Cancer (Colorectal)

Question:

What are the screening tests for colon cancer? When should I begin screening?

Answer:

Colorectal cancer (cancer of the colon or rectum) is the second leading cause of cancer death (after lung cancer) in the U.S., affecting both men and women, typically over age 50. About 135,400 Americans will be diagnosed with colorectal cancer this year, and 56,700 will die from the disease.

When cancer is detected at an early stage, usually when there are no symptoms, the disease is 90 percent curable. But, today, only 37 percent of all cases are detected in their early, most treatable stages. Therefore, the American Cancer Society (ACS) is helping sponsor a major national public awareness campaign this month to recognize the first, inaugural National Colorectal Cancer Awareness Month, which is intended to generate awareness about colorectal cancer and prompt people to take action by learning more about preventing the disease.

Start having regular screening tests for colorectal cancer soon after you turn 50. Earlier or more frequent tests may be needed if: you have a close relative who has had colorectal cancer or polyps; you have had colorectal cancer, polyps or inflammatory bowel disease; or you have symptoms such as rectal bleeding, stomach pain, a change in bowel habits or unexplained weight loss.

Several tests are used to screen for colorectal cancer. Discuss the options with your doctor to determine which combination would be best for you.

• Fecal Occult Blood Test (FOBT). Recommended annually. At home, with a small stick from a test kit, you spread a thin layer of your stool on tests cards for three consecutive bowel movements. You mail the cards to your doctor's office or a lab, where they are checked for occult blood (blood you cannot see). A new study published in The New England Journal of Medicine reveals that regular screening with a FOBT can reduce the incidence of colorectal cancer by at least 20 percent.
• Flexible Sigmoidoscopy. Recommended every five years. The doctor uses a flexible, lighted tube (about the thickness of a finger) to look at the lining of the rectum and lower part of the colon. (Some experts recommend both a FOBT and flexible sigmoidoscopy to increase the chance of finding polyps and cancer.)
• Colonoscopy. The doctor uses a flexible, lighted tube to look at the lining of the rectum and entire colon. Suggested every 10 years; usually recommended as a follow-up exam if anything unusual is found during FOBT, flexible sigmoidoscopy, or double-contrast barium enema.
• Double Contrast Barium Enema. Suggested every five to 10 years as an alternative to colonoscopy. This test lets the doctor see an x-ray image of the rectum and entire colon. Barium flows from a tube into the colon, creating an outline around polyps and other growths so they are visible on the x-ray.

Discuss screening options with your doctor and visit the Center for Disease Control and Prevention Web site and the ACS Web site for additional information.