Everything You Need to Know about Colon Cancer and How to Prevent It

Nick Leeson, the rogue trader who brought down Barings Bank in 1995 by losing $1.4 billion in bad future deals, returned to Britain last July a changed man. Not only had he served more than three years of a six-and-a-half-year sentence in Singapore's Tanah Merah prison, but during his internment he underwent an operation to remove a malignant tumor from his colon. Though the cancer is now in remission, Leeson still has regular check-ups and with his graying hair cropped close to his head he looks much older than his 33 years. As long as the disease hasn't spread, he stands a good chance of complete recovery--survival rates for his form of cancer average around 70%--and if there's no relapse within five years, odds are that the cancer is gone for good. Leeson, whose mother died of lung cancer when he was 20 and whose father suffers from bone marrow cancer, now works as a volunteer for the U.K.'s Colon Cancer Concern charity. He even plans to run the London Marathon next month to raise money for more research. "Colon cancer is the second biggest killer in the U.K.," says Leeson. "Part of the reason for this is that people either ignore the symptoms, or people simply don't understand what to look for. I'm running in the marathon and working with Colon Cancer Concern to help raise both money and awareness."

Leeson's case is an unpleasant reminder of a fact that many people would prefer to ignore: cancers of the large intestine, which includes the colon and the rectum, are relatively common--and can be deadly. According to the London-based Cancer Research Campaign, colorectal cancer kills 98,500 men and women each year in the European Union, and among men it is the second most common cause of death from cancer. Although it occurs more frequently after the age of 50, Nick Leeson's experience shows that younger people are also affected. Over the next 12 months, an estimated 437,000 people worldwide will die of the disease. But the good news is, it doesn't have to be this way. Provided it's caught in its earliest, most treatable stages, colorectal cancer is curable more than 90% of the time. "This is a disease almost no one needs to die from," says Carolyn Aldige, president of the Cancer Research Foundation of America.

To get that message across--and to encourage people to be screened for the disease--last week Katie Couric, the co-host of the popular Today show, a breakfast program airing every weekday morning on the American NBC television network, broadcast live footage of the inside of her own intestine. Couric, whose husband Jay Monahan died of colon cancer two years ago at age 42, is eager to spread the word that early detection works, that treatment is improving and that what you eat and how you exercise can dramatically reduce your chances of developing the disease. If more people underwent routine screening to find small tumors, experts estimate, the death toll could drop by 50% to 75%.

Looking back, Couric recalls that the only clue they had that anything might be wrong was that her husband often felt tired and achy. The fatigue persisted and, a few months later, doubled over with abdominal pain, he went to see a doctor. A series of X rays and other scans revealed that Couric's husband was suffering from advanced colon cancer--so advanced that the disease had spread to his liver. He died Jan. 24, 1998, two weeks after his 42nd birthday.

Before you start thinking, "Just what we need, another gimmicky disease of the month," stop to consider how much good a little more awareness about colon cancer can do. There are probably more myths and misconceptions about colon cancer than about any other killer disease. Young people think only old people get it. Women think only men get it. In fact, the disease strikes men and women, young and old. And the rest of us--mired in inhibitions that date back to our toilet training--don't even want to think about it. Potty talk is for two-year-olds, not grownups. The idea of a full-scale colon exam (You're going to stick that thing where?) scares most people away from the very screening test that could save their life.

That sort of reticence proved deadly for the late Charles Schulz, beloved creator of the cartoon strip Peanuts, who resisted being tested despite the fact that his mother, two uncles and an aunt died of colon cancer. By the time physicians discovered his tumor, it had spread to his stomach lining, and there was little they could do.

Even when our own doctor tells us to get our colon checked, we don't always listen. A year and a half ago, Florence Seguin, 73, of Williamsburg, Va., shrugged off her physician's recommendation that she undergo a colonoscopy, a procedure in which a doctor inserts a flexible lighted tube into the colon to look for abnormal growths. Seguin knew that one of her brothers had died of colon cancer, but it wasn't until she saw an article about Couric and her husband that she stopped procrastinating. Fortunately, the tumor that her doctors found was still small enough to be surgically removed. No one expects stories like Seguin's to make up for the loss Couric has experienced, but they do bring her a measure of satisfaction. "It's difficult every day without Jay," Couric says. "But it's not difficult to do this, because I feel that if I can save even one family the heartbreak that mine went through, it's worth it."

If you're serious about protecting yourself and your loved ones against colorectal cancer, it will help to know something about the disease. Nearly all colon cancers start as polyps, tiny grapelike projections that sprout on the inside of the large intestine.

Most of the time these growths are benign, but occasionally a collection of cells--through a series of genetic mishaps--will get bigger and bigger until it turns into a tumor. About 25% of these malignant growths are triggered by a genetic predisposition that has been present since birth. The rest of the time, normal genes become damaged with age or exposure to the toxic brew of wastes that collect in the colon.

Researchers have identified the genes responsible for at least two types of hereditary colon cancer--dubbed FAP and HNPCC --that trigger malignant growths in people in their 30s and 40s. But it can be tough to tell who has these genes, since they are often camouflaged by normal ones. Last month Dr. Bert Vogelstein and his colleagues at Johns Hopkins Medical School in Baltimore, Md., reported in the journal Nature that they have figured out how to unmask the defective genes. Meanwhile, researchers at Exact Laboratories in Maynard, Mass., have developed a simple stool test that detects dangerous genetic changes in the colon. The test costs $250 and may become more widely available in the U.S. by the end of the year.

What if you could prevent the polyps from forming in the first place? In 1991 Michael Thun, an epidemiologist with the American Cancer Society, made an intriguing observation: people who regularly take aspirin are less likely to develop colorectal cancer. It turns out that aspirin blocks the production of an enzyme, called COX-2, that is found in 90% of all tumors and half of the polyps in the large intestine. Apparently most of these abnormal tissues need COX-2 to grow. Stop the production of the enzyme, and you might be able to prevent the cancer from getting larger--or from forming in the first place. According to professor Peter Boyle of the European Institute of Oncology in Milan, COX-2 inhibitors are "one of the hottest things, but there is no data yet. People are hopeful that these could be very powerful chemopreventive agents for colorectal cancer in years to come."

At least that's the idea. Since COX-2 is produced by normal cells as well, doctors may run into trouble if they try to shut down its production entirely. Also, taking aspirin on a regular basis can lead to other problems, like internal bleeding. Still, researchers are sufficiently intrigued by the COX-2 connection that they're trying to determine whether a new generation of seemingly safer drugs, called COX-2 inhibitors, can reduce the incidence of cancer among people with the FAP or HNPCC genes. "It's a very exciting area of research," says Thun. "But it's too early for clinical application."

Surgery is still the front line of defense against colon cancer, and it is highly effective against the smaller tumors. (Better techniques mean that less than 2% of all colorectal cancer patients now undergo a colostomy, in which the large intestine is rerouted to a hole in the abdomen and emptied into a bag. That's down from as many as 20% two decades ago.) Larger or more aggressive tumors usually require chemotherapy, which can be a problem. Whereas breast cancer, for example, often succumbs to any of eight to 10 powerful drugs, there has until recently been only one drug strong enough to battle colon cancer--a drug that was developed in the 1950s called 5-fluorouracil, or 5-fu.
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Audrey Hepburn
Our Fair Lady suffered from stomach pain that was initially misdiagnosed as an infection before surgery in 1992 revealed she had colon cancer.

Elizabeth Montgomery
Best known for her magical nose twitch on Bewitched, TV's favorite spell caster died in 1995 at age 62, eight weeks after her colon cancer was detected.

Charles Schulz
Creator of Charlie Brown and the Peanuts gang, "Sparky" Schulz succumbed to colon cancer only four months after it was diagnosed.

Thomas ("Tip") O'Neill
All politics was local to this former Speaker of the U.S. House of Representatives, who hailed from Massachusetts and lived for seven years after a 1987 diagnosis.

Ronald Reagan
Like most people with colon cancer, he didn't know he had anything until a routine physical turned up polyps, one of which was malignant.

Nick Leeson
In 1998, while doing time in a Singapore prison, British rogue trader Nick Leeson had a cancerous tumor removed from his colon.

Ruth Bader Ginsburg
Acute diverticulitis was diagnosed first; then the 66-year-old U.S. Supreme Court Justice had surgery for colon cancer last year.

Barbara Barrie
Suddenly Susan's TV grandmother ignored the blood in her stool for years but is now the senior poster child for colon screening.


How it forms...

1
Cells that line the colon are very active, constantly dividing and creating buds, known as polyps. Most polyps are small, benign growths that eventually stop growing.

2
But a tiny percentage of these polyps keep growing, sometimes for 10 years or more. Various genetic mutations can transform them into cancerous tumors.

3
As these tumors grow larger, they gather more mutuations and begin to burrow deeper and deeper into the muscle wall that surrounds the colon.

4
Once the cancer invades the blood and lymph systems, malignant cells can break off and spread to other organs, such as the liver, lungs and stomach.

How To Spot It...

Sigmoidoscopy
A flexible tube is inserted into the lower third of the colon; repeat every five years, in conjunction with annual stool test.

Barium Enema
Intestines are coated with liquid so that abnormal growths show on X-ray; repeat every five to 10 years.

Colonoscopy
Flexible tube reaches full length of large intestine; can remove small growths; repeat every 10 years.

...And how to prevent it

Diet
Eat plenty of fruits and vegetables, consume less than 20% fat and eat fiber, which helps your heart as well as your colon.

Exercise
Joggers in particular have a low risk of colon cancer. But any physical activity boosts your heart and mental health as well.

Get Screened
Options include stool tests plus sigmoidoscopy, barium enema and colonoscopy. Most people find the idea worse than the exam.