Colorectal Cancer Screening: What You Need To Know

What do you know about colorectal cancer screening? Do you know what age you should be attending colorectal cancer screening? 90% of colorectal cancer cases have a high success rate if they are diagnosed in time.

This week, LetsGetChecked explains colorectal cancer and screening in a language that everyone can understand. LetsGetChecked is joined by Riley Lewis who was diagnosed with stage 4 colorectal cancer at 24 years of age. Riley shares her story from hearing of her diagnosis to beating cancer and how to maintain overall wellness after treatment.


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What Is Colorectal Cancer?


Colorectal cancer, also known as CRC refers to the abnormal growth of cancerous cells on the large intestine and rectum. Colorectal cancer is also known as colon cancer in the U.S and bowel cancer in Europe. Colorectal cancer generally affects those that are over the age of 45, however, there is a rise in the incidence of colorectal cancer among younger demographics.

Colorectal cancer is the third most common cancer diagnosed in both men and women each year in the United States, excluding skin cancer. It is the second leading cause of cancer related death in the United States for men and women combined. This year, an estimated 140,250 adults in the United States will be diagnosed with colorectal cancer.


What Are The Symptoms Of Colorectal Cancer?


The symptoms of colorectal cancer may mimic commonplace side effects of everyday life including feeling tired all the time, digestive discomfort, bloating and gas, however if these symptoms persist, you need to get checked.

Some of the most common symptoms associated with colorectal cancer include:

A persistent change in bowel habits
Changes in bowel habits may include constipation, diarrhea or a change in the texture of your stool lasting for four weeks or longer.

Blood in your stool
Blood in your stool may occur due to tumour bleeds, generally speaking tumours will not bleed alot and the bleeding will be on and off, so this may only show in fecal immunochemical tests.

Unexplained weight loss
Unintentional and inexplicable weight loss of upto ten pounds in six months may indicate a number of cancers, cancer cells can release substances that change the way food is converted to energy in the body. Cancer cells may also use the majority of the body’s energy supply as all systems in the body try to combat the disease.

Feeling tired all of the time
Rectal bleeding or finding blood in your stool may cause anemia, or an iron deficiency which can explain why you may feel tired all of the time coupled with your body's internal battle with cancer cells.

Persistent abdominal pain
Abdominal pain may be caused by changes in bowel movements, the side effects of diarrhea and constipation can include cramping, bloating and gas. Abdominal pain is generally non-specific and is often compared to colic if the tumour causes complete or partial rectal obstruction.

Other symptoms may include feeling dizzy or breathless, hemorrhoids, anal fissures, or feeling a lump in your abdomen.

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How Do You Screen For Colorectal Cancer?


90% of cancer cases can be treated effectively if they receive an early diagnosis.

It is estimated that 50,630 deaths (27,390 men and 23,240 women) will be attributed to colorectal cancer this year.

There are a number of ways to test for colorectal cancer including tests that examine the stool for cancer cells and genetic material, procedures that involve an internal examination of the rectum and intestine, and finally imaging technology.


Colorectal Cancer Screening Using Stool Samples


  • Fecal Immunochemical Tests

Fecal Immunochemical Tests (FIT) take a swab sample from stool to detect blood that may not be visible to the naked eye. Blood in the stool and rectal bleeding are common symptoms of colorectal cancer. FIT tests can detect blood that has been secreted from the lower intestines in the faeces. This type of testing does not offer a definite answer of whether or not you have colon or colorectal cancer, however it offers an indication of whether or not you should seek out further testing. If you are experiencing early symptoms associated with colorectal cancer, you should take a FIT test.

  • Stool DNA Tests

Stool DNA Tests use DNA taken from a stool sample to determine whether or not one should get a colonoscopy by examining changes in DNA that occur alongside changes in polyps and cancerous tissues.


Colorectal Cancer Screening Using Internal Examinations


  • Colonoscopy

During a colonoscopy, a lighted tube called a colonoscope is inserted into the rectum while the patient is sedated. Using this method, a physician can examine the entire rectum for tumours, also known as polyps that may be benign or malignant. During a colonoscopy, a physician may remove polyps for a biopsy, in which the tissue is tested for cancer cells.

  • Sigmoidoscopy

During a sigmoidoscopy, a lighted tube is inserted into the rectum and lower colon in the same way a colonscope is while a patient is sedated. During this examination however, it is not possible to check the upper intestine. Polyps can be removed for a biopsy in this test however, if there are cancerous tissues found, a colonoscopy is then recommended, indicating that it may be more effective to undertake a colonoscopy in the first instance.


Colorectal Cancer Screening Using Imaging Technology


  • Double Contrast Barium Enema (DCBE)

DCBE testing is used for patients who cannot receive anesthesia, or for those who cannot undergo a colonoscopy. During this test, x-rays are taken of the colon and rectum. This form of colorectal screening is usually not recommended by doctors as it cannot identify pre-cancerous cells.

  • Computed Tomography (CT/CAT Scans)

CT/CAT scans work in a similar way to a colonoscopy, however, in this instance, a radiologist works to find polyps through the x-ray images as opposed to physically searching with a colonscope. This is an alternative for those who cannot receive anesthesia.


What Is The Recommended Screening Age For Colorectal Cancer?


The American Cancer Society illustrates what portion of people with the same type and stage of cancer are still alive for a certain amount of time, after they were diagnosed, using the 5-year survival rate equation.

Overall, the 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for people with colorectal cancer is 65%.

The recommended colorectal cancer screening age in the U.S dropped to 45 years of age following a study by the American Cancer Society who found that a dramatic increase in the number of colorectal cancer cases reported by young adults.

In the study, it was found that there was a 2% increase year on year of colon cancer cases in those aged between 20 and 39. In rectal cancer cases, there was a 3% increase in incidence rates per year from 1974 to 2013 in adults aged 20-29.

Previously, the recommended age for screening in the U.S was between 50 and 75. Today Japan has the lowest recommended colorectal cancer screening age at 40 years, while Finland and Iceland have the highest recommended screening age at 60 years and over.

This week, we are joined by Riley Anne who was just 24 when she received her diagnosis of colorectal cancer and states that the screening age should be lower, highlighting that the symptoms of colorectal cancer are often dismissed among younger demographics.

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Surviving Colorectal Cancer: Riley Lewis Shares Her Story


Riley Lewis, a survivor of stage 4 colorectal cancer, received her diagnosis at the age of 24, when she was 17 weeks pregnant.

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“I thought to myself I’m too young, this can’t happen to me, it doesn't make sense, it’s an old man’s disease, I’m not an old man, I’m pregnant so it can’t be cancer.”

What signs and symptoms were you experiencing in the lead up to your diagnosis?

What made me get checked was abdominal pain on my left side. It was all chalked up to pregnancy. During a scan they said they saw “something” but they believed it was a twisted ovary.

Before the scan, I was having a lot of the pregnancy related symptoms like getting sick, loss of appetite, constant nausea, fatigue, cramping, diarrhea and then constipation and I even saw blood. At the start, I always disregarded it and never reported it to my healthcare providers because I kept thinking: It’s IBS or ulcerative colitis, PMS changes, it’s always something else but it’s not cancer.

Eventually I just thought to myself: I’m not eating, drinking or urinating and this pain is so bad.
When they did find the cancer, they saw my intestine was dead, cut it out and gave me a colonoscopy bag. I didn’t find out till 5 days later when I woke up after what was supposed to just be a scan.

People seem to focus on the physical aspects of cancer, with less regard for how the disease can affect you on an emotional level. What impact did it have when you found out about your diagnosis?

I cried after I found out it was stage 4. I didn’t find out I was stage 4 until a week after, once I realized it was, I just started asking questions: “What do I need to next?” “Are we aiming for remission? an extended life? What do I need to do? I wasn’t emotional until after. Anxiety and depression came after remission.

The colorectal screening age has been reduced in the U.S. Do you think that the recommended screening age needs to be reduced further?

It has been changed to 45 but I think it needs to be lower and rightfully so. We need to ask ourselves, if they’re lowering the age, why are they doing that? I would like to see it down to 30. I was 24 but 30-45 is where the main diagnosis happens.

Do you think people avoid talking about the topic of cancer?

Cancer is such a bad word to a lot of people, they get uncomfortable, they don’t know how to approach the topic.

“People think if you talk about it , it gets worse, if you talk about it, it comes back.”

A lot more education happens if people talk about taboo subjects, especially colorectal cancer because it has to do with poo. Poop and cancer are both taboo which makes it worse. Talking about bodily functions was never uncomfortable for me to deal with, now I’m like whatever, everyone needs to know.

What did your treatment involve?

Treatment is different for everyone. For me personally, I did chemotherapy and surgery due to the location of where my tumour was and because I was pregnant. The tumour was in my intestinal lining

The chemo they put me on when I was pregnant was pretty textbook, once I had my daughter they put me on what was often used for metastatic cancer for 9 rounds.

I experienced every possible side effect you could experience. I was bedridden for all of my chemo treatment, with a newborn and my husband was playing mom and dad. He had to look after everything.

What does it feel like to undergo chemotherapy?

People talk about nausea or being tired but multiply that by 100. The nausea is a constant feeling of “I’m just about to throw up” but you don't or you wish you would or you do and it doesn’t relieve anything.

There are also other symptoms associated with chemotherapy that people don’t know about like feeling dizzy all the time, your tongue can start peeling, your kneecaps can go numb, you can lose feeling in your hands and knees and you feel like your in a fog machine. It always feels like you’re in a room of fog.

Once you’re healing from chemo, you start realizing you were not just tired you were in a fog.

What advice would you give to someone who has just received a colorectal cancer diagnosis?

I recommend finding a support group either online or in person, meeting people who have been where you’re at now for their insight and advice. You have this support if your oncologist says something weird and you want a second opinion and you have someone to talk to who knows how it feels to be this way

Having people who can process those thoughts and emotions with you - someone who has been there and someone who can help reframe your thinking is so important.

My advice to caregivers is to take time out. They can get so wrapped in your illness. They also need an outlet. They need to reach out for support and take time for themselves, even a day where they can just go for lunch by themselves.

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What advice would you give to people who are rebuilding their health after receiving the all-clear?
I was never a health freak andI still have a really poor diet because in my mind I had stage 4 cancer and I’ll eat what I want.

During my treatment I was leaning so much on my diagnosis, I was like “I can't workout because of my surgeries, my abdominal area is weak, chemo has changed my body forever.”

Today I can say that I have been working out consistently for six months. I still struggle post chemo and surgeries, but working out has given me some energy back. I can make a difference with how I feel. I find that yoga is really helpful, while working out helps to build my endurance, my mindfulness and my ability to manage my time and say no if I need to.

One of my favourite sayings that has always stuck with me is: "You have cancer, cancer doesn’t have you."


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Written by Hannah Kingston | Approved by Medical Director Dr. Dominic Rowley