GUT CHECK

How Is Your Intestinal Health?

BY ROB SAINT LAURENT, M.ED

Many Americans fail to appreciate the polyp on the inner wall of the colon or rectum; though not all significant role their gut health plays polyps are cancerous, some polyps over a long period (10-20 in their well-being, which comes with years, typically) do become a danger. It has been noted that less a steep cost. than 10 percent of polyps become cancerous. The likelihood of

The American Cancer Society a polyp containing cancer cells depends on polyp type: hyper(ACS) estimates more than 104,000 plastic polyps and inflammatory polyps are common and genernew colon cancer cases in 2021, ally do not become cancerous, whereas adenomatous polyps along with over 45,000 new rectal cancer cases. These predic- (adenomas) are treated as precancerous, as can be sessile serrated tions are expected to result in roughly 53,000 deaths for this polyps (SSP) and traditional serrated adenomas (TSA) which year. That puts colorectal cancer (CRC) in third place among also have a higher cancer risk.4, 5 the leading causes of death in the US, behind lung and prostate The majority of CRCs are called adenocarcinomas, which cancer in men, and lung and breast cancer in women. Cancer is occur in mucosal cells that line the inner wall of the colon the second-leading cause of death among American adults.1, 2 or rectum and make lubricating mucus. Less common types

In the US, CRC ranks as the third most common form of of CRC include carcinoid tumors (from hormone-producing cancer among men and women, excluding intestinal cells), gastrointestinal stromal tumors skin cancers.1 Worldwide, CRC incidence also (from cells in the colon wall called interstitial holds third place, with 1.8 million cases in cells of Cajal), lymphomas (from lymph tissue 2018. (Lung and breast cancer took first and second place, respectively, while cancer of the CRC is a name given for of the immune system in the colon or rectum) and, rare in occurrence, sarcomas (from a blood prostate, skin, and stomach took fourth, fifth, cancers of the colon and vessel, muscle, or connective tissue in the colon and sixth place.)3 rectum, which share many or rectal wall).5

Between 2012 and 2017, statistics showed similar characteristics. If unchecked, cancer inside a polyp can that New England states ranked among those CRC can also be called spread from the innermost wall of the colon or with the lowest CRC incidence and death either colon or rectal cancer, rectum, where it starts (the mucosa), through rates per 100,000 people, while Maine, New Hampshire, and Vermont had slightly higher rates than Massachusetts, Rhode Island, depending on where cancer starts. Whereas a normal to the outside of the wall. Inside the wall, cancer cells can expand to blood and lymph vessels and make their way throughout the body. The and Connecticut.4 cell can grow and divide stage of CRC depends on how deeply the canto replace old or damaged cer has gone inside the colon or rectal wall and COLON, RECTUM, AND cells and then die a natural whether it has spread beyond the intestine.5 COLORECTAL CANCER death (apoptosis), a

The colon and rectum comprise the large mutated or damaged cell ADVANCE WARNING intestine, a muscular tube about five feet long that is the end region of the gastrointestinal is unable to repair itself and Symptoms of CRC may include, for example, abdominal pain, rectal bleeding; changes in (GI) tract or digestive system. When undi- multiplies uncontrollably bowel activity, such as diarrhea, constipation, gested food enters the colon from the small to form a tumor. or bloody or black stools; decreased appetite; intestine, residual water and salt are absorbed and unexplained weight loss. A colonoscopy by the body. After traversing the colon, the can help determine why these symptoms may remaining waste is deposited in the rectum, be happening. Along with an annual physical, the last six inches of the GI tract, where it is held until removal it can also function as a screening tool before symptoms occur.6 through the anus.5 A colonoscopy is a procedure in which a scope (a long, thin

CRC is a name given for cancers of the colon and rectum, tube with a very small camera at the end) is used to examine the which share many similar characteristics. CRC can also be rectum and/or colon for inflamed tissue, abnormal growths/polcalled either colon or rectal cancer, depending on where cancer yps, and ulcers. A colonoscopy checks the entire large intestine; starts. Whereas a normal cell can grow and divide to replace a Sigmoidoscopy looks at just the rectum and lower colon.6 old or damaged cells and then die a natural death (apoptosis), a Several discoveries upon screening can increase the odds of a mutated or damaged cell is unable to repair itself and multiplies polyp being cancerous or raise a person’s CRC risk: 1) a polyp uncontrollably to form a tumor. over 1 cm in length; 2) finding more than three polyps; or 3)

In most cases, CRC starts with a small growth known as a abnormal, precancerous changes to cells in a removed polyp or

along the inner wall of the colon or rectum. The ACS notes that people with hyperplastic polyps over 1 cm may need to be screened for CRC more frequently.5 Polyps are usually removed during screening with a looped wire inside the tubing, which can significantly reduce cancer risk.

Routine screening for CRC is recommended beginning at age 50 (possibly earlier for people with a family history of CRC). Bowel cleansing instructions are given before the procedure so the doctor can see inside the intestines clearly. Sedative medication is provided prior to a colonoscopy, so a person is generally asleep during the procedure.

Alternately, a virtual colonoscopy may be available using computed tomography (a form of X-ray) without the need for sedation. (Under new federal rules, the insurer-negotiated price for screening and removal of any polyps should be publicly available on a hospital’s website or through other accessible means.)

New England states, except for Vermont, ranked highest in the US for CRC screening in people over 50 between 2008 and 2018.4

LIFESTYLE MATTERS

The ACS says, besides routine screening—“one of the most powerful tools for preventing colorectal cancer,” there are other evidence-based health behaviors that may help lower CRC risk.

Health and Human Services’ Healthy People 2020 campaign states, “Good nutrition, physical activity, and a healthy body weight are essential parts of a person’s overall health and wellbeing. Together, these can help decrease a person’s risk of developing serious health conditions, such as high blood pressure, high cholesterol, diabetes, heart disease, stroke, and cancer.”7

Keep a healthy weight. Studies show that CRC risk can be reduced by avoiding overweight and obesity, especially in men. CRC risk can be higher in overweight and obese people, even if they are physically active. Abdominal fat is also associated with excessive CRC risk.4, 8

Be more active. Regular physical activity of moderate-tovigorous intensity, with limited time sitting and lying (not counting sleep), can lower the risk of developing CRC and polyps and is “strongly associated” with reduced colon cancer risk. Recommendations are for either 150-300 minutes of moderate activity or 75-150 minutes of vigorous activity over the course of each week.4, 8

Eat healthy. Studies of US immigrant populations suggest that diet is linked to CRC risk. Both excessive calories leading to obesity and specific dietary factors may influence risk. An anti-inflammatory diet high in fruits, vegetables, and whole grains providing added fiber, with minimal or no red and processed meat, is likely most preventive. “Many studies have found a link between red meats (beef, pork, and lamb) or processed meats (such as hot dogs, sausage, and lunch meats) and increased colorectal cancer risk,” says the ACS. They explain that a poor diet, high in refined carbohydrates, processed sugar, and red meat can negatively impact gut bacteria in the large intestine (part of the digestive tract microbiome) and cause chronic inflammation. Such foods are linked to higher CRC risk.4, 8

Concerning vitamins/minerals, research has shown that about 700-1,000 mg/day of calcium, as from dairy intake, provides protection from CRC. Higher intake of magnesium and vitamin D (many Americans are deficient in these nutrients) may also reduce CRC risk, in addition to working with calcium in normal metabolism.4, 8

Other research has revealed that green tea or one to two daily cups of coffee may reduce CRC risk as part of a healthy lifestyle.9, 10

The ACS is now researching further whether altering gut microbiota can lower CRC risk and whether increased consumption of cooked dry beans (i.e., added fiber) can help lower the risk of CRC recurrence in obese survivors.4

Avoid alcohol and smoking. Both alcohol and smoking have been linked to increased CRC risk, particularly in male drinkers.4

THE LARGER PICTURE

About 4.3 percent of men and 4 percent of women will develop colorectal cancer.1

Though there is “no sure way to prevent colorectal cancer,” according to the ACS, it is important to modify those risk factors that are controllable. CRC is mostly caused by gene mutations that happen during a person’s lifetime—versus inherited mutations—and likely involve risky health practices. Nevertheless, those with a family history of colorectal polyps or cancer are advised to speak with their doctor about their risk.11

Overall, CRC diagnoses and deaths have been declining due to better awareness and screening. However, the incidence has been rising among people under 50 and those 50-64, while deaths have been increasing in people under 55.1

For more information on colorectal cancer, refer to the American Cancer Society, National Cancer Institute, and National Institute of Diabetes and Digestive and Kidney Diseases.

1. American Cancer Society. (n.d.). Key Statistics for Colorectal Cancer. cancer.org/cancer/ colon-rectal-cancer/about/key-statistics.html 2. John Stoddard Cancer Center. (n.d.). Top Five Most Dangerous Cancers in Men and Women. unitypoint.org/desmoines/services-cancer-article.aspx?id=c9f17977-9947-4b66-9c0f15076e987a5d 3. World Health Organization. (n.d.). Cancer. who.int/news-room/fact-sheets/detail/cancer 4. American Cancer Society. (n.d.). Colorectal Cancer Facts & Figures 2020-2022. cancer.org/ content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-andfigures/colorectal-cancer-facts-and-figures-2020-2022.pdf 5. American Cancer Society. (n.d.). What Is Colorectal Cancer? cancer.org/cancer/colon-rectalcancer/about/what-is-colorectal-cancer.html 6. Colonoscopy. (n.d.). National Diabetes and Digestive and Kidney Diseases. niddk.nih.gov/ health-information/diagnostic-tests/colonoscopy 7. Office of Disease Prevention and Health Promotion. (n.d.). Nutrition, Physical Activity, and Obesity. healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Nutrition-Physi cal-Activity-and-Obesity 8. American Cancer Society. (n.d.). Can Colorectal Cancer Be Prevented? cancer.org/cancer/ colon-rectal-cancer/causes-risks-prevention/prevention.html 9. Chen, Y., Wu, Y., Du, M., et al. (2017, June). An inverse association between tea consumption and colorectal cancer risk. Oncotarget, 8(23), 37367-76. https://doi.org/10.18632/oncotar get.16959 10. Stallard, J. (2019, March 22). Should I Drink Coffee to Prevent Colorectal Cancer? Memorial

Sloan Kettering Cancer Center. mskcc.org/news/should-drink-coffee-prevent-colorectal-cancer 11. American Cancer Society. (n.d.). What Causes Colorectal Cancer? cancer.org/cancer/colonrectal-cancer/causes-risks-prevention/what-causes.html