Colorectal Cancer
Colorectal cancer includes cancers of the colon, rectum, appendix, and some anal cancers. Colorectal cancer is the number two cancer killer in the United States. The American Cancer Society estimates that, in the United States, 153,760 men and women will be diagnosed with colorectal cancer this year and that 52,180 people are expected to die from the disease this year.

Early detection
Despite its high incidence, colorectal cancer is one of the most detectable and, if found early enough, most treatable forms of cancer. Over 90% of those diagnosed while the cancer is still localized survive more than five years. Currently, however, only 37% of colorectal cancers are detected while still localized.

Don't wait for symptoms
The most common symptom of colorectal cancer is no symptom. Colorectal cancer can be present in people without symptoms, known family history, or predisposing conditions, such as inflammatory bowel disease. Regular screening will help identify pre-cancerous polyps and colorectal cancers earlier.

Screening makes a difference
The Harvard Center for Cancer Prevention recently reported that regular screening, combined with a healthy lifestyle, can prevent over half of all colon cancer deaths in the United States. Primary prevention through polypectomy, or the removal of polyps, substantially reduces the risk of developing colorectal cancer.

How screening saves lives
Screening for colorectal cancer works in two ways: first, by finding cancers early when treatment is most effective; second, by finding growths (polyps) inside the colon and removing them before they become cancer; and second, by finding cancers early when treatment is most effective.

Why remove polyps if they are benign?
Colon polyps are important, since some may turn into colon cancer over time. While not every colon polyp turns to cancer, it is felt that almost every colon cancer begins as a small non-cancerous polyp. Fortunately, during colonoscopy these polyps can be identified and removed or destroyed--thus preventing a possible colon cancer. If a polyp is large enough, tissue can be retrieved and sent for biopsy to determine the exact type of polyp.

What are the types of colon polyps?
There are 4 types of polyps that commonly occur within the colon:

Inflammatory - Most often found in patients with ulcerative colitis or Crohn's disease. Often called "pseudopolyps" (false polyps), they are not true polyps, but just a reaction to chronic inflammation of the colon wall. They are not the type that turns to cancer. They are usually biopsied to verify type.

Hyperplastic - A common type of polyp which is usually very small and often found in the rectum. They are considered to be low risk for cancer.

Tubular adenoma or adenomatous polyp - This is the most common type of polyp and the one referred to most often when a doctor speaks of colon polyps. About 70% of polyps removed are of this type. Adenomas carry a definite cancer risk which rises as the polyp grows larger. Adenomatous polyps usually cause no symptoms, but if detected early they can be removed during colonoscopy before any cancer cells form. The good news is that polyps grow slowly and may take years to turn into cancer. Patients with a history of adenomatous polyps must be periodically reexamined.

Villous adenoma or tubulovillous adenomas - About 15% of polyps removed are of this type. These are the most serious type of polyp with a very high cancer risk as they grow larger. Often these are sessile and not on a stem making removal more difficult. Smaller ones can be removed in piecemeal fashion--sometimes over several colonoscopies. Larger sessile villous adenomas may require surgery for complete removal. Follow up depends on size and completeness of removal.

What is Colorectal Cancer Screening
Experts are not in total agreement on which screening tests should be used or how often adults without known risk factors for colorectal cancer should be tested. However, all professional guidelines emphasize the importance of a regular screening program that includes annual fecal occult blood tests (FOBT), periodic partial or full colon exams, or both. Leaders in the field have estimated that, with widespread adoption of these screening practices, as many as 30,000 lives could be saved each year. That's over 50 percent of the colorectal cancer deaths expected this year.

Screening tools currently approved:

• Fecal Occult Blood Test (FOBT): Once a year, for three days in a row, the man or woman checks his or her own stool for hidden (occult) blood with a special kit from a pharmacy or provided by a physician. A positive stool test must be followed up by a colonoscopy. FOBT alone is considered an inferior screening method and, if at all possible, patients should combine it with flexible sigmoidoscopy or should opt for one of the screening options that will examine the entire large intestine.
• Flexible-Sigmoidoscopy: Using a slender, flexible, lighted tube, the physician looks inside the rectum and the lower portion of the colon. If polyps or suspicious lesions are found, the test must be followed up by a full colon exam by colonoscopy. A DCBE may be substituted only if it is not possible to have a colonoscopy in a timely fashion.
• Double Contrast Barium Enema: After the person being examined has been given an enema containing a white dye called barium, the doctor (a radiologist) takes x-rays of the colon. A positive test is followed up with a colonoscopy.
• Colonoscopy: Using a slender, flexible, lighted instrument called a colonoscope, a doctor (a gastroenterologist) looks at the inside walls of the full length of the colon. If abnormalities are found, they can be removed or biopsied during the same procedure.

Additional screening tools currently being used:

• DNA-based Stool Test: This test examines DNA taken from a stool sample, looking for genetic defects that could indicate the presence of pre-cancerous polyps or colorectal cancer. This test is obtained from a physician, and the sample collection can be done in the privacy of your home with no advance preparation or dietary restrictions. The test is non-invasive, painless and easy to administer. It involves placing a container over the toilet to collect the bowel movement and sending the sealed container to a medical lab for analysis. If something abnormal is detected, a traditional colonoscopy is usually required for further examination. Final studies are being completed to determine the test's accuracy; early results indicate the test is likely to be highly accurate.
  
• Virtual Colonoscopy: Sometimes called a computed tomography colography, this is a non-invasive procedure, meaning the screening is done completely outside the body. A virtual colonoscopy requires the same advance preparation as a standard colonoscopy. During the virtual colonoscopy procedure, the physician inserts a small tube into the rectum to fill the colon with air. Then, instead of inserting a colonoscope into the rectum and through the colon like in a traditional colonoscopy, the physician uses MRI or CT scan technology to examine the colon from outside the body. The physician then carefully analyzes these images. If an abnormality is found, a traditional colonoscopy is required for further examination. This less invasive method of screening for colon cancer could become more common, if results from a newly published clinical trial are proven by further research. Doctors from the National Naval Medical Center report in the New England Journal of Medicine (Vol. 349, No. 23: 2191-2200) that virtual colonoscopy using computed tomography (CT) scans was just as effective as traditional optical colonoscopy at finding precancerous polyps in people at average risk of colon cancer.

Most people don't screen
Unfortunately, screening rates are low. In a recent survey of Americans over 50 conducted by the Centers for Disease Control (CDC), only 40% reported that they had ever had an FOBT (the take-home stool card test) and only 42% reported that they had ever had a flexible sigmoidoscopy. This compares to 85% of women who were screened for breast cancer.

If screening works, why aren't more people doing it?
Screening compliance rates are influenced by many factors, not least of which are:

• lack of public awareness about colorectal cancer and of the benefits of regular screening
• inconsistent promotion of screening by medical care providers
• uncertainty among insurance providers and consumers about insurance benefits and limitations on covered benefits
• characteristics of the screening procedures (e.g., imperfect tests, negative attitudes towards the screening procedures)
• absence of social support for openly discussing and doing something about "the disease down there"

The Colon Cancer Alliance brings the voice of survivors to battle colorectal cancer through patient support, education, research, and advocacy. In order to achieve these goals, the Colon Cancer Alliance hereby declares war on colorectal cancer. We invite any and all organizations, government agencies, members of the medical community, and individuals to join us in our determination to eradicate colorectal cancer.

For more information, please contact Amy Kelly, Co-Founder and Vice President, at akelly@ccalliance.org or (954) 341-0212.