WRNMMC, Bethesda, MD  –   Observed during March, Colorectal Cancer Awareness Month seeks to increase the public’s knowledge about the disease and encourage people to get screened for it.
“The colon and rectum, also referred to as the large intestine, are the last several feet of the gastrointestinal tract and are responsible mostly for absorbing water prior to the evacuation of stool,” explained Army Maj. (Dr.) Mary O’Donnell, chief of the Division of Colon and Rectal Surgery, part of the General Surgery Department at Walter Reed National Military Medical Center. She is also an associate program director of the General Surgery Residency and assistant professor of surgery at the Uniformed Services University.
“The human body is made up of cells that grow and divide regularly throughout our lives,” O’Donnell continued. Colorectal cancer (CRC) occurs when those cells in the large intestine begin to grow or divide abnormally, invade into the wall of the colon, and sometimes lymph nodes or other organs.”
The physician said CRC is often discovered on a colonoscopy, whether done for symptoms or as a screening exam, recommended for everyone at age 45. “Luckily, much of the colorectal cancer is preventable. Screening exams like colonoscopy and sigmoidoscopy remove pre-cancerous polyps before they can grow into cancer.”
Priscilla Cullen, a registered nurse in Gastroenterology at WRNMMC, and since 2004, the virtual colonoscopy nurse located in Radiology near the CAT scan machine, explained procedures done at the medical center to screen for colorectal cancer.
“At our command, we perform sedated and CAT scan colonoscopies Monday through Friday, and we do stool tests, call FIT test, on low-risk patients,” Cullen stated.
“I think it’s wonderful we offer various methods of screenings, and patients have a voice in the method chosen,” Cullen, added. She said colon cancer screening has lowered the disease mortality and morbidity in those over 60.
O’Donnell listed some of the risk factors for colorectal cancer, including: increasing age (greater than 50 years of age); a family history of colorectal cancer or colon polyps; and diets high in animal fat and low in calcium, folate and fiber. “Eat plenty of fruits and vegetables! It is also recommended adults eat 25 to 35 grams of fiber daily. Exercise regularly, do not smoke and minimize alcohol intake,” she stated.
“Unfortunately, colorectal cancer can often be asymptomatic,” O’Donnell added. “This is why screening through procedures like colonoscopy are so important in individuals who have no family history of colon or rectal cancer. The current recommendation for a person with no family history of colon or rectal cancer, or unknown history, is to receive their first screening exam for the disease at age 45.”
She added symptoms of colorectal cancer can include, but not limited to, blood in the stool; weight loss; changes in stool habits or caliber; diarrhea; constipation or feeling that the bowel does not empty completely; fatigue; anemia; abdominal pain or bloating; nausea; and vomiting.
O’Donnell explained that while screening for colorectal cancer should begin at 45 for most people, if a person’s first degree relative has had colorectal cancer diagnosed before age 55, then that person should be screened 10 years earlier than the age at which their relative was diagnosed. For instance, if a person’s mother or father was diagnosed with CRC at age 43, then the person should be screened for it at 33. “Also, CRC is now tested for markers that may indicate an inherited component. If you have a family member with CRC, ensure you discuss if this may affect screening in your family,” she added.
If your screening exams is normal, no polyps or other findings, screening intervals for each exams are:
• Colonoscopy – every 10 years
• Virtual colonoscopy – every five years
• Flexible sigmoidoscopy – every five years
• Fecal occult blood sample or fecal immunochemical test – every year
• FIT-DNA stool test – every three years.
“Again, these stool tests should only be done if you have no symptoms or concerns for CRC, as they are screening exams,” O’Donnell explained.
According to the American Cancer Society and the National Cancer Institute, if diagnosed early during Stage 1, nine out of 10 people survive colon cancer five or more years. If diagnosed later during Stage 4, less than two out of 10 people survive colon cancer five or more years. Also according to the ACS and NCI, colon cancer is third most common cancer in the United States and the second leading cause of cancer-related deaths in the U.S. for both men and women; 90 percent of new colon cancer cases occur in people 50 or older; and there are more than one million colon cancer survivors in the United States. The disease claims more than 50,000 lives yearly in the U.S.
She added CRC disproportionately affects African Americans, who are 20 percent more likely to get colorectal cancer than other ethnic groups, for reasons that are complex, including access to health-care exams and screening, according to the American Cancer Society.
“All beneficiaries in our military health-care system have access to colonoscopies and screening exams at age 45 or earlier if prescribed by your doctor,” O’Donnell stated. “It is important to talk to your doctor about any symptoms you are having concerning for CRC or if you have a family history of CRC or colon polyps.”
Treatments for colorectal cancer vary, O’Donnell explained. “Small colon cancers that have not yet invaded the colon wall deeply can be treated by a gastroenterologist through advanced colonoscopy techniques. The majority of colon cancers are treated through surgical removal of a portion of the colon and its associated lymph nodes. Chemotherapy can be necessary in addition not surgery based upon the stage of the cancer. Radiation and chemotherapy are often used to treat rectal cancers prior to surgery.”
“One of the most common questions I get from patients is, ‘Will I need a bag?’ or ‘Do I have to have an ostomy bag?’ This is one of the most feared risks of intestinal surgery that patients have in my clinic and often leads to the avoidance of a first colonoscopy in patients,” O’Donnell stated. “It is important to know that needing an ostomy or stoma, where stool is emptied into a bag on the abdominal wall from a connection made by bringing the intestine up to the abdominal wall, is often not necessary in the treatment of these cancers. While we do create an ostomy during some of our surgical procedures, it is often temporary to decrease the risks of a procedure.
“Lastly, if an ostomy needs to be permanent to ensure the cure of a cancer, we have dedicated wound ostomy care nurses trained in helping patients adjust to having a stoma,” O’Donnell added. “Many people have completely normal lives with an ostomy bag.”
She encourages people to visit the WRNMMC site to see a list of conditions treated and services offered within her division. The site is located at https://walterreed.tricare.mil/Health-Services/Hospital-Care-Surgery/Colorectal-Surgery.
For more information about colorectal cancer, visit https://www.cdc.gov/cancer/dcpc/resources/features/colorectalawareness/index.htm.