Friday, February 15, 2013 - Colon Cancer: It's a Cancer You Can Actually Prevent

How much do you know about colorectal cancer? That it’s one of the most commonly diagnosed cancers in the U.S.? That it’s one of the only types of cancer that can truly be prevented?

Nearly 90 percent of all colorectal cancers start as precancerous polyps – abnormal growths attached to the lining of the colon, or large intestine. Fortunately, they grow slowly. But some, not all, will mutate and become cancerous.

The only way to find and remove these polyps is with a colonoscopy. This preventive screening procedure, performed while the patient is sedated, enables a physician to examine the inside of the colon with an endoscope ­– a flexible, lighted tube that transmits images onto a computer monitor.

As cancer awareness rises, “women are becoming more diligent about mammograms and men about prostate screenings, yet both men and women equally put off colon cancer screening,” notes Felice Zwas, MD, head of gastroenterology at Greenwich Hospital. The procrastination is likely due to the planning required, and until you’ve actually had one, the anxiety is usually worse than the event itself.

Are You at Risk?
“Incidence of colon cancer peaks in a person’s 60s, which is why we suggest patients come in ten years before then, at age 50,” Dr. Zwas explains. “However, if you have an immediate family member who has had colon cancer, or multiple relatives who have had different types of cancer, it’s recommended you have your first colonoscopy ten years before the age at which your family member was diagnosed.”

While genetics play a role, 80 percent of people who get colon cancer have no family history of it. Inflammatory bowel disease (not the same as irritable bowel syndrome) is another risk factor.

As for eating habits, Dr. Zwas agrees with the scientific community that there is no direct evidence that certain diets cause colon cancer. Nor do smoking or alcohol.

Yet health experts are taking a hard look at these same lifestyle factors, along with lack of regular exercise, to see if there is a connection. A diet low in animal fat and filled with fruits, vegetables and high-fiber whole grains is generally recommended to reduce the overall risk for chronic disease.

Choosing Wisely
If you don’t already have a gastroenterologist, or GI doctor, your primary care physician may recommend one to you. Savvy healthcare consumers may choose to do some research on their own.

Vigilance. Look for a board-certified specialist who finds polyps above the national average of 15 percent. “It’s okay to ask the doctor what his or her polyp detection rate is,” encourages Dr. Zwas. “A higher detection rate means the doctor is taking a careful look behind the natural folds in the intestinal lining.”

High-tech. Access to the latest technology is important, too. “The new equipment at Greenwich Hospital’s Endoscopy Center gives us extremely precise, high-definition screen and scope images,” Dr. Zwas says. “The pictures are so clear, we’re picking up subtle and flat polyps we would never have been able to see five years ago.”

Even so, she cautions, “All the high-def in the world isn’t going to help if the patient’s colon isn’t clean.”

The Preparation
Once you have selected a GI doctor, you will have an initial consultation to discuss your medical history and ask questions. The doctor will also write a prescription for the preparation kit you must use the day before.

A clean colon is the most important first step for your procedure. Preps differ: Some involve mixing a powder with liquid; others are in pill form. Either way, drinking lots of fluid, at least a half-gallon, is necessary. You will make many trips to the bathroom that day, so make sure you are at home with no obligations to go anywhere. Also, no food after midnight.

The Day Of…
At Greenwich Hospital’s Endoscopy Center, a registered nurse will have contacted you the day before your procedure to review important medical information and answer any questions you might have.

After your arrival and check-in, your nurse will get you settled and comfortable, and an IV will be started. This allows the board- certified anesthesiologist taking care of you that day to administer medicine and fluids so that you will sleep during the colonoscopy and stay hydrated. Your GI doctor, anesthesiologist and registered nurse will stay with you throughout the procedure.

“When you wake up, you’ll feel as if you’ve slept for eight hours,” says Dr. Zwas. A nurse will offer you a warm muffin and a beverage, and once you have your aftercare instructions and are cleared for discharge, you can go home. Start to finish, a typical appointment is just a few hours. Because of the sedation, you will need someone else to drive. A nurse will call you the next day to see how you are doing.

When Polyps Are Removed
Fifteen to 30 percent of patients will have polyps removed during their colonoscopy. These are sent to a lab where a pathologist determines if they are adenomatous (precancerous, or can become cancerous) or hyperplastic (noncancerous and not the type to develop into cancer).

The Internet is filled with information about alternatives to the traditional colonoscopy, such as sigmoidoscopy and virtual colonoscopy. Neither is as effective. A sigmoidoscopy only lets the doctor see the bottom third of the colon; and if polyps are detected during a virtual exam, the patient must then undergo a standard colonoscopy to have them removed.

“Overall, patients feel more comfortable with the traditional colonoscopy,” says Dr. Zwas, “and detection rates are much better today, so it remains the gold standard.”
Warning Signs
Polyps and colorectal cancer don’t always cause symptoms. That’s why regular screenings are so important. Call your doctor if you experience:
• Blood in or on your stool (bowel movement)
• Stomach pain, aches, or cramps that don’t go away
• Unexplained weight loss

The following board-certified physicians provide colonoscopy services at the Endoscopy Center of Greenwich Hospital:

Center for Gastrointestinal Medicine of Fairfield and Westchester, PC 203-863-2900
• Jennifer Barro, MD
Nelson Bonheim, MD
Neda Khaghan, MD
• Neal Schamberg, MD 
• Alan Selkin, MD 
• Felice Zwas, MD

Sound Shore Gastroenterology Associates, PC 914-253-9252
• Robert Goldblatt, MD
• Neil Shapiro, MD

If you would like to have your procedure at the Endoscopy Center of Greenwich Hospital, please let your doctor know at the time of scheduling. We will make every effort to accommodate your busy life! For more information, visit

The Endoscopy Center of Greenwich Hospital 500 W. Putnam Ave., Greenwich Hours: Monday-Friday, 7am-4pm

March is National Colorectal Cancer Awareness Month

Join us for the special event:
Risk, Screening and Prevention of Colorectal Cancer
Monday, March 18
Speaker: Neal Schamberg, MD, Gastroenterologist
See calendar for details >>