By Chris Ayeko, FNP
Colorectal cancer is the third most common type of cancer in the world. Despite this, about one in three U.S. adults 45 and older remains unscreened. Because colorectal cancer is so common, understanding what it is, what the risk factors are, and when to start screening can help you stay healthy as you age.
What is colorectal cancer?
Colorectal cancer is cancer of the colon or rectum and often occurs when abnormal growths called polyps turn cancerous. Colorectal cancer is typically a slow-growing cancer, but it can metastasize, or spread, to surrounding organs and bones such as the ovaries, prostate, or hip bone.
You need to speak to your primary care provider if you have symptoms such as continual constipation, a change in bowel habits, ongoing abdominal aches or cramps, blood in the stool, or unexpected (or unexplainable) weight loss. Some of these symptoms can come from less severe health problems such as hemorrhoids, so it’s important to speak to your provider. They can diagnose what’s happening and either provide peace of mind or the medical treatment you need.
Are you at a higher risk for colorectal cancer?
Because colorectal cancer is a possibility for all adults as they age, it is important to start screening regardless of other risk factors when you reach the age of 45. However, if you have certain risk factors, you should talk to your provider about getting screened before you turn 45.
Risk factors can come from a variety of sources, both inside and outside of your control. You are at elevated risk for colorectal cancer if you are male, older than 45, have a family history or related health issues such as diabetes or obesity, or are African American or Native American. Frustratingly, you cannot change these risks. However, you are also at higher risk if you use tobacco or alcohol or eat a low-fiber diet, and these are lifestyle choices you can control.
What does screening look like?
When the time comes to get screened, you have three options. The first option is a colonoscopy. A colonoscopy is the gold standard as far as colorectal screenings. It involves emptying the bowels the night before and then being sedated while a doctor uses a flexible scope through the rectum to identify any polyps or lesions. If a colonoscopy comes back normal, then you don’t need to do another screening for 10 years.
The next best option is Cologuard, which is a non-invasive stool test. It involves capturing an entire stool sample, start to finish, for DNA testing to identify genetic markers that put the patient at heightened risk for colon cancer. With a clear result, this test is required once every three years.
The third option is a fecal immunochemical test (FIT), which is another type of stool test. FIT can detect even microscopic amounts of human blood from the lower intestines, indicating the possibility of cancer. Unfortunately, this test runs the risk of false positives and negatives, but with a clear result, it is required once a year.
When the time comes to start getting screened, talk to your primary care provider about what screening would work best for you.
Why does screening matter?
As with many other kinds of cancer, it is much easier to prevent colorectal cancer than it is to treat it. If warning signs are caught early enough, treatment can be minor, as simple as removing a problematic polyp. If cancer isn’t detected until after it has progressed, the eventual treatment can be much more invasive, requiring a larger surgery that removes part of the colon or rectum, chemotherapy or radiation treatment, and even the need for an ostomy bag.
Colorectal cancer and the screenings needed to avoid it can be a subject that people don’t want to discuss or even think about. This has been especially true during COVID, with people avoiding screenings and elective operations. With the risk of COVID waning, it is time to schedule routine screenings again. They are crucial to avoiding any number of cancers, including colorectal cancer. Waiting isn’t worth the risk. Talk to your primary care provider to find out what screenings you should consider.
Chris Ayeko is a family nurse practitioner at MCHC Health Centers, a community-based and patient-centered organization that serves Mendocino and Lake Counties, providing comprehensive primary healthcare services as well as supportive services such as education and translation that promote access to healthcare. Learn more at mchcinc.org.