For the month of March, which is Colon Cancer Awareness Month, I want to review the early symptoms of colon cancer so we can prevent this disease more successfully. Colon cancer is one of the few cancer you can prevent by doing colonoscopies.
The general recommendation is to have a baseline colonoscopy at 50 years and then repeat it every 5 to 10 years, which reflects that polyps or colon cancer development takes a long time. This leaves a window of opportunity to do the screening, remove polyps, and prevent colon cancer.
However there are exceptions. Patients with family history are at higher risk. Any family member diagnosed with colon cancer increases your risk. You need to discuss when you should start screenings with your primary care physician.
Today I am reviewing early symptoms. I have seen too many patients, particularly young ones, who had symptoms for more than a year. They went to their physicians, but they were thought too young to have colon cancer. If you have any of the symptoms discussed here which do not respond to treatment, continue, or get worse you need to think about a colonoscopy.
Colorectal cancer can develop with very few, if any, symptoms at first. One of the most obvious signs which can signal colon cancer is bright red blood in or on the stool. However, we all know that blood in the stool does not always mean cancer. In most cases it means hemorrhoids and in rare cases polyps or diverticula which can bleed. Bright red blood is different than black stool. Blood which was in contact with stomach acid turns bright red blood into black stool.
Any persisting blood in the stool should be worked up. Usually when blood is on the toilet paper when you wipe, it is more likely to be hemorrhoids. Hemorrhoids often also have itching and painful bowel movements associated with them. Rarely anal cancer can hide behind these symptoms. All ongoing blood in the stool should be examined by a physician.
Other early symptoms are any change in bowel movement habits or stools that are narrower than usual. However, changes may be subtle. You may have constipation and diarrhea. As you can imagine we all undergo changes in how we move our bowels depending what and how much we eat. Changes of bowel habits are also associated with unexplained stomach discomfort. Frequent gas, pain, or indigestion should trigger a visit to a physician to work these symptoms up. Stomach flu can cause the same symptoms, but the critical element that symptoms persist and don’t go away.
Any persisting symptom should be of concern and get you to see a physician for examination and laboratory work up. I have many patients, particularly young one in their thirties, who are in treatment for metastatic disease and who had symptoms for years. One of these patients is 34-year old young man who had blood in his stool for over a year but otherwise was very healthy. He saw his doctor three times for his symptoms but was told he had hemorrhoids.
He was not the first young patient who was told he was too young for colon cancer, and it must be hemorrhoids causing the bleeding. If you have ongoing blood through your rectum, you should undergo a colonoscopy even when you are young and have no family history.
Depending on the location of the cancer symptoms may be very different. There are right side, transverse and left side colon and rectal locations. When tumors develop on the right site of the colon, which found more often in young patients with a genetic predisposition, they may just have uncharacterized stomach discomfort. Some of these patients have been treated for months for indigestion or upset stomach because it seemed that their symptoms were related to the stomach and not the large bowel.
If you have any family history of colon, endometrium, or ovarian cancer or any the symptoms above, please contact your doctor and get a diagnostic work up which should include colonoscopy and laboratory tests.
April 24, 2009 at 1:37 am, greta said:
It seems that much of the medical profession is locked into outdated guidlines for colon cancer screening. The age of 50 to start screening for example, with the fastest growing age group being diagnosed with CRC is 25-35 years of age. The refusal to remove hyperplastic polyps when some of the latest studies have shown they are not absolutely benign, and can be a precursor to malignancy.
May 31, 2009 at 4:03 pm, Linda Stout said:
Hello Dr. Lenz,
It took a while for me to find you but I am delighted to again get to read your blogs.
Could you please expand on this topic about early symptoms of colorectal cancer?
I personally had anemia for numerous years before being diagnosed at age 43. I am told my cancer probably started when I was around 28. I was always pointed towards iron supplements. I eventually just thought being anemic was normal. Had I only had a doctor who investigated a little deeper.
Thank you for your time. I love reading your blogs and wish I lived closer to California.
Michigan fan (Linda Stout)
May 31, 2009 at 9:04 pm, Heinz Josef Lenz said:
glad to hear you are doing well and happy you find me. HJLO
July 09, 2009 at 1:18 pm, Heinz-Josef Lenz said:
Linda, thanks for sharing your concerns and symptomps. I would certainly if these are ongoing symptoms consider work up wiht laboratory including liver, kidney function and some markers such as CEA and CA19-9 as well as a CT scan to make sure there is nothing in your belly. bloating can be a symptom of incomplete digestion which can be stomach, bile or pancreas issues. did you loose weight, you have smelly stool? floating? any nausea with or without eating, you should discuss this with your MD, also what kind of cancer was in your family what gut? HJL
January 12, 2011 at 6:34 pm, Al B said:
I am scheduled for screening and was advised the symptoms I have been experiencing for three years would have become much worse and detected if from cancer. Then I read the attached. “tarted at age 28 and diagnosed a age 43″ I have used several home test kits for blod detection all neg. Would blood likely be detected it a cancer was present?
“Hello Dr. Lenz,
It took a while for me to find you but I am delighted to again get to read your blogs.
Could you please expand on this topic about early symptoms of colorectal cancer?
I personally had anemia for numerous years before being diagnosed at age 43. I am told my cancer probably started when I was around 28. I was always pointed towards iron supplements. I eventually just thought being anemic was normal. Had I only had a doctor who investigated a little deeper.”
January 12, 2011 at 10:12 pm, Kate Murphy said:
Al,
Unexplained anemia is one of the symptoms of colorectal cancer.
When someone has low red blood counts, it is important to find out why. A colonoscopy should be part of the work-up.
Both some polyps and some cancers bleed. Since they don’t bleed all the time, tests that look for blood in the stool can miss them. They can also find blood from other problems higher in the intestinal tract like stomach ulcers.
That’s why a colonoscopy is so important when someone has anemia for which there is no real known cause.
Iron supplements may help — or they may just mask a problem.
Other symptoms of colorectal cancer include:
** Changes in bowel habits including persistent diarrhea or constipation.
** A feeling that the bowel isn’t emptying completely when you go to the bathroom.
** Bright red or very dark red blood in the stool or black, tarry stools.
** Very thin stools.
** Abdominal discomfort including frequent gas pain, abdominal fullness, cramping, or bloating.
** Weight loss with with no apparent reason.
** Constant fatigue or tiredness.
** Unexplained anemia.
Of course, there are many other reasons for these symptoms. They don’t necessarily mean cancer.
But it is critical to evaluate what they do mean, including getting a colonoscopy.
January 20, 2012 at 8:32 am, JUDY IRVIN CRAWLEY said:
my brother has a black retum what is wrong
January 23, 2012 at 7:40 pm, Kate Murphy said:
If you mean he is having black stools or diarrhea, that can be a sign of blood somewhere in the intestinal tract, including the upper part of the colon.
It is critical that he talk to a doctor and have a colonoscopy as well as tests for stomach problems.
April 03, 2012 at 1:11 am, Karie said:
I have bloody stools for about a year and I just thought it was because of hemorrhoids. Then it started getting worse. I have all the symptoms you have listed and I so scared, I have a history of cancer in my family. I am only 29, I made an appointment with a GI and I will request a colonoscopy. Thank you for your blog I would hate to get
April 08, 2012 at 3:44 pm, matt said:
37 yearold male blood in stooles and when i wipe
plus i wiped and there mucus like substance
April 10, 2012 at 9:14 am, Kate Murphy said:
If you have blood in your stool, it is important to see a doctor and find out why.
There are some reasons for blood in the stool other than cancer, but it is critical for anyone at any age to rule out colon or rectal cancer when they see blood in the stool.
The best test for that is a colonoscopy.
Don’t let a doctor tell you that you are too young for colorectal cancer. About 1 in 10 people with colorectal cancer are diagnosed under the age of 50. Recognizing and following up on symptoms is critical to find and treat those cancers early when they can be cured.