Tips From a Member of Our Medical Advisory Board

Al B. Benson III, MD, FACP FASCO is Professor of Medicine, Feinberg School of Medicine,  and Associate Director for Clinical Investigations, Robert H. Lurie Comprehensive Cancer Center, Northwestern University

One of the nation’s most respected experts in colorectal cancer, Dr. Benson has supported and worked with Fight Colorectal Cancer for years as an active member of our Medical Advisory Board.

Written by Dr. Al Benson, March 18 2013, Chicago, Illinois

Although March is Colorectal Cancer Awareness Month, this disease is so frequent yet in most cases preventable that we should be striving every month of the year to make even more people aware of the importance of colorectal cancer and colorectal cancer screening. The good news is that we are seeing a trend that showing more people are getting screened and more people are surviving this disease. Even so, we have much more work to do to prevent and treat colorectal cancer.

Important information to know – from screening to diagnosis for colorectal cancer:

1) Know your family history. In some cases, colorectal cancer risk is inherited and the genetic risk can be passed on to generations within a family. For those with a risk for inherited colorectal cancer, genetic counseling and testing is strongly recommended. Also if you have an immediate family member who has had colorectal cancer, your risk for developing the disease is greater. Let your doctor know about the details of your family history. If you are unsure of your family history, discuss it with your relatives to be as complete as possible.

2) If you are of African-American descent, you are potentially at higher risk for developing colorectal cancer and screening should begin earlier, at age 45.

3) There is growing recognition that obesity, diabetes and lack of exercise are contributing factors to the risk of developing colorectal cancer and these risks should also be discussed with your doctor.

4) Talk with your doctor if you experience bleeding from the rectum. Many people assume bleeding is “just hemorrhoids,” which might be true, but it also could be a sign of colorectal polyps and/or cancer. Discuss any bleeding with your doctor as well as other symptoms including change in bowel habits (e.g., recent but persistent diarrhea and or constipation), persistent abdominal pain, weight loss or loss of appetite, or increasing fatigue.

5) If you are diagnosed with colorectal cancer, make sure you ask which members of the medical team will be important for your care. A gastroenterologist, surgeon, medical oncologist, radiation oncologist (for rectal cancer), nurse, nutritionist, psychologist, social worker, financial counselor, genetic counselor are some examples of team members who you may really need to help with your diagnosis and treatment.

6) Ask if you are a potential candidate to participate in a clinical trial. All of our current therapies and advancements in the treatment of colorectal cancer have come about because people through the years participated in a clinical trial. Oncologists consider clinical trials to be one component of the standard of care. Further advances in colorectal cancer treatment will require many people willing to enroll in our clinical trials.

7) There are resources available for you. Fight Colorectal Cancer has great information available for you. The National Comprehensive Cancer Network (NCCN) has created guidelines for treatment used around the world by health care professionals. There is a patient version of colorectal cancer guidelines  that you can obtain on the internet and bring to your doctor.

I hope some of these tips will offer you and your family some additional guidance as we continue our efforts to control this common cancer.

Colorectal cancer develops with few, if any, symptoms at first.

It depends a little on the location of the colon cancer. If the cancer is closer to the anus (left side), symptoms may include blood in or on the stool, a change in bowel habits, stools that are narrower than usual and general weakness and weight loss. These symptoms are more typical for colon cancer and physicians would easily recommend a colonoscopy for further work up. However if the tumor is on the right side, almost a foot away from the anus, the symptoms may be more  general such as unexplained stomach discomfort, frequent gas, pains, or indigestion, unexplained weight loss and chronic fatigue.

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“Symptoms and Risks” fact sheet (PDF)
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People come to an initial medical work-up for colon or rectal cancer from different places. They may have had a suspicious polyp or cancer found during a routine screening. They may be experienced symptoms that might be caused by colorectal cancer. Getting an accurate diagnosis is critical because treatment for colorectal cancer depends on the diagnosis. For example, treatment for colon cancer is different than treatment for rectal cancer, and treatment for cancer which has spread outside of the colon is different than treatment for cancer which is limited to the colon. Getting an accurate diagnosis can take time and many different tests. It may require surgery, and examination of surgically-removed tissue to determine whether the cancer has spread. This process can involve several health professionals including:

• The gastroenterologist who will perform a colonoscopy if it has not been already done and remove tissue for biopsy. The gastroenterologist may remove suspicious polyps for pathology or, if they are large, leave them in place for later surgical removal.
• Pathologists who will examine biopsies under the microscope to identify precancerous cells or cancer (malignancy.)
• Radiologists who will perform CT-scans or other x-ray tests to see if the cancer has spread to other parts of your body.
• A general surgeon or colorectal surgeon who will give you a physical examination and ask about your medical history, order blood tests, review reports from gastroenterologist, radiologist, and pathology, and help decide on an initial treatment plan.
• If necessary, a medical oncologist who deals with chemotherapy treatment or a radiation oncologist may be involved at this point or they may join the treatment team after surgery. Specialized surgeons may also be called in to examine you if there is a possibility that the cancer has spread beyond your colon.

Choosing a medical team is an important initial step in getting an accurate diagnosis, especially if rectal surgery is involved. Work with your medical team to make sure that your evaluation, diagnosis, and staging are done carefully and thoroughly.. Get a second opinion if there is uncertainty about issues such as what tests are necessary, if surgery is the right first step, and whether staging is accurate. A second opinion at a large cancer center, particularly a National Cancer Institute designated cancer cancer or a member of the National Comprehensive Cancer Network can be valuable even early in the diagnostic process.

• Locate an NCI Cancer Center in your state.
• Locate an NCCN Comprehensive Cancer Center

Where Can You Go for More Information?

American Cancer Society How is Colorectal Cancer Diagnosed? Cancer.Net When the Doctor Says Cancer along with a podcast can help you learn questions to ask about your cancer and its diagnosis and how to understand and manage the information you get from your doctor.

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