Why is it important to get colorectal cancer screening?
The population of the United States above the age of 50 is about 125 million. Among them, approximately 40 million people, or about one-third of eligible individuals, are not getting screened for colorectal cancer. In Thailand, out of the 72.8 million people, about 30% of the population is above 50 years of age. Probably more than two-thirds of this population are also not getting screened for colorectal cancer.
Colorectal screening is not widely practiced in Thailand due to the lack of resources and availability of gastroenterologists. So far, colorectal screening in Thailand is still in its infancy and not widely implemented. Although the Thai government is trying hard to push colorectal screening programs by encouraging people above the age of 50 to do fecal occult blood tests and, if positive, proceed to colonoscopy, this practice has not been widely adopted.
This fact is concerning, given that colorectal cancer is the third most common cancer diagnosed in the USA and in Thailand, according to Assoc. Prof. Dr. Sathaporn Manatsathit, a Gastroenterology & Hepatology specialist at MedPark Hospital Bangkok.
Early detection of colorectal cancer saves lives
The simple answer as to why it is important to get colorectal cancer screening is because it increases the chances of successful treatment and survival.
Dr. Manatsathit points out that colorectal cancer screening and diagnostic tests are effective at spotting precancerous polyps (growths on the lining of your colon) before they develop into cancer. During a procedure called a colonoscopy, doctors can remove these polyps, which helps in preventing the disease entirely.
Moreover, the earlier the cancer is caught, the better the chances for successful treatment and recovery. If colorectal cancer is detected at an early stage, it is usually still localised and hasn’t spread to other areas of the body. This makes treatment much simpler and often results in better outcomes for patients. “Studies show that early-stage colorectal cancer can have a near 100% five-year survival rate,” adds Dr. Manatsathit.
When should you undergo colorectal cancer screening?
As people get older, their chances of getting colorectal cancer increase, says Dr. Manatsathit. Therefore, it is recommended that anyone over 50 get regular screening for colorectal cancer. Screenings should start even earlier, at around age 40, if there’s a family history of the disease or any other risk factors.
Your doctor will recommend a specific screening schedule. In general, people with a clear colonoscopy, meaning no polyps or adenomas (non-cancerous tumours), should have their next one in 5 to 10 years. If the previous exam revealed 1 or 2 polyps smaller than 1 cm, the follow-up should occur in 3 years. For those with polyps or adenomas larger than 1 cm, the doctor will likely recommend the next colonoscopy within 1 to 2 years. However, these timelines may vary based on specific histological findings and the doctor’s advice.
The risk factors and symptoms
It is still unclear what causes colorectal cancer, but the two main risk factors associated with it are genetic and environmental or lifestyle factors. Genetic factors don’t always come directly from your parents; sometimes, they can skip generations. If you have a close family member, such as a parent, sibling, or child, who has had colorectal cancer or adenomatous polyps (a type of polyps that can change into cancer), your risk of developing the disease increases.
On the environmental side, there are various things that can increase risk, too. For example, exposure to certain carcinogens, like smoking or consuming grilled and smoked meats, can be harmful. A diet high in red meat and low in fibre, along with processed foods and heavy alcohol consumption, as well as not exercising enough and being overweight, can all contribute to higher risks, too. Additionally, some medical conditions, e.g. Inflammatory Bowel Disease both ulcerative colitis and Crohn’s disease, Lynch syndrome, Familial Adenomatous Polyposis (FAP), Type 2 diabetes, Acromegaly, etc., also raise the likelihood of developing colorectal cancer.
Since age plays a role in the development of colorectal cancer, adults over the age of 50 should undergo fecal occult blood tests and/or colonoscopy for colorectal screening, even if they have no gastrointestinal (GI) symptoms. If they wait until symptoms appear, it may be too late, as the polyps, adenomas, or tumors may be large enough to produce symptoms. Therefore, it is always wiser to get screened once they pass the age of 50 and not wait for symptoms to appear. People at high risk or with a family history of colon cancer should start colorectal screening at age 40 or 45. Regardless, any gastrointestinal symptoms should prompt serious consideration for screening. Symptoms to watch for include:
- Changes in bowel habits, such as diarrhoea or constipation that persist for several weeks. To be more precise, if a patient normally moves their bowels 2-3 times or more a day and then changes their bowel habit to once a day for several weeks, this is already a “change of bowel habit.” Conversely, if a patient normally moves their bowels every 2-3 days or more and then changes their bowel habit to once a day for several weeks, this is also a “change of bowel habit” that needs screening.
- Stool that appears narrower than usual lasting a few days.
- A sensation of not fully emptying the bowels (known as tenesmus).
- Visible rectal bleeding or blood in the stool, which can cause it to appear red or dark. This can be enhanced by testing for fecal occult blood, which helps detect blood that is too minuscule to be visible.
- Unexplained abdominal pain.
- Weakness and fatigue, later found to have anemia.
- Unexpected weight loss.
Should you get colorectal cancer screening even without symptoms?
Yes, as mentioned above, you should still consider colorectal cancer screening as a precautionary measure, even in the absence of symptoms.
“Colorectal cancer can progress silently for quite some time,” Dr. Manatsathit says. The disease is often called a silent killer because it takes years to progress to a point where you experience symptoms. Many only seek screening after seeing blood in their stool or having bowel blockages. Some don’t realise there is a problem until the cancer has spread to other organs like the lungs or liver. However, by the time patients notice these symptoms, the cancer is often at a more advanced stage and harder to treat.
What are the different types of colorectal cancer screenings?
Dr. Manatsathit explains that colonoscopy is the main screening tool at MedPark Hospital. This procedure is highly accurate and effectively locates tumours. During the procedure, your doctor will insert a long, flexible instrument called a colonoscope to examine the entire colon and rectum. Again, if your doctor discovers any polyps or adenomas, they will remove them immediately to prevent future development of cancer. Your doctor may also take tissue samples for further testing during the process.
Many find colonoscopy to be painless, while others may feel agitated, anxious, or experience some annoying pain. You can request your doctor to perform it with an anaesthetist, who can help you relax by administering stronger sedatives under their monitoring, further minimising discomfort. You will recover or regain consciousness almost immediately once the colonoscopy procedure is finished.
From the patient’s point of view, the most difficult part is the preparation of the bowel and the bowel cleansing from the laxatives your doctor provides, as well as the fasting for six hours before the procedure. The purpose of intense cleansing is to clear any stools that may cause blind areas from the residual stools. This means avoiding a low-fibre diet, such as vegetables, fruits, grains, nuts, and seeds, for a few days prior to the procedure. Still, some people tend to avoid it because it involves a rigorous bowel cleansing process and fasting beforehand.
There are alternatives to consider, such as an annual stool test that checks for hidden blood or occult blood. However, if this test shows positive results, your doctor will usually advise you to undergo a colonoscopy anyway. For those who prefer another method, CT colonography is an option. This is less invasive than a traditional colonoscopy but requires intense cleansing and also involves exposure to radiation. If the CT colonography is negative, it is fine. But if your doctor finds polyps or adenomas during a CT colonography, you will still need a colonoscopy for removal.
Stool genetic testing is also available as an alternative screening method. It is a non-invasive method for screening colorectal cancer, involving the analysis of a stool sample for abnormal DNA and blood, which can be early indicators of colon cancer or precancerous polyps. You can collect a stool sample at home or collect blood samples at the hospital and send them to a laboratory for analysis.
- DNA analysis: The lab examines the DNA in the stool sample for specific genetic markers associated with colorectal cancer.
- Blood genetic analysis: These can identify genetic mutations associated with an increased risk. The lab analyses your DNA for specific gene mutations linked to hereditary colorectal cancer syndromes like Lynch syndrome and familial adenomatous polyposis (FAP).
If you have a strong family history of colorectal cancer, especially at a young age, and you do not want to undergo a colonoscopy, your doctor may recommend genetic testing. It is important to note that the test does not confirm or rule out colorectal cancer. It just helps to assess your risk and guide you in screening recommendations. Please note that it is less sensitive than a colonoscopy and may not detect all precancerous polyps. However, it may help determine how often you should have a colonoscopy based on your risk level. Sometimes the test can produce a positive result when no cancer or polyps are present, requiring further testing. Therefore, its reliability should be discussed with your doctor.
What happens if your doctor finds abnormalities during a colonoscopy?
The plan for follow-up care after finding something abnormal will vary based on what your doctor discovers during the procedure. For instance, if your doctor removes non-precancerous polyps, depending on their size and number, they might suggest another colonoscopy in about three to ten years. However, if any polyps are precancerous, more frequent check-ups every one to three years may be necessary to monitor them and remove any new ones that develop.
If your doctor detects inflammation due to conditions like ulcerative colitis or Crohn’s disease, they will recommend appropriate treatments tailored to address those specific issues. In cases where diverticula are present but not causing problems, you may not need any special treatment; however, if diverticulitis occurs, indicating inflammation, you might receive advice on antibiotics and changes in diet.
Lastly, if your doctor finds cancer during the screening, they will quickly refer you to specialists such as a GI surgeon or oncologist, who will help determine the best treatment approach for you. This could include options like surgery or chemotherapy, or even radiotherapy, among others.
It is important to remember that this overview provides general information, and individual circumstances may vary significantly based on specific findings from each person’s colonoscopy.
If it is so important, why don’t more people get colorectal cancer screening?
Many people delay colorectal cancer screening until it is too late due to misconceptions and fears. Here are some of the most common reasons.
I don’t experience any symptoms or have any risk factors
As explained above, colorectal cancer often doesn’t show symptoms until it is advanced. And since this type of cancer can affect anyone, regardless of their health and risk factors, it is a good idea to get a screening as soon as you can.
I’m too young/too old for screening
Older adults may dismiss the necessity of screening, believing they are past the age of concern. However, medical guidelines suggest that regular screenings should continue well into older adulthood. On the other hand, if you’re younger than 40, you might think you’re too young to get colorectal cancer screening – but that’s not true. Although the majority of colorectal cancer cases are found in adults over the age of 50, recent studies show an alarming increase in this type of cancer among those in age of 40 or below.
Colorectal cancer screening is too expensive
Many people avoid getting colorectal cancer screening because they think it is too expensive. In reality, many insurance plans cover the full costs of colorectal cancer screenings. Plus, medical centres like MedPark Hospital understand financial concerns and accept most types of insurance. MedPark also arrange a Package, so that the cost of examination is within reach of your financial burden. This means that you can do it without worrying about a hefty bill afterwards.
Talk to your doctor about screening options and reach out to your insurance provider for more specific details about your plan.
It is too invasive and scary
If you’ve been avoiding colorectal cancer screening because it seems too invasive and intimidating, you’re not alone. It is normal to experience fear and anxiety but remember that there are various screening options available. Some options are minimally invasive and may not require the same level of preparation as others.
Make sure to have open conversations with your doctor about what each option entails. Doctors are there to help by discussing which screening method is the most suitable based on personal comfort levels and health history.
Now is the perfect time for colorectal cancer screening
If you’re thinking about getting a colorectal cancer screening, now is the time, even if you feel fine. Screening plays a crucial role in preventing (and possibly curing) colorectal cancer, and MedPark Hospital is making it easier for people in Thailand to access these services.
The team at MedPark consists of various specialists. These include gastroenterologists, endoscopists, surgeons, radiologists (both general and interventional), oncologists, radiation experts, pathologists, nutritionists, and genetics professionals. Thus, in addition to colorectal cancer screenings, MedPark’s GI Teamwork offers solutions for a variety of gastrointestinal issues that can affect the entire digestive system, from the mouth to the anus, as well as problems related to the liver, pancreas, and abdominal organs like lymph nodes and blood vessels.
For more information and to book an appointment, visit MedPark Hospital’s website. Remember, screening can save lives!
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