What is colorectal cancer?
Colorectal (or large bowel) cancer is any cancer that occurs in the large intestine, made up of the colon and the rectum. Nearly all colorectal cancers start as polyps - non-cancerous growths on the inner lining of the bowel. Over time, these polyps can grow larger and some – but not all – may turn cancerous. 

Why test or screen for colorectal cancer?
Regular testing or screening (looking for cancer before you have symptoms) is important because colorectal cancer can often develop without any warning signs. The goal is to catch and remove polyps early before cancer develops or before it spreads. 

Does Nova Scotia currently have a colorectal cancer prevention / screening program?
Currently, there is no provincially organized screening program in place for colorectal cancer, but Cancer Care Nova Scotia is working to develop one. In the meantime, individuals who have questions, concerns or symptoms should and can speak with their family doctor to find out if they need to be tested.

What are the symptoms of colorectal cancer?
Colorectal cancer grows slowly and often has no symptoms until the cancer is more advanced.  Common symptoms of colorectal cancer include:

• a change in bowel habits
• blood in stool
• diarrhea, constipation, vomiting
• abdominal pain or discomfort (bloating, gas, cramps)
• Unexplained weight loss
• Constant tiredness

These symptoms are not unique to colorectal cancer, and may be caused by something else.  Therefore, you should speak with your doctor if you experience any of the symptoms listed above. However, if you wait for symptoms to develop, that may be too late: cancer can be prevented if precancerous polyps are found and removed.

How do you screen for colorectal cancer?
Polyps (growths) in the small intestine often leak small amounts of blood into the stool. A Fecal Occult Blood Test (FOBT) can find these small amounts of blood and indicate the need to find the source of the blood loss.The FOBT is a simple test that can be done in the privacy of your home.  While no screening test is 100% accurate, the FOBT is currently the most researched and widely used screening test for colorectal cancer in the world.

Widespread use of this test has shown that it helps prevent death from cancer and can find cancer at an earlier stage when it is curable. It’s important to know that if blood is found using this test (called a “positive FOBT”), it does not necessarily mean you have cancer. Another test - a colonoscopy – is necessary to find out if you have cancer and to identify the source of blood loss. During a colonoscopy, a colonoscope is inserted into the bowel and passed the whole way around the colon. The purpose of the test is to see if there is anything present, which might be bleeding. As the bowel is examined, any polyps that are present can be removed.

Who should be screened for colorectal cancer?
The National Committee on Colorectal Cancer Screening and the Canadian Task Force on Preventive Health Care recommend that all healthy people aged 50 - 74, with no family history of colorectal cancer should complete an FOBT every two years.

People with symptoms of colorectal cancer (such as blood in the stool, or changes in bowel habits) and those who have a family history of bowel cancer are treated differently; they should talk with their doctor who will arrange for the most appropriate investigation that is indicated from their history.

Who is at an increased risk of developing colorectal cancer?
Some people have a higher risk of developing colorectal cancer than the general population.  Individuals at a higher risk include those with:

• a family history (parent, child or sibling) of colorectal cancer
• heredity conditions such as Familial Adenomatous Polyposis or Hereditary non-polyposis colon cancer
• long-standing inflammatory bowel disease (ulcerative colitis and Crohn’s disease)
• history of previous uterine, ovarian, breast or small bowel cancer
• previous colorectal polyps or cancer

If you fall in this higher risk category, please speak with your family doctor to determine your risk and to develop and appropriate testing plan.

How can I lower my risk for colorectal cancer?
A number of things have been suggested to lower your risk for colorectal cancer:

• eat a balanced diet, high in fruits and vegetables
• maintain a healthy weight
• exercise
• stop smoking
• reduce alcohol consumption
• take vitamin D supplements

When will Cancer Care Nova Scotia’s Colon Cancer Prevention Program be operational?
Building a high quality cancer prevention program takes time. We need to make sure we have the right kind and number of health professionals who screen for and treat colorectal cancer appropriately. We need to make sure we have the processes in place to collect information and support these health professionals. We must also develop education and awareness materials so that Nova Scotians understand why screening is important and have the information they need to take advantage of it themselves and to encourage those close to them to do so as well.

In the meantime, Cancer Care Nova Scotia is working with health professionals in districts across the province to develop and finalize a proposed implementation strategy. This strategy was presented to the Department of Health in December 2007. Our hope is to have the Colon Cancer Prevention Program operational early in 2009.
 
However, individuals who have symptoms, concerns or questions about colorectal cancer should speak to their family doctor