The term colorectal refers to the parts of the digestive tract known as the colon (also known as the large intestine) and the rectum.
The most significant risk for developing colorectal cancer is a polyp found during a colonoscopy. A polyp is a growth on the surface of the colon. The polyp can grow from an adenoma, a polyp that can become cancerous, to a carcinoma, a cancerous growth. The sequence of this development from polyp to cancer is well identified. Thus, we know that removing polyps almost ensures a low risk of cancer. We can remove polyps during the colonoscopy procedure, as soon as a polyp is detected.
Adults 50 and older are most at risk of developing colorectal cancer. For this reason I advise screenings for everyone over age 50. Some patients resist having a colonoscopy until their 60s, and then we discover an advanced cancer that could have been detected and treated when it posed little threat.
Family history also is a risk factor, especially if you have a father, mother or sibling who has had colorectal cancer. We screen these patients more aggressively than others.
Physicians and patients can detect the signs and symptoms of colorectal cancer. During a colonoscopy, when I see a polyp, I can remove it. You can notice when a stool is bloody or black. Once the cancer progresses past that stage, you will have abdominal pain and weight loss.
I recommend several types of screenings to detect colorectal cancer early. These screenings also are recommended by the American Cancer Society and the U.S. Preventive Services Task Force:
• An annual fecal occult blood test, which tests for blood hidden in the stool.
• A colonoscopy every 10 years, providing that you have no symptoms that would warrant a screening earlier. Another form of screening, the flexible sigmoidoscopy, is not nearly as valuable as a colonoscopy. It only allows a physician to see into the left side of the colon.
• A double-contrast barium enema allows the physician to see the right side of the colon. While this is more valuable than the flexible sigmoidoscopy, I still prefer a colonoscopy as the one best means of detecting a potential cancer.
I treat patients who have developed colon cancer with surgery that removes the portion of the bowel containing cancer, the associated lymph nodes and blood vessels and margins of at least five centimeters that are clear of cancer. Most of the time we can reconnect the bowel portions on either side and leave the patient able to go to the bathroom normally, with no need for an ostomy bag.
We now also can perform this surgery laparoscopically. This involves only a few small incisions, resulting in a more rapid recovery and less scarring and blood loss than with open surgery.
We always send the removed tissue to pathology to determine whether the cancer has spread to the lymph nodes. If it has, we follow the surgery with chemotherapy to stop that cancer.
Rectal cancer presents greater challenges than does colon cancer. It occurs in the pelvis, so more spreading of the cancer is possible. Treating this cancer requires more staging (forms of treatment) than with colon cancer; patients receive chemotherapy, radiation and then surgery. One primary aim in treating rectal cancer is saving the sphincter, which means that the patient would not require an ostomy bag. Radiation and chemotherapy shrink the cancer before surgery, which is important in saving the sphincter.
Take action to reduce your risk of colorectal cancer and, thus, the need for surgery. If you are overdue for a colorectal cancer screening, call your physician today and have him or her arrange your screening. This is one relatively easy step you can take to prevent a serious illness.
Dr. Schultheis’ office is located at Vista Medical Terrace at 2345 E. Prater Way, Suite 107, and she is currently accepting new patients. To schedule an appointment, call 352-5300.
Mary Beth Schultheis, M.D., FACS, is a general surgeon with the Northern Nevada Medical Group and specializes in colon and rectal surgery. Schultheis graduated from Creighton University School of Medicine in 2001. Following graduation she completed an internship and residency in general surgery with Saint Agnes Healthcare in Baltimore, Maryland and a fellowship in colon and rectal surgery from the Greater Baltimore Medical Center.