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colon cancer: no one likes a colonoscopy, but the alternative is worse
after months of being told by her doctor that she was "pre-cancerous," but not to worry about it, artist jennifer cuthbert got the call she was dreading.
colorectal cancer is on the rise in people under 50. when was the last time you peeked at your poo?
cases of colorectal cancer among people under 50 have jumped almost 50 per cent since the mid-1990s, and it’s one of the most lethal cancers in this age group.
experts recommend checking your bowel movements for blood at least once a week. getty
do you take a peek at your poop? experts say you should at least once a week. blood in your stool is one of the early signs of colorectal cancer, a leading cause of cancer death in canada, according to 2021 statistics. but when it’s caught early on, it’s very treatable.
“blood in the stool is usually a sign that there’s something going on, so once a week, maybe once every few days, just take a quick look after you’ve had a bowel movement and make sure there’s no redness in there,” says dr. sami chadi, a colorectal surgeon with a focus in oncology at the university health network’s toronto general hospital.
“be aware of the fact that things like beets can make your stools red, just like they can make your urine red. and red gatorade can do that as well. if you do have blood, asking your family doctor for an assessment is the easiest and most effective thing you can do.”
if you think you’re too young to make this a habit, don’t take that risk. a recent report from the american cancer society has found that colorectal cancer is quickly shifting to diagnosis at a younger age. in fact, cases among people under 50 have jumped almost 50 per cent since the mid-1990s — and it’s one of the most lethal cancers in this age group.
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colorectal cancer may be more aggressive in people under 50
dr. chadi says the trend is a concerning global phenomenon. one of his youngest patients in her early 20s survived about five years following treatment. the average age of his younger patients is late 30s. even in the past week, he’s received four referrals for people under 45. he says the other alarming fact is that the cases in younger people are more advanced and complicated, suggesting that colorectal cancer is becoming more of an aggressive disease compared to the traditional disease in most patients who are usually over age 60.
a 2019 canadian study published in jama online looked at data up to 2015, noting the increasing incidence in colorectal cancer diagnosis in canadian men and women under the age of 50. the authors called for further research on possible risk factors and highlighted the need for prevention to reduce the numbers of young adults developing colorectal cancer.
a big part of prevention is knowing the warning signs. early detection is what saved andrii, a 31-year-old toronto software developer who saw blood in his stool in april 2022. he says he was in good health and active in sports, although he spent long hours sitting at a computer desk.
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andrii went to a walk-in clinic where he was told that he likely had hemorrhoids — a common condition where extra pressure on the veins around your anus and lower rectum can cause swelling and bleeding. he had another episode where he experienced more significant bleeding and some abdominal pain, so he went to a hospital emergency and was referred for a colonoscopy to have a better look at what might be happening internally. unfortunately, the procedure was scheduled for the end of october.
“that colonoscopy probably saved my life”
he decided to be proactive and returned to the walk-in clinic to push for an earlier date, and was referred to a downtown colonoscopy clinic for mid-may.
“that colonoscopy probably saved my life,” he says of the screening that showed a suspicious mass. he was referred to chadi for a ct scan for further diagnosis and then surgery to remove the stage 3 colorectal cancer tumour in june. six rounds of chemotherapy injections followed to prevent the cancer from reoccurring — and just this week he had a followup colonoscopy with chadi, confirming he is disease-free.
he’ll have another ct scan next fall and colonoscopy procedures every three years for ongoing monitoring.
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“i’m not a different person now, but i know that i’m lucky,” andrii says. although he didn’t have any risk factors for colorectal cancer like excess weight, family history or excessive alcohol consumption, he has changed his diet to reduce sugar and processed foods, and is conscientious about managing stress.
“you can’t become a hypochondriac, but there is evidence that disease can be brought on by stress,” he says.
why are younger people at greater risk of colorectal cancer?
while there’s no research yet that has clearly identified the reasons why younger people are at greater risk of colorectal cancer than ever before, there are prevailing theories, chadi says. data out of the u.k. has linked higher chance with an increase in body mass index (bmi) associated with a more sedentary lifestyle.
and chadi’s surgical partner, dr. catherine o’brien, is studying a potential link to dysbiosis or the disruption of the gut microbiome that influences how well a person can digest and then expel waste.
“this brings up the whole concept of you are what you eat, because what you eat really does impact what kind of microbiome you have and the bacteria that make up your gi tract,” chadi says. “it’s not yet to a point where we can take somebody’s stool, run it through a lab and say, ‘you’re at a very high risk of colon cancer, you should be screened more aggressively.’”
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the overall goal is to identify people at higher risk and screen them more frequently to look for issues like polyps that can predispose them to colon cancer, and then remove them with colonoscopies.
preventing colorectal cancer
the best form of prevention for colorectal cancer is putting yourself in a low-risk category based on your own activities and lifestyle, understanding the signs and seeking help, says chadi.
he talks about a family history of cancer and other science-backed risk factors: smoking, alcohol and frequent consumption of red meat. other important steps toward prevention are increasing your physical activity, where there are additional benefits of being outside and getting sun exposure for vitamin d, making healthy food choices and considering supplements for the nutrients you may be lacking.
“there’s some data that suggests that good calcium levels and good calcium consumption can lower your polyp formation risk. and the one that i try to hammer home is appropriate fibre consumption,” he says, adding that he often recommends a fibre supplement so that patients can get the daily 25 to 30 grams of fibre needed to keep bowel movements regular.
embarrassment is major hurdle in diagnosing colorectal cancer
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but he says the main hurdle to prevention is the embarrassment of talking about symptoms like a change in bowel movements, unexplained diarrhea, constipation or cramping with your primary care practitioner. these conversations could be critical for your health.
“colorectal cancer is often confused with hemorrhoids and fissures. so anyone and everyone who has a hemorrhoid or a fissure in their anal area has some underlying straining and difficulty with evacuation of their stools,” chadi says. “your primary care practitioner is going to want to know about these symptoms because they may be linked with some other part of your history, or trigger certain tests that could identify and treat something a lot earlier.”
karen hawthorne is a toronto-based writer.
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