What is Colorectal Cancer?
Colorectal cancer is the uncontrollable growth of cells, often starting as a polyp, in the colon or rectum. A polyp is a small growth of cells lining the intestines. Polyps can be flat or raised. Raised polyps are described as pedunculated, if on a stalk, or sessile, if there is no stalk. Polyps are common in those over 50 years of age. They are not cancer. However certain types have a risk of becoming cancerous. Pathologists characterize polyps based on their appearance under the microscope. Those that have pre-malignant potential are termed adenomas.
Colon cancer is the third most common cancer in both men and women, excluding skin cancer. The American Cancer Society estimates there will be 95,270 new cases of colon cancer and 39,220 new cases of rectal cancer in 2016. About 1 in 20 people in the US will develop colon cancer during his or her lifetime. These are alarming statistics. However, if everyone was tested as recommended more lives could be saved.
As a physician specializing in pathology and laboratory medicine, I use the microscope to examine cells and tissues to diagnose colon cancer and other diseases. I know that regular screening is the best way to find colon cancer early. When detected early, colon cancer is highly treatable; survival rates can be high as 90 percent.
Several tests can be used to screen for pre-cancerous polyps and colon cancer—the fecal occult blood test; flexible sigmoidoscopy; and colonoscopy. All three are widely used and available to patients. Other newer techniques include stool DNA testing (Cologuard) and virtual colonoscopy.
How Can a Patient Decide Which Test is Appropriate?
People should talk with their health care provider about when to begin screening for colorectal cancer, what test(s) to have, the advantages and disadvantages of each test, how often to undergo colorectal cancer screening, and when to stop.
The decision about which test to have usually takes into account several factors, including:
The person’s age, medical history, family history, and general health
The potential harms of the test
The preparation required for the test
Whether sedation may be needed for the test
The follow-up care needed after the test
The convenience of the test
The cost of the test and the availability of insurance coverage
The commonly used colorectal cancer screening tests all have advantages and disadvantages. Talk with your physician about what test is right for you.
Also, ask about the pathologist and lab that will be examining your biopsies. Patients can take steps to help ensure their colon biopsy is read accurately:
Inquire about the pathology laboratory that will examine your tissue sample. Is the laboratory accredited? The CAP accredits more than 7,600 laboratories worldwide and provides an online directory for patients.
Make sure the pathologists who are examining your tissue samples are board-certified.
If you are diagnosed with cancer, find out if your hospital has a multidisciplinary colorectal cancer conference. This is a team of physicians and other health care professionals that meets regularly to discuss diagnosis and management of patients with breast disease, guaranteeing more consultation about the best approach for your care.
If your hospital doesn’t have a multidisciplinary conference, consider getting a second opinion. Second opinions are always welcome. Have your doctor send the biopsy slides to another laboratory and request they be read by a pathologist who specializes in gastrointestinal pathology. Insurance typically covers second opinions.
Seek out accurate and credible resources to help you understand your pathology report and diagnosis, such as the CAP’s resource, “How to Read Your Pathology Report.”
Most accredited surgical pathology laboratories include second opinion slide review as part of their quality management program. Ask about this.
Remember, all treatment begins with a diagnosis. Take control of your healthcare, ask questions, get answers and become engaged, it makes for better care.