March is National Colorectal Cancer Awareness Month. There’s an ever-present need to be more vigilant about colon cancer as it’s the second leading cause of cancer deaths in the U.S. In fact, it’s the third most common cancer in men and women.
To mark the significance, GOOD Morning Wilton asked gastroenterologist and Wilton resident Dr. Mae Tighe to answer some important questions for our new series, “5 Questions With…”
Dr. Tighe has 20 been a gastroenterologist for more than 20 years. She recently moved her practice from New Haven (out of Yale, Milford Hospital and St. Raphael’s) to join Danbury Hospital just over a year ago. She served two terms as chief of gastroenterology and president of the medical staff at Milford Hospital; president of the New Haven County Medical Association; and an assistant clinical professor of medicine at Yale. She has an office in Wilton.
1. GMW: What are the risk factors for colon cancer?
Dr. Mae Tighe: One of the biggest risk factors for colon cancer is increasing age. The majority of cancers are diagnosed in patients over age 50. African Americans are at increased risk and need to be screened starting at age 45. A family history of colon cancer increases your risk, but note that 75-percent of colon cancers are sporadic rather than genetic. That’s why everyone needs to be screened. Other risks are a history of inflammatory bowel disease, radiation to the abdomen and a personal history of colon polyps. Obesity, smoking, alcohol abuse, low-fiber/high-fat diet and diabetes also increase your risk.
2. GMW: What are signs that people should look for that may signal it’s time to talk to a doctor?
Tighe: Symptoms of a cancer can include rectal bleeding, narrow stool caliber or change in bowel pattern, anemia (which can be signaled by fatigue), abdominal pain, and weight loss. But you don’t want to wait for symptoms to occur; many people can have no symptoms, especially if the cancer is higher up inside the colon. The reason for screening is to find polyps and remove them before they turn into a cancer.
It’s one of the few cancers we can find and remove while it is still benign, a “polyp.” If it is found as a cancer and caught in an early stage, there is a 90-percent 5-year survival.
3. GMW: What are the different types of tests for this kind of cancer?
Tighe: There are some noninvasive alternatives, like tests of the stool for blood or DNA or a CT colonography, but those are reserved for people who either refuse colonoscopy or are at too high risk for the procedure. They are not as sensitive as a colonoscopy for picking up polyps or cancers.
The worst part of the colonoscopy is the night before. You will need to be on a clear liquid diet, like broth, Jell-O and Gatorade, for the entire day, and then in the evening you need to drink a prep solution which will clean out your colon so the doctor can see inside.
You will need to take the procedure day off from work because you will be sedated by anesthesia. You need to bring somebody who can drive you home afterwards. When you come in, you will be hooked up to monitors for your heart rhythm, blood pressure and oxygen levels. You will wear nasal oxygen. The anesthesiologist will give you medicine through an intravenous which will make you fall asleep but you will be breathing on your own. They will monitor you and be with you for the whole procedure.
You will be lying on your left side. The gastroenterologist will insert a long flexible tube, the colonoscope, into the rectum and advance the scope through the whole colon. The scope has a camera built in and is hooked up to a TV screen. During the exam, the gastroenterologist can remove polyps, which are growths that can turn into colon cancer. There are instruments that can be passed through a channel in the scope to remove these. If a cancer is found, biopsies can be taken. The procedure lasts about twenty minutes.
You will wake up feeling refreshed and just a little gassy. Specimens sent to pathology will take couple of days but the doctor can tell you right away what they saw.
The risks of the procedure include bleeding, infection, perforating the intestine, reaction to anesthesia and missed lesions, but luckily, these are rare, especially if you see a doctor who has done many of these exams. The perforation risk nationally is on the order of about 1/1000 but that includes all providers.
Patients are almost always pleasantly surprised by how easy the whole process was. I like to refer to it as their “spa day.” A colon cleanse and a nice nap and an afternoon to relax. What could be better?
4. GMW: Even if I have no family history of colorectal cancer or polyps, should I start getting tested? And at what age do I need to start to pay attention to this?
Tighe: A lot of people tell me they aren’t worried about it because it doesn’t run in their family. The truth is, 75 percent of cases are sporadic, meaning that they occur with no previous family history.
The recommendation for screening is every 10 years starting at age 50. It is 45 for African Americans because studies show they are at increased risk.
If you have a family history of colon cancer, you may need to start sooner, like age 40 or even younger, depending on your family history. You should ask your GI doctor, or gastroenterologist.
5. GMW: Are there things I can do in addition to being tested regularly, to help maintain my colorectal health?
Quit smoking, lose weight, eat healthy and exercise! Eat fruits and vegetables which contain antioxidants and high fiber foods. Drink alcohol only moderately. There have been some data to suggest that aspirin or nonsteroidal anti-inflammatories may decrease polyp and cancer formation, but an official recommendation for this in average-risk patients has not been made because these medicines can carry other risks, so you would need to discuss your individual risk with your doctor.
I have found many polyps and cancers in my twenty years in gastroenterology. I have diagnosed cancer in people who “do everything right.” They eat right, exercise, have “good genes.” It is really important to consider having a colonoscopy. It could truly save your life.