Colon Cancer in Seniors

Ninety percent of the time, colon cancer occurs in those who are over age 50. Also called colorectal cancer, this disease is the second leading cause of cancer death in the United States, claiming the lives of almost 50,000 men and women annually.

Colorectal Cancer & Age-Related Myths

Colon cancer in seniors remains one of the most preventable cancers if detected early enough. However, most doctors believe that, because of the perceived invasive and uncomfortable nature of the screenings, people delay screening and colon cancer is often far along by the time it’s diagnosed. Another factor in delayed diagnosis is age.

“We make the mistake of bypassing the detection screenings in the elderly,” Dr. Samuel Whiting, of the Seattle Cancer Care Alliance and the University of Washington Medical Center, explains. “Yet there is not necessarily an appropriate time to stop screening for colon cancer. In fact, the odds are just as good for someone over seventy to survive this disease as it is for someone half that age.”

Whiting states that there is no reason to make decisions concerning treatment based on someone’s age. “Age is also not a deciding factor because all of the drugs that we use for younger patients are available for older patients. Though of course, doctors will look carefully at the vulnerability of aging areas like the kidneys, etc.”

While some patients may not be property screened due to old age, others may receive a delayed diagnosis due to young age.

“I went to my primary care doctor after discovering blood in my stool,” recalls Anita Mitchell, a 44-year-old Seattle resident and outspoken advocate for preventive screening. “My doctor told me not to worry, it was probably hemorrhoids. I went in again after a noticeable change in my bowel movements, another significant symptom of colon cancer. Again, my doctor said it was nothing, blaming the change on the coffee I drank.”

Anita Mitchell was only 40 at the time of her first symptoms. Her doctor didn’t consider an oncologist referral because only 10% of people under fifty contract the disease. She returned to her doctor after the blood level in her stool increased dramatically. She had also just learned that her father had died of colon cancer. In fact, she should have received her first screening at age 30, 10 years before her father’s initial diagnosis.

When Mitchell finally saw a gastroenterologist, he found so many polyps in her colon that he bypassed a biopsy and sent her straight to the oncologist. Her CAT Scan revealed seven additional tumors in her liver. Immediate surgery removed eighteen inches of colon, sixteen lymph nodes, and an ovary. Four years later, Mitchell is finally feeling healthy again.

“It’s easy for doctors to blow you off when you are young and showing signs of an older person’s disease,” she says. “It’s important to have hope, and not let anyone tell you you’re a statistic.”

Colorectal Cancer Risk Factors

According to the Mayo Clinic, one in 17 Americans contracts colon cancer at some point in their lives. Because of this, it’s recommended that people begin screening for the disease no later than age 50. Of course, screening should begin earlier if one has familial history with the disease. A history of inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis may also lead to higher rates for the cancer. Though the disease strikes men and women equally, African Americans appear much more vulnerable. People who smoke are twice as likely to get colon cancer. Those who are obese, drink heavily, maintain a sedentary lifestyle, or suffer from diabetes are also considered more susceptible.

Conversely, a healthy, active lifestyle that includes consistent exercise and a high fiber diet rich in vegetables and fruits with limited red meat intake improves the chances of preventing colon cancer in seniors.

Colorectal Cancer Screening

Because colon cancer is usually slow growing, timely screening for small precancerous growths (called adenomatous polyps) is by far the most successful preventative of the disease. Awaiting symptoms, including a change in bowel habits, narrow stools, rectal bleeding, cramps, or unexplained weight loss, increases the chances of discovering a stage III or IV cancer.

“Colon cancer is almost completely preventable,” says Dr. William Grady, medical director of the Gastrointestinal Cancer Prevention Program at the Seattle Cancer Care Alliance. “Unfortunately, only 20 to 40 percent of people receive screenings when they turn 50, which also explains why roughly a third of the cases we see are too far advanced for realistic survival.”

There are several effective methods of screening for colon cancer, including:

• Colonoscopy: This remains the most comprehensive of tests. Long thought to be as painful as it was invasive, Whiting explains that there is plenty of myth in this assumption: “People tend to fear what the colonoscopy entails, but this is just an issue of education because the more people learn how the study is done, the more they realize it is not unbearably invasive. Just based on probabilities, I would never discourage someone from having one.”
• Flexible Sigmoidoscopy: A less invasive procedure, the sigmoidoscopy surveys just the lower portion of the colon. Worrisome polyps and tissue can also be removed surgically through the sigmoidoscope. Rarely conducted with anesthesia, the procedure costs less than the colonoscopy, but should be conducted every five years. Both Whiting and Grady recommend that people over 50 with low risk undergo the procedure in tandem with an annual fecal occult blood test.
• Fecal Occult Blood Test (FOBT): Completely noninvasive, the FOBT is designed to identify traces of blood in your stool, blood that is invisible to the naked eye. Though quite inexpensive and as convenient as collecting a stool sample, the FOBT doesn’t distinguish the source of blood, which can result in a false-positive test. Additionally, cancers and (most polyps) don’t always bleed, which may then result in a false-negative.
• Barium Enema: Recommended every four to five years, this analysis involves coating the entire colon with barium, then viewing it via X-ray for abnormalities. Though this procedure carries less physical discomfort then the scopes, the doctor doesn’t enjoy the potential of removing suspicious polyps and tissue. This test should also be issued together with an annual FOBT.

Recent research developments may offer new standards in colon cancer screening. These tests include:

• Capsule Endoscopy: This involves ingesting a pill-sized camera that records the middle portion of your colon. The endoscopy even contains its own light source. The apparatus detects intestinal bleeding and polyps, as well as inflammatory bowel disease, ulcers and tumors. Unfortunately, the pill-camera cannot remove troublesome polyps.
• DNA Stool Testing: This looks for DNA changes in your stool that are caused by existing cancerous cells. Precancerous polyps are also revealed by DNA changes, as detected by genetic markers. According to the Mayo Clinic, this test ranges from 71 to 91 percent for detecting cancers, and from 51 to 82 percent for detecting large polyps.
• Virtual Colonoscopy (VC): A three-dimensional X-ray of the colon, hundreds of instant photographs are taken to capture the entire landscape of the colon wall. Though equally noninvasive and much more accurate than the barium enema, VC shares the same limitations on real time surgery as the barium enema. There is also the potential for missing the smallest polyps with this screening method.

These numerous screening tests, combined with an early-detection survival rate of nearly 95 percent, means there are few excuses for people to avoid a preventive procedure. Even Stage II detection leads to an 85 percent recovery rate. To add perspective, Stage IV recovery is but 5 percent. Most insurance companies, including Medicare, cover the standard cycles of tests as well.

“There are even new colonoscopes that are more flexible and less invasive,” Grady explains. “So if there is anything that can be done to prevent colon cancer it may come from more discussion about the importance of [timely] screenings.”

Colorectal Cancer Treatment

Treatment after early detection is often straightforward, and positive. “Surgical treatment results in a very high rate of success if the cancer is detected early,” Grady says. Treatment may involve the following:

• Surgery: For Stage I and Stage II colon cancers, surgery is often so effective that no other form of treatment is needed. Several surgical procedures exist, ranging from a “local excision,” when surgeons remove the cancer and surrounding tissue during the colonoscopy, to the “extended resection,” when the cancer has spread beyond the colon wall and the removal of most of the colon is necessary.
• Chemotherapy: This may include oral or injected drugs designed to kill remaining cancers. Chemotherapy may also be injected in the specific area of the body to focus on a specific organ or set of organs. Fluorouracil (5-FU) has been the drug most often used in colorectal cancer treatments. Newer drugs include Camptosar®, Eloxatin®, and Xeloda®.
• Radiation Therapy: High dose X-rays can be used to kill cancer cells. External radiation uses an outside x-ray machine and internal radiation employs a radioactive substance that is sealed in a variety of time-released apparatuses placed within the body near the cancer.
• Immunotherapy: While most of these therapies are considered experimental, the FDA has recently approved two new drugs in this class, Erbitux® and Avastin®, to treat colorectal cancers. These medications, called monoclonal antibodies, are usually used in conjunction with chemotherapy and encourage the body’s own immune system to fight cancer.