Colon cancer is the second leading cause of death of all cancers, but it is preventable.

Dr. Ahmed Hasan, a gastroenterologist with Lehigh Valley Health Network and the Carbon Schuylkill Endoscopy Center in Lehighton, said colon cancer is the third most common cancer, and cases of it are increasing in people younger than 50 years old.

The medical community traditionally has recommend getting a colonoscopy for the first time at age 50, but that has changed.

“The slogan now is 45 is the new 50,” Hasan said. “The reason is that we found that people in their 40s are having more aggressive colon cancer.”

By aggressive, Hasan means that the cancer has already spread throughout the body. He explained that doctors have found huge polyps in people in their 40s with no family history of colon cancer. They have also seen more cases in younger people where the cancer has metastasized to other parts of the body. Doctors don’t know why yet.

“Colon cancer prognosis is very good, if it’s not metastatic,” Hasan said.

He said that sometimes only surgery is needed to treat the cancer, but sometimes surgery, chemotherapy and/or radiation are needed.

According to the American Cancer Society, the five-year survival rate is based on several factors, such as age, general health, stage of the cancer, and the degree to which the treatment works. This is percentage of people who are alive five years after their diagnosis. People can live much longer.

The five-year survival rate with a localized stage colon cancer, which means the cancer has not spread beyond the large intestines, is 91%. If the cancer has spread to surrounding tissues, organs or nearby lymph nodes, that rate is 72%.

If the cancer has spread to distant parts of the body, the five-year survival rate is 13%, but the ASCO stated on its website cancer.net, that if a patient has a minimal number of polyps and tumors, such as one polyp and just a few tumors in the lung or liver, and the tumors can be eliminated, then the survivability improves.

Hasan said that if there is a family history of colon cancer, then a person should have his or her first colonoscopy 10 years before the age in which the family member was diagnosed with the cancer. For instance, if a person’s father was 50 years old when he was diagnosed with colon cancer, then his son and daughter should get screened at 40.

If a person has family history of Lynch syndrome or familial adenomatous polyposis, Hasan said, then he or she should be screened 20 years prior to the family member’s age of diagnosis. There have been higher rates of colon cancers in people with some rare genetic disorders.

In addition to family history, there are certain risk factors that increase a person’s chance of getting colon cancer.

According to cancer.net, some of these risk factors include inflammatory bowel disease, smoking, diabetes, dietary factors, physical inactivity, obesity, and history of having other cancers.

“The good news is that it is very, very curable,” Hasan said. “If you do the colonoscopy screening, then we can find the polyp. And if we remove it, you remove the potential cancer.”

During a colonoscopy, the doctor will remove any polyps that are found.

“If it’s not too big where it can cause complications it can be removed,” Hasan said.

Hasan said there are noninvasive ways to test for colon cancer, but there have been false positives, false negatives, and small polyps have been missed in CT scans.

Gastroenterologist Dr. Mahreema Jawairia, who has a practice with Dr. Hasan, said the worst thing about getting the colonoscopy is the preparation at home. Patients have to drink a laxative solution the day before the procedure to clean out the large intestines.

As for the colonoscopy, Jawairia said, “It’s a relatively benign procedure.”

She encourages people who have had a colonoscopy to encourage their friends and families to get screened if they want to spread awareness about colon cancer.

Early diagnosis

Crystal Hunter, a bubbly person with an infectious personality, is a leader in her family. In 2021 when her very first colonoscopy discovered that she had colon cancer, she was understandably shocked.

“I was always the strong one in the family,” she said. “I’m a go-getter, the one who gets things done. I’m the one who takes care of people. The hardest part of having the cancer was my self-identity, because suddenly I was the who needed someone to help care for me.”

Hunter, 49 at the time, chose St. Luke’s gastroenterologist Caitlin Foley, MD, for that colonoscopy.

She had the cancer surgically removed and was treated with chemotherapy. Colonoscopies since then show her to be cancer-free.

“We can cure it,” Dr. Foley said of colorectal cancer. “Sometimes we can cure it with surgery, sometimes we must cure it with surgery and chemotherapy or radiation, but we know if we catch it early, we can cure it. That’s why it is so important to get screened and not ignore any potential symptoms.”

Crystal almost ignored her symptoms. She took iron supplements for a mild case of iron deficiency and experienced constipation that she chalked up to taking the iron supplements and not drinking enough water. But then she experienced rectal bleeding, and reported it to her primary care physician, who recommended the colonoscopy.

After her recovery, Hunter noticed that some other aches and pains she described as stomach issues simply disappeared.

“The biggest thing I would tell people is to take an active part in your health care,” she said. “Be candid with your physician. Something you may not think is important may be a sign of a bigger problem. Dr. Foley was wonderful with me, and she pulled out information about me that I barely thought about. She allowed me to be myself. Even after my colonoscopy when the diagnosis came back, she was mindful of and attentive to my response. Her bedside manner is commendable.”

The entire time she battled through cancer, she pushed herself to take her grandchildren to and from the school bus stop, but says she is now mobile without fatigue and can run up and down the stairs like a 2-year-old.

“Colorectal cancer is one of the few cancers that we can prevent from developing into a more serious form,” Dr. Foley said. “It’s the reason we recommend colon cancer screenings. Colon cancer starts as a pre-cancerous polyp called an adenoma, and we can find them when they are very small and remove them during a colonoscopy so that they don’t get a chance to grow into cancer.”