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Cancer develops when cells in a part of the body begin to grow out of control. They can continue to grow as tumors and replace normal tissue. Not all tumors are cancerous (malignant). Benign (non-cancerous) tumors do not metastasize (spread to other parts of the body), and with very rare exceptions, are not life threatening.
The colon is the first five feet of the large intestine. It connects to about six inches of the intestine called the rectum, which in turn ends with the anus. Colorectal cancer describes malignant tissue that grows in the wall of the colon or rectum. The majority of tumors begin when normal tissue in the colon or rectum forms an adenomatous polyp, or pre-cancerous growth projecting from the colon or rectum wall. These polyps, which may bleed from time to time, can be detected by testing the stool to determine if any blood is present.
Precancerous colorectal polyps can become malignant, but this process can take many years. This allows time for early detection with screening tests. Early detection of colorectal cancer clearly saves lives. When detected in its earliest stage and treated promptly, the disease has a relative five-year survival rate of 91%. If the cancer spreads regionally, the survival rate drops to 63%, and if it has spread to distant parts of the body, just 71% survive.
According to the American Cancer Society, only 37% of colorectal cancers are detected in the earliest state; thousands more lives could be saved if more cases of colorectal cancer were detected earlier. Some of the screening tests available are fecal occult blood tests, flexible sigmoidoscopy, colonoscopy, and barium enemas.
fecal occult blood test (FOBT)
Fecal occult blood tests are non-invasive tests that can detect occult (hidden) blood in the stool (fecal matter). The American Cancer Society recommends annual FOBT screening if you are over 50, even if you have no symptoms or history of the disease. Their statistics show that regular screening with FOBT’s has lowered colorectal cancer death rates by 33%. They recommend that a patient test three closely spaced bowel movements since some precancerous polyps bleed only intermittently.
Some FOBT’s are “card and stick” type tests. Using a wooden stick, the patient retrieves a small sample of stool from the toilet and smears it onto treated paper in a card. The card is then sent to the physician’s office or a laboratory to be developed and read. Another, more convenient test for a patient to use is a “wipe test”. With this test, the patient simply wipes into the holes of a perforated liner and onto the special paper after a bowl movement. This essentially “silk-screens” just the right amount of stool onto the paper as a pattern of dots. After peeling and flushing the liner paper, the test is folded in half and sealed. Once sealed, the test can be developed and read within fourteen days. The LifeGuard® test by MedTek is such a wipe test, and can be developed and read by the patient in the privacy of his own home.
A positive result does not necessarily mean that you have cancer. Other abnormalities such as ulcers, hemorrhoids, polyps, colitis, diverticulitis or fissures may also produce blood in the stool. A negative result does not necessarily mean that the patient does not have colorectal cancer since not all polyps bleed, or just bleed intermittently.
The American Cancer Society recommends that this procedure be performed every 5 years after age 50. In this procedure, a sigmoidoscope, a slender, flexible tube that has the ability to view about half of the colon, is used to detect a tumor or polyp. If a polyp or tumor is detected with this test, the patient must be referred for a full colonoscopy.
The physician uses a colonoscope to perform a colonoscopy. Although a general anesthesia is often used for this procedure, it usually only causes discomfort rather than pain. The colonoscope is similar to the sigmoidoscope, but is longer, and can view the entire colon. If a polyp is found, the physician can remove it, and send it to a pathology lab to determine if it is adenomatous (cancerous). As a screening method, the American Cancer Society recommends that a colonoscopy be done every 10 years after age 50.
Double Contrast Barium Enema (DCBE)
The double contrast barium enema or barium x-ray is an x-ray examination of the colon and rectum. The patient is administered an enema containing white dye or barium, followed by an injection of air. Since the barium coats and outlines the intestine, the physician is able to take x-rays of the entire colon and rectum and visualize any tumors or polyps that might be present.
A polyp is a growth projecting from the intestinal wall, produced by normal tissue in the wall. Polyps can be benign (noncancerous or precancerous) or malignant (composed of cancer cells), and may or may not bleed or bleed only intermittently.
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