Mount Auburn Healthcare Connection

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March is National Colon Cancer Awareness Month and at Mount Auburn Hospital in Cambridge, a teaching hospital of Harvard Medical School, physicians are striving to educate the public about the preventable disease.

In the United States, colorectal cancer, which is cancer of the large intestine or rectum, is the second leading cause of cancer-related deaths in men and the third leading cause of cancer-related deaths in women. Symptoms include a change in bowel habits, narrow stools, rectal bleeding and bloody stools, abdominal discomfort and unexplained weight loss.

A risk factor for colorectal cancer is family history, which can determine if a patient falls into the average-risk or high-risk category. “When we see people we ask them about their personal and family history of colon cancer or polyps, which are tumors that can become cancerous,” says John Chobanian, M.D., Gastroenterologist at Mount Auburn Hospital. “If people answer no to all of the questions then they are average-risk. If they answer yes to any of the questions, they may fall into the high-risk category.”

Additional risk factors include inflammatory bowel disease, diabetes, smoking, heavy use of alcohol and diet. “Saturated fat and red meat certainly have a relationship with an increase in the risk for colon cancer,” says Dr. Chobanian. “Other clear risk factors are alcohol and tobacco use. People who use those substances have a higher incidence of colorectal cancer at an earlier stage in life.”

Dr. Chobanian explains that the prognosis is determined by the stage at which a patient presents. The stages are outlined below:

• Stage A: Cancer is in its earliest stage and is confined to the mucosa or lining of the colon.

• Stage B: Cancer has progressed through the mucosa into the colon wall to some degree.

• Stage C: Cancer has invaded nearby lymph nodes but is not yet affecting distant parts of the body.

• Stage D: Cancer has spread to other parts of the body including organs such as the liver.

Common treatments for colorectal cancer include surgery, chemotherapy and radiation therapy. “Treatment for Stages A and B is surgical only but Stage B is sometimes treated like Stage C depending on how aggressive the cancer is,” he says. “Patients in Stage C have a 55 percent chance of five year survival.” Patients with Stage D colorectal cancer are considered terminal but usually respond to chemotherapy treatment and can do well for an extended period of time.

The majority of colorectal cancer cases begin as small, benign polyps and Dr. Chobanian says one of the best ways to prevent colon cancer is to get a colonoscopy screening beginning at age 50 for the average-risk person and earlier for a high-risk person. According to the American Cancer Society, colonoscopy should be repeated every ten years for an average-risk person and every two to five years for patients at high-risk.

During a colonoscopy, physicians are able to screen and remove polyps, which generally cause more than 90 percent of colorectal cancer. The removal of polyps at an early stage is key to preventing the development of colorectal cancer.

“Screening is very important and everybody has to be on board with this,” explains Dr. Chobanian. “Unfortunately, colonoscopy is a fairly invasive procedure and people are often reluctant to proceed. If it were a simple blood test, people would probably be more receptive. Usually it is a comfortable exam and patients are well medicated for the procedure.” For more information about colonoscopy, read Dr. Ruymann’s article.

At Mount Auburn Hospital, physicians are raising awareness for colorectal cancer through venues including community discussions and informal open house events. Dr. Chobanian says the more educated people are about the disease, the more likely they will proceed with screening, which will reduce the incidence of colon cancer.

“It is about spreading the word and educating people,” he says. “Early detection is great and preventing the disease completely is even better.”

For a free Mount Auburn Hospital physician directory, please call us at 617-499-5094.