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Colorectal Cancer Awareness Month: Learn More about Colonoscopy and Polyps

Colorectal cancer affects both men and women and is the second leading cause of cancer-related deaths in the United States, according to the Centers for Disease Control and Prevention. In addition, it is also one of the most commonly diagnosed cancers in the United States. 

“There are certain risk factors associated with colorectal cancer,” says Immanuel Ho, M.D., chief of the Division of Gastroenterology and Hepatology at Crozer-Chester Medical Center. “The most important risk factors for colorectal cancer are age, a family history of colon cancer, personal history of a precancerous colon polyp, or certain conditions such as ulcerative colitis or Crohn’s colitis. However, with proper diagnosis, many cases can be successfully treated. Most importantly, early detection of colon cancer is the key to long-term survival.”

Ho explains that a colonoscopy is a “widely used and tolerable test and is associated with the decrease in cancer mortality during the 15 years, according to studies.”

The frequency of screenings can vary with the patient’s age and medical history, but as a general rule colonoscopies are recommended:

  • For those with no family history of colon cancer, once every 10 years starting at age 50.
  • For those with a family history of colon cancer, once every five years starting at age 40, or 10 years earlier than when their closest first-degree relative was diagnosed with colon cancer.
  • For those with inflammatory bowel disease at any age, once every two or three years.

If you are preparing to undergo a colonoscopy screening, it helps to understand why physicians schedule this test, and what they are looking for when they receive the results. Despite the information presented here, it is always best to consult your physician with questions or concerns before any procedure.

At the time of the colonoscopy, polyps, tumors and other tissue that may look suspicious are removed and sent to the lab for examination under a microscope by a pathologist. This process is called a colon biopsy. The doctor will give you a general description of what he or she saw in your colon, but the final report from the pathologist will provide you with a more detailed explanation. 

Once the results are back from the pathologist, your doctor will be able to tell you whether your polyps are benign or malignant. The tissues in your body are made up of millions of tiny individual cells that regularly grow and divide in an orderly way. As old cells die, they are replaced with new healthy cells. A glitch in this process can cause too many cells to form, creating a lump or mass of cells, called a tumor. Tumors are made up of benign (non-cancerous) or malignant (cancerous) cells.

The majority of colon polyps are benign; which means that they are not cancer, they won’t spread and can be removed easily. Polyps rarely cause symptoms, so they continue to grow silently for many years if left untreated. When colon tumors or polyps become malignant, they are called colon cancer, or adenocarcinoma of the colon or rectum. This is when symptoms like pain, bleeding or bowel changes may become more noticeable.

Some polyps can turn into cancer so, as a safety precaution, all polyps are removed and analyzed during a colonoscopy. The cancer risk increases with the size, number and type of polyps found over a period time. Polyps can be hereditary, so it is important to know and share your medical history with your physician and your family members. Those with a medical history of colon polyps, certain tumors, or inflammatory bowel disease should have more frequent colon exams.

“During colonoscopy, your doctor looks at the inside of your colon in search of polyps or other signs of cancer,” says John W. Seedor, M.D., chief of the Section of Gastroenterology at Taylor Hospital. “If cancer is found, then surgery is the most common form of treatment for cancers found at an early stage, which means that the disease has not spread outside the colorectal area.”

Most polyps grow on stems or stalks, like a mushroom, called pedunculated, and are usually simple to remove during a colonoscopy. Sessile or flat polyps grow on the surface of the colon wall, making them more difficult to see and remove. Once the polyps have been sent to the pathologist, several different types of polyps are diagnosed.

There are four types of non-malignant polyps that the pathologist is likely to see. One kind, inflammatory or pseudopolyps, are actually a local reaction to a chronic inflammation. These may be isolated or found in people with inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease. Another kind is hyperplastic polyps, which are usually very small and have a low risk of turning into cancer. On the other hand, tubular adenoma or adenomatous polyps are the most common and have a definite risk of turning into cancer, which increases with the size of the adenoma. Villous or Tubulovillous adenomas are less common, but carry a much higher risk of cancer.

Dysplasia describes abnormal cells in adenomas that are pre-malignant, or halfway between benign and cancer. Dysplasia in polyps can be low grade or high grade, and usually requires follow-up because it may be a sign of malignancy.

“Colorectal cancer (often referred to as colon cancer) occurs when abnormal cells grow in the lining of the rectum or colon,” says Mark Jacobs, M.D., chief of the Section of Gastroenterology at Delaware County Memorial Hospital. “The cause of colon cancer is still unknown, but proper screening and early detection matched with the appropriate treatment plan can help to cure this disease.”

“Most importantly, the best time to diagnose colorectal cancer is before symptoms appear. Therefore, screening is essential and should not be put off,” says Michael Farber, M.D., medical director of the Endoscopy Center at the Crozer Medical Plaza and Crozer-Keystone Regional Cancer Center at Brinton Lake, which opened in December 2011 at 500 Evergreen Dr. in Glen Mills. “If you experience blood in the stool, stomach cramping and pains, changes in bowel habits (diarrhea, constipation and narrowing of the stool), decreased appetite, vomiting, weakness and fatigue, it’s important to see your doctor as soon as possible. Even symptomatic colorectal cancer can be treated successfully.”

As with most diseases, prevention is the best prescription for decreasing your risk. Practice a healthy lifestyle and see your specialist regularly to lower your risk of colorectal cancer.

Crozer-Keystone offers colonoscopy services at five locations: Crozer-Chester Medical Center, Delaware County Memorial Hospital, Springfield Hospital, Taylor Hospital and the new Crozer Medical Plaza and Crozer-Keystone Regional Cancer Center at Brinton Lake.

For more information about Crozer-Keystone gastroenterology services or to find a physician who performs colonoscopies, call 1-877-CKHS-GI1 (1-877-254-7441) or visit http://www.ckhsgi.org. To find a Crozer-Keystone physician who cares for cancer patients, call 1-866-695-HOPE (1-866-695-4673) or visit http://ckcancer.crozerkeystone.org.

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