control and form into a precancerous polyp. A colonoscopy essentially removes these precancerous polyps and reduces your risk of developing colorectal cancer.

The gold standard procedure for screening colorectal cancer is the colonoscopy. This test employs a colonoscope, which is a flexible tube that has a tiny TV camera and a light at the end. Through fiber-optic technology, the colonoscope can view the inside of the large bowel and transmit images to a video screen. Not only does the colonoscope transmit images it also has the ability to remove polyps thus making it both a diagnostic and therapeutic modality.

The next question to address is what to expect during a colonoscopy?
The answer to that question is subjective; but, essentially 98 percent of patients reported that the procedure was virtually painless and that they did not have any recollection of the procedure. In other words, they do not remember the procedure. The reason for such is that patients are sedated and monitored throughout the entire procedure to ensure safety and efficacy.

Is colonoscopy the only modality to detect “pre-cancerous” polyps?
No, colonoscopy is not the only modality to diagnose polyps. There are other procedures that can be performed, other than a colonoscopy, to detect polyps. Unfortunately, these modalities do not remove polyps. If polyps are present, a colonoscopy must be performed. Therefore, colonoscopy provides both a diagnostic (seeing polyps) and therapeutic (removing polyps) effect. It is highly recommended that you just undergo a colonoscopy to save the extra visit to your doctor. However, if you feel uncomfortable with the colonoscopy procedure, then ask your doctor about the other modalities for detecting pre-cancerous polyps.

How can I reduce colon cancer risk factors?
Due to multiple risk factors, anyone can develop colorectal cancer; however, your chance of developing colorectal cancer significantly increases after you turn 50. As a result, it is highly recommended that colorectal screening should start at the age of 50. But, it is important to understand that some people are at higher risk to develop colorectal cancer. Some preventable colorectal cancer risk factors that might increase your chance of developing colorectal polyps and ultimately, colorectal cancer include:

• Diet that is high in red meat and processed meats
• Physical inactivity and obesity
• Smoking
• Heavy alcohol use
Some non-preventable colorectal cancer risk factors that increase risk your chance of developing colorectal polyps and ultimately, colorectal cancer include:
• Aging
• Personal History of colorectal polyps or colorectal cancer
• Inflammatory bowel disease (IBD), including either ulcerative colitis or Crohn’s disease
• A family history of colorectal cancer in a first-degree relative (parent, sibling, or child) are at increased risk
• Family history of inherited syndromes linked with colorectal cancers such as familial adenomatous polyposis (FAP) and Lynch syndrome (hereditary non-polyposis colorectal cancer, or HNPCC)

Overall, Colorectal Cancer is preventable, treatable, and beatable. However, in order to prevent the development of colorectal cancer it is important to get screened for colorectal cancer. Colonoscopy is the most thorough screening test to prevent and detect early stages of colorectal cancer; however, there are other modalities out there if you do not wish to undergo a colonoscopy. Just remember, screening is better than no screening.

Gastroenterologist, Dr. Alsalahi, is the Director of Gastroenterology and Endoscopy at Rochester Regional Health’s Newark-Wayne Community Hospital. He is ABIM board certified and sees patients in his office located in the doctor’s office building at Newark-Wayne Community Hospital in Newark, New York.