Martina B., 59 years old, slowly opens her eyes after the short anesthesia. “Good morning Ms. B., you survived it, the colonoscopy is already over. Everything is fine,” she hears the nurse say. “How was it all over? I didn’t notice anything, that wasn’t so bad. And I was so scared! I’ve been postponing the colonoscopy for three years now. If I had known how harmless it is! I slept so well! “
Martina B. is relieved. The medical check-up was inconspicuous. “On the whole, I thought that everything was fine, I feel good too. But I was still worried because my three-year-older brother got colon cancer in the summer three years ago.” Like Martina B.’s brother, about 28,000 women and 33,000 men fare every year in Germany. You are newly diagnosed with colon cancer.
Colon cancer is the third most common cancer in both sexes. It occurs more frequently from the age of 50. The mean age of onset is in the early to mid-70s. The umbrella term “colon cancer” covers cancers of the colon (colon carcinoma) and of the rectum (rectal carcinoma). One also speaks of colorectal cancer. The risk factors for the development – lack of exercise, obesity, unhealthy diet, smoking and alcohol consumption – are widespread in western industrial society. Hereditary factors also play a role. But other diseases, such as inflammatory bowel disease, can also be associated with an increased risk of colon cancer.
Symptoms appear late
A major problem with the disease is that symptoms often only appear at an advanced stage. Like Martina B.’s brother, many sick people actually feel healthy, the disease is only noticed when symptoms or symptoms appear. For example, significant, unwanted weight loss, blood in the stool, constant abdominal pain or stool irregularities can be the first signs of colon cancer. However, unspecific symptoms such as tiredness, exhaustion or paleness as possible signs of anemia are also suspect.
The majority of malignant intestinal tumors arise from benign preliminary stages, the so-called intestinal polyps. Most of these polyps transform into malignant tumors very slowly over years or decades. Initially, the malignant cancer cells remain confined to the polyp before growth progresses. As the disease progresses, the tumor cells can grow into lymph and blood vessels and the associated risk of cancer cells spreading into other organs. Often these settlements (metastases) only lead to symptoms and a diagnosis of cancer.
Acute intestinal obstruction is also a dreaded first sign of colon cancer. This means that the tumor in the intestine has closed the intestinal lumen to such an extent that no more bowel movements can be excreted. Since the intestine constantly produces secretions even without ingesting food, there is a risk of the intestine bursting – an absolute emergency situation that can only be resolved with an operation.
As problematic as the late onset of bowel cancer symptoms are for diagnosis, the slow development of bowel tumors is beneficial for prevention. If a polyp is removed in a timely manner, colon cancer can be prevented. And even if colon cancer is discovered at an early stage, there are excellent chances of recovery, said Dr. Björn Lewerenz, chief physician in the gastroenterology department and head of the intestinal center at the Traunstein Clinic.
Since 2002 the colonoscopy has been part of the cancer early detection program of the statutory health insurance companies. Even so, only 20 to 30 percent of those entitled to take advantage of this offer. The reasons for this range from fear and shame to a simple lack of information. After all: the number of new cases and the mortality from colon cancer in Germany are declining.
Stool examinations that detect invisible blood in the stool are currently offered for colorectal cancer screening from the age of 50. From the age of 55 for women and 50 for men, a colonoscopy is directly taken over by the health insurance companies as a preventive benefit. About 25 percent of colon cancer cases are familial, which means that several members of a family have colon cancer. Hereditary colon cancer is present in around eight percent of cases; a genetic defect is known here that contributes to its development. People with one of these risks have to start colon cancer screening much earlier, sometimes as early as adolescence.
Every colon cancer patient who is treated at a certified colon center such as the Traunstein Clinic is screened for the presence of a hereditary form of colon cancer so that relatives can be offered adequate preventive care.
Hereditary component cannot be recognized
Around 70 percent of colon cancer cases occur sporadically, which means that a hereditary component cannot be identified. Nevertheless, close relatives also have an increased risk of developing bowel cancer and should therefore go for a preventive colonoscopy earlier, preferably ten years before the relatives are diagnosed, but at the latest between 40 and 45 years of age.
In addition to prevention, there are a number of other indications for having a colonoscopy. These include blood in your stool, a change in bowel behavior, and chronic diarrhea. A colonoscopy is also required to clarify constipation and recurring abdominal pain. In these cases, the family doctor will decide when a colonoscopy is advisable.
Martina B. can now sleep peacefully again. She knows that she will not get colon cancer in the foreseeable future, and even if she has found the reflection to be significantly less bad: If the result is completely normal, the next reflection will not be necessary for up to ten years. − red
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