Fri, Apr 19, 2019 at 02:50 PM

Colon cancer: What to know and 5 things to ask your doctor

Gastroenterologist Dr. Benjamin Shepard shared a wealth of knowledge and good advice about colorectal cancer with two local groups.

Colon cancer "is the fourth most frequently diagnosed cancer in our country,” according to Marshall Medical gastroenterologist Dr. Benjamin Shepard, but the incidence rate is falling thanks to colonoscopy screening and education. 

Dr. Shepard shared the latest information and some great health tips at two recent Marshall Medical events — the monthly L.I.F.E. support group meeting, and a GoldCare 55+ Lunch N’ Learn. 

As with any health issue, the more you know the better you can manage your situation. These highlights from Dr. Shepard’s talks offer a good overview of what you need to know about this dangerous cancer.

The good news, Dr. Shepard said, is that the rate of colon cancer deaths fell by nearly 3% between 2005-2014. That’s thanks to more people getting colonoscopies, which leads to earlier detection of pre-cancerous lesions. 

Everyone should be screened by age 50. Doctors acknowledge that it can be a difficult test due to the preparation. It requires drinking a large volume of special cleansing liquid that causes a torrent of diarrhea to flush the system. 

“The prep is horrible,” Dr. Shepard said. “We’re trying to make the colon squeaky clean in 12 hours. That’s hard work.” But the results are clearly worth the effort, he stressed.

Know the risk factors

Colorectal cancer has many risk factors, the primary being genetics. It is known that obesity, smoking, a high consumption of red meat and a sedentary lifestyle contribute to the disease, which is the second highest cause of cancer death. Factors that lower risk include regular exercise and maintenance of an ideal body weight. 

Most early cases of colorectal cancers have no symptoms. Some signs are rectal bleeding, weight loss, change in bowel habits and abdominal/pelvic pain. Familiarize yourself with what’s normal so you will be aware of changes.

“Look at your stool,” Dr. Shepard recommended. “It’s very, very important".

Most colorectal cancers arise from polyps, which are also called adenomas. Dr. Shepard said it takes 10 to 15 years for a polyp to grow into a cancer so if none are found during a colonoscopy, the test doesn’t have to be repeated for 10 years provided there is not a known hereditary risk of colorectal cancer. If no polyp has ever been found at age 75, no more tests are needed. 

If a polyp is found, it is removed and examined under a microscope. Dr. Shepard said his rate of finding polyps since he started working at Marshall Medical last summer is 60%, which is high in comparison to national statistics. He also photographs important landmarks during the procedure to document appropriate visualization of the entire colon. 

5 questions to ask your doctor

Dr. Shepard recommends patients ask their doctor the following questions to enhance colonoscopy quality:

1. What is your rate of adenoma detection? It should be greater than 25% overall. 

2. What is your cecal intubation rate? The completeness of a colonoscopy is measured by the cecal intubation rate, the cecum being where the colon begins. Cecal intubation means that the endoscope could be advanced through the whole length of the colon, allowing for assessment of all the colonic segments. Your doctor’s rate should be 95% for colonoscopies. 

3. Do you use split-dosing of bowel prep? Effective bowel preparation requires that at least half the preparation be ingested on the day of the colonoscopy. 

4. Does the report include photographs of the end of the colon?

5. Is the bowel prep quality described? The preparation must be adequate to ensure effective examination.

One attendee asked Dr. Shepard his opinion of the home test known as Cologuard, a noninvasive screening option available by prescription only. He said it is not for people who have had polyps, family history of colon cancer or symptoms of colorectal cancer, such as bleeding. It has to be done every three years and costs $500. If it turns out positive, you still have to undergo a colonoscopy. 

However, it is good alternative for people who should not be put to sleep, such as someone who has had a heart attack within a year or is very high risk for sedation. 

Dr. Shepard came to Marshall Medical from Oklahoma, joining the practice of Medical Specialists with Dr. Winter Wilson and Dr. Jeffrey Barton in Marshall South’s professional office building. Dr. Shepard also trained at Cancer Treatment Centers of America in Tulsa, Okla., and works with oncologists at Marshall Cancer Care Center in treating gastrointestinal cancer. 

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About the groups Dr. Shepard spoke to

GoldCare 55+ is Marshall Medicals’ program to promote a healthy lifestyle in senior citizens. If you are 55 or older and would like to take advantage of all the benefits from discounted gym membership to group travel, get an application here or pick one up in the lobby of Marshall North or South, or email peggy.hudson@mmcenters.com.

Anyone is welcome to attend a GoldCare Lunch N’ Learn. You must reserve your seat at least one week in advance. Call 256.571-8025 or 256-753-8025 for Arab area residents. Cost is $5. Lunch is served at 11:30 a.m. and program begins at noon.

L.I.F.E. (Lean In For Encouragement) gives cancer patients, survivors and caregivers the opportunity to learn about various topics related to cancer. The group meets the second Tuesday of each month - for more information or to register call 256-571-8000 or 256-753-8000 for Arab area residents.