Early Detection

One of the most dangerous aspects about colorectal cancer is the lack of any symptoms for a long period of time (5-10 years or longer), during which an initially benign tumor (polyp) develops into a malignant carcinoma. Once the first symptoms appear, the tumor is often already at an advanced stage. The chances for cure strongly depend on the cancer stage. At an early stage the mostly benign polyp can be removed and cured in nearly all cases. This, again, underlines the importance of screening tests.

Irregularities of stool like blood, discolorations or slime as well as unclear bowel disorders such as obstipation, diarrhea or cramps should always lead to an immediate consultation with a physician.

Screening tests should be attended by both males and females, beginning at the age of 50 at the latest. In case of hereditary risk or family history, it is important to be screened at a younger age.

Review of screening tests:

  • physical examination including palpation of rectum (at the age of 50 or earlier): This is a simple method to detect tumors in the rectum by palpation. However, tumors further up in the colon cannot be detected this way. Maximum 10% of all tumors can be found by palpation.

  • stool testing (Fecal Occult Blood Test) (at the age of 50 or earlier): This simple test is used to find occult (hidden) blood in feces. However, not all polyps bleed, so the test alone is not sufficient. From the age of 50, the test is done once per year. 25-30% of colorectal polyps and early cancers can be detected this way.

  • colonoscopy (at the age of 50 or earlier): The most effective and best method of all screening tests. This is the only test available to detect even small changes of the intestinal mucosa. The colonoscope (a thin, flexible tube) can view the entire colon. A biopsy may be done (a small piece of tissue taken out through the colonoscope) and polyps can be removed (polypectomy). The test usually takes about 20 minutes and is perceived as being somewhat unpleasant, but not painful. On request, sedation can be given in advance, making the patient feel comfortable and sleepy.

  • virtual colonoscopy (VC): This is a high tech procedure which is still quite new. No colonoscope needs to be inserted in the colon, since the screening is simulated by the computer (computertomography), but small changes of the intestinal mucosa are usually not detected, a biopsy is not possible and the radiation exposure is very high. A colonoscopy still needs to be done, subsequently, if polyps are found. The virtual colonoscopy is a procedure not yet fully developed and is not available routinely in the clinic.

Intestinal Polyps
Intestinal polyps are found in about 10% of the population in Germany, genetic factors playing an important role as well as Western lifestyle and a diet with high intake of fat and sugar, red meats, smoking and alcohol. Increasing age is also a risk factor for intestinal polyps.

In nearly all cases these intestinal polyps are so-called adenomas (benign growth). In the beginning this growth usually is still benign but may turn malignant with further growth. A larger polyp usually implies an increased risk for malignant cell growth.

During colonoscopy most polyps can be removed painlessly with a wire sling and be sent off for further pathological examination. Only larger, flat polyps with suspicion of cancer must be removed by surgery. This can be done either by abdominal surgery or transanal removal depending on the location of the tumor.

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