Colorectal Cancer Screening

Colorectal cancer is both the third most common cancer in the United States and the third leading cause of cancer death in the United States. The prevalence of the disease increases with age, and over 90% of colorectal cancer is diagnosed in clients over the age of 50.

Colorectal cancer is a disease in which cells in the colon or rectum become abnormal and divide without control, forming a mass called a tumor. The colon and rectum are parts of the body’s digestive system, which takes up nutrients from food and water, and stores solid waste until it passes out of the body (National Cancer, 2008).

Patients who have a history of adenomatous polyps or inflammatory bowel disease, or a family history of colorectal cancer or adenomatous polyps should receive a colonoscopy (Mauk, 2010, p. 373). Most polyps are benign, but experts believe that the majority of colorectal cancers develop in polyps known as adenomas (National Cancer, 2008). Colorectal cancer is more likely to occur as people get older, most people develop colorectal cancer are over age 50. Personal and family history increases the risk of colorectal cancer. People who have ulcerative colitis or Crohn’s colitis may be more likely to develop colorectal cancer than people who do not have these conditions. Diet, exercise, and smoking can increase the risk of colorectal cancer.

Fecal occult blood testing (FOBT), sigmoidoscopy, and colonoscopy are several good screening tests to detect early colon cancer. Choice of screening, however, is determined based on client risk factors and preference. Screening for these high risk clients is begun before age 50. Screening strategies for clients of average risk include FOBT, sigmoidoscopy performed every 5 years, or a combination of FOBT performed annually with sigmoidoscopy every 5 years when FOBT testing is negative. If the results of this test are positive, clients are sent for colonoscopy or double barium enema combined with sigmoidoscopy, where colonoscopy is not available. Digital rectal exam (DRE) is another screening test performed, allowing examination of only the lower part of the rectum.

The decision to have a certain test will take into account several factors, including the following:

- The person’s age, medical history, family history, and general health

- The accuracy of the test

- The potential harms of the test

- The preparation required for the test

- Whether sedation is necessary during the test

- The follow-up care after the test

- The convenience of the test

- The cost of the test and the availability of insurance coverage

Colonoscopy is the most sensitive of the screening methodologies but is associated with the highest cost and risks. These risks include a small risk of perforation and bleeding and the risks associated with sedation, which is required for the procedure (Mauk, 2010, p. 374). FOBT advantage include no cleaning of the colon is necessary, samples can be collected at home, and does not cause bleeding or perforation/tearing of the lining of the colon. Disadvantages include possible false positives, fails to detect most polyps and some cancers, and additional screening procedures may be necessary (National Cancer, 2008).

The exact causes of colorectal cancers are not known. However, studies help show certain factors that can increase an individual’s risk for developing colorectal cancer. It is important for these individuals to talk with their healthcare providers about when to begin screening for colorectal cancer, along with the risks and benefits of each test.

References

Mauk, K. (2010). Gerontological Nursing Competencies for Care (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.

National Cancer Institute. (2008). Colorectal Cancer Screening Fact Sheet [Brochure]. National April 7, 2011, Cancer Institute http:/​/​www.cancer.gov/​cancertopics/​factsheet/​detection/​colorectal-screening/​print

NOTE: This blog post reflects the work of a Registered Nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.