According to the World Health Organization, colon cancer is the third most common cancer worldwide and the second leading cause of cancer-related deaths.
Next month (March) is Colon Cancer Awareness Month and in preparation, Kanakanak Hospital in Dillingham’s Chief of Staff, Dr. Marlena Strandir, a family medicine, EGD, and colonoscopy physician, spoke with KDLG about the risks and symptoms of colon cancer, and why screening is key to prevention.
Strandir: My name is Marlena Strandir. I am a family medicine physician. I work at Bristol Bay Area Health Corporation. I've been there for about eight and a half years.
Sutherland: How common is colon cancer?
Strandir: Well, colon cancer is extremely common throughout the United States and the world. Alaska Native people have the highest rates of colon cancer of any group of people in the world. They actually don't exactly know why that is, and there are groups that are studying this and trying to figure it out to try to reduce those rates.
Sutherland: Let's say I'm just a person wandering out in the world and haven't really been thinking about this. What are signs and symptoms that I can look for and know that I should consult a doctor?
Strandir: Colon cancer can be very creepy and insidious in that it can get away with a lot without you knowing it is there. It can grow and develop without really any signs or symptoms. Some people will have a change in their bowel habits, diarrhea, and occasionally constipation. It just depends on where the cancer is at and where it's affecting the colon. Sometimes people will get really skinny stools, we call them pencil-thin stools. You could get belly pain, blood in your stool, weakness, and fatigue, which comes from anemia, from losing all the blood slowly over time. Sometimes unintentional weight loss is another clue. So you know that the list of things is very broad, and it could mean a lot of things. And so I think the take-home message is, never rely on symptoms. The best thing to do is just get screened early before any of that comes about.
Sutherland: And when you say screening, are you speaking in terms of a colonoscopy?
Strandir: Typically. Colonoscopy really is the gold standard test, because it is the most reliable in terms of being able to detect any abnormalities. We can also treat it during that procedure. So if we see anything that doesn't look right, we can remove it right then and there. If it's too large to be removed, we can take a sample of it and at least find out what it is.
There are alternatives for people who do not want to get a colonoscopy, they are not looking forward to that, and they really don't want to. If you are low risk, then we can do something called a FIT test, which is a stool test. In order for it to be really effective, we need to do that every year. It's not as good as colonoscopy at picking up on pre-cancerous polyps or cancer, but it does a pretty good job. And then if you do get a positive result on your FIT, the reflex is that you would go for a colonoscopy to find out why that was positive.
Sutherland: So, what is a colonoscopy?
Strandir: A colonoscopy is a procedure done to detect early signs of colon cancer and even other conditions that might affect the colon, like ulcerative colitis, to provide a little bit more detail.
You're given just enough medication to put you into a deep sleep so that you don't feel the procedure. And then once you're asleep, your doctor inserts a thin, flexible tube. It has a very, very fancy camera on the end, and they just insert that through your bottom and look at the entire large colon, all the way to the end where it meets the small intestine. And on their way, they'll remove anything that doesn't look normal.
Once the procedure is finished, you're taken over to a recovery room where you're given lots of food and juice and coffee, and then you can be discharged, and that's usually about three hours from the time you set foot in the hospital.
Sutherland: Who should get screened for colon cancer and when should people start thinking about this?
Strandir: So the Alaska Native Medical Center(ANMC) actually has created its own criteria for screening because rates of colon cancer are so high among Alaska Native people. So while the general population is encouraged to begin screening at age 45, ANMC recommends that all Alaska Native people begin screening at 40. There are special circumstances, though, to the age 40-45 rule. If you have a first-degree relative, like a mom, dad, brother, or sister, who is diagnosed with colon cancer before the age of 50, you should be screened 10 years prior to when they were diagnosed. So for example, if your brother was diagnosed with colon cancer at the age of 45 you should begin your screenings at 35 instead of 40. There's not a lot known about the specific risk factors, but we do know obviously that increasing age, family history of colon cancer or polyps, or personal history of that, as well as tobacco, alcohol, and obesity are all risk factors for colon cancer. So if you fall under any of those categories, it's just another reason to come in and get screened.
Sutherland: Is there anything else that you want to add?
Strandir: We're here to get this done, and we are very passionate about getting people screened and removing polyps and trying to reduce the rates of colon cancer in the Alaska Native people. So I really encourage people to come in. Get screened. We'd love to see you.
That was Dr. Marlena Strandir from Kanakanak Hospital in Dillingham, speaking with KDLG about colon cancer risks, symptoms, and the importance of early screening.
To schedule an appointment for colon cancer screening at Kanakanak hospital call (907) 842-9222.
Get in touch with the author at margaret@kdlg.org or (907) 842-2200.
