Friday, October 2, 2009


I am way over my head in trying to read, understand and repeat this information on screening and surveillance for colorectal cancer or CRC also known more commonly as colon cancer. The cancer itself can affect the colon, rectum and appendix. In the reading, I was tripped up by the term proximal colon cancer and proximal neoplasms or adenomas. Proximal means distant and the neoplasms and adenomas are lesions or tumors that are not yet cancerous and may never be cancerous, but which part of the colon is the distant part? I thought it might mean distant from where the endoscope was searching. The colon, as you may remember from school, is huge. It has many sections. It has five sections and apparently the descending and redundant sections would be the proximal or distant ones.

Why the heck does that matter? Because many tests, i.e. the ones that might be the least intimidating, risky and expensive, don't find proximal polyps or abnormal growths, i.e these neoplasms and adenomas that can turn into cancer.

There is good reason to believe (research) that removing precancerous lesions can prevent CRC which according to D. Lieberman in Medscape is the second cancer killer in North America. I am going to imagine that Lung Cancer is the first.

Guidelines for screening (who, what and when) and surveillance (how often) have been established by the US Preventative Services Task Force and a combo group of the American Cancer Society, Multi-Society Task Force on CRC and the American College of Radiology. These two guidelines have some agreement and disagreement.

Unfortunately, at this time, the most effective at recognizing the adenomas throughout the colon area is the colonoscopy. The newest imaging test, computed tomographic colonography is pretty good at finding larger lesions or 10mm ones but there is no way to then remove them without scheduling another appointment and another bowel prep. There was also some concern about different clinicians reading the scans differently. But the biggest thing that I noted in reading what the guidelines offered as an area of uncertainty with this test was this:

Radiation exposure could increase the risk of developing cancer.. and some countries will not allow imaging for screening purposes. (see - and that is why I am against CT scans of the lungs as a screening tool)

There are fecal occult tests as well, but they do not find polyps and there is a lot of belief in the health community that removing polyps is protective.

I learned today that men are likely to get CRC sooner than women and that blacks of both sexes have a higher risk at younger ages. Though the recommendation for all persons for screening is now age 50, it could be said that blacks have their first one at 45 and women (white) at 55 or 60. However, the experts are afraid that multiple age dates will cause an overall drop in screening.

How often to test if negative is a debatable 10 years (10, 5, 0r 3 years if polyps found and removed) and when to stop testing is also in question, but some recommend stopping at 75 if there have been no symptoms over the years and at 85 even if there have been symptoms.

So there you have it. Get screened. At least the colonoscopy is done with sedation and I was recently told by a friend that she doesn't remember the procedure at all.

For prevention, avoid red and processed meats, consume a plant based diet, don't smoke , exercise and maintain a healthy weight. You know, same old same old!

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