By Deborah Jeanne Sergeant
Physician Mohammad Fahad Ali, chief of gastroenterology and hepatology and director of endoscopy at Oswego Health, offered some background on colon cancer and the need for screening starting at age 45, for someone with an average risk, or sooner for those with family history.
Q: What are the symptoms someone might notice if he or she has colon cancer?
A: That’s what a lot of my patients ask me when they come in for screening. A vast majority of the cancers originate as polyps, growth in the lining of the colon. In the early stages and sometimes after that, colon cancer doesn’t produce any symptoms. That’s why there’s a need for regular screening. They could have mild symptoms. Typical symptoms are changes in bowl habits, blood in stool, fatigue, not having an appetite and unexplained weight loss. When they do exhibit, those are the symptoms we look for.
Q: If these symptoms are absent, is there still risk someone has colon cancer?
A: The likelihood is that there are no symptoms.
Q: At what age should someone begin screening with colonoscopy?
A: Age 45 for someone with an average risk. It used to be 50 years but there has been a shift in the cohort, there’s been an uptick in the incidence of colon cancer. That’s why the screening age has moved to 45.
Q: What are the factors that indicate higher risk?
A: Higher risk can mean various things. One thing we most commonly see is family history of colon cancer, like a first-degree relative diagnosed. Or if you had past polyps. They should be screened at either age 40 or 10 years before the earliest known case of colon cancer in your family. A brother or sister diagnosed at age 45, then start at age 35. Repeat every five years.
Q: How effective are at-home kits?
A: Right now, there are a lot of options available. Colonoscopy is the gold standard, as you can diagnose and treat at the same time. But there are other tests like stool kits like Cologuard and others. What they look for are signs of genetic material or microscopic amounts of blood in the stool not visible to the patient. This could suggest a growth. Anything the patient is able to do is an effective screening. But the stool-based test or blood tests are available commercially are two-step tests in that if they come back positive, they’ll need a colonoscopy.
Cologuard is a kit you can do at home. It is self-sufficient with a container and instructions and a return label to send it back to the company that reads it. It’s easy to do. They can do it at home. The sample goes through analysis at a lab.
Q: How about CT scanning, also known as virtual colonoscopy?
A: The patient will still have to take a bowel prep to clean out the colon. The CT reconstructs 2D and 3D of the lumen of the colon. It’s a virtual view, using a 2-inch probe. You don’t have to have anesthesia and it can substitute for the screening purpose. But I see less and less of it as people have concerns for low grade radiation. It’s a concern for patients with renal insufficiency. Most say as long as I have to do a bowel prep, I might as well do the ‘real thing.’ You may have extra colonic findings like in the kidney, lung or adrenal gland. Sixty-nine percent of patients get an extra workup which might be unnecessary. These are findings outside the colon. They subsequently might be incidental findings that are benign. A lot of the times they’re increasing the costs. They’re not false positives. But they may be nonhelpful things that don’t lead to further management. In the latest recommendations, CT colonography is taking a backseat to the stool tests. In 2017 and 2021, a study looked at the increase in the number of people looking for the stool-based test and the number grew tenfold.
Q: How widespread is colon cancer?
A: This is a crisis. The incidence of colon cancer has gone up in the 45 to 55 cohort. Colon cancer is now the No. 1 cause of cancer-related deaths in patients under the age of 50. I think that when we see that kind of information, it’s worrisome. It’s always been in the top five. More than 50,000 people die from it every year in the US. Resources are available in the community. We go above and beyond to screen people through Oswego Health and through our primary care offices. We have a direct access program for people healthy enough or who are managing their chronic condition. If insurance is a problem, we partnered with an organization to help patients.
Q: Why are we seeing younger age of onset?
A: We don’t have a clear answer. Various theories like something in the diet that has changed, including more ultra processed foods. A paper published mentioned a possible association with certain kinds of infections. We don’t have a clear-cut answer as these area associative studies.