HOW CAN I GET A COLON CANCER ANALYSIS?

¡Good question! Women are used to get mammography for breast cancer detection, and men get their PSA (prostate specific antigen) to check for prostate cancer. Unfortunately, many people don’t know that colon cancer is the second leading cause of death by cancer, but it is completely preventable.

Polyps are abnormal growths that can become cancerous as they increase in size. These polyps are easily removed by a colonoscopy when detected early. The analysis should begin to take place at the age of 40 for people at risk. Colonoscopies are generally performed as an ambulatory outpatient procedure (with sedation) and the results are seen immediately.

¿Gastroenterology procedures are painful?

Although most people understand the importance of analysis, postpone the completion of a procedureof this type because they fear it will be painful and / or uncomfortable. This "myth" is not true. During the procedure the patient is medicated so you can sleep comfortably throughout the process.

¿What are the symptoms of colon cancer?

While colorectal cancer often develops without symptoms, which is so fundamental analysis to verify the existence of disease, there may be some symptoms especially in advanced stages of the disease, including:

• Rectal bleeding
• Blood in stool (bright red)
• Change in bowel habits
• Stools narrower than usual
• General stomach discomfort (bloating, cramping and / or bloating)
• Diarrhea, constipation, or feeling that the bowel does not completely evacuated
• Frequent gas pains
• Weight loss for no apparent reason
• Constant tiredness
• Vomiting

¿What is it that causes the formation of polyps?

The exact causes of polyps are not known with certainty, but they seem to be more related to heredity or lifestyle. Genetic factors may determine a person's susceptibility to the disease, while dietary factors and lifestyle can determine what people actually risk going to form polyps (which later become cancer). Diets high in fat and low in fruits and vegetables may increase the risk of polyps. The lifestyle factors such as smoking, sedentary lifestyle and obesity may also increase the risk.

¿How can you prevent polyps from forming?

Few studies could demonstrate that lifestyle modification reduces the risk of colon polyps or cancer. However, lifestyle changes such as reducing dietary fat, increasing fiber, ensure adequate intake of vitamins and micro-nutrients, and exercise, can improve overall health. The studies showed that the proper amount of calcium as diet or supplements can reduce the risk of polyps.

¿Exactamente cuál es el pólipo “pre-canceroso”? Si se remueve el pólipo, ¿significa que estoy curado?

El término de pólipo "pre-canceroso" puede tener dos interpretaciones posibles. Una describe la evolución de la capa interna del colon, de células normales de colon a cáncer de colon. En esta evolución, el paciente primero desarrolla un pólipo, las células en el pólipo luego se convierten en atípicas o displásticas. Luego, el pólipo se degenera en cáncer prematuro, continuado al pólipo en sí, y finalmente hay un cáncer de colon invasivo. Algunas personas se refieren a todos los pólipos hasta el punto de cáncer como pólipos “pre-cancerosos”.

La otra interpretación se relaciona con la clasificación de pólipos y su potencial de malignidad. Hay dos categorías amplias de pólipos que se encuentran comúnmente durante el análisis de cáncer: pólipos adenomatosos y pólipos hiperplásticos. Los adenomatosos son el tipo asociado con mayor riesgo de cáncer de colon y a veces se denominan “pre-cancerosos”. Los tipos de pólipo en esta categoría incluyen adenomas, adenomas tubulares, adenomas dentados y pólipos adenomatosos. Los hiperplásticos, por otro lado, son otra categoría importante de pólipos no asociados con mayor riesgo de cáncer de colon.

Si se descubre un pólipo adenomatoso en una sigmoidoscopía, muchos médicos recomendarían una colonoscopía completa para analizar el resto del intestino. La remoción de un pólipo benigno evita que se desarrolle el cáncer en ese lugar, pero es probable que el paciente desarrolle pólipos en otros lugares. Se indica un seguimiento más minucioso para estos pacientes.

¿Los pólipos pueden "desprenderse" o cuidarse de sí mismos sin tener que eliminarlos?

Los pólipos tienen un índice de crecimiento lento y los estudios demuestran que los pólipos de hasta 10 mm poseen un tamaño bastante estable durante un intervalo de 3 años. Un verdadero pólipo nunca se “desprenderá” ni cuidará de sí mismo por sí solo.

¿Qué alimentos o dieta debería seguir para evitar el cáncer colorrectal? ¿Hay alimentos que realmente causen el cáncer colorrectal?

No hay alimentos que causen el cáncer colorrectal. Sin embargo, los estudios de diferentes poblaciones identificaron asociaciones que pueden afectar el riesgo de desarrollar cáncer colorrectal, o lesiones precancerosas llamadas pólipos. Parece haber un riesgo levemente mayor de desarrollar cáncer colorrectal en países con mayor ingesta de grasas no lácteas (asociadas con la carne) o carnes rojas. Por ejemplo, EE.UU. y Canadá tienen mayores índices de cáncer colorrectal que países como Japón o Nigeria y esto se relaciona con el consumo de grasas y carnes. De manera similar, ha habido una relación con los menores índices de cáncer colorrectal y mayor ingesta de fibras. Estudios recientes cuestionaron esta relación, pero en general recomendamos una dieta elevada en fibras vegetales y baja en grasas y un consumo de carnes rojas moderado a bajo. Finalmente, el calcio y el ácido fólico parecen tener efectos protectores en el colon. Quedan muchas preguntas sin responder en este área. No importa cual sea su ingesta dietaria, ¡no olvide preguntarle a su médico cual es la prueba de análisis apropiada para identificar pólipos y cáncer prematuro!

¿La semilla de lino o el té verde evitan el cáncer colorrectal?

Los vegetales crucíferos parecen brindar algo de protección contra el cáncer colorrectal. Hay mucha bibliografía actualmente que apunta al efecto del té verde y el cáncer colorrectal. Los catechins de té y polifenoles relacionados pueden tener efecto inhibidor en el cáncer de colon. El jugo de uva puede tener un efecto similar al té verde en líneas celulares de cáncer de colon humano. Los ensayos clínicos son necesarios para determinar la verdadera eficacia. Si su libro de bolsillo le permite adquirir té verde, probablemente no le hará daño consumir té verde.

¿La fibra juega un rol protector en el cáncer colorrectal?

La cuestión de si la fibra juega un rol protector contra el cáncer colorrectal se convirtió en un tema de controversia. Los primeros estudios sugirieron que la fibra es protectora realmente, mientras que los últimos estudios muy difundidos no encontraron efecto protector. Los estudios adicionales pendientes pueden resolver la controversia, una dieta elevada en fibras es lo recomendado por su valor nutritivo integral y porque promueve una buena función intestinal. Además, la fibra es también beneficiosa para personas con diabetes, insuficiencia cardíaca, hipertensión y una variedad de otras afecciones médicas.

¿La intolerancia a alimentos o lactosa aumenta el riesgo de cáncer de colon o recto?

No se conocen datos reales de que el consumo de productos con lactosa o que la intolerancia a la lactosa sean un factor de riesgo para el cáncer de colon. Sin embargo, existen muchos libros recientes, sugiriendo que la terapia probiótica es saludable, que la microflora del colon puede tener alteraciones por productos lácteos dietarios como por ejemplo retardo del riesgo de cáncer de colon.

¿Cuáles son los primeros síntomas de este tipo de cáncer?

El cáncer colorrectal puede asociarse con pérdida de peso inexplicable, cambios en hábitos intestinales con respecto a lo considerado normal para una persona, ya sea constipación o diarrea, anemia inexplicable (bajo conteo de glóbulos rojos), sangre visible en deposiciones, sangre oculta en deposiciones (verificada por medio del untado de deposiciones en una tarjeta llamada prueba de sangre oculta en heces), y dolores abdominales con o sin explicación. Es también importante recordar que el cáncer de colon puede no tener síntomas ni estar asociado a ninguno de estos. Por eso la detección temprana mediante un análisis es tan importante.

¿Es posible tener cáncer de colon o recto sin tener pólipos?

El cáncer colorrectal se puede producir sin pólipos, pero es muy poco común. Las personas que padecen enfermedades intestinales inflamatorias desde hace mucho tiempo, como colitis ulcerosa crónica o colitis de Crohn, tienen mayor riesgo de desarrollar cáncer colorrectal que se produce en ausencia de pólipos. Cuanto mayor es el grado de participación del colon por enfermedad inflamatoria de intestino y mayor es la duración de la enfermedad, mayor es el riesgo de cáncer colorrectal. Los cánceres colorrectales en personas con enfermedad inflamatoria del intestino crónica pueden parecer lesiones planas tipo placa, o incluso tal vez no se distinguen del tejido de color circundante. Las lesiones grandes masivas con márgenes distintivos observadas en la mayoría de los casos de cáncer colorrectal no son comunes en enfermedad inflamatoria del intestino.

El cáncer colorrectal asociado con enfermedad inflamatoria del intestino representa menos del 1 por ciento de todos los cánceres colorrectales diagnosticados en Estados Unidos cada año. También hay informes que sugieren que puede surgir pequeño cáncer de colon en tejido de colon plano lo cual es totalmente normal o contiene una pequeña área plana de tejido adenomatoso (precanceroso). Este tipo de cáncer colorrectal es una excepción a la regla y se considera un evento poco frecuente. La mayoría de los cánceres colorrectales surgen de pólipos adenomatosos (precancerosos) pre existentes.

¿Es posible tener sangre en deposiciones pero no tener cáncer de colon?

Yes, it is possible to have blood in your stool but not have colon cancer. Hemorrhoids, anal fissures or tears, infections of the colon (infectious diarrhea), inflammatory bowel disease (ulcerative colitis or Crohn's colitis), colonic diverticula and abnormal blood vessels (arteriovenous malformations or angiodysplasia) may all be associated with bleeding from the rectum or colon. Blood in the stool may also occur from lesions in the stomach and small intestine such as peptic ulcer disease, angiodysplasia and Crohn's disease of the small intestine. Rectal bleeding of any amount or blood in or on the stool is never normal and should not be ignored, as some causes of rectal bleeding and blood in the stool (colon cancer) are more serious than others. Speak with your gastroenterologist about any rectal bleeding and schedule a colonoscopy to get the bleeding properly checked out.

¿Cuál es la mejor prueba de análisis de cáncer de colon?

La colonoscopía es el único método que tiene alta sensibilidad para todos los pólipos, pequeños y grandes, que presenta la capacidad de removerlos en el momento del procedimiento. La colonoscopía virtual es una posibilidad para el análisis, pero no está aprobada aún. Si se aprobara la colonoscopía virtual existe una probabilidad de perder lesiones pequeñas o planas. Además, cualquier anormalidad vista exige un examen colonoscópico para verificar el hallazgo o para remover el pólipo. Otros procedimientos de análisis más nuevos incluyen la prueba de ADN anormal en heces y la combinación posible de una sigmoidoscopía y un enema de bario, que se sugiere actualmente si la colonoscopía no está disponible en general. Sin embargo para remover pólipos, solo existe un procedimiento útil actualmente, y es la colonoscopía.

¿Las pruebas de análisis colorrectal las realiza su médico de cabecera o deben ser realizadas por gastroenterólogos u otros expertos?

Existen varios tipos de prueba de análisis de cáncer colorrectal. Las pruebas de sangre oculta en heces son generalmente realizadas por su médico de cabecera para que usted se lleve a casa con instrucciones para la prueba y sobre cómo devolverlas al laboratorio para su desarrollo. La sigmoidoscopía flexible, que evalúa la última tercera parte del colon con un endoscopio, es realizada por algunos médicos de cabecera pero no por todos. Los médicos de cabecera que no realizan sigmoidoscopías flexibles en su consultorio en general derivan pacientes a un gastroenterólogo de otro especialista para el procedimiento. La colonoscopía es una evaluación endoscópica más extensiva de toda la longitud del colon y no es realizada por médicos de cabecera, sino por gastroenterólogos u otros especialistas. La colonoscopía es considerada por la American Cancer Society como procedimiento de alto nivel para analizar cáncer de colon y también por muchas organizaciones profesionales, y se recomienda ampliamente que su médico de cabecera lo derive a un gastroenterólogo o endoscopista con certificación académica para que realice esta prueba.

¿El síndrome de colon irritable es un factor de riesgo para el desarrollo de cáncer colorrectal?

El síndrome de colon irritable (IBS) es un problema funcional crónico en el intestino que se caracteriza generalmente por patrones de diarrea y heces flojas, alternadas con constipación. También puede asociarse con dolores y calambres abdominales. El IBS no está asociado con aumento de riesgo de desarrollar cáncer colorrectal. Los pacientes con IBS tienen expectativa de vida normal. Aunque los pacientes con IBS no tengan mayor riesgo de cáncer colorrectal, no están en menor riesgo tampoco, y deben seguir los lineamientos de análisis recomendados como cualquier otra persona. Si los síntomas de su IBS cambian con respecto a lo habitual o a su patrón regular, o si ve sangrado en sus heces, notifique a su médico o gastroenterólogo.

¿Las personas jóvenes pueden tener cáncer colorrectal? ¿Si no hay antecedentes familiares y si la persona tiene menos de 30 años, debería preocuparse por el riesgo de padecer cáncer colorrectal?

En general es muy poco común para las personas jóvenes padecer cáncer colorrectal. Sin embargo, existen dos síndromes hereditarios bien reconocidos en los cuales puede desarrollarse el cáncer el personas jóvenes. El primero es la poliposis adenomatosa familiar (FAP). Esta es una enfermedad en la cual existe una mutación de un gen supresor de tumor y las personas afectadas desarrollan cientos a miles de pólipos precancerosos en el colon. Salvo que se extirpe el colon, el 100 por ciento de estos pacientes padecerán de cáncer colorrectal, generalmente cerca de los 30 años. La enfermedad se hereda directamente de uno de los padres afectados (herencia dominante autosómica) lo que significa que cada hijo tiene un 50 por ciento o posibilidad de 1 en 2 de heredar el gen anormal. Si se hereda el gen, el hijo con el tiempo desarrollará pólipos. La edad promedio para desarrollo de pólipos en este síndrome es a mediados de la adolescencia, aunque a veces se descubren pólipos en los hijos de 8 o 10 años de edad.

Si se sabe que la familia tiene FAP, el padre afectado y los hijos en riesgo pueden someterse a análisis para ver la mutación del gen con una prueba genética. Los hijos de familias que se niegan o no pueden hacerse pruebas genéticas comienzan a realizarse sigmoidoscopías o colonoscopías a los 10 o 12 años de edad y cada 6 a 12 meses para verificar la presencia de pólipos. Cuando se empiezan a desarrollar pólipos numerosos se programa una cirugía. Lo bueno de esta enfermedad es que las opciones quirúrgicas son muy buenas y ahora el colon puede removerse con frecuencia por medio de una mini o laparoscopía. El intestino se coloca de vuelta directamente y no se necesita bolsa. Las personas mueven el intestino de manera normal.

El otro trastorno heredado reconocido es el cáncer colorrectal hereditario sin poliposis (HNPCC). En este síndrome el cáncer también se produce en forma temprana y se desarrolla a partir de pólipos. Pero aquí, no hay cientos de pólipos como en el FAP. La enfermedad se presenta a una mayor edad también. La recomendación común es la colonoscopía en hijos en riesgo de familias afectadas que se realice a los 25 y se repitan cada dos años. Las pruebas genéticas también pueden ser útiles. Por lo tanto, existen recomendaciones específicas para hijos en familias con altos índices de cáncer de colon. Pero debe conocerse el síndrome específico. Es muy importante para los hijos de familias como esta ser examinados por expertos con experiencia en estos síndromes y en instituciones donde haya disponibles servicios de pruebas y asesoramiento en genética.

Es posible, aunque poco frecuente, que se produzca cáncer de colon esporádico en personas jóvenes que no sean las afectadas por FAP o HNPCC.

Frequently Asked Questions

What causes a polyp to form?
How can you prevent polyps from forming?
Exactly what is a “pre-cancerous” polyp? If the polyp is removed, does that mean I am cured?
Can polyps “fall off” or take care of themselves without having them removed?
Can flax seed or green tea prevent colorectal cancer?
Does fiber play a protective role against colorectal cancer?
Does food intolerance or lactose intolerance increase your risk for colon or rectal cancer?
What are early symptoms of this type of cancer?
Is it possible to have colon or rectal cancer without having polyps?
Is it possible to have blood in your stool, but not have colon cancer?
Are intestinal obstructions an early symptom of colon cancer?
Is a palpable lump in the side a symptom of colon cancer? Or is it only found as a polyp inside and can not be felt?
What is the best colon cancer screening test?
What is a PET scan and can it be used for colon cancer detection instead of a colonoscopy?
Are colorectal screening tests done by your general practitioner or should they be done by gastroenterologists or other experts?
Is there a correlation between the length of your colon and colon cancer?
Is there a connection between stomach cancer and colorectal cancer?
Is Irritable Bowel Syndrome a risk factor for developing colorectal cancer?
Can young people get colorectal cancer? If there is no family history and if the person is under 30, should they be concerned about getting colorectal cancer?

What causes a polyp to form?

The exact causes of polyps are uncertain, but they appear to be caused by both inherited and lifestyle factors. Genetic factors may determine a person’s susceptibility to the disease, whereas dietary and other lifestyle factors may determine which individuals at risk actually go on to form polyps (and later cancers). Diets high in fat and low in fruits and vegetables may increase the risk of polyps. Lifestyle factors such as cigarette smoking, a sedentary lifestyle, and obesity may also increase the risk.

How can you prevent polyps from forming?

Few studies have been able to show that modifying lifestyle reduces the risk of colon polyps or cancer. However, lifestyle modifications such as reducing dietary fat, increasing fiber, ensuring adequate vitamin and micro-nutrient intake, and exercise, may improve general health. Studies have shown that getting adequate calcium in the form of diet or supplement can reduce the risk of polyps.

Exactly what is a “pre-cancerous” polyp? If the polyp is removed, does that mean I am cured?

The term “pre-cancerous” polyp can have two possible interpretations. One interpretation describes the evolution of the lining of the colon from normal colon cells to colon cancer. In this evolution, the patient first develops a polyp, the cells on the polyp then become atypical or dysplastic. Next, the polyp degenerates into an early cancer, still continued to the polyp itself, and finally there is an invasive colon cancer. Some people refer to all of the polyps up to the point of cancer as “pre-cancerous” polyps.

The other interpretation relates to classification of polyps and their malignant potential. There are two broad categories of polyps that are commonly found during cancer screening: adenomatous polyps and hyperplastic polyps. Adenomatous polyps are the type of polyps associated with an increased risk of colon cancer and are sometimes referred to as “pre-cancerous.” Types of polyps in this category include villous adenomas, tubulo-villous adenomas, tubular adenomas, serrated adenomas and adenomatous polyps. Hyperplastic polyps, on the other hand, are the other large category of polyps and are not associated with an increased risk of colon cancer.

If an adenomatous polyp is discovered on sigmoidoscopy, many physicians would recommend a full colonoscopy to examine the remainder of the bowel. Removal of a benign polyp does prevent a cancer from developing at that one location, but the patient is likely to develop polyps at other locations. Close follow up is indicated for these patients.

Can polyps “fall off” or take care of themselves without having them removed?

Polyps have a slow growth rate and studies show polyps that are 10 mm or less have a fairly stable size over a three-year interval. A true polyp will never “fall off” or take care of itself on its own.

5. What foods or what diet should I follow to prevent colorectal cancer from occurring? Are there any foods that actually cause colorectal cancer?

There are no foods that cause colorectal cancer. However, studies of different populations have identified associations that may affect your risk of developing colorectal cancer, or the precancerous lesions called polyps. There appears to be a slightly increased risk of developing colorectal cancer in countries with higher red meat or non-dairy (meat-associated) fat intake. For example, the U.S. and Canada have much higher rates of colorectal cancer than countries like Japan or Nigeria, and this correlates to meat and fat consumption.

Similarly, there has been an association with decreased rates of colorectal cancer and increased fiber intake. Recent studies have questioned this association, but in general we recommend a diet high in vegetable fiber and low in fat and moderate to low in red meat. Finally, calcium and folic acid appear to have protective effects in the colon. There remain many unanswered questions in this area. No matter what your dietary intake is, don’t forget to ask your doctor about the appropriate screening test to identify polyps and early cancers!

Can flax seed or green tea prevent colorectal cancer?

Cruciferous vegetables seem to covey some protection against colorectal cancer. There is an explosion of literature looking at the effect of green tea and colon cancer. Tea catechins and related polyphenols may have an inhibitor effect on colon cancer. Grape juice may have a similar inhibitory effect to green tea on human colon cancer cell lines. Clinical trials are needed to determine true efficacy. If your pocket book will permit purchase of green teas, there is probably little harm in consuming green teas.

Does fiber play a protective role against colorectal cancer?

The question of whether fiber plays a protective role against colorectal cancer has become quite controversial. Early studies suggested that fiber is indeed protective, whereas more recent and highly publicized studies find no protective effect. Pending additional studies that may resolve this controversy, a high fiber diet is recommended because of its overall nutritional value and because it promotes good bowel function. Furthermore, fiber is also beneficial for individuals with diabetes, heart disease, hypertension and a variety of other medical conditions.

Does food intolerance or lactose intolerance increase your risk for colon or rectal cancer?

There currently is not hard data that consumption of lactose products or that lactose intolerance is a risk factor for colorectal cancer. However, there is a huge amount of new literature, suggesting probiotic therapy is healthy, and that microflora of the colon may be altered by dietary dairy products such that the risk for colon cancer is retarded.

What are early symptoms of this type of cancer?

Colorectal cancer can be associated with unexplained weight loss, change in bowel habits from what is considered normal for a given individual – either constipation or diarrhea – unexplained anemia (low blood count), visible blood in the stool, hidden blood in the stool (which is checked by smearing stool on a special piece of card called fecal occult blood test), and unexplained or sustained abdominal pain. It is also important to remember that colon cancer may be silent and not associated with any symptoms. That is why early detection through screening is so important.

Is it possible to have colon or rectal cancer without having polyps?

Colorectal cancer can occur without polyps, but it is an uncommon event. Individuals with long-standing inflammatory bowel diseases, such as chronic ulcerative colitis and Crohn’s colitis, are at increased risk for developing colorectal cancer that occurs in the absence of polyps. The greater the extent of colonic involvement by inflammatory bowel disease and the greater the duration of the disease, the greater the risk of colorectal cancer. Colorectal cancers in individuals with chronic inflammatory bowel disease may appear as flat, plaque like lesions or may even be indistinguishable from the surrounding colon tissue. Large mass-like lesions with distinct margins seen with most colorectal cancers are uncommon in inflammatory bowel disease.

Colorectal cancer associated with inflammatory bowel disease accounts for less than 1 percent of all colorectal cancers diagnosed in the United States each year. There are also reports that suggest some tiny colon cancers may arise in flat colon tissue which is either entirely normal or contains a small flat area of adenomatous (precancerous) tissue. This type of colorectal cancer is the exception to the rule and is considered a rare event. The vast majority of colorectal cancers arise from pre-existing adenomatous (precancerous) polyps.

Is it possible to have blood in your stool, but not have colon cancer?

Yes, it is possible to have blood in your stool but not have colon cancer. Hemorrhoids, anal fissures or tears, infections of the colon (infectious diarrhea), inflammatory bowel disease (ulcerative colitis or Crohn’s colitis), colonic diverticula and abnormal blood vessels (arteriovenous malformations or angiodysplasia) may all be associated with bleeding from the rectum or colon. Blood in the stool may also occur from lesions in the stomach and small intestine such as peptic ulcer disease, angiodysplasia and Crohn’s disease of the small intestine. Rectal bleeding of any amount or blood in or on the stool is never normal and should not be ignored, as some causes of rectal bleeding and blood in the stool (colon cancer) are more serious than others. Speak with your gastroenterologist about any rectal bleeding and schedule a colonoscopy to get the bleeding properly checked out.

Are intestinal obstructions an early symptom of colon cancer?

Colonic obstruction is a late symptom of colon cancer. It occurs when the tumor has grown so large that it blocks the bowel. When it occurs, urgent surgery is required to relieve the blockage. Screening for colon cancer with colonoscopy can detect tumors long before they cause symptoms, let alone serious complications like obstruction.

Is a palpable lump in the side a symptom of colon cancer? Or is it only found as a polyp inside and can not be felt?

A palpable lump in the abdomen can be a symptom of colon cancer, but it could also be a symptom of other conditions. Your doctor would be able to examine you and give you a more personal opinion, ordering testing as appropriate to determine the cause of a lump. A polyp inside the colon can not be felt from the outside. Polyps are found by looking inside the colon with various procedures: a sigmoidoscopy (which only looks at a portion of the colon) or colonoscopy (which can look at the whole colon); a Virtual Colonoscopy is an x-ray technique as with a barium enema. Colonoscopy is considered the gold standard test for this condition.

What is the best colon cancer screening test?

Colonoscopy is the only method that has a high sensitivity for identifying lesions and all polyps (both small and large) and has the capability of removing them at the time of the procedure.

Use this guide to help you discuss screening options with your health care professional. Consider one of the following:

Tests that Find Pre-Cancer AND Cancer:

Colonoscopy	every 10 years
Flexible sigmoidoscopy	every 5 years
Virtual colonoscopy (CT colonography)	every 5 years
Double contrast barium enema	every 5 years

Tests that Mainly Find Cancer:

Fecal occult blood test (FOBT)	every year
Fecal immunochemical test (FIT)	every year
Stool DNA test (sDNA)	ask health care professional

All abnormal virtual colonoscopy and double contrast barium enema results as well as positive FOBT, FIT or sDNA tests should be followed up by a colonoscopy.

What is a PET scan and can it be used for colon cancer detection instead of a colonoscopy?

PET scanning is still at an early stage of development in the detection and staging of gastrointestinal tumors. At the present time it is not replacing colonoscopy for diagnosing colon cancer.

Are colorectal screening tests done by your general practitioner or should they be done by gastroenterologists or other experts?

There are several types of colorectal cancer screening tests.

1. Fecal occult blood tests are usually provided by your general practitioner for you to take home with instructions for the test and how to return them to the laboratory for development.

2. Flexible sigmoidoscopy, which evaluates the lower 1/3 of the colon with an endoscope, is performed by some but not all general practitioners. General practitioners who do not perform flexible sigmoidoscopies in their office typically refer patients to a gastroenterologist of other specialist for the procedure.

3. Colonoscopy and virtual colonoscopy are a more extensive endoscopic evaluation of the entire length of the colon and is usually not done by general practitioners; it is done by gastroenterologists or other gastrointestinal specialists. The colonoscopy is considered the gold standard procedure for colon cancer screening by the American Cancer Society and many more professional organizations, and it is highly recommended that your general practitioner refer you to a Board Certified gastroenterologist or endoscopist to have the test done.

Is there a correlation between the length of your colon and colon cancer?

There is no known correlation with the length of the colon and colon cancer. Cancer is at least as common in men as women, but women tend to have longer colons.

Is there a connection between stomach cancer and colorectal cancer?

There is no association between stomach (gastric) cancer and colorectal cancer, except in individuals with the hereditary non-polyposis colorectal cancer. This is a rare genetic syndrome in which affected individuals are at risk of colorectal cancer at a young age, as well as other cancers, including gastric cancer. Individuals with a strong family history ( three or more affected relatives spanning two generations with at least one affected relative under age 50) of colorectal cancer, or colorectal cancer and endometrial (uterus) cancer, may have this syndrome and may warrant genetic testing and/or screening with colonoscopy. Patients with familial polyposis also have an increased risk of gastric cancer. It should be kept in mind that many individuals may claim a personal or family history of “stomach cancer” when they mean colorectal cancer.

Is Irritable Bowel Syndrome a risk factor for developing colorectal cancer?

Irritable bowel syndrome (IBS) is a chronic functional problem of the gut usually characterized by patterns of diarrhea and loose stools alternating with constipation. It may also be associated with abdominal cramping and pain. IBS is not associated with an increased risk of developing colorectal cancer. Patients with IBS have normal life expectancies. Although patients with IBS are not at increased risk for colorectal cancer, they are not at decreased risk either, and should follow the recommended screening guidelines like everyone else in the population. If your IBS symptoms change from their usual behavior or regular pattern, or if you see blood in your stool, please notify your physician and gastroenterologist.

Can young people get colorectal cancer? If there is no family history and if the person is under 30, should they be concerned about getting colorectal cancer?

In general, it is very uncommon for young people to get colorectal cancer. However, there are two well recognized hereditary syndromes in which cancer can develop in young people. The first is Familial adenomatous polyposis (FAP). This is a disease in which there is a mutation of a tumor suppressor gene and affected people develop hundreds to thousands of precancerous polyps in the colon. Unless the colon is removed, 100 percent of these patients will get colorectal cancer, usually by the late 30′s. The disease is inherited directly from an affected parent (autosomal dominant inheritance), which means that each child has a 50 percent or 1 in 2 chance of inheriting the abnormal gene. If the gene is inherited, the child will eventually develop polyps. The average age for polyp development in this syndrome is the mid-teens, although children as young as eight or 10 have sometimes been found with polyps.

If a family is known to have FAP, the affected parent and at risk children may be screened for a gene mutation with a genetic test. Children from families who refuse or cannot have genetic tests start having sigmoidoscopies or colonoscopies at about 10 or 12 years old and every 6 to 12 months to look for the presence of polyps. Once numerous polyps start developing surgery is planned. The good news about this disease is that the surgical options are very good and now the colon can often be removed by a mini-or laparoscopic approach. The bowel is put directly back together and no bag is necessary. People move their bowels normally.

The other well recognized inherited disorder is hereditary non-polyposis colorectal cancer (HNPCC). In this syndrome cancers also occur early and develop from polyps. But here, there are not the hundreds of polyps seen in FAP. The disease presents at a later age, too. The standard recommendation is colonoscopy in at risk children of affected families beginning at age 25 and repeated every two years. Genetic testing may also be helpful here. So, there are specific recommendations for children in families with high rates of colorectal cancer. But the specific syndrome must be known. It is very important for kids from families like these to be seen by experts who have experience with these syndromes and in institutions where genetic counseling and testing services are available.

It is possible, although quite rare, for sporadic colon cancer to occur in young people outside of those affected by FAP or HNPCC.