Colorectal cancer has received a lot of attention this year due to the untimely death of celebrity Chadwick Boseman who, much to his credit, waged a four-year silent battle with the disease while maintaining his extraordinarily active lifestyle. Mr. Boseman was first diagnosed back in 2016 when he was in his thirties, thus establishing an extremely early onset for the illness.
This article intends to briefly discuss the etiology, signs and symptoms of colorectal cancer. The goal is to educate as many people as possible in order to recognize (and hopefully curb) the incidence of this disease within the American (even more specifically, African American) community.
What is colorectal cancer, anyway?
To answer the above question, we should first define the word “cancer.” Put simply, cancer is any disease process that occurs within the body that is characterized by undifferentiated (un-specialized) cells that multiply (usually unchecked), “overtake” and disrupt the normal function of any specified body part/organ. If left untreated, cancer can spread (metastasize) to other areas of the body and cause severe global dysfunction, morbidity and in many cases, death.
Colorectal cancer originates in the colon and/or rectum. The condition usually starts out with an abnormal growth (called a polyp) on the inner lining of the colon; however, not all polyps evolve into cancer. In fact, it can take some years for a polyp to become cancerous; which is why early screening is so important. When a polyp does become cancerous it can grow into the inner lining of the colon wall, eventually reaching the outer layers and into the blood vessels and lymph nodes. The cancer is then transported to different areas of the body (metastasis) where it continues on its destructive journey.
What causes colorectal cancer?
There are several factors that have been associated with increased risk of developing colorectal cancer. Some of these factors are lifestyle-related (and therefore changeable). These include: lack of exercise, smoking, obesity and diet.
Other risk factors for this type of cancer are: age (individuals aged 50+ are at a higher risk of developing colon and rectal cancer than their younger counterparts), personal history of colon polyps (adenomas), inflammatory bowel disease, inherited syndromes, diabetes (type 2) and racial/ethnic background.
More specifically, African Americans are the most afflicted group with the highest incidence and mortality rates of all racial groups in the United States. The risk of developing colorectal cancer is about 20% higher and the mortality rate is disturbingly high at 40% compared to other racial groups.
What do symptoms of colorectal cancer look like?
Unfortunately, colorectal cancer many times cannot be detected right away as many symptoms do not appear until the later stages of the disease. However, when symptoms do arise they can include the following: diarrhea and/or constipation lasting several days, bowel movement “urgency”
that is not relieved by having a bowel movement, bloody stools, rectal bleeding, abdominal pain, marked/unintentional weight loss and generalized weakness and fatigue. Another major symptom of colorectal cancer is anemia (low blood cell count) due to excessive blood loss into the digestive tract.
Is colorectal cancer preventable?
According to the American College of Gastroenterology (ACG), “(c)olorectal cancer is the number 2 cancer killer in the United States, yet it is one of the most preventable types of cancer.” Early detection is the key to preventing this disease.
The “gold standard” for early detection is colonoscopy; wherein precancerous polyps can not only be detected, but in certain instances they can also be removed. This is a very powerful means of cancer prevention; however, it must be taken advantage of as early as possible to achieve the best outcome. Most significantly, the ACG reports that “(t)he development of more than 75-90 percent of colorectal cancer can be avoided through early detection and removal of precancerous polyps.”
What types of screens are there?
It goes without saying that early detection of colorectal cancer is essential for improved rates of survival. As mentioned above, colonoscopy is the most powerful method of detection for colorectal cancer.
Another pre-screening tool is the Fecal Immunochemical Test (FIT). This test assesses for trace amounts of blood in the stool which can further determine the need for a colonoscopy.
There are a few other screening tools including the Flexible Sigmoidoscopy, CT colonography, Fecal DNA Testing and Annual Hemoccult Sensa. These screens, while effective, are not as sensitive or as powerful as the colonoscopy.
What about African Americans?
For African Americans specifically, earlier detection can literally mean the difference between life and death.
Black Americans are being diagnosed with colorectal cancer at an earlier age than other ethnic groups for reasons which remain unclear. They are also dying earlier than their cultural peers, which makes early screening even more crucial for African Americans.
According to the ACG (2009), the new recommended screening age for African Americans has decreased from 50 to 45. In light of this information (which is now over a decade old), African Americans continue to be at the highest risk for developing the disease. Much of this is due to many members of the African American community remaining unaware of the dire need to not only be screened, but screened by age 45 or even earlier in some cases. Had Chadwick Boseman been screened earlier he probably would still be among the living.
What to do next…?
Everyone who is an adult above a certain age (usually starting in the mid-thirties) needs to consider and actively pursue colorectal cancer screening. More specifically, African Americans and other people of color need to be extra-vigilant because of their increased morbidity and mortality rates due to colorectal cancer. Some steps to follow include:
- Talk to your physician about getting screened for colorectal cancer if you are above a certain age.
- Consider colonoscopy versus other types of screenings. It is the most conclusive and effective screening tool.
- Make appropriate lifestyle changes including a better diet, more exercise and avoidance of smoking.
- Encourage other members of your community to learn more about and get screened for colorectal cancer when appropriate.
Knowledge is power; and acting with knowledge will enable not only African Americans but EVERYONE to finally get a handle on colorectal cancer for good.