Colorectal cancer

Awareness months, weeks, and days help to bring a greater understanding of illnesses and issues that affect people. March is Colon Cancer Awareness Month and serves to get people aware of what colon cancer is, how it can be prevented and how it can be treated. Gastroenterologist Dr. E. Marcus Cooper said colon cancer screening is a part of health maintenance and that everyone aged 45 and older should be screened for colon cancer. And he said medical professionals are seeing more and more colon cancer numbers.

Referencing Andrea Darville, who died on April 2, 2022, due to complications from colorectal cancer at age 31, and who he said was one of the strongest advocates for colon cancer awareness and was vocal about it after her diagnosis with stage four colon cancer at age 28, Cooper said, highlights the challenge in The Bahamas where people are being diagnosed younger and presenting at a much later stage when there is very little that can be done.

“There has been very good education for breast cancer, and very good education for prostate cancer, but colon cancer has lagged behind significantly,” said Cooper, who heads GastroCare Bahamas. “As far as overall numbers … breast cancer, at least in our country, takes more lives than both prostate cancer and colon cancer. Prostate cancer, the longer you live, will definitely affect more men. Colon cancer numbers haven’t always been so great, but steadily because of our poor dietary habits and sedentary lifestyles, and unknown family histories, we are starting to see more colon cancers every year and starting to see them present at earlier ages.”

Darville was one of those cases who Cooper said was a champion for awareness through her campaigns and organization of the inaugural Get Your Rear in Gear – Bahamas fun run/walk with the Colon Cancer Coalition. She died a month prior to the event.

“Andrea’s story was one that attracted a lot of attention and sort of highlighted this challenge that we have in the country where people are being diagnosed younger and presenting at a much later stage when there is very little that can be done,” said Cooper.

In order to have the best possible outcome, he said people need be screened before they develop any symptoms, and asymptomatic people should be screened.

“So, we ideally want people to have their colonoscopies or screening before they develop any symptoms , hence, annual screening.”

National screening guidelines recommend screening at 45, which the gastroenterologist said has become the age standard internationally at which people of African descent should start their screening.

“While it may not have allowed us to prevent Andrea’s colon cancer, because she was an unsual case, the majority of people presenting will do so after the age 45,” said Cooper.

Symptoms

Unexplained abdominal pain is a common symptom.

If you develop unexplained abdominal pain – and for women, it’s not period pain; and not food poisoning that’s very short-lived; or someone who has gallstones and having pain – then the doctor said the pain could be related to your bowel.

The most alarming symptom he said is blood in stool.

“Blood in stool is never normal and should always be investigated by a healthcare professional,” said Cooper.

In his 12 years of practice, Cooper, who operates out of 68 Collins Avenue, Centreville Medical Centre, said he has seen an increase in the number of people doing colonoscopies, and even asking their primary physician and general practitioner about colonoscopies. He said the practitioners are also getting better at asking patients if they have had a colonoscopy, or some form of colon cancer screening.

“Like with everything, repetition is key, and so, people who were in their 30s and early 40s when I started may be a little more sensitive to the need to take a colonoscopy. Some people who may not have symptoms are now getting the message to get colon cancer screened.

“Both men and women need to get better at preventative healthcare and not waiting to see a doctor when something happens, so having that annual wellness visit where all cancer screenings can be discussed is critically important to living a healthy lifestyle free of sickness and disease.”

Risk factors

Major risk factors for developing colon cancer, Cooper said, are based on an unhealthy lifestyle.

“A diet that is high in fat and low in fiber are considered risk factors for developing colon cancer,” said Cooper.

“Obesity, which is an epidemic in our country, is also considered a risk factor for colon cancer. Cigarette smoking, which may not be so common, is also a risk factor. And family history cannot be ignored if you have a first-degree or second-degree relative who has been diagnosed with colon cancer; this increases your risk of developing colon cancer in your lifetime.”

Screening

With a number of screening options offered, Cooper said people can choose to do a fecal occult blood test (stool blood test); a virtual colonoscopy (barium enema); or the gold standard, colonoscopy.

The fecal occult blood test he said is the easiest and least expensive. It detects microscopic amounts of blood in the stool. It is a test that is recommended be taken at least every other year.

“Before colon cancers become cancer, they start off as polyps and polyps start off as pimples inside the colon. As they grow, they release very small amounts of blood that cannot be detected by the human eye but are detected on these stool tests.”

The virtual colonoscopy is a CAT scan that allows the doctor to take a three-dimensional picture of the inside of the colon. It is a test that Cooper said is useful in identifying polyps or cancers in their early stages.

“Unfortunately, the virtual colonoscopy does not allow us to remove or biopsy any abnormality that is seen. That’s the con, so a positive test will have to be referred for the routine colonoscopy.”

The barium enema, which Cooper said is an older test, in which an x-ray dye is injected into the rectum and an x-ray taken, shows abnormalities inside the colon, and can still be effective in identifying colon polyps and colon cancer. 

And that it does not allow the doctor to biopsy or remove anything that’s seen.

“The colonoscopy is the universal gold standard for colon cancer screening. It allows the detection and removal of colon polyps, or colon cancer, in its very early stages,” he said.

A colonoscopy is only required once every seven to 10 years, if it’s normal. Besides the gold standard colonoscopy, Cooper said all other forms of colon cancer screening have to be done more often.

Test preparation and
what to expect

While the colonoscopy has not changed much, the preparation for the procedure has, a little, so that the process of cleaning out the bowel is less stressful. It used to be a two-day prep – now, it is a one-day prep.

The doctor said the procedure is also comfortable and painless.

“A colonoscopy usually takes 20 to 30 minutes. So, on the day of the procedure, a person will be sedated with medications that are given intravenously and this keeps them comfortable during the duration of the procedure. You wake up and go home. It’s a same-day procedure.”

Preparation usually starts the day before as a liquid diet – clear liquids which can entail coffees teas, broth, coconut water and anything that a person can see through. In the evening after work, the doctor said is when a person’s preparation begins, which he said is usually drinking a solution that contains a laxative that will totally clean out the bowels, before the individual goes into the office the following morning. The gastroenterologist said under most circumstances, people will only have to take the day of the procedure off.

During Colon Awareness Month, Cooper said he and his colleagues collectively offer colonoscopy discounted prices, countrywide, to encourage people to have their colonoscopies done. If a person has insurance, in most cases, the doctor said the co-pay is waived, but the individual has to have met their deductible.