Think About Your Colon This Month

Most of us probably try to avoid anything involving our colon. However, according to the National Cancer Institute, in 2021 there were an estimated 1,392,445 people living with colorectal cancer in the United States. Therefore, we need to think about it.

Maged Khalil, MD, Physician Lead of Gastrointestinal Medical Oncology and Associate Director of Oncology Research with Lehigh Valley Topper Cancer Institute, says distinguishing between ordinary health factors – such as constipation – and potential signs of colon cancer can be challenging. It’s because symptoms can overlap.

“Constipation itself is not a direct sign of colon cancer,” he says. “However, if it’s new, persistent or accompanied by other changes such as blood in the stool, unexplained weight loss, abdominal pain, fatigue or change in stool shape, it can be indicative of a growth in the colon.”

Colonoscopy, the standard screening test for colon cancer, is another topic we tend to avoid. But its value cannot be underestimated. Early-stage colon cancer may not present noticeable symptoms, so screening is the best way to find it. Also, if a polyp is found during the exam, it can be removed at the same time.

“A colonoscopy is recommended every 10 years starting at age 45 for average-risk individuals,” Dr. Khalil says, noting that the new recommendation starting at age 45 rather than 50 aligns with the American Cancer Society and the U.S. Preventive Services Task Force. And for those who cringe at the idea of colonoscopy prep, Dr. Khalil offers hope.

“There are new and improved options available for colonoscopy preparation that aim to make the process more comfortable,” he says. These options include low-volume preparations that require less fluid intake, making it easier for patients to tolerate, and split-dose regimens, where you take the bowel prep the night before, then a few hours before the procedure. This enhances comfort and effectiveness. 

Another development is the increasing use of stool-based tests for colon cancer. According to primary care physician Joseph Perez, MD, with LVPG Family Medicine–Bangor, they are recommended as an alternative way to screen. “If performed at the appropriate intervals, they can detect any issues as they arise,” he says. Dr. Perez believes it’s the conversation between clinicians and patients that’s most important.

“My medical assistants and I talk with every single patient we see,” he says. “We emphasize that maintaining a healthy diet and regular exercise can significantly reduce the risk of colon cancer. Conversely, consuming fried, processed and smoked foods can increase your risk. Additionally, Type 2 diabetes and obesity are also contributing risk factors.”

Dr. Perez says it’s important to discuss a patient’s family medical history. If you have a first-degree relative who had colon cancer, you should be screened more often than someone of average risk. Ethnicity matters as well since Black Americans have the highest incidence of colon cancer and the highest mortality. “In these cases, a stool-based test might not be the best choice,” he says.

He says when patients are open to talking about their history and the team lets them know there are options for screening, it becomes a case of shared decision-making. “We find when the decisions are shared, patients are more likely to follow through.” 

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As the landscape of colon cancer treatment evolves, the Cancer Institute is on top of developments in surgery, chemotherapy, radiation therapy and targeted therapies. Some of these include:

• Minimally invasive robotic-assisted surgeries that allow more precise resections of tumors. They improve outcomes, and reduce recovery times, hospital stays and postoperative pain.
• Stereotactic body radiotherapy (SBRT), which delivers high doses of radiation with precision, minimizing damage to surrounding healthy tissue.
• Tailored chemotherapy regimens based on the type of tumor; these can lead to more effective treatment with fewer side effects.
• Targeted therapy and immunotherapy, which have been shown to be effective in treating certain subsets of colorectal cancer.

Dr. Khalil points to the Cancer Institute’s membership in the Memorial Sloan Kettering Cancer Alliance and resources through Jefferson Health. “Ongoing clinical trials are crucial for exploring new treatment options and combinations, and they often provide patients access to leading-edge therapies,” he says.

In recognition of Colon Cancer Awareness Month in March, Dr. Khalil and Dr. Perez offer their thoughts about prevention. “The most important thing is early detection and regular screening,” Dr. Khalil says, acknowledging that while colonoscopy is the standard, there are other options.” As quoted by the American Cancer Society, “The best test is the one that gets done,” Dr. Perez adds.