Colorectal and bowel cancer
Colorectal cancer is the second most common cancerous disease affecting humans. As with all forms of cancer, but especially for this kind, screening is of paramount importance: if a bowel tumour is discovered, then surgery may be followed by chemotherapy; for rectal cancer, radiotherapy and chemotherapy (while rarely required) are conducted before the operation.
And, as also with all forms of cancer, the sooner its is discovered, the more positive the prognosis.
In short: A positive cancer prognosis goes hand in hand with early discovery and successful surgery.
Since bowel cancer can, as a rule, grow for a long time before it becomes noticeable – in the form of digestive problems, changes to “stool consistency”, abdominal pain or even ileus (bowel obstruction) – screening therefore has an important role to play. The principle underlying such screening derives from the fact that most cases of bowel cancel can be traced back to what are, initially, benign growths on the intestinal mucosa, known as polyps or adenomas. As a rule, the transformation of what were originally altered – but benign – cells into malignant cells lasts so long that the interval between colonoscopy screenings could be extended to 10 years without serious cause for concern about cancerous disease occurring in the intervening period. Then again, it must also be said that there will always be patients who would benefit from a shorter interval – and, equally, patients for whom the interval can be extended even further. If risk factors are present, then, following consultation with your GP, a shorter interval can be selected. The existence of multiple benign polyps in particular would prompt most specialists to perform a colonoscopy check-up at an earlier stage.
The bowel cancer screening model as practised in Germany has now been evaluated statistically by researchers: you can view the article from the Deutsches Ärzteblatt here. The article shows that screening has achieved major successes.
Screening is performed until the age of 55 with the aid of the “stool test”: this either reveals the presence of blood components in the stool or, more recently, genetic material from tumours. Recent studies have revealed no major differences between the test outcomes: accordingly, we can continue to recommend the standard version without reservation.
If patients find blood in their stools themselves, however, this has the same status as a positive test, since the statement “There’s blood in it.” is the same in both situations. In both cases, further investigation is necessary.
For patients aged 55 and over, we recommend colonoscopy screening: this is an endoscopic procedure performed on patients who are in good health – something we also wish to preserve! There’s clearly a superstition, however, that a cancerous illness only exists because a patient decides to have a medical examination. If a routine medical exam of a patient without any symptoms does reveal an illness, then he or she has the best-possible prognosis. Fortunately, however, the presence of bowel cancer is a very rare finding in colonoscopy screening. If there are no adverse findings – which is, as said, the usual outcome – then a check-up is recommended in 10 years. While no upper age limit is defined, one could suggest approximately 85 years for women and 80 for men. Since major differences between one’s biological age and one’s calendar age are often found in older patients, the upper limit for colonoscopy screening must be discussed on a case-by-case basis.
If there is a genetic predisposition, then we recommend performing endoscopic screening at an earlier date. This is considered essential for patients whose immediate relatives (parents, children, siblings) have suffered from some sort of intestinal cancer. In such cases, the screening year is brought forward to 45, or at least 10 years earlier than the age of disease onset for the “index” patient. As an example: if a patient’s father was diagnosed with bowel cancer at age 52, then an endoscopic screening should be performed on the patient and his/her siblings when they are about 42 years old.