Colorectal cancer: Symptoms, family history don’t always precede the preventable disease

Edmonds resident Helen Nind, 55, smiles for a photo at Paradise inside Mt. Rainier National Park on Aug. 13, 2019, which was her 25th wedding anniversary. (Photo courtesy Virginia Mason Medical Center)

Edmonds resident Helen Nind learned she had colorectal cancer in June 2018, which surprised her since the 55-year-old mother of two teenage sons had no family history of the disease, was not having symptoms, felt healthy and never thought she would have cancer.

However, as sometimes happens, she received a diagnosis after her first colonoscopy, which discovered a suspicious polyp. During the noninvasive screening procedure, her gastroenterologist removed it – along several other polyps – and biopsied some tissue that was tested and confirmed her diagnosis.

Numbers

According to the American Cancer Society (ACS), colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. In 2019, the ACS estimates there will be more than 101,000 new cases of colon cancer and more than 44,000 new cases of rectal cancer.

Overall, the lifetime risk of developing colorectal cancer is about one in 22 (4.49 percent) for men and one in 24 (4.15 percent) for women.

Risk factors

Although having a risk factor, or even many, does not mean you will get the disease, some people who get the disease, like Nind, may not have any known risk factors. However, researchers have found several risk factors that might increase a person’s chance of developing colorectal polyps or colorectal cancer.

Many lifestyle-related factors have been linked to colorectal cancer. In fact, the links between diet, weight, and exercise and colorectal cancer risk are some of the strongest for any type of cancer.

  • Being overweight or obese – If you’re overweight or obese, your risk of developing and dying from colorectal cancer is higher. Being overweight raises the risk of colon and rectal cancer in both men and women, but the link seems to be stronger in men.
  • Physical inactivity – If you’re not physically active, you have a greater chance of developing colon cancer. Being more active can help lower your risk.
  • Certain diets – A diet that’s high in red and processed meats raises your colorectal cancer risk.
  • Smoking – People who have smoked tobacco for a long time are more likely than non-smokers to develop and die from colorectal cancer.
  • Heavy alcohol use – Colorectal cancer has been linked to moderate to heavy alcohol use.

There are also risk factors for colorectal cancer that aren’t related to lifestyle, including:

  • Age – Risk for the disease increases with age. Younger adults can get it, but it’s much more common after age 50. However, due to an increasing number of cancers among people younger than 50 in recent years, a few national medical organizations are considering lowering the recommended age for first colonoscopy.
  • Polyps – If you have a history of polyps, you’re at increased risk of developing colorectal cancer. This is especially true if they are large, if there are many, or if any of them show dysplasia (abnormal looking cells). Having family members who have had polyps is also linked to a higher risk of colon cancer. If you have a family history of polyps or colorectal cancer, talk with your doctor about the possible need to start screening before age 45. Also, if you’ve had polyps or colorectal cancer, it’s important to tell close relatives so they can relay that to their doctors and start screening at the right age.
  • Inflammatory bowel disease (IBD) – Colorectal cancer risk increases if you have IBD, ulcerative colitis or Crohn’s disease.
  • Family history – Although most colorectal cancers are found in people without a family history of colorectal cancer, nearly one in three people who develop colorectal cancer have other family members who have had it. People with a history of colorectal cancer in a parent, sibling or child are at increased risk. The risk is even higher if that relative was diagnosed with cancer when they were younger than 45, or if more than one first-degree relative is affected.
  • Inherited syndromes – About 5 percent of people who develop colorectal cancer have inherited gene changes (mutations) that cause family cancer syndromes and can lead to them getting the disease. The most common inherited syndromes linked with colorectal cancers are Lynch syndrome (hereditary nonpolyposis colorectal cancer, or HNPCC) and familial adenomatous polyposis (FAP).
  • Racial and ethnic background – African Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the US. Jews of Eastern European descent (Ashkenazi Jews) have one of the highest colorectal cancer risks of any ethnic group in the world.
  • Type 2 diabetes – People with type 2 diabetes are at increased risk for colorectal cancer. They also tend to have a less favorable prognosis after diagnosis.

Treatment

Based on the position of Nind’s cancerous polyp and section of bowel she needed removed, robotic-assisted surgery at Virginia Mason was recommended, which was the least invasive approach with the fastest recovery time. As part of the surgery, my physician partner removed and checked a number of her lymph nodes. Unfortunately, they found cancer in several, which required Nind to have chemotherapy every two weeks for six months. She also had a second chemo drug administered at home over a couple of days each time.

“It took a few months to recover from the effects of fatigue that gradually increased during chemo treatment. About five months after my last chemo treatment, I started to feel more like myself and confident that I’d be able to do all the things I used to do,” said Nind.

Going forward, she will have regular blood tests, colonoscopies and scans to check on her health and make sure the cancer has not returned.

Learnings

When I asked Nind if there were any learnings she felt might be helpful to relay to someone potentially – or actually – facing a colon cancer diagnosis, she said it was very helpful to have a family member or friend come to her appointments to provide another set of ears, another memory of what was said, someone to write things down, and someone to ask questions you might not have thought about. She also said that person helped her feel that she wasn’t going through it alone and it allowed her to discuss what happened at an appointment with someone else who was there.

“Someone I know who had been through cancer treatment advised me to keep a diary to note any changes or health concerns. I found this very helpful. It also helped me recall things more clearly when meeting with my care team,” said Nind. “In addition, write down questions you have so you remember to ask them at each visit, and don’t be afraid to message your providers for more immediate help since there might be no need to experience even slight discomforts that treatments might cause.”

Advice

Although Nind put off her colonoscopy for a couple of years after turning 50, mainly due to the perceived unpleasantness, she now regularly encourages people not to put it off and advises that they follow current screening guidelines. “The minor inconvenience of the prep was not as bad as I had thought,” said Nind. “It is nothing compared to what the alternative might be. If they can catch a problem early, the treatment is going to be much easier.”

Screening guidelines

The ACS 2018 guideline for colorectal cancer screening recommends that average-risk adults aged 45 years and older have regular screening with either a high-sensitivity, stool-based test or a structural (visual) exam, based on personal preferences and test availability. As part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with a timely colonoscopy.

— By Vlad V. Simianu, MD, MPH

Vlad V. Simianu, MD, MPH, is a general surgeon who practices at Virginia Mason Hospital and Seattle Medical Center. He specializes in colon, rectal and anal cancer with an emphasis on minimally invasive techniques, anorectal concerns, Crohn’s disease, ulcerative colitis, diverticulitis, polyposis syndromes, presacral tumors, rectal prolapse and pelvic floor disorders. He has specialty training in laparoscopic, robotic and trans-anal approaches for these diseases. Beyond his clinical expertise, Dr. Simianu is actively conducting research on colorectal cancer and diverticulitis. He has a special interest in population health, health-services research and surgical education.

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Photo caption

Edmonds resident Helen Nind, 55, smiles for a photo at Paradise inside Mt. Rainier National Park on Aug. 13, 2019, which was her 25th wedding anniversary.

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