Colon health may not be something we think about every day, but it should be, especially when it comes to good habits that can lower risk for disease. March is Colorectal Cancer Awareness Month, an ideal time to schedule the doctor visit or screening colonoscopy you may have been putting off, says Dr. Samuel Rheinhardt, a colorectal surgeon at SSM Health St. Joseph Hospital – St. Charles.

screening
“The vast majority of colon cancers are adenocarcinomas,” Rheinhardt says. “They tend to start off in the form of polyps that grow on the inner wall of the large intestine, and some symptoms are more obvious than others. Some patients don’t notice signs until the cancer is at a more advanced stage, so it’s important to pay attention to any changes. As soon as you see a problem like passing blood or a difference in the size or consistency of your stools, you should consult a doctor.”

Rheinhardt says it’s easy for patients to dismiss stool changes as temporary gastrointestinal upset, but they may signal a more serious problem. For example, if your stools are normally a couple of inches wide, but they start appearing more like the width of a pencil, it could be a sign that a cancerous growth is partially blocking the large intestine. Or, you might have polyps that are causing symptoms like watery diarrhea.

“Most colorectal cancer patients I talk with, even those who are only in their 30s or 40s, say they had a feeling something was wrong even before they received a diagnosis,” Rheinhardt says. “It’s important to pay attention to your body’s signals. Unseen problems such as internal blood loss from gastrointestinal tract cancers can cause symptoms like unexplained weakness and fatigue. If you have any sense that something isn’t right, don’t hesitate to talk with your doctor and get any tests that may be needed.”

Rheinhardt says patients who have postponed seeking colorectal care during the COVID-19 pandemic may be experiencing unfortunate effects of the delay now. “We are seeing some more advanced cancers because people felt leery about going out and didn’t see their doctors during the first two years of the pandemic,” he notes. “It’s very important not to put off this kind of care. That delay actually could mean the difference between a polyp that can be removed during a colonoscopy and a cancerous growth that requires part of the large intestine to be taken out.” He points out that hospitals have full COVID-19 precautions in place, so there’s no reason to delay care over safety concerns.

prevention
The best advice for lowering colorectal cancer risk is three-pronged: Don’t smoke, eat a nutritious diet with plenty of fiber and try to avoid consuming too much red meat. “The typical Western diet tends to be high in red meat and low in fiber, but it should be the opposite,” Rheinhardt says. “When red meat is broken down in the digestive system, it goes through a process called putrefaction that produces metabolites that are carcinogenic, so this type of meat should be limited in the diet. At the same time, a healthy amount of fiber is protective; it balances the scales in terms of stool consistency and motility. If you’re having looser bowel movements, fiber can thicken the consistency, and if you’re constipated, it can regulate your bowel movements in the opposite direction.”

Rheinhardt tells patients that the benefits of fiber can be illustrated by the idea of squeezing toothpaste out of a tube. “When the tube is full, you don’t have to apply much pressure, but at the end, you have to apply a lot more,” he says. “When you consume the right amount of fiber, the colon doesn’t have to work as hard to move stool along, and that helps prevent inflammation, which is a precursor to most cancers in the body.”

While it’s beneficial to eat fiber from natural foods like fruits and vegetables, it may not always be feasible to get all your fiber that way, so Rheinhardt often recommends a combination of fresh produce and over-the-counter fiber supplements like Metamucil or Benefiber. “We want to see a patient’s fiber intake at more than 30 grams per day,” he says. “It’s a good idea to make conscious dietary changes like substituting brown rice for white rice and whole grain bread for white bread, then add in a fiber supplement as well. That’s a more realistic, manageable approach than trying to reach 30 grams a day through produce alone.”

at-home testing
If you’ve thought of trying at-home tests for colon cancer, it’s important to keep in mind that they are not for everyone, according to Rheinhardt. “Mail-in tests like Cologuard are only for people with average colon cancer risk and no personal or family history of disease,” he says. “Talk with your primary care physician or gastroenterologist, who can discuss these important subjects and advise when you should have a screening colonoscopy. Prepping for the procedure is easier than it used to be, so there’s no reason not to have it done when it’s time.”

what is a colonoscopy?
For this outpatient procedure, the patient is anesthetized and the physician inserts a long, flexible tube called a colonoscope through the rectum and into the large intestine. A tiny video camera at the tip of the scope allows the physician to examine the inside of the colon for any abnormal tissue. Biopsies can be taken during the procedure, and polyps may also be removed.

colorectal cancer facts

  • About 52,500 people die of colorectal cancer in the U.S. per year; slightly more than half are men.
  • Colorectal cancer is the second most common cause of cancer death for men and women combined.
  • The colorectal cancer death rate has declined by about 56% since 1970 due to increased screening and advanced treatment. However, the death rate for people under age 55 is on the rise. Deaths in this age group increased 1% per year from 2008 to 2017.

Additional source: Mayo Clinic, American Cancer Society