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Dr. Andrew J. Vorenberg of Colon and Retal Specialist Photo by Sarah Walor
It's the second most deadly form of cancer, but Dr. Doumit S. BouHaidar maintains colorectal cancer is one you can do something about. The gastroenterologist at Virginia Commonwealth University's Massey Cancer Center is something of a pied piper for colonoscopies. They work, he says. "Screening is a very important strategy to fight this cancer."
Preventive maintenance is necessary because the disease often doesn't announce its symptoms until it's too late. "When the polyps are small, patients will have absolutely no symptoms," says BouHaidar, the director of Massey's Advanced Therapeutic Endoscopy. "Once you start having symptoms, unfortunately, it means that the cancer is advanced to the point where you are experiencing signs — whether it is iron deficiency anemia or abdominal pain or obstruction of the bowels."
According to the American Cancer Society (ACS), more than 50,000 people will die from colorectal cancer this year. But a study published in February by the New England Journal of Medicine determined that the death rate has been cut by 53 percent for patients who undergo a colonoscopy, in which a tube with a camera is inserted inside the large intestine. There are now more than 1 million survivors of colorectal cancer in the United States, according to ACS statistics.
"We think it takes about five to 10 years for the colon lining to turn into a polyp and another five or 10 years for the polyp to turn into a cancer," says Dr. Andrew J. Vorenberg, who practices with Colon and Rectal Specialists. "The theory is that if you can catch the polyp before it turns into a cancer, you can beat colon cancer to the punch."
Before internal colonoscopies were introduced to the medical community in 1969, doctors would rely on analyzing stool samples, or performing "flexible colonoscopies" (you don't want to know). "These strategies worked at times, but there were some pitfalls for each," BouHaidar says. "When modern colonoscopy came along, it helped detection tremendously, and doctors have improved the procedure along the way." For instance, he says, it's now accepted that a colonoscopy will only be as good as the patient's pre-exam preparation. "If the colon is completely clear of any fluid or stool, then your exam is very accurate."
Another advancement is that, during a colonoscopy, doctors are not only able to detect small polyps, but they also can remove them on the spot. "Most colon cancer starts in the form of small polyps, less than 1 centimeter in size," BouHaidar explains. "The polyps can stay there doing nothing, just growing slightly more every year … but even when you have a small cancer on the tip of that polyp that hasn't gone through the base yet, you can take care of it endoscopically and stop the cancer from spreading."
BouHaidar also notes the advancement in virtual colonoscopies, where a radiologist scans the patient with a joystick — it's called a "flyover" — to construct a 3-D image of the colon doctors can examine. It's a good tool, he says, but there are disadvantages. "The 3-D scan won't detect polyps in the colon that are smaller than 1 centimeter," he says. "And it requires the same prep as a colonoscopy. So if we do find a polyp, you are going to have to go through the prep again to remove it."
As scary as it sounds to have a medical prod invading your insides, it isn't the procedure itself that most patients complain about — it's the prep, where they can't eat for 24 hours before the exam, and they have to consume 4 liters of a special chalky laxative, then deal with the aftereffects. BouHaidar sympathizes with them. "Going to the bathroom a lot the day before can be really miserable for some patients, especially if they have other medical problems," he says.
What can cause colon cancer? Advancing age can be a big factor, which is why most doctors recommend colonoscopies to people 50 or older. Family history of the disease is important to consider too, as is diet. "High-fat, high-red-meat diets, high caloric intake — all of those are a factor in developing cancer," BouHaidar says. What protects you, he says, are low-fat, high-fiber diets, calcium, vitamin B, even aspirin and ibuprofen can help (if not abused).
Once colon cancer has spread, the treatment will be surgical — and that's where specialists like Vorenberg come in. There have been advancements in the operating room too, such as a laparoscopic partial resection of the colon. "If the polyp has grown too large to be removed through a colonoscope, then you have to remove a segment of your intestines," explains Vorenberg, vice chairman of the Department of Surgery at Bon Secours St. Mary's Hospital. "It's a major operation, but it's minimally invasive. We're making tiny incisions, about a quarter of an inch in size, using instruments that go through the skin … manipulating the intestines with the instruments and then taking the specimen out."
In contrast, the old-school laparotomy involved major cuts into the abdominal wall, he says. Now, "patients get home faster, it's less painful and the expense is less because you don't require a long hospital stay."
For now, both doctors say colonoscopies are the best way to fight colon cancer. "It was once very hard to convince people [to get screened]," BouHaidar says. "Public awareness is better than it was five or 10 years ago, but we are not there yet."
The nonprofit Hitting Cancer Below the Belt organization will sponsor a "Boxer/Brief Battle" 5K race/walk supporting colon and rectal cancer research on June 8 at Rocketts Landing. Learn more at hcb2.org/events/boxer-brief-battle .