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Colon Cancer: What you need to know & What’s Weight Got to Do with it

Updated: Sep 3

Like many the passing of the talented actor Chadwick Boseman at just age 43 from colon cancer hit me hard. Not only because Mr. Boseman was private about his cancer so there was no forewarning; but also because though colon cancer is the second highest cancer in the US we consider it preventable & treatable. According to the American Cancer Society even if colon cancer is found in stage III ( spread outside of the colon) the five year survival rate is 60-80%.

However if it is detected before it spreads the rate of survival is 94%.

Whenever we lose someone too soon we begin to think about our own health and mortality.

What can we do to prevent colon cancer?

What do I need to know about it?

This blog post and the Facebook live video address some of these questions. The main focus will be on colon cancer basic information, signs & symptoms, prevention and the association better colon cancer and obesity. I'll then offer practical changes you can make now.

For information treatment please see Colon Cancer Treatment (PDQ®)–Patient Version - National Cancer Institute

Basics

The colon is part of the digestive tract. The digestive tract starts with your mouth and ends in your anus. The colon is about the last 5 feet near the end of digestive tract. It helps absorb final water and nutrients before stool leaves the body. It also helps with your immune system.

Colon cancer is a overgrowth of cells in the colon. It usually starts as something called a “polyp” which a small growth that can be usually removed easily if found early. If the polyp isn’t caught early. It gets larger which can cause blockages. It also spreads deeper and invades the blood/ lymphatic system to spread to other organs in the body . Colon cancer is divided in stages based on how deep or how widespread the cancer is.

In simplistic terms

Stage I local (first layer of the colon wall)

Stage II (invade the colon wall but not spread to lymph nodes)

Stage III- spread to lymph nodes

Stage IV- spread outside the colon to distant organs like the liver or lungs

For more details on stages see Colorectal Cancer: Stages | Cancer.Net

Signs & Symptoms of Colon Cancer

Now that you know where the colon is and how the cancer grows you can imagine some of the symptoms. The most common presenting symptom is bleeding in the stool. Other symptoms are changes in the stool size, color, decreased appetite, unintentional weight loss, nausea, or vomiting.

Colon cancer screen

The American Cancer Society recommends colon cancer screening starting at age 45 for people with average risk. You may need to start soon based on your risks.

Potential screening options are detailed here:

https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html


https://www.cancer.gov/types/colorectal/patient/colorectal-screening-pdq


If you are between age 45 to 85 you can calculate your individual risk here:

Colorectal Cancer Risk Assessment Tool


It’s important to note the racial disparities in colon cancer screening. African Americans are less likely to be screened for colon cancer and have higher rates of colon cancer.

My friend from med school Dr. Pascal White recently published an article looking at the potential causes ranging from physician patient relationships to the impact of systemic racism. Barriers Driving Racial Disparities in Colorectal Cancer Screening in African Americans - PubMed

Prevention & Risk Factors

Ideally colon cancer should be caught in the earliest stage possible. Screening for colon cancer has helped to decrease the incidence of colon cancer in people over the age of 55. Sadly for unknown reasons rates are increasing in people younger than age 55.

Some risk factors for colon cancer at a younger age than 55 are

-Family history having a first degree relative with colon cancer before 50 increase your risk

-Medical history: conditions such as Crohn’s disease or Inflammatory bowel

-Genetic conditions: Familial Adenomatous Polyposis, Lynch Syndrome,

Smoking, high alcohol use, high meat consumption, decreased vegetable consumption and obesity have also been associated increased risk of colon cancer. For the rest of the this post I'll discuss the association between obesity and colon cancer risk. I'll also share practical tips to help decrease your risk while working on weight loss.

Obesity

Having the medical condition of obesity is associated with 30% increased risk of colon cancer. While some body fat is essential the type of fat cells that accumulate in obesity produce harmful hormones and toxins that can cause cellular damage and inflammation that plays a role in cancer. More concerning as we are seeing rising colon cancer rates in younger people (<age 55). In 2018 a study showed that obesity was a risk factor for younger women who developed colon cancer.



Obesity is defined as a body mass index of greater than 30 kg/m2, waist circumference > 35 inches for women, 40 inches for men or body fat percentage > 32% women, >25% men.

For people that meet the criteria for obesity it can be discouraging to hear the increased cancer risk. You may think it’s hopeless but it’s not. Even if you have a significant a mount of weight to lose there are still meaningful changes you can make.

Food

There has been significant evidence that regularly eating processed meats and red meats are associated with increased risks bowel cancers like colon cancer*

In fact there are some agencies that rate eating bacon daily as harmful as smoking.

Therefore food changes that can help reduce cancer risk while working on your weight are:

Meat Reduction/ Elimination

-Minimize or eliminate processed meat intake.

-Minimize or eliminate red meat intake. Goal <1x/week

High fiber intake especially through fruits and vegetables had been shown to decrease risk so

-Increase vegetables fruit intake to at least 10 servings per week

-Having meat free days is helpful. I started with Meatless Monday in 2015. I now try to eat a least 50% plant based to improve my health.

Dairy decrease

-There’s some evidence that decreasing dairy intake is helpful. Again some dairy foods like cheese are high in saturated fat which can contribute to inflammation and weight gain.

Refined Sugar Reduction

The average American eats 17 teaspoons** added sugar a day way more added sugar than is recommended (6 teaspoons/ day per American Heart Association).

While direct link between sugar and cancer has not been proven high intake of added sugar indirectly contributes to cancer through increased levels of obesity and association with foods that cause inflammation in the body.

Breaking up with sugar can be tough, I know I’ve been there and still have to be vigilant not to eat too many sweets. To help with my sugar intake I used Break Your Sugar Addiction in 10 Days – Health Essentials from Cleveland Clinic

Physical Activity

Regular exercise has been shown to reduce risk of colon cancer. It’s recommended you get at least 150 minutes of moderate to vigorous exercise per week.

That amount can seem like a lot if you don’t exercise regularly or feel like you don’t like exercise. When I started my exercise journey in 2014 I never imagined I’d be a regular runner today. I recommend you just try to move one minute a day and gradually aim to meet your weekly goal. I always say one minute of exercise is better than zero.

See my tips on Fitting In Fitness


The untimely loss of Mr. Chadwick Boseman is truly painful. Deepest condolences to his family and loved ones. In addition to reflecting on his life and his work we are thinking about colon cancer and our risk factors. I truly hope this post has answered some of your questions on colon cancer, risk factors and the association with weight. More importantly I’ve provided some practical tools that we can all implement to decrease our colon cancer risk. Starting with knowing your personal risk factors and taking the necessary steps to correct them. Talk to your family about your family history, schedule an appointment with your primary care clinician to discuss your risk, or follow up with your gastroenterologist if you’re over due for colon cancer screening.

If you have more than 30lbs to lose don’t just focus on the weight loss which can seem overwhelming. Start making small changes in your nutrition like eliminating processed meats, moving more or if you’re overwhelmed with trying to lose weight schedule with an obesity specialist You can schedule with me at Consultation | EmbraceYOU W & W

Like video? See my Facebook Live: Colon Cancer What You Need to Know & What’s Weight Got to do with it https://www.facebook.com/DrSylviaMD/videos/987270755121835/?vh=e&d=n

Useful Links

https://www.cancer.gov/types/colorectal

https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#what-is-known-about-the-relationship-between-obesity-and-cancer-

https://cebp.aacrjournals.org/content/cebp/16/12/2533.full.pdf



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Dr. Sylvia Gonsahn-Bollie, M.D.
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