Colin Bird, MD, a surgeon at Regional Surgical Specialists, an affiliate of Mission Health, and the only board-certified colorectal surgeon in western North Carolina, has seen this time and again, not just in published statistics, but among his own patients. “Colorectal cancer can be preventable,” he said. “The key to it being preventable is early detection. And the gold standard of early detection remains the colonoscopy.”
Follow the Schedule
According to current screening recommendations, anyone who doesn’t have a personal or family history of colorectal cancer should get a colonoscopy at age 50 – then every 10 years after that, if the screening is clear.
Anyone with a family history of colorectal cancer should get his or her first colonoscopy 10 years before the age a first-degree relative was diagnosed with colon or rectal cancer. “If your mother was diagnosed at age 45, you should start getting screened at 35,” said Dr. Bird.
For those with a history of polyps or cancerous tumors, Dr. Bird said screening recommendations are highly tailored based on the patient’s specific diagnosis and treatment history.
Listen to Your Body
While you should plan to follow standard screening recommendations in most cases, don’t hold off on a colonoscopy until your next scheduled screening if you have concerns about your colorectal health.
In February 2017, at the age 57, Lu Anne Sheffield of Asheville didn’t have an upcoming colonoscopy on her calendar, but she scheduled one anyway because she sensed something was wrong.
“Things didn’t seem right,” said Sheffield. “I felt like I couldn’t empty myself. I knew something was affecting me, and thought it might be a polyp. I said to myself, ‘I’ll just have it checked out so that I can move on with my life.’ It’s a good thing I did because that decision saved my life.”
Dr. Bird said Sheffield did the right thing, but it’s something a lot of people choose not to do, which can have a negative effect on survival rates. He said the decision can be due to a lot of factors, many of them fears or misunderstandings.
“Some people just don’t want to deal with the awkwardness, or they mistakenly believe it will be painful,” he said. “Then there are some who are afraid of a diagnosis and just don’t want to know.”
“Listen to your body, pay attention to your body,” continued Sheffield. “If you think there’s something that might be wrong, have it checked out.”
Dr. Bird said that significant improvements in how colonoscopies are performed and the corresponding bowel preps have greatly improved patient experiences. He said many patients will be surprised to find that the test isn’t the big deal they thought it was.
Seek Immediate Treatment
Sheffield wasn’t afraid of the test. Nor was she worried about a diagnosis – although she initially assumed it would be something minor, like polyps. Ultimately, Sheffield ended up with a diagnosis of rectal cancer, which Dr. Bird would later identify as stage III cancer, but she is glad she got the screening when she did.
“As soon as the tumor was discovered, they got right on it,” she said. “The fact that it was found sooner rather than later made a big difference in my outcome.”
Dr. Bird explained that colorectal cancers under stage IV are usually staged following surgery. “As a surgeon, our first goal is to assess and rule out metastatic disease, stage IV cancer, which for colorectal cancer typically means extension to their liver or lungs,” he said. “Once we have ruled this out, we are able to use surgery as the backbone of our treatment and work towards curative intent. However, only after we’ve taken out the cancer can we truly tell if it’s stage I, II or III.”
Staging the tumor will determine whether subsequent treatment, such as radiation or chemotherapy, will be necessary. Sheffield had stage III cancer, which meant that her lymph nodes were also involved and that she would therefore require chemotherapy.
Sheffield’s treatment was also a little different in that she underwent radiation prior to her surgery. Dr. Bird explained that in some cases of rectal cancer it’s advantageous to begin chemotherapy and radiation first.
“For rectal cancer, the mass is in a fixed spot in the pelvis, not free-floating in the belly,” he said. “This anatomic relationship lets us utilize additional modalities like radiation. In these cases, not only does the up-front radiation augment surgery, the multidisciplinary approach leads to improved outcomes.”
Sheffield successfully completed all of her treatments – radiation, surgery and chemo. With regular follow ups, she anticipates a cancer-free 2018.
“That’s the value of a colonoscopy,” said Dr. Bird. “There are other tests, such as stool analyses or imaging studies that may detect cancer, but only the colonoscopy allows us to diagnose and visualize the tumor at same time.”
Considering all of the advantages of a colonoscopy, Sheffield said she wants people to see how important it is to not be afraid of the test. “You have the right to go find out,” she said. “You need to treat yourself with that kind of respect. And if they find something, at least you have peace of mind and can move forward with whatever treatment is necessary to save your life.”
Colin Bird, MD, of Regional Surgical Specialists, an affiliate of Mission Health, is the only board-certified colorectal surgeon in western North Carolina.