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Featured Story Written by Breann Lujan-Halcon

Colorectal Cancer Awareness

General surgeons Dr. Graham and Dr. Ullrich answer questions about prevention, detection and symptoms of colorectal cancer.

In 2020, we experienced extreme delay and disruption to our everyday lives. While events big and small faced cancellation, so did less grand engagements, like routine doctor’s appointments and elective procedures.

A Jama Oncology study found that healthcare facilities saw a decline in routine cancer screenings due to COVID-19. Their findings cause concern for delayed detection and treatment of many cancers that went undiagnosed due to the pandemic. As the number of missed screenings continues to rebound, healthcare providers are urging patients to not delay their own care. 

According to the American Cancer Society, in 2021, there will be an estimated 104,270 new cases of colon cancer and over 45,000 cases of rectal cancer. With the exception of skin cancer, colorectal cancer is the third most common cancer detected in both men and women. Fortunately, screening and detection for colorectal cancer is very effective and a personal specialty for the general surgeons at Ivinson Medical Group.

Dr. Jack Ullrich and Dr. Pete Graham provide countless colorectal cancer screenings every month. In honor of colorectal cancer awareness month, the surgeon duo sat down to discuss the importance of the screenings and how they are preventing colorectal cancer from ever occurring.

What is colorectal cancer?

Dr. Graham: Colorectal cancer is a cancer in the colon or rectum. Almost all colorectal cancers start off as a polyp, but not all polyps will progress to a colorectal cancer. The good news is that polyps are very treatable.

If you catch it at the level of polyp, you can take it out during a colonoscopy and it is not an issue. Once it progresses to the level of cancer, almost always it requires surgery, potentially some chemotherapy and/​or some radiation depending on the location. Often we are successful with that but colon cancer is a life threatening illness. 

How is colorectal cancer screened for and detected?

Dr. Ullrich: There’s multiple ways to detect it, the gold standard is colonoscopy.

The reason it is the gold standard is because you can see the polyps, you’re laying direct eyes on them or a cancer if a cancer is present. If you go in and remove polyps before they ever have a chance to become a cancer, then you can prevent the cancer from happening to begin with.

What are other methods of screening?

Dr. Ullrich: There are some methods that look for microscopic blood in the stool and other tests look for DNA in the stool, stool testing. I think it’s a reasonable way to go if somebody just absolutely refuses to have a colonoscopy. If it’s positive then they can get a colonoscopy

The reason colonoscopy is the gold standard is because those other ways are indirect ways of looking for cancer. They have a higher false positive and false negative rate. I’ve done numerous colonoscopies on persons who have had a positive stool test and you go in and it’s a normal colonoscopy. A colonoscopy has a much higher detection rate of early lesions than these other tests.

Dr. Graham: If stool testing is positive, a stool test in no way treats the potential colon cancer and you would still need a colonoscopy anyways. The other part of it is, that the stool test are not going to pick up on smaller polyps. On a colonoscopy you can see those and just take them out. Only a small percentage of stool tests that are positive are actually colon cancer, but it does prompt a lot of people to get in and get a colonoscopy. 

When should a person get a colonoscopy?

Dr. Ullrich: We divide people into two categories, average risk people and higher risk people.

An average risk person has no known family history of colon or rectal cancer and they themselves have never had a colon polyp or a colon cancer. For an average risk person, it is recommended to get a colonoscopy starting at 50 and then every 10 years. Although, those recommendations are in the process of changing to 45 because there has been a skewing of incidence of onset colon cancer to younger age. It’s thought that a diet of high end processed foods and obesity rates in this country have skewed that rate a little bit lower.

For higher risk people, people with a known family history of colon or rectal cancer or if you have had a colorectal cancer or colon polyps yourself. If you have a family history, then you should start getting your colonoscopy screening at 40 years old or 10 years before when your relative was diagnosed, whichever is earlier. You will need to get them every 5 years.

If you don’t have a family history and during your colonoscopy we remove precancerous polyps, then we recommend you get a colonoscopy every 5 years. 

What are the symptoms of colorectal cancer?

Dr. Ullrich: Well the first thing for colon cancer, is often the symptoms do not occur until later. So really, colon cancer may not cause any symptoms at first and that is why it is important to look. Symptoms may include:

  • Blood in stool.
  • Abdominal pain/​Bloating.
  • Trouble evacuating stool.
  • Diarrhea or Constipation.
  • Unintended weight loss.

Dr. Graham: It is important to not ignore these symptoms because if you do have colon cancer, the earlier you find it, the easier it is to treat and the more likely that you will survive it.

If you catch a polyp before it ever becomes a cancer, it is very easy to treat, you just snare it out during the colonoscopy. It is not painful. You don’t feel it and you don’t have sensation like you do on the skin. If you catch it early, it is never an issue.

It is possible with early stages of colorectal cancer to not present with any symptoms and that is another reason for the screening. Not only to look for polyps that could become a colon cancer, but to look for a colon cancer that is asymptomatic.

What steps can I take to prevent colon cancer?

Dr. Ullrich: There is an association of red meat and colon cancer, so decreasing your amount of red meat. That isn’t to say you need to become a vegetarian but minimizing your intake of red meat and processed foods.

Other prevention factors include maintaining a healthy weight, regular exercise and limiting alcohol consumption.

Dr. Graham: There is some thought that changing our diet can be beneficial to prevention. Adding more fiber to your diet and less meat and potatoes. However, I think the best way is by getting your colonoscopy and making sure you do the prep correctly and as instructed. If you do a really good prep, it makes for a more effective, safer and faster colonoscopy.

How can I get my colonoscopy?

For someone coming to get their screening colonoscopy it is even easier now. They don’t have to come in for a clinic visit beforehand. Now, they can call in and say they are due for a screening colonoscopy, fill out some paperwork and have a phone consultation with a nurse. We meet them the morning of the procedure, we perform the procedure and they are done. It saves them a clinic appointment, it saves them from taking time off work and it saves them that added expense. 

There are some cancers that are difficult to detect but fortunately, colon cancer is one that we have a very good means to catch it early or catch it before it happens in the form of identifying and removing polyps. It’s a cancer that is very preventable when other cancers can be very difficult to detect. 

To learn more about our surgical clinic or to fill out a colonoscopy questionnaire, visit our website at ivin​son​hos​pi​tal​.org/​s​u​r​g​i​c​a​l​-​c​linic. If you are experiencing symptoms or have questions, call our team at (307) 7554540.

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