Gut Check | Wednesday, October 7, 2020

The Keys to Digestive Cancer Detection and Prevention

By Lea Anne Myers, MSN RN CGRN, SGNA President

Let’s talk about the elephant in the room: cancer is a scary disease that no one wants to think much about. It is a physical, emotional and financial burden that affects millions of Americans each year. But in order to beat cancer, or even have a fighting chance, we have to talk about it. 

At SGNA, our members are dedicated gastroenterology nurses and associates who work daily to help patients understand how to maintain good digestive health. Just one area of focus for us as GI professionals is patient education on cancers that are found in the large intestine (colon cancer) and the rectum (rectal cancer). These are often called colorectal cancer and are the second-leading cause of cancer deaths in the U.S. One in 20 men and one in 24 women will be diagnosed with colorectal cancer in their lifetimes, and approximately one-third of patients with colorectal cancer die within five years.

But there is good news: Screening is the key to early detection and prevention of colorectal cancer. It is used to look for cancer before you have any symptoms or signs. The overall goals of cancer screening are to lower the number of people who die from the disease, or eliminate deaths from cancer altogether and lower the number of people who develop the disease.

In May 2018, the American Cancer Society revised their screening recommendations. They recommend that screening begin at age 45 for patients at average risk. The previous recommendation was to start at age 50; however, colorectal cancer rates have increased in young and middle-age populations, which prompted the change.

In general, patients are either at average or increased risk for colorectal cancer. Factors that put a patient in a high risk category include: personal history of colorectal cancer or adenomatous polyp (a growth found on the inside of the colon), family history (parent, sibling or child) of colorectal cancer or advanced polyp, family history of any known genetic syndromes that can cause colorectal cancer or a personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease). 

There are different test options used to screen for colorectal cancer. Colonoscopy remains the gold standard for screening tests, as it allows for direct visualization of the inside of the colon and allows for the detection and removal of colon polyps in the same procedure. Some polyps can develop into cancer. By finding and removing precancerous polyps, we can stop colorectal cancer before it ever starts. When colorectal cancer is diagnosed in the early stages, the patient has a 90% chance of survival for five or more years.

Another disease that may be lesser known to the general public, but a very real threat to digestive health, is cancer of the esophagus. The esophagus is the long, hollow, muscular tube that connects the throat to the stomach. When a person swallows, the walls of the esophagus squeeze together to push the food down into the stomach.

Esophageal cancer rates have risen dramatically since the mid-1970s. The American Cancer Society estimates that 17,650 adults in the U.S. will be diagnosed with esophageal cancer this year. Only 19% of those will survive five years after diagnosis. Approximately 16,000 people will die from esophageal cancer this year. It is the seventh most common cause of cancer death among men.

The most common form of esophageal cancer in the Western Hemisphere is adenocarcinoma. It primarily affects Caucasian men over the age of 55, as well as people with gastroesophageal reflux disease (GERD). Many people associate GERD with heartburn, as it is its most common symptom. More than 30 million Americans experience daily heartburn. Everyday heartburn can lead to changes in the lining of the esophagus, and potentially lead to a condition called Barrett’s esophagus. Even if you treat heartburn by taking medications to control the symptoms, you can still develop Barrett’s esophagus. This condition raises the risk for esophageal cancer.

Unlike colorectal cancer screening, there are no recommendations for screening the general population for esophageal cancer, but it never hurts to talk to your physician. There are recommendations among several professional guidelines that patients with chronic GERD should work with their physician to determine if screening is appropriate for them. Patients with chronic GERD, in combination of other associated risk factors, such as obesity, should have an upper gastrointestinal endoscopy to screen for Barret’s esophagus. During an endoscopy, a physician will use a lighted tube to look inside the esophagus. If Barrett’s is suspected, the physician will take biopsies to remove small amounts of tissue. The tissue will be sent to a pathologist who will examine it under a microscope. This is how Barrett’s is diagnosed. This type of screening can help find cancer early or find changes that could become cancerous over time.

Traditional treatment for esophageal cancer generally involved radiation, chemotherapy and major surgery that requires the removal of part or all of the esophagus. New procedures offer less invasive options of treatment that often yield better results if the disease is found in early stages. It is important for patients to talk openly with their physician about any symptoms of heartburn and any over-the-counter medications that are being taken to relieve symptoms. This allows the physician to get a clear picture of the patient’s health and make appropriate recommendations for screening based on symptoms the patient describes.

Proper screening and follow-up surveillance is imperative for early detection and prevention of colorectal and esophageal cancers. Prevention allows us to stop cancer before it even starts, and early detection often provides a patient treatment options that are less invasive and more effective to live a long and healthy life.