Colon Cancer In Seniors
Last Updated: April 2, 2013
Colon cancer occurs ninety percent of the time in people who are
over the age of 50. Also called colorectal cancer, a more accurate
name due to the focus on the lower intestine including the rectum,
this disease is the second leading cause of cancer death in the
United States. The cancer claims the lives of almost 50,000 men and
Colorectal Cancer Facts and Myths
Colon cancer in seniors remains one of the most preventable
cancers if detected early enough. However, most doctors believe
that, because of the perceived invasive and uncomfortable nature of
the screenings, people delay screening and colon cancer is often
far along by the time it's diagnosed. Unlike many diseases that
exacerbate as the patient ages, both diagnosis and treatment of
cancer in seniors is the same as it is for younger people.
"We make the mistake of bypassing the detection screenings in
the elderly," Dr. Samuel Whiting, of the Seattle Cancer Care
Alliance and the University of Washington Medical Center, explains.
"Yet there is not necessarily an appropriate time to stop screening
for colon cancer. In fact, the odds are just as good for someone
over seventy to survive this disease as it is for someone half that
Whiting states that there is no reason to make decisions
concerning treatment based on someone's age. "Age is also not a
deciding factor because all of the drugs that we use for younger
patients are available for older patients. Though of course,
doctors will look carefully at the vulnerability of aging areas
like the kidneys, etc."
"Witness the 55-year-old with co-morbid diseases," he continues,
"Additional physical problems that impact the cancer treatment. An
80-year-old who exercises and is healthy will react much better to
the therapy, which will likely include surgery and, possibly,
Whiting admits it's not just the general population who assumes
the elderly are more vulnerable to colorectal cancer prevention and
"Doctors arbitrarily scale back the treatment of chemotherapy
because they think the elderly can't take it," he confides.
If doctors frequently limit the intensity of the treatment for
their senior patients due to a presumption of weakness, the younger
victim falls prey to misdiagnosis due to the doctor's presumption
"I went to my primary care doctor after discovering blood in my
stool," recalls Anita Mitchell, a 44-year-old Seattle resident and
outspoken advocate for preventive screening. "My doctor told me not
to worry, it was probably hemorrhoids. I went in again after a
noticeable change in my bowel movements, another significant
symptom of colon cancer. Again, my doctor said it was nothing,
blaming the change on the coffee I drank."
Anita Mitchell was only 40 at the time of her first symptoms.
Her doctor didn't consider an oncologist referral because only ten
percent of people under fifty contract the disease. She returned to
her doctor after the blood level in her stool increased
dramatically. She had also just learned that her father had died of
colon cancer. In fact, she should have received her first screening
at age 30, ten years before her father's initial diagnosis.
When Mitchell finally saw a gastroenterologist, he found so many
polyps in her colon that he bypassed a biopsy and sent her straight
to the oncologist. Her CAT Scan revealed seven additional tumors in
her liver. Immediate surgery removed eighteen inches of colon,
sixteen lymph nodes, and an ovary. Four years later, Mitchell is
finally feeling healthy again.
"It's easy for doctors to blow you off when you are young and
showing signs of an older person's disease," she says. "It's
important to have hope, and not let anyone tell you you're a
Mitchell, though hardly elderly, serves as prime example of the
value of preventive health care and colon cancer. If her cancer had
been detected early, even with a hereditary predisposition to the
disease, surgery and treatment could have all but eliminated the
cancerous tumors. Because she did not learn of her cancer until her
symptoms were frighteningly far along, her life almost ended.
According to the Mayo Clinic, one in seventeen Americans (or
about 150,000 annually) contract colon cancer at some point in
their lives; it is recommended that people begin screening for the
disease no later than age 50. Of course, screening should begin
earlier if one has familial history with the disease. A history of
inflammatory bowel disease (IBD) such as Crohn's disease or
ulcerative colitis may also lead to higher rates for the cancer.
Though the disease strikes men and women equally, African Americans
appear much more vulnerable. People who smoke are twice as likely
to get colon cancer. Those who are obese, drink heavily, maintain a
sedentary lifestyle, or suffer from
diabetes are also considered more susceptible.
Conversely, a healthy, active lifestyle that includes consistent
exercise and a high fiber diet rich in vegetables and fruits with
limited red meat intake improves the chances of preventing colon
cancer in seniors.
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Colorectal Cancer Screening
Because colon cancer is usually slow growing (twelve to fifteen
years according to Whiting), timely screening for small
precancerous growths (called adenomatous polyps) is by far the most
successful preventative of the disease. Awaiting symptoms,
including a change in bowel habits, narrow stools, rectal bleeding,
cramps, or unexplained weight loss, increases the chances of
discovering a stage III or IV cancer.
"Colon cancer is almost completely preventable," says Dr.
William Grady, medical director of the Gastrointestinal Cancer
Prevention Program at the Seattle Cancer Care Alliance.
"Unfortunately, only 20 to 40 percent of people receive screenings
when they turn 50, which also explains why roughly a third of the
cases we see are too far advanced for realistic survival."
Thanks to researchers like Whiting and Grady (who are also both
affiliated with the Clinical Research Division at the Fred
Hutchinson Cancer Research Center), the screening techniques are
well known and, with recent scientific innovations, improving
The screenings do vary in effectiveness and convenience. One
should consider age, medical history, and comfort level (or
discomfort tolerance) when evaluating the appropriate screening
Colonoscopyremains the most comprehensive of tests. Long thought
to be as painful as it was invasive, Whiting explains that there is
plenty of myth in this assumption: "People tend to fear what the
colonoscopy [a rectal probe] entails, but this is just an issue of
education because the more people learn how the study is done [the
more] they realize it is not unbearably invasive. Just based on
probabilities, I would never discourage someone from having
Patients may receive anesthesia for their colonoscopy, usually a
mild sedative to lessen anxiety. The colonoscope extends the length
of the colon, allowing the camera (and doctor) to scan the entire
surface. The apparatus also allows the doctor to insert instruments
to remove polyps, and even destroy ominous-looking tissues. The
exam, which averages about forty minutes in duration, currently
remains the best screening method, and is often covered by
Medicare. An older, low-risk individual should undergo a
colonoscopy once every decade.
Flexible sigmoidoscopyis a less invasive procedure because it
only surveys the lower portion of the colon, but this limits its
scope. Worrisome polyps and tissue can also be removed surgically
through the sigmoidoscope as well. Rarely conducted with
anesthesia, the procedure costs less but should be conducted every
five years. Both Whiting and Grady recommend that people over 50
with low risk undergo the procedure in tandem with an annual fecal
occult blood test.
Thefecal occult blood test(FOBT) is completely noninvasive, and
patients are often given a kit to conduct the procedure in the
comfort of their own home. The FOBT is designed to identify traces
of blood in your stool, blood that is invisible to the naked eye.
Though quite inexpensive and very convenient, the FOBT doesn't
distinguish the source of blood, which can result in a
false-positive test. (Blood in the stool may not be the result of a
cancerous polyp.) Additionally, cancers and (most polyps) don't
always bleed, which may then result in a false-negative.
Thebarium enema, recommended every four to five years, is a
chemical analysis that involves coating the entire colon with
barium, then viewing it via X-ray for abnormalities. Though this
procedure carries less physical discomfort then the scopes, the
doctor doesn't enjoy the potential of removing suspicious polyps
and tissue. This test should also be issued together with an annual
Recent research developments may offer new standards in colon
cancer screening. These tests include:
- Capsule endoscopy: This involves ingesting a pill-sized camera
that records the middle portion of your colon. The endoscopy even
contains its own light source. The apparatus detects intestinal
bleeding and polyps, as well as inflammatory bowel disease, ulcers,
and tumors. Unfortunately, the pill-camera cannot remove
- DNA stool testing: This looks for DNA changes in your stool
that are caused by existing cancerous cells. Precancerous polyps
are also revealed by DNA changes, as detected by genetic markers.
According to the Mayo Clinic, this test ranges from 71 to 91
percent for detecting cancers, and from 51 to 82 percent for
detecting large polyps.
- Virtual colonoscopy (VC): A three-dimensional X-ray of the
colon, hundreds of instant photographs are taken to capture the
entire landscape of the colon wall. Though equally noninvasive and
much more accurate than the barium enema, VC shares the same
limitations on real time surgery as the barium enema. There is also
the potential for missing the smallest polyps with this screening
These numerous screening tests, combined with an early detection
(Stage I) survival rate of nearly 95 percent, means there are few
excuses for people to avoid a preventive procedure. Even Stage II
detection leads to an 85 percent recovery rate. To add perspective,
Stage IV recovery is but 5 percent. Most insurance companies,
including Medicare, cover the standard cycles of tests as well.
"There are even new colonoscopes that are more flexible and less
invasive," Grady explains. "So if there is anything that can be
done to prevent colon cancer it may come from more discussion about
the importance of [timely] screenings."
Colorectal Cancer Treatment
Treatment after early detection is often straightforward, and
positive. "Surgical treatment results in a very high rate of
success if the cancer is detected early," Grady says.
Surgeryis often considered so effective in Stage I and Stage II
detections that chemotherapy and radiation treatment become
unnecessary. Several surgical procedures exist, ranging from a
"local excision," when surgeons remove the cancer and surrounding
tissue during the colonoscopy, to the "extended resection," when
the cancer has spread beyond the colon wall and the removal of most
of the colon is necessary. This often, but not always, results in a
colostomy, where waste is removed through a hole in the abdomen
into a specially designed bag. Chemotherapy and radiation (see
below) may also be used prior to and/or after surgery as well.
Chemotherapyincludes oral or injected drugs designed to kill
remaining cancers. Chemotherapy may also be injected in the
specific area of the body to focus on a specific organ or set of
organs. Fluorouracil (5-FU) has been the drug most often used in
colorectal cancer treatments. Newer drugs include
Camptosar®, Eloxatin®, and
Radiation therapyuses high dosage X-rays to kill cancer cells.
External radiation uses an outside x-ray machine and internal
radiation employs a radioactive substance that is sealed in a
variety of time-released apparatuses placed within the body near
Immunotherapystimulates the body's own immune system to treat
cancer. While most of these therapies are considered experimental,
the FDA has recently approved two new drugs in this class,
Erbitux® and Avastin®, to treat colorectal
cancers. These medications, called monoclonal antibodies, are
usually used in conjunction with chemotherapy.
"It is simply inertia that leads people to avoid inconvenience,
and yet colorectal cancer is very pertinent to the senior
community," Whiting says. "It is also important to remember that,
while treatment remains the same for older individuals, there is no
age at which one should end the screening cycle. You should never
assume you are too old to be screened."