March is Colorectal Cancer Awareness Month

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Provided by Sentara Northern Virginia Medical Center

The American Cancer Society estimates there are more than 100,000 new cases of colorectal cancer diagnosed every year. Christina Cheng, M.D., with Fairfax Colon & Rectal Surgery, is a board-certified colorectal surgeon at Sentara Northern Virginia Medical Center. Dr. Cheng recently answered some questions to clear up common misconceptions.

Many may think of colorectal cancer as a “middle-aged man’s disease,” but in recent years, it feels like more women and younger people (30s to 50s) are dealing with it? Why is that? I’m not sure where the rumor came from that this is a man’s disease, but colorectal cancer affects males and females relatively equally. It is the third most common cancer found in men and women, behind prostate cancer and lung cancer (in
men) and behind breast cancer and lung cancer (in women). The risk of CRC increases with age, especially after age 50.

While CRC in patients under 50 is still relatively rare (less than 1% overall incidence), it is true that in the past couple decades, there have been increasing numbers of younger people diagnosed with CRC. We do not fully understand why this is, but studies have identified certain risk factors, including obesity, physical inactivity, smoking, and diets high in fat and processed meat.

What are the symptoms that people of all ages should be aware of?

Early stage CRC usually does not have any symptoms at all. Most CRC comes from a small benign growth called a polyp. Small polyps are found in 15 to 20% of patients, and they do not have any symptoms. If the polyp grows over many years, they can then transform into a cancer. When a cancer gets larger over time, it can cause symptoms such as bleeding or even a blockage of the GI tract. Bleeding can range from bright red blood to dark, black stools. A blockage can present with constipation, change in stool caliber, nausea/vomiting, abdominal pain or distension. By the time there are symptoms, the cancer is oftentimes advanced.

This is why we do not rely on symptoms to diagnose CRC. We aim to prevent CRC with screening colonoscopies. During a colonoscopy, we are looking for polyps and removing them. This prevents that polyp from growing and becoming cancer.

Should people start getting colonoscopies earlier?

The recommended age to begin colonoscopies for both men and women used to be at age 50. However, in light of the increasing incidences of CRC in younger patients, recently those recommendations have changed to start screening at the age of 45. The exceptions to this would be in young patients with
inflammatory bowel disease (Crohn’s or ulcerative colitis), family history (first degree relative) of CRC or genetic mutations that increase the risk for CRC. These patients should talk to their physician about when they should begin screening.

What do you think is the biggest misconception about this disease?

I think one of the biggest misconceptions is that patients will have symptoms if they have cancer. As I said earlier, traditionally, it takes time for a polyp to grow and become a cancer, and then a few years more to develop signs and symptoms.

If you could tell people one thing about CRC, what would that be?

Colonoscopy is a very, very safe and quick outpatient procedure. The procedure is done under anesthesia so you don’t feel anything. The worst part is the day before, when you have to clean out your colon with a special laxative drink. But it’s one annoying day of your life that can ultimately be lifesaving.

Christina Cheng, M.D. is one of nine colorectal surgeons at Fairfax Colon & Rectal Surgery — part of the Sentara Northern Virginia Medical Center Digestive Program, Surgical Services and Sentara Cancer Network. To speak with a patient navigator about colorectal cancer, call 703-523-1599. Visit for more information or to make an appointment.


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