Colorectal Cancer Screening

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Colorectal Cancer Screening

Gail Burton, RN, CGRN, is familiar with cancer. Not only has the endoscopy nurse treated numerous patients in her 30 years at Central Baptist Hospital in Lexington, Ky., but she has also seen family members diagnosed.

The reality is every American knows someone who has faced cancer. Lost loved ones, celebrities, children, grandparents, and many others have died from varying forms of the mysterious killer.

Guidelines for Prevention

Colon cancer, unlike many other forms, can be detected early and potentially prevented by following specific guidelines. Some 5 percent of all cases of colorectal cancers are caused by genetic mutations. The exceeding majority can be prevented because they are caused by adenomatous polyps. These precancerous tumors grow slowly and can be removed.

“Looking at the statistics, there will be more than 100,000 colon cancer diagnoses this year,” Burton says. “Unfortunately 50 percent of those will also die. This is particularly bad because colon cancer is curable with early detection and intervention.”

The recommended guidelines also say that all positive tests should be followed up with a colonoscopy and patients with a personal or family history of the disease should begin testing earlier.

“The gastroenterologist and the surgeon work hand-in-hand to diagnose the disease in its early stages with surgical intervention,” Burton says. “We have a complete cure in more than 60 percent of patients, but we still need to emphasize early detection. If it isn’t detected early, cancer can pass through the wall of the colon and affect other organs.”

Elevated Risk

There are conditions that place patients at a heightened risk for developing colon cancer. A family history of the disease is the most prevalent risk. Certain conditions, (i.e., familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer) are caused by genetic mutations. These conditions can be diagnosed by a simple genetic test.

Officials at the American Cancer Society recommend patients with these conditions be screened for colon cancer earlier and more frequently. FAP patients often have their bowels removed in their twenties to prevent the development of cancer.

Gardner’s syndrome is also associated with a high risk of developing colon cancer. The condition causes multiple osteomas and soft-tissue tumors of the skin. It is an autosomal dominant trait genetic condition.

Characteristics of patients with a hereditary colon cancer condition often include:

  • At least three relatives with colon cancer
  • Two successive generations with colon cancer
  • One of the family members with colon cancer was younger than 50 when diagnosed
  • At least two people who are diagnosed are first-degree relatives.

For those patients who have these characteristics, doctors often recommend genetic counseling.

Additional groups who are at a heightened risk include Ashkenazi Jews with the I1307K APC genetic mutation. Although they do not develop this cancer when they are young, as with other genetic mutations, patients with this family heritage should be more mindful of screening.

The American Cancer Society lists the following risk factors for patients without a family history of the disease.

  • A personal history of the disease
  • A personal history of intestinal polyps
  • A personal history of chronic inflammatory bowel disease
  • Aging – More than 90 percent of patients diagnosed are age 50 or older
  • A diet mainly of animal sources
  • Physical inactivity
  • Obesity
  • Smoking

“We have found that the primary care physician will evaluate patients for colon cancer through intensive communication with their patient regarding family history of cancer — not just colon cancer,” Burton says. “A variety of other cancers, like ovarian, breast and lung, can increase your chance of developing colon cancer as a secondary area of the disease. The physicians will then refer their patients to either a gastroenterologist or a colorectal surgeon to have a colonoscopy.”

Symptoms

Patients who are age 40 or older and notice one of the following should consult their physician:

  • A change in bowel habits (diarrhea, constipation) that lasts one week or longer
  • Rectal bleeding or blood in the stool
  • Cramping or severe stomach pain
  • Decreased appetite
  • Vomiting
  • Weakness, fatigue
  • Jaundice

“Some generalized symptoms would be fatigue, weight loss, changes in bowel habits, rectal bleeding and bloating of the abdomen,” Burton says. “Yet it is one of those things where a lot of people do not have any symptoms. The gold standard (to begin screening) is age 50, but the patient must consider family history and their own body. This reemphasizes the need for the primary care physician to listen to their patients. More times than not, the patient will communicate these feelings of worry to the nurse and he or she must be educated in the symptoms of colon cancer. The nurse must communicate this to the physician and be the patient’s advocate.”

Officials at the American Cancer Society say a patient can decrease their risk for this disease by eating fruits, vegetables, and whole grain foods. Additionally, they note patients should limit intake of high-fat foods and have at least 30 minutes of physical activity on 5 or more days of the week. Overweight patients should make a concerted effort to lose weight.

Yet Burton says perhaps the best method of preventing the development of colon cancer is being familiar with your body and knowing when to speak with your physician.

“As a nurse, I would encourage a patient to be aware of any changes, no matter how minuscule they may seem to be,” she says. “It is like breast cancer. They say the mammogram is negative, but the patient still says something isn’t right and they reexamine the patient only to find that something is there. Mammograms have been wrong before. Seek information and listen to your body.”

For healthcare workers helping patients through a colorectal cancer diagnosis, Burton says being comforting and knowing the latest information about the disease will only help patients deal with the news.

“Reassure the patient that the prepping of today and the sedation utilized makes a colonoscopy a very safe procedure,” she says. “The physician and nurse work hand-in-hand to promote good care of the patient. It is also imperative to have a pathologist examine any specimen or tissue under a microscope for a definitive diagnosis. On a personal note, I have a family member have polyps that the doctor was convinced were benign. The pathology report came back malignant, only reinforcing that the pathology department is crucial.”

Burton, who is also the Central Kentucky Regional SGNA chapter president, helped organize a colorectal educational campaign with the Central Baptist Hospital Oncology Department.

“In March, our oncology center, working with the American Cancer Society and our endoscopy unit, provided a table of information and video for colorectal cancer awareness month,” she says. “It was in the main lobby of the hospital and we received an excellent response. There were numerous questions by patients, family members, and best friends. We had a nurse manning the table at all times and we passed out brochures and spoke with those who were interested in more information.”

Gail and her colleagues at the Central Kentucky Chapter #23 of SGNA also are involved in community education at the Lexington Home and Garden show for numerous years. The nurses talk with those attending the show and have information available to increase public awareness of all gastroenterology diseases, diagnostic intervention, and treatment. Burton says educating the community, along with healthcare workers, is essential because this disease is preventable.

“I have seen and experienced the evolution of colon cancer diagnosis and intervention,” she says. “Fortunately in 2002, we can diagnose, intervene and cure many more patients than ever before. I think every nurse and physician should take great pride in educating our patients, who are our customers. I have seen the results and I think many nurses can say they have helped at least one person. If anyone asks a nurse, ‘Do you really save lives,’ in the field of GI, the answer is yes!”

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Category: Colon Cancer

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