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 women annually.
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 colon 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 age.”
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, chemotherapy.”
Whiting admits it’s not just the general population who assumes the elderly are more vulnerable to colorectal cancer prevention and treatment.
“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 of strength.
“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 statistic.”
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.
Risk Factors
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.
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 steadily.
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 choice:
Colonoscopy remains 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 one.”
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 sigmoidoscopy is 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.
The fecal 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.
The barium 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 FOBT.
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 troublesome polyps.
- 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 method.
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.
Surgery is 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.
Chemotherapy includes 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 Xeloda®.
Radiation therapy uses 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 the cancer.
Immunotherapy stimulates 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.”