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Staying Proactive on Gut Health

Five percent of people will be diagnosed with colon cancer in their lifetime. As Cooper Clinic Gastroenterologist Andrew Gottesman, MD, says, that’s a big deal.

“In medicine, 5% is a huge number. It’s one in 20 people.”

“The good news is colon and rectal cancer is largely a preventable disease,” Gottesman said. “In the United States, it is the fourth most common malignancy. Only lung cancer kills more people. It’s important to be proactive to reduce the risk of colon cancer. This includes lifestyle changes such as quitting smoking, limiting alcohol, controlling obesity and minimizing red meat consumption. It is also important to schedule a colonoscopy, beginning at age 40.”

Colon cancer, or colorectal cancer, is a disease in which cells in the colon or rectum grow out of control. It usually arises from abnormal growths, called polyps. Over time, colon polyps may become malignant. This usually takes 5 to 10 years to occur. Not all polyps are of equal importance. When a colonoscopy is performed, all polyps are removed. Statistically, pre-cancerous polyps are identified in 30% of patients undergoing screening colonoscopy. With their removal, the likelihood of developing colon cancer is significantly reduced.

The incidence of colon cancer is increasing in patients under the age of 50. Many patients are diagnosed at later stages, so patients of average risk should begin routine screening colonoscopy at age 40. Some physicians advocate for screening at an even earlier age.

The results of your screening colonoscopy will determine the next time you’re screened. If no precancerous polyps or malignant polyps are found, the next colonoscopy should be scheduled in 7 - 10 years, unless you have a family history of colon cancer or polyps. In this situation, follow up colonoscopy is recommended in five years.

If pre-cancerous polyps are found, follow-up colonoscopy is recommended in three to five years, depending upon the size, number and microscopic appearance of the polyps. Occasionally, one year follow-up is recommended.

When a diagnostic colonoscopy may be needed:

Colonoscopy is also performed to evaluate gastrointestinal symptoms such as anemia, weight loss, abdominal pain and to detect a variety of diseases such as colitis, inflammatory bowel disease and diverticulosis. This is called a diagnostic colonoscopy.

Family history: If a close relative (parent, sibling or child) less than 60 years old has been diagnosed with colon cancer or pre-cancerous polyps, colonoscopy should be performed the earlier of age 40 or 10 years younger than the affected relative.
Blood on or in your stool: Talk to a health care provider if you notice blood in your stool or on the toilet tissue, or if your stool looks dark or bright red. It’s important to remember blood in your stool doesn’t mean you have colon cancer. Other things—from hemorrhoids to anal tears to eating beets—may change your stool’s appearance. But it’s always best to check with a health care provider any time you notice blood in or on your stool.
Persistent changes in your bowel habits: Talk to a health care provider if you have persistent constipation and/or diarrhea.
Abdominal pain: Talk to a health care provider if you have abdominal pain with no known cause, that doesn’t go away. Many things may cause abdominal pain, but it’s always best to have unusual or frequent abdominal pain evaluated.
Bloated stomach: Similar to abdominal pain, many things may make you feel bloated. Talk to a health care provider if your bloated state lasts for more than a week, worsens or you have other symptoms such as vomiting or blood in or on your stool.
Unexplained weight loss: This is a noticeable drop in your body weight when you’re not trying to lose weight.
Fatigue and feeling short of breath: These can be symptoms of anemia, or loss of blood. Anemia may be a sign of colon cancer.

What causes colon cancer?

Like all types of cancer, colon cancer happens when cells grow and divide uncontrollably. All cells in your body are constantly growing, dividing and dying. That’s how your body remains healthy and working as it should. In colon cancer, cells lining your colon and rectum keep growing and dividing even when they’re supposed to die. These cancerous cells may come from polyps in your colon.

There are thought to be multiple causes for colon cancer. Diet and genetics play a role. To reduce the risk of colon cancer, limiting the consumption of red meat and alcohol is recommended. Eating fruits and vegetables has been shown to reduce the risk of colon cancer. Low dose aspirin has also been shown to be useful in some patients, though this is not generally recommended due to the long-term side effects of aspirin use.

When you might need an endoscopy

Routine screening of the upper gastrointestinal tract (esophagus, stomach and small intestine) is not generally recommended. However, for patients with chronic reflux, difficulty swallowing or in patients with an abnormal lining of the esophagus, upper endoscopy can be performed at the same time as colonoscopy.

During the procedure, following sedation, an endoscope (a thin tube with a light and a camera at the end) is inserted into the mouth and slowly passed through the esophagus, stomach and small intestine. The camera then sends video images to a monitor, allowing the doctor to see inside the body and diagnose any issues.

An endoscopy may be needed for the following conditions.

Gastrointestinal bleeding: An endoscopy may be used to identify the source of gastrointestinal (GI) bleeding. It can help to determine the cause of the bleeding, such as an ulcer in the stomach or small intestine. An endoscopy can also treat the bleeding by cauterizing or injecting a substance to stop the bleeding.

Gastroesophageal reflux disease: Endoscopy can be used to diagnose and treat gastroesophageal reflux disease (GERD) which can develop as a result of chronic heartburn or acid reflux. An endoscopy can help identify any damage to the lining of the esophagus caused by stomach acid and can also be used to take biopsies of the tissue.

Ulcers: An endoscopy can be used to diagnose and treat ulcers in the stomach or small intestine. Because of the size and flexibility of the endoscope, your doctor can view the ulcer and take biopsies of the tissue.

Gastrointestinal obstruction: An endoscopy can be used to view obstructions and diagnose and treat blockages in the digestive tract. This procedure can also be done to remove food or foreign objects stuck in the upper GI tract.

Inflammatory bowel disease: Other chronic inflammatory bowel diseases (IBD) such as Crohn’s disease can be diagnosed and treated with an endoscopy. Your doctor can use the endoscope to view the inflammation, assess the severity of the damage and take biopsies of the tissue.

Barrett’s esophagus: Your doctor may recommend an endoscopy to diagnose and treat Barrett’s esophagus. This condition occurs when people who have chronic GERD also experience regular acid reflux which damages the lining of the esophagus. In this scenario, the endoscope can view the abnormal cells and take biopsies of the tissue.

Celiac disease: The diagnosis of celiac disease is often confirmed by biopsy of the small intestine through an upper endoscopy.

Cooper Clinic Gastroenterology provides on-site colonoscopy and endoscopy using the latest technologies. Our practice surpasses the national standard. Andrew Gottesman, MD, a board-certified gastroenterologist, and our nursing staff, with nearly 30 years of experience, provide personalized care and a clear picture of our patients’ health. A limited number of patients are seen daily with flexible scheduling and thorough pre- and post-procedure follow-up.

To schedule a GI consultation, colonoscopy or endoscopy, call 972.560.3255.