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.