Articles written by me on Self-care and Palliative Medicine
On Self-Care & Palliative Medicine

The Scope of the Problem

At age 92, Charlie Martin Jones told his grandson, “The secret to a long and happy life is to keep your mouth shut and your bowels open.” Both aspects of this wonderful advice are important, but I want to speak to the second point this week. March 2000 is “Colon Cancer Awareness Month”. Although a developing tendency for constipation may be a subtle sign of colon blockage. . . possibly colon cancer, it does appear that a lifetime of constipation may, in fact, be one relative risk for colon cancer. A diet high in fiber–especially whole grains, fruits, and vegetables, coupled with regular EXERCISE may actually be ‘protective’ to an individual since these habits decrease the tendency for constipation. But there are multiple reasons for colon cancer, not all of which we fully understand.

We do know that colorectal cancer is the second most common cancer in the United States. In the year 2000, it is estimated that over 150,000 Americans will be diagnosed with this disease, and that approximately one third of them will subsequently die because of this cancer. Consequently, colorectal cancer is expected to kill more Americans this year than either breast cancer or AIDS. More importantly, you need to know that up to two thirds of these deaths are preventable with simple screening and prevention methods. More than 90% of colorectal cancers can be cured if they are caught early. . . before there are any symptoms. Obviously, if you don’t go regularly to your doctor for the screening tests, your likelihood of detecting this cancer at its very earliest stage is diminished. However, even if you do develop symptoms, colorectal cancer can still be cured if you don’t minimize these symptoms and just “hope they will go away.” If you develop rectal bleeding, blood in your stool, a definite change in your bowel habits, persistent abdominal cramping and either chronic diarrhea or constipation, go to your doctor; check these symptoms out!

Men and women are equally at risk for colon cancer. Definitely, one’s risk increases with age, but over 12,000 Americans under the age of 50 are diagnosed annually with colon cancer. But remember, colorectal cancer usually takes a very long time to develop–years–and that’s why it is so preventable. If a person is screened and found to have significant polyps in his or her colon, these can be removed through a colonoscope before the polyps become cancerous. For “Average Risk” patients who are 50 years old and over, screening stool specimens for occult blood, flexible sigmoid exams, double contrast barium enemas and/or full colonoscopies are recommended at various intervals for surveillance. Check with me or your own personal physician about the guidelines appropriate for you. If you have a family history of colon cancer or have had precancerous polyps removed before, you will need more stringent screening guidelines.

But, above all, take the responsibility to request these tests. Who knows your body better than you? Is there anyone more appropriate to be your health advocate than you? Educate yourself about appropriate screening techniques, and then see your doctor. Discussing bowel habits can be embarrassing to some people. Additionally, fear of the screening tests I have mentioned above may keep some people from seeking the tests. But, just remember, every year, I discover at least two early colon cancers in patients in my own practice alone. These cancers are discovered through routine screening procedures; the patients have no symptoms and no idea that they have cancerous polyps. And these people are completely cured by polyp removal. The scope of the colon cancer problem in the United States can be significantly reduced if each of us has stool blood exams and either sigmoidoscopic or full colonoscopic screenings at appropriate, regular intervals. As the Oscars approach, remember that a picture is worth a thousand words; and a look at your colon may save your life.

Stephen L. Hines, M.D.
March 2000

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