This week in my office, a 53-year-old woman complaining of gastrointestinal issues refused to get a colonoscopy because she was afraid of the ‘prep’ required the day before. Unfortunately, her mother and uncle died of colon cancer, which constitutes a pretty strong family history. I realized her concern about the "clean out" process trumped her potential for cancer given the genetics.
Colon cancer (also known as colorectal cancer) is the third most diagnosed cancer in the world. Symptoms can vary widely from nothing to rectal bleeding (red or black), new constipation or diarrhea, change in stool size (such as pencil-thin), mucus, abdominal pain, or bloating. Blood loss in the stool is the most consistent symptom and it's important to not ignore it or chalk it up to hemorrhoids.
What should you do if you suspect something? Make an appointment with your health care provider and don’t be afraid or embarrassed because it involves your colon. Your provider will check for hemorrhoids and perform a rectal exam checking for lumps, bumps, or any lesions. You will probably be given a fecal occult test which is a card that checks for blood in the stool if not done after the rectal exam.
A colonoscopy is typically recommended starting at 50 years old unless you have a history of polyps, irritable bowel disease (such as crohn’s or ulcerative colitis), or a family history of colon cancer. Then it is recommended much earlier. This differs from a sigmoidoscopy that only exams the rectum and lower colon as opposed to the entire colon.
Risk factors include: age, family history (like my patient above), a history of adenomatous polyps on prior colonoscopy, smoking, a diet high in red meat, a history of inflammatory bowel disease, a low fiber diet, obesity, low vitamin D levels, and increased alcohol intake.
Many of these risk factors are modifiable and should be taken seriously especially if you have a family history or a history of polyps or inflammatory bowel disease.