Colon Cancer: Symptoms to Look For and How Screening Can Save Your Life

It’s the middle of the day and a couple of us are standing glued to the TV screen in the corner of a large room. But instead of a live look in at a sports event, what we’re seeing is live footage of the inside of Mr.Johnson’s colon.

Mr.Johnson had recently turned 50 and his primary care doctor had sent him for a screening test for colon cancer. He was scheduled for a colonoscopy, a test where a camera is inserted through the rectum and advanced through the colon to look for any abnormal lesions that might represent cancer. Most cases of early stage colon cancers are found through this method of screening and these patients often don’t have any symptoms. For Mr.Johnson, we found some abnormal lesions which we were able to remove during his colonoscopy. Once biopsy results came back, he was scheduled for a repeat colonoscopy in a few years’ time as was consistent with his findings.

We soon moved on to see clinic patients and Ms.Carter was next on the list. She had been recently admitted to the hospital with abdominal pain, nausea and vomiting and was found to have advanced colon cancer. She was 63 years old and had not gotten any colon cancer screening previously, reasons for which were unclear. To treat the cancer, she underwent extensive surgery and now was in clinic to discuss her options regarding chemotherapy. She looked weary and not ready to have this conversation. And maybe she would not have had to have this conversation if she was more aware of the risk of colon cancer and the appropriate screening recommendations for people in her age group.

These two cases seen within hours of each other represent different ends of the spectrum of how patients with colon cancer may first present. But it also highlights the important role of patient education and screening about colon cancer which may lead to early recognition of colon cancer.

Patients with colon cancer can present with a variety of symptoms. Some of these include bleeding noticed in the stool, stomach ache or bloating, weight loss and changes in bowel habits. The changes in bowel habit can include constipation or diarrhea that lasts multiple weeks. Sometimes routine lab tests showing low blood counts, also called anemia, can also point towards non-obvious bleeding from the colon which can point towards colon cancer. This can lead to symptoms of fatigue and weakness. Patients who present with some of these symptoms and then go on to be diagnosed with colon cancer often have a more advanced disease because the symptoms are often caused by the increasing size of the cancer.  But it is important to realize that most of these symptoms can be seen with many other conditions that are not cancer related and are much more benign. It is best to seek care from your primary care provider when experiencing these symptoms to figure out the underlying cause.

Screening for colon cancer is first recommended at age 50 by the U.S Preventive Services Task Force.  But it is important to note that this age recommendation is not a one size fit all and can be different for you depending on your or your family’s past medical history. For instance, if you have a relative who was diagnosed with colon cancer at a young age or if you have a genetic disease that puts you at higher risk for colon cancer then you may need to get colon cancer screening at a much younger age then 50. For optimal medical care, it’s best to discuss your risk of colon cancer and the screening guidelines that you should follow for colon cancer with your primary care provider.

Certain lifestyle choices have also shown to decrease your risk of colon cancer. Increased physical activity and a diet high in vegetables, fruits and fiber can possibly lower your risk of colon cancer. On the other hand smoking, obesity and diabetes may increase your risk of colon cancer. Effects of processed or red meat are less well known but also could possibly increase the risk of colon cancer.

This is the discussion that we had with Mr.Johnson after we gave him news of his colonoscopy findings. This is the discussion that every adult patient should have with their primary care provider. In the U.S. not everyone who should be getting colon cancer screening is getting one so it is important for patients to be informed and ask their doctor about their risk and need for colon cancer screening. If we can better educate our patients and our medical community then we can hope for more cases like Mr.Johnson and less of cases like Ms.Carter.

 

Patient names mentioned in the article have been changed to protect patient privacy.

 


References:

https://www.mayoclinic.org/diseases-conditions/colon-cancer/symptoms-causes/syc-20353669

https://www.cancer.org/latest-news/signs-and-symptoms-of-colon-cancer.html

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Bellyaches: Red Flags and Reasons to See a Doctor

Modern life is busy, and visits to the doctor are generally the furthest thing from efficient.   Figuring out just when to see your physician is a challenge, especially in the internet era, in which we can convince ourselves in 5 minutes of googling that our minor nausea is in fact a rare parasite only found 5000 miles away.   With that in mind, today we will cover a few of the prototypical “red flags” for abdominal pain, and what you should do if these symptoms are happening to you.

There are two ways in which pain presents, acute and chronic.  First, let’s talk about the acute issues.  Acute sharp pain in your abdomen is generally worrisome, and depending on the degree of pain is enough to warrant a doctor’s visit all on its own.  However, the things that should get you mobilized to the emergency room include vomiting blood, inability to tolerate liquids, vomiting bile (bile will look green, either dark or very bright), or uncontrollable vomiting.   While I think most people know to go to the ER if they start vomiting blood, it’s important to know that this can be a manifestation of many diseases, and acutely life threatening.  If this happens to you, especially if there is no inciting factor (like having a nosebleed and swallowing a lot of blood) you need to head to the ER straightaway.

If you are unable to tolerate liquids, you need to present to the ER even if nothing serious is happening, as dehydration can absolutely become serious, and it raises the possibility that a serious medical issue is occurring.  This is the same reasoning behind seeing a doctor for uncontrollable vomiting. We can do something about it, and it can be dangerous or indicate that something serious is happening.  Vomiting bile is concerning for something called an “obstruction” in which a section of the intestine is blocked.  If you block the way out, everything comes back up the way in, and you will see significant abdominal pain, vomiting, and vomiting of bile.

Lastly, it’s worth noting that if you have severe abdominal pain associated with high fever, this could also indicate a serious infection, and you should see a physician.

Chronic abdominal pain works slightly differently.  Many of the causes of chronic pain are relatively benign, like functional abdominal pain, gas, or constipation.  However, there are many red flags that clue you in to needing to get to the doctor.  First and foremost, weight loss. If you are having chronic abdominal pain and unintended weight loss, you need to see a physician.  There are many possible causes of this, and many of them are quite unpleasant (such as celiac disease or inflammatory bowel disease), so getting to the doctor ASAP is a must.

Second, the location.  A persistent pain in your right upper quadrant could indicate an issue with your liver or gall bladder, which are slightly more important areas than your left lower side, which is most likely affected by gas pain.  As always, if your pain is really severe, go see a doctor even if the area of the pain isn’t too high risk.

Third, the timing.  If pain is waking you up from sleep, that’s a big deal.  A lot of abdominal pain can feel excruciating but once you’ve gone to sleep you can rest easy (see: Gas).  This usually indicates that you do not have a severe problem.  However, if pain persistently wakes you up, that is a great reason to drop into your doctor.

Last but not least is the presence of other symptoms.  Chronic abdominal pain with new or unexplained rash, unexplained fevers, ulcerations in your mouth or other sensitive areas, or joint pain is much more likely to be caused by a systemic illness like an autoimmune disease, and definitely suggests it is time to make the trip your doc.