March is Colon Cancer Awareness month. I have written extensively about colon cancer in my blog. I encourage you to read my prior blogs about colon cancer to learn more about this dreaded disease which currently is the number one cause of cancer-related deaths among non-smokers. One in 20 (or 5%) of Americans will develop colorectal cancer (by the way, for the purposes of this blog post and my other posts consider colon cancer and colorectal cancer similarly). The goal of Colon Cancer Awareness Month is to highlight the importance of colon cancer and encourage colon cancer screening.
I want to devote this blog to addressing the presentation of colon cancer. Specifically, what are the signs and symptoms of colon cancer? I am struck when friends, family, or patients age 50 and above tell me that they are not concerned about colon cancer because they do not have symptoms; they feel well and cannot fathom harboring a colon cancer. They are usually stunned when I explain to them that the most common symptom of early stage colon cancer is NO SYMPTOM. This misperception of colon cancer unfortunately leads to patients not pursuing a life-saving screening colonoscopy.
Patients with colon cancer present in one of three ways:
- No symptom. The colon cancer is detected by a screening colonoscopy or other screening test typically at an early stage
- Suspicious signs such as an anemia (low blood count) and/or symptoms such as rectal bleeding
- Emergency symptoms due to intestinal obstruction such as abdominal pain, vomiting, abdominal infection (peritonitis)
When symptoms develop, it is usually a sign of advanced disease. As a rule, the more advanced or widespread the cancer, the more difficult it is to cure the cancer. Screening colonoscopy diagnoses early colon cancer when it is asymptomatic. This leads to cure in the vast majority of cases.
When symptoms develop, they include the following:
- gastrointestinal bleeding which can present with bright red blood (rectal bleeding) or dark or black stool (known as melena)
- abdominal pain
- change in bowel habits; typically constipation due to a partial obstruction by the cancer
- abdominal distention typically due to obstruction by the cancer
- nausea and vomiting typically due to obstruction by the cancer
What can you do? If you are age 50 or above and have not had a screening colonosocpy, you should contact your healthcare provider and schedule a screening colonoscopy. Currently, there should be no barriers to getting a screening colonoscopy. The Affordable Care Act (‘Obamacare’) requires all health plans that started on or after September 23, 2010 to cover colon cancer screening tests. In my gastroenterology practice, I have not seen an insurance provider deny coverage for a screening colonoscopy in several years, indicative of the widespread adoption of this policy. You can also encourage friends, family, and co-workers who are age 50 and above to get their screening colonoscopy. I would also encourage you to support the non-profit organizations dedicated to raising awareness of colon cancer such as the American Cancer Society and the Colon Cancer Alliance.
Here’s to your colon health!
Frank Farrell, MD, MPH, AGAF