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Colon Cancer Colon Cancer Treatment

Taking Action Against Colon Diseases

"Doctor, I frequently see blood in my stool when I have a bowel movement. I know that this means cancer, right?"

Patients are often referred to my office because they have a history of some form of rectal bleeding. Most people do not realize that rectal bleeding is actually a very common problem, and in the vast majority of cases it is the result of hemorrhoids. This does not mean that rectal bleeding should be ignored; it just means that one should not immediately jump to the conclusion of cancer. Hemorrhoids are small veins around the anus and rectum. If they become inflamed, they can bleed. Most frequently, patients notice bright red blood on the toilet paper after a bowel movement or even red blood dripping into the toilet water. Usually, this bleeding is painless and intermittent.

Unless a bleeding hemorrhoid can be directly seen on physical examination, a patient will often be referred for a flexible sigmoidoscopy to assure that there is no other source of bleeding. If a patient is older than age 50, a colonoscopy may be recommended since this is the recommended age that patients should start screening for colorectal cancer. Full descriptions of these procedures are described below.

"My primary care doctor told me that there was a small amount of blood in the three stool sample cards that I had provided."

The test described above is called a fecal occult blood test (FOBT), also referred to as a hemoccult test or Guaiac card. A patient is given three cards to take home and asked to put a small sample of stool on a card on three separate occasions. Technically, the FOBT is a screening test for cancer that looks for microscopic amounts of blood in the stool. The concept behind this test is that large polyps (benign growths that have the potential to turn cancerous) and cancers may pull away from the intestinal wall that drip small amounts of blood into the stool that may be invisible to the naked eye.

Unfortunately, these tests are very inaccurate. In fact, some physicians choose not to do them at all. Even when positive, there is only about a 2% chance that the bleeding is caused by cancer. And there are some foods that can produce a false positive result. However, the FOBT is inexpensive, simple to use, and easily administered. The FOBT is rarely used alone. Other colon cancer screening modalities such as a flexible sigmoidoscopy or colonoscopy are used to visualize the colon directly. However, I have found that the FOBT allows patients to become involved and educated about colorectal cancer screening and prevention. It should be emphasized that, like rectal bleeding, the chances are good that a positive test will turn out to be caused by factors other than cancer.

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