By Jesse Dominguez, DO
My uncle Frank came to CVMG in January 2017 to establish care. His previous doctor convinced him to have a colonoscopy three years prior and my uncle was found to have three colon polyps which were removed. He did not know the pathology results of the three polyps.
In December 2016, my uncle had his second follow up colonoscopy and was told the examination was normal. By March 2017, Uncle Frank had been complaining of general abdominal pain, nausea and vomiting, decreased appetite and weight loss.
A CT scan of the abdomen showed metastasis from adenocarcinoma of the rectum. Uncle Frank was treated by an oncologist with chemotherapy. Eventually he was placed on hospice care when treatment was not working, and unfortunately passed away in 2018.
Uncle Frank worked for the railroad for more than 30 years. He enjoyed exercising at the local 24-hour fitness center, watched his beloved Lakers, Dodgers and Chargers sports teams consistently and loved spending time with his wife, two children and four grandchildren.
His death is a reminder of just how fragile life is and how important it is for us to be aware of the recommendations for colorectal cancer screening.
Colorectal cancer (CRC) is the third most common cancer in men and women in the U.S.
There are approximately 145,000 new diagnoses each year and approximately 50,000 deaths per year. Over the past 20 years, the incidence of CRC-related death has been declining due to increased public awareness, yet thousands continue to die each year.
More than half of all CRC are preventable.
There are modifiable risk factors such as smoking, obesity, inactivity, heavy alcohol use, red meat consumption and decreased fiber in the diet.
The non-modifiable risk factors include a family or personal history of CRC, a personal history of irritable bowel disease (IBD), and a personal history of hereditary polyposis.
Colorectal cancer screening in the general population should begin at age 50 and continue through age 75. The American College of Gastroenterology recommends screening African Americans at age 45.
Individuals between the ages of 76-85 do not need routine screening but may be screened if the patient’s overall health is good and prior screening is unknown. Patients over the age of 85 do not need screening.
Patients with risk factors based on family history can be screened as early as 40 years of age or 10 years younger than the family members age at the time of diagnosis. It is important to speak to your physician regarding these.
The progression from polyp to cancer usually takes about 10 years. After a colonoscopy, the patient should know the results of the procedure especially if polyps were removed.
Polyps can either be benign or malignant and depending on the pathology results will determine how often follow up screening tests be done.
There are three types of stool-based tests:
- Fecal occult blood test (FOBT) done yearly
- Fecal immunochemical test (FIT) done yearly
- FIT-DNA (Cologuard) done every three years
There are three types of direct visualization tests:
- Colonoscopy done every 10 years
- Flexible sigmoidoscopy done every 5 years
- Flexible sigmoidoscopy with FIT – flexible sigmoidoscopy done every 10 years with FIT yearly
The job of the CVMG provider is to inform our patients to get screened by any method listed above. The patient’s responsibility is to use the information provided to them and perform the one of six tests offered. If a stool-based test is positive for blood and a direct visual examination should follow.
March is colorectal cancer awareness month, let’s get informed and start screening our love ones.