There are no two ways about it, testing for colon cancer is invasive and unpleasant at best. Colonoscopies can require almost a week of preparation, with a strict fluid diet and a final 24-hour regimen of laxatives and enemas needed to clear any waste products.
And that is the easy part.
On reaching the hospital, sedatives are given to make it easier to tolerate the discomfort of a fiber optic probe being inserted deep into the colon. Irregularities like polyps—small, potentially cancerous, clumps of cells that may have formed on the colon lining—are cut out and later biopsied.
It makes for a few rough days, before and after, and, according to a study by UC-San Diego Health, fear of the procedure is the No. 1 reason that 40% of at-risk persons have never been screened. But, according to Dr. Paul Percival of Hollister Home Medicine, getting tested for colon cancer is critically important for those 45 or older.
“Most people have no symptoms,” Percival said. “And most people have no family history of colon cancer, which is a common misperception. This form of cancer is silent until it is very advanced and sometimes untreatable.”
Colon cancer affects approximately one in 25 people and is the third leading cause of cancer deaths. People over 65 years old, according to a recent study, account for 70% of cases. Seniors also account for 75% of colon cancer deaths, but all age groups are vulnerable: “Black Panther” star Chadwick Boseman died of colon cancer at 43.
Aromas resident and Rotary Club member Wayne Norton, 74,underwent surgery after being diagnosed with colon cancer.
“I went in for my routine colonoscopy after being a couple of years late,” he said. “They discovered cancerous nodes, and my doctor told me they could identify them pretty well during the procedure, but they also did the biopsy to confirm it. I was very lucky because they were very early in their formation.”
Catching his cancer early also meant that it had not spread to his lymph nodes, which would have resulted in cancer possibly traveling to other parts of his body. It also meant he avoided a colectomy, a procedure that results in the removal of some or all of the colon itself.
“They went into my stomach to cut out the nodes,” he said. “The surgery wasn’t too bad—they kept me in the hospital for a couple of days after, and I was pretty groggy. But I feel very fortunate that surgery resolved the problem and that I did not have to do any radiation.”
While the only sure way to diagnose colon cancer is the dreaded colonoscopy, there are other tests that can be done that might indicate the disease is present, but they are less reliable. The three most common are the Cologuard DNA test, the fecal immunochemical test (FIT) and the fecal occult blood test (FOBT). All three require the patient to collect a stool sample which is then analyzed in a laboratory.
“Colonoscopies are about 95% accurate in diagnosing colon cancer,” Percival said, “The Cologuard test can pick up about 93% of cases, which is really darned good, but, unfortunately, it only picks up about 50% of the precancerous polyps. That means it needs to be repeated every three years, whereas a colonoscopy must only be repeated every 10 years. The tests cost about $100, and medicare does cover it.”
Other tests, according to Percival, are much less accurate.
“There are the FIT and FOBT tests,” he said. “They look for traces of blood in the stool and are only about 30% accurate, which is a big difference. The main benefit is that they are pretty cheap tests to do, at about $25. But if you go that route for screening, you must do it about once a year.”
No matter which of the three tests is used, a doctor will most likely order a colonoscopy if the results come back positive to search for cancerous or precancerous polyps as well as cancerous cells, which are then biopsied. Early-stage cancers can be treated by further colonoscopies, but more advanced cancers require more serious treatments.
According to a recent study, radiation and chemotherapy are both effective treatments for more advanced cancers in seniors. One form, hyperthermic intraperitoneal chemotherapy (HIPEC), involves a concentrated treatment delivered directly to the cancer cells in the abdomen during surgery, which allows for a higher dosage than conventional chemotherapy.
The good news is that colon cancer has a 91% 5-year survival rate when caught early, though if it has spread to the lymph system, the rate drops to 72%.
Recovery from the surgery is relatively swift. Norton said that he was back to his regular activities within six weeks.
“Anesthesia takes a lot out of you, and I was tired for a while,” he said. “I took a lot of naps and let my body catch up. And for the first six months, there was a lot of poking and prodding from my surgeon and my oncologist. They ordered a lot of X-rays and blood tests to be sure they got everything, and that it was not popping up anywhere else.”
Norton has just passed the five-year mark on his surgery and no longer has to see the oncologist, though he will have to continue to be examined for cancer.
“To me, it is worth it to go in,” he said. “It is important to get your colonoscopy, no matter what the schedule is. Five years, two years, one year, whatever it is. It is a lot less inconvenient than having colon cancer.”
BenitoLink thanks our underwriters, Health Projects Center and Del Mar Caregivers for helping expand our senior health coverage. Health Projects Center supports more reporting on senior health issues and solutions in San Benito County. All editorial decisions are made by BenitoLink.