Let's Talk Poop

Understanding the symptoms can save you from this common malignant killer.

Colon Cancer Cells. Getty Images

Moving our bowels is one of the handful of bodily functions that we are embarrassed to talk about.  Even to our spouses.  Even to our doctors.  And that would be fine and well if our large intestine (colon and rectum) wasn’t the source of several common conditions, including cancer.  Not all that long ago, openly talking about breast cancer was taboo.  Fortunately that has all changed, and the breast cancer awareness public education campaign has been highly successful.

  More recently, campaigns to alert the public as to the danger posed by colon and rectal (colorectal) cancer and the importance of cancer screening have been initiated.  But why drive awareness of large bowel cancer over other cancers?  For two reasons:  colorectal cancer is the second leading cause of cancer deaths; and virtually all colorectal cancers are preventable.

Almost all colorectal malignancies develop as benign, pre-cancerous polyps.  These small mushroom-shaped bumps growing out of the intestinal lining take many years (even a decade or longer) to transform into cancers (which not all do).  Thus, regular endoscopic screening, in which a flexible, fiber optic tube is passed through the large intestine, can spot and even remove these polyps, preventing the development of cancer.  Take five minutes to educate yourself on this potentially life-saving, safe, and simple screening.

Unfortunately, many doctors do not push and/or many of us fail to undergo colorectal cancer screening as recommended.

  The result of this failure is dramatic.  This year, an estimated 132,700 will be diagnosed with a cancer of the colon or rectum.  But while this represents only 8% of all malignancies, colorectal cancer will kill an estimated 49,700 adults, making it number two on the cancer killer list (after lung, but ahead of breast and prostate).

Clearly, it is critical for you and your loved ones to understand and follow the screening recommendations.  But you should also understand the signs and symptoms of colorectal cancer.  Now, when a woman finds a breast lump, she often immediately fears cancer and sees her physician, who is also on high alert for breast cancer and will rapidly evaluate the new breast lump via mammography, MRI, needle biopsy, or some other means.  Unfortunately, when it comes to colorectal cancer, the signs and symptoms often fail to impress (let alone frighten) most people, and even physicians often miss the diagnosis during initial evaluation of a new colorectal cancer-related complaint.  Thus you must Own Your Health and educate yourself on the warning signs of these common malignancies.  Such an education is neither difficult or lengthy.  First you must understand simple large intestine anatomy.  Your colon begins in your lower right abdomen, receiving liquid contents from the small intestine (also the location of your appendix).  The colon then travels up your right abdomen, turning left just under your lower ribcage.  The colon then crosses horizontally, turning back downward just beneath your lower left ribcage.

  It then drops vertically down the left abdomen before entering into your pelvis (a cavity surrounded by your hip bones, sacrum, and bladder).  In your pelvis, the colon seamlessly joins the rectum, which finally connects to your anus and the outside world.  During the journey from right colon to rectum, water is absorbed from the intestinal contents, and the traveling stool becomes more and more solid.  Also, the diameter of the intestine narrows.

Cancers of the narrower left colon, where stool is more solid, tend to cause obstructive (blockage) symptoms, presenting as persistent or intermittent new-onset constipation and/or narrowing of your stool.

  While counter-intuitive, such obstructive tumors can also lead to new-onset diarrhea.  Many such obstructive cancers can also cause recurring, crampy abdominal pain.

In the wider right colon, where stool is liquid, cancer usually do not cause blockage.  These tumors may bleed small amounts which mix into the liquid stool, becoming invisible to the eye but causing chronic anemia, which leads to your slowly becoming chronically fatigued (very tired).  New generalized fatigue which does not rapidly improve with rest should lead you to see your physician, who can order a rapid and simple blood count to check for anemia (which should trigger a colorectal evaluation).

Rectal cancers don’t often block stool passage.  Most often, they bleed.  And because they are just above the anus, the blood is red, often coating the stool on one side or appearing as a red streak. The danger here is that patients and doctors often attribute such bleeding to hemorrhoids or other benign anal conditions and fail to look for a cancer. Do not simply accept your doctor saying, “it’s probably just hemorrhoids!” Push for proof of a diagnosis (hemorrhoids, cancer, or other)!

Regardless of location, some colon cancers do bleed enough for you to see blood on your stool or in the toilet.  When the tumor is on the left, the blood may be red.  When the tumor is further from your anus, the blood may change to a maroon or brown color and appear tar-like.  Finally, as with many cancer types, colorectal malignancies can present as unexplained weight loss.

Colorectal cancer is a common cancer killer.  Following recommended colorectal cancer screening guidelines and knowing the signs and symptoms of colorectal cancer can greatly protect you.

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